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2021 Vol. 27, No. 10
Published: 2021-10-25
 
865 Accuracy and Safety Evaluation of Open Wedge High Tibial Osteotomy Assisted by 3D Printed Guide
Wang Xingshan，Huang Ye，Liu Jian，et al
Objective  To evaluate the accuracy and safety of high tibial osteotomy assisted by 3D printed guide.Methods  A retrospective study was conducted on 22 patients (36 knees) who underwent medial open wedge high tibial osteotomy (OWHTO) assisted by 3D printed guide in our hospital from April 2020 to October 2020，including 11 males (16 knees) and 11 females (20 knees).The average age was (41.1±15.8)years.The differences between preoperative planned weight bearing line ratio(WBLR) and postoperative WBLR were compared，as well as the changes of posterior slope of the tibial plateau before and after operation.The operative time，frequency of intraoperative fluoroscopy，intraoperative and early postoperative complications were extracted. Results  The average operation time was (40.1±12.8)min，and the frequency of fluoroscopy was (13.3±4.5).The medial proximal tibial angle (MPTA) was corrected from (83.0±1.8)° preoperatively to (90.1±2.3)° postoperatively，P＜0.001.The WBLR was adjusted from (22.6±9.7)% preoperatively to (52.9±3.8)% postoperatively，P＜0.001.There was no significant difference between the postoperative MPTA and the targeted MPTA value (90.4±2.2)° (P＝0.159).The postoperative WBLR (52.9±3.8)% was significantly different from the preoperative target WBLR (54.4±3.3)% (P＝0.005)，and the difference was (1.5±3.1)%.The posterior tibial slope(PTS) was (10.4±3.5)° preoperatively and (10.2±3.3)° postoperatively (P＝0.077).There were 2 cases of lateral hinge fracture in this group，including 1 case of Takeuchi type I fracture and 1 case of Takeuchi type Ⅲ fracture.The fracture healed well eventually，with no displacement or loss of correction.Conclusion  OWHTO assisted by 3D printed guide can achieve precise correction of the WBL，while maintaining the slope of the tibial plateau，good accuracy and safety can be obtained.
2021 Vol. 27 (10): 865-869 [Abstract] ( 281 ) HTML (1 KB)  PDF (1673 KB)  ( 359 )
870 Effect of Medial High Tibial Osteotomy on Patellofemoral Articular Cartilage Lesions
Su Ke，Sang Weihua，Wang Qinghai，et al
Objective  To evaluate the effect of open wedge high tibial osteotomy (OWHTO) on the patellofemoral joint according to the preexisting patellofemoral arthritis.Methods  A total of 86 patients with unilateral varus knee osteoarthritis and patellofemoral osteoarthritis who underwent arthroscopy and OWHTO between January 2014 and December 2018 were evaluated retrospectively.The patients were stage Ⅰ~Ⅲ according to Iwano's classification.All the patients with knee osteoarthritis consistent with medial pain but no patellofemoral joint symptoms，the anteroposterior radiograph showed medial compartment osteoarthritis of the knee and the patellofemoral space narrowing was observed on lateral and axial radiographs of the patella.The patients were divided into two groups according to the arthroscopic view of cartilage statusof the patellofemoral joint.There were35 patients in group A ［international cartilage repair society (ICRS) grade 0~Ⅰ］，including 9 males and 26 females.The average age was (55.66±4.66).There were 51 patients in group B (ICRS grade Ⅱ~Ⅲ)，including 21 males and 30 females.The average age was (55.90±4.44).All patients underwent OWHTO and they were recommended to remove the internal fixation plate when the osteotomy space was healed.Patients in the two groups were compared at the time of primary osteotomy and the time of reremoval of internal fixation，the evaluation included the visual analogue scale(VAS)，Western Ontario and McMaster universities score (WOMAC) and the scoring of patellofemoral disorders(Kujala).Iwano's classification and the ICRS grading were compared between each group before and after osteotomy. Results  There were statistically significant differences in VAS score，WOMAC score and Kujala score between the two groups at the time of two operations (P＜0.05).Compared with the initial operation，the ICRS grade showed a tendency to progress at the second-look operation，but without statistical significance in Iwano's classification and the ICRS grading system (P＞0.05).The noninferiority test showed that the Kujala score of group B was not worse than group A.Conclusion  Patients with varus knee osteoarthritis without patellofemoral joint symptoms，the presence of cartilage lesion of ICRS grade 0~Ⅲ in the patellofemoral joint，will not affect the surgical outcome of OWHTO in short-term follow-up，and the functional scores will be improved.
2021 Vol. 27 (10): 870-874 [Abstract] ( 208 ) HTML (1 KB)  PDF (1370 KB)  ( 309 )
875 To Investigate the Safety and Anti-inflammatory Effects of Tranexamic Acid on High Tibial Osteotomy
He Wei 1，Wang Min 2，Ren Jing 2，et al
Objective  To investigate the safety and anti-inflammatory effects of tranexamic acid(TXA)on high tibial osteotomy(HTO).Methods  224 patients who met the criteria for high tibial osteotomy were included in the study using a randomized controlled clinical method.112 cases were included in group A including 58 males and 54 females.The average age was (49.33±6.83)years.TXA was administered 10 to 15 minutes before dermectomy，and another 1 g was intravenously 3 h，6 h and 9 h after surgery.Group B had 112 cases，including 49 males and 63 females.The average age was (52.21±6.28)years.15 mg/kg TXA was given 10~15 min before dermectomy，and another 1 g was given intravenously 3 h later.according to the TXA study plan.All patients were followed up for 9 months.Total blood loss，postoperative recessive blood loss，postoperative drainage volume at 24 hours，operative time，anti-inflammatory factors including C-reactive protein(CRP)、interleukin 6(IL-6) and erythrocyte sedimentation rate(ESR) 3 days after surgery.Incidence of venous thrombosis，wound complications，and other complications were recorded and compared between the two groups.Results  All patients were followed up for 9 months.The total postoperative blood loss，the recessive blood loss and the 24 h postoperative drainage volume of patients in the A group were significantly lower than those in the B group，and the differences were significant (P＜0.05).CRP，IL-6and ESR were all lower in group A than in group B at 1，3 and 5 days after surgery，and the differences were statistically significant (P＜0.05).The peri-menstrual value of the affected limb and the incidence of ecchymosis hematoma in group A 1，3 and 5 days after surgery were all lower than those in group B，and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the incidence of deep vein thrombosis between the two groups at 1 day，2 weeks and 4 weeks after surgery(P＞0.05).There was no significant difference in WOMAC score and operation time between the two groups before surgery，1 month and 3 months after surgery(P＞0.05).There was no respiratory infection or pulmonary embolism in the two groups，and there was 1 case of urinary infection in group B，two weeks after the operation.Conclusion  Repeated administration of TXA reduced perioperative blood loss in patients undergoing HTO without increasing the incidence of venous thrombosis，and showed significant antiinflammatory effects with the increase of administration times.
2021 Vol. 27 (10): 875-880 [Abstract] ( 185 ) HTML (1 KB)  PDF (905 KB)  ( 224 )
881 Postoperative Rehabilitation of Biplane Open Wedge High Tibial Osteotomy
Zhong Shan 1，Liu Jian 2，Huang Ye 2*
Objective  To summarize and analyze the effect of systematic rehabilitation after biplane open wedge high tibial osteotomy (Biplane OWHTO)，so as to provide reference for the development of standardized rehabilitation program.Methods  27 patients (39 knees) with medial knee osteoarthritis were treated with biplane open wedge HTO.They were divided into young group (18~29 years old)，middle-aged group (30~49 years old) and middle-old aged group (50~75 years old) according to age.According to the classification of Takeuchi hinge fracture，the corresponding rehabilitation program was formulated，and followed up for 3~6 months.VAS (visual analogue score) was used to evaluate the pain of all patients on the second day after operation and three months after operation，to compare the longest walking distance of patients before and after operation，and to record the time of patients completely leaving crutches.Results  There was significant difference in VAS pain score between the first time and 3 months after operation in all patients (P＜0.05).There was significant difference in the farthest walking distance before and 3 months after operation between 18~29 years old group and 50~75 years group (P＜0.05)，but there was no difference in 30~49 years old group.The mean time of complete walkwithout crutch was 2 months in the group of 18~29 years old，and 2.5 months in the group of 30~49 years old and 50~75 years old.Conclusion  Biplane OWHTO is an effective and safe surgical method for the treatment of medial compartment osteoarthritis of the knee，which can improve the pain and restore the ability of activity.The age，activity needs，intraoperative conditionsand other factors of the patients should be taken into account when formulating the standardized rehabilitation program.
2021 Vol. 27 (10): 881-885 [Abstract] ( 190 ) HTML (1 KB)  PDF (538 KB)  ( 270 )
903 Comparison of Early Effectiveness of Simultaneous and Staged Bilateral Unicompartmental Knee Arthroplasty for Bilateral Anteromedial Compartment Osteoarthritis
Objective  To investigate the early clinical efficacy of simultaneous and staged unicommental knee arthroplasty(UKA) for anterior medial knee osteoarthritis. Methods  The clinical data of 52 patients with bilateral anteromedial compartment osteoarthritis who underwent bilateral UKAs between March 2017 and March 2020 was retrospectively analyzed.Of them，24 patients were treated with simultaneous bilateral UKAs (simultaneous group A) and 28 patients with staged bilateral UKAs (staged group B).All surgeries were performed by the same surgeons.General data such as gender，age，body mass index，osteoarthritis grading，American Hospital for Special Surgery Knee Score (HSS)，visual analogue scale (VAS) an drange of motion (ROM) of knee were collected for comparison between the two groups，and the differences before operation were not statistically significant (P＞0.05).Operationtime，length of hospital stay，maximum haemoglobin decline within 1 week after surgery，and postoperative drainage volumewere recorded.The staged group was compared with the sum of the two operations.The effectiveness wasevaluated by HSS score，VAS score and ROM of knee at3 months after surgery.Results  All patients were followed up for 12 to 24 months，with an average of (18.6±5.8)months.Postoperative intermuscular vein thrombosis of distal lower extremityoccurred in group A and superficial incision infection in group B were found in 1 case.All patients were discharged from hospital and recovered afterregulartreatment.No knee dislocation，prosthesis infection or prosthesis loosening occurred in the two groups during the follow-up period.There were no statistically significant differences in HSS scores，VAS scores and ROM of knee between the two groups at last follow-up after surgery (P＞0.05).The operation time and hospitalization stay of thesimultaneous group were significantly lower than those of the staged group (P＜0.05)，and there was no significant difference in the maximum decrease of hemoglobin in the first week and total drainage volume after operation between the two groups (P＞0.05). Conclusion  Our results demonstrated that simultaneous and staged bilateralunicompartmental knee arthroplasty for the treatment ofbilateral anteromedial compartmentosteoarthritis has the comparable effect.Patients can benefit from a single hospitalization and anaesthesia.However，the total length of the operation time and hospitalization is shorter for patients undergoing bilateral simultaneous surgery，which effectively reduces the burden on patients.
2021 Vol. 27 (10): 903-912 [Abstract] ( 188 ) HTML (1 KB)  PDF (1076 KB)  ( 262 )
908 Comparison of Clinical Efficacy of Mobile Bearing and Fixed Bearing Unicompartmental Knee Arthroplasty in Unicompartment Arthritis Knee
Yan Jingde 1，Hu Bin 1，Xie Xingwen 2，et al
Objective  To observe the clinical application effect of Unicompartmental Knee Arthroplasty(UKA) with mobile bearing and fixed bearing platforms in singlecompartment arthritis of the knee joint.Methods  84 patients with anteromedial knee arthritis admitted from January 2018 to January 2019 were selected and randomly divided into a control group and an observation group，with 42 cases in each group.The control group was treated with Link fixed bearing UKA.and there were 20 males and 22 females；age 52 to 88 years，with an average age of (68.16±5.28).There were 13 left knees and 29 right knees.The body mass index was (23.51±3.82)kg/m2.And the average Knee Flexion Angle (KFA) before surgery was (115.62±5.49)°.In the observation group，23 men and 19 women were treated with Oxford mobile bearing UKA.The age ranged from 48 to 89 years，with an average of (68.37±5.43)years.There were 14 left knees and 28 right knees.The body mass index was (23.54±3.75)kg/m2.And the mean preoperative KFA was (115.58±5.37)°.Knee function，pain，range of motion and the occurrence of complications were observed and recorded.Results  The HSS scores and KSS scores of the two groups were higher than the preoperative scores at 24 months after surgery in both groups (P＜0.05).There was no significant difference in HSS score and KSS score between the two groups at 24 months after operation (P＞0.05).The postoperative Visual Analogue Scale/Score (VAS) of the two groups were lower than those of the preoperative group (P＜0.05)，and there was no statistically significant difference between the groups (P＞0.05).The postoperative FTA and sagittal tibial Angle (sTA) were significantly smaller in both groups than before surgery (P＜0.05).The maximum KFA and the maximum knee extension angle were significantly better than those before the operation (P＜0.05).The difference between the groups was statistically significant (P＜0.05).There was no statistically significant difference between the two groups in the incidence of postoperative complications such as infection，prosthesis loosening，liner dislocation，joint bleeding and fibrosis，and arthritis progression (P＞0.05).Conclusion  Both the mobile and fixed bearing platform UKA can improve knee joint function，relieve pain，improve joint mobility，and reduce the incidence of adverse reactions in the treatment of unicompartment arthritis in the knee joint.
2021 Vol. 27 (10): 908-912 [Abstract] ( 158 ) HTML (1 KB)  PDF (1611 KB)  ( 256 )
913 Analysis of Mixed Unicompartmental Knee Arthroplasty Guided by the Concept of Enhanced Recovery After Surgery
Objective  To explore the clinical outcomes of the primary mixed unicompartmental knee arthroplasty(UKA) under the guidance of enhanced recovery after surgery(ERAS) in the treatment of anteromedial knee osteoarthritis.Methods  From February 2018 to June 2019，a total of 75 patients who underwentprimary mixed unicompartmental knee arthroplasty for anteromedial osteoarthritis in our hospital were enrolled in this study underwent and randomly divided into two groups，which included 40 cases of surgical patients guided by the concept of enhanced rehabilitation(observation group) and 35 cases of routine surgery patients(control group).There were 17 males and 23 females in the observation group，aged 47~82 years old，with an average of (58.63±7.95)years；in the control group，10 males and 25 females，aged 46~71 years old，with an average of (60.80±5.76)years old.The surgical blood loss，postoperative time in the field，hospitalization time，24 h postoperative hemoglobin reduction，postoperative pain score Visual Analogue Scale/Score(VAS)，Hospital for Special Surgery(HSS) knee score，knee Joint Range of Motion(ROM) after surgery were compared.The postoperative complications such as infection，prosthesis loosening，fractures around the prosthesis，and deep vein thrombosis of the lower extremities were recorded at the last follow-up.Results  Intraoperative blood loss，postoperative time in the field，and hospital stay in observation group was significantly lower than that of the control group(P＜0.05).The value of hemoglobin reduction at 24 hours after surgery in observation group was significantly lower than that of the control group(P＜0.05).VAS pain score at 1 day，3 days，7 days，1 month and 3 months after surgery，HSS score at 1 month and 3 months after surgery，and the ROM in observation group were better than the control group(P＜0.05).The VAS score，knee HSS score，and postoperative ROM at 12 months after operation had no significance difference (P＞0.05).Conclusion  The primary mixed unicompartmental knee arthroplasty guided by the concept of ERAS can effectively control pain，reduce intraoperative bleeding，improve knee joint function，shorten hospital stay，reduce complications，and promote early recovery of patients，improve satisfaction and promote rapid recovery of patients.
2021 Vol. 27 (10): 913-917 [Abstract] ( 164 ) HTML (1 KB)  PDF (861 KB)  ( 280 )
941 A Novel 3D-Printed Patient-Specific Instrument based on “H” Point for Medial Opening-Wedge High Tibial Osteotomy：A Cadaver Study
Liu Guobin，Liu Sen，Wang Lifei，et al
Objective  To explore the feasibility and accuracy of a novel 3D-Printed Patient-Specific Instrument(PSI) based on “H”Point for medial opening-wedge high tibial osteotomy(OWHTO) in a prospective cadaver study.Methods  Twenty-four entire fresh-frozen lower limbs from twelve cadavers were collected，including 5 males and 7 females and aged 53~72 years old with mean age of (60.92±5.92).All lower limbs were randomly divided into two groups：(1)PSI group (n＝14) treated with 3D virtual preoperative planning and a novel 3D-Printed PSI；(2)control group (n＝10) with 2D planning and standard technique.Utilizing medical software and three-dimensional design software，3D models were reversely reconstructed for preoperative surgical planning，guide plate design，and simulated osteotomy.Both the preoperative design and the actual operation，“H” point bony bulge was used as the positioning mark of the PSI guide.All specimens recorded the parameters including preoperative mechanicalmedial proximal tibial angle(mMPTA)，pre-and postoperative mechanical femorotibial angle(mFTA)，pre-and postoperative posterior tibial slope(PTS)，the number of intraoperative fluoroscopy and operation time.Results  There was no statistical difference between the two groups in mFTA (P＝0.553) and PTS (P＝0.813) after operation.But the absolutecorrection error of mFTA and PTS were significantly smaller in the PSI group.The effective rate of mFTA in the PSI group was more concentrated with absolute correction error within 1° for 85.7% compared to 60% in the control group.The effective rate of PTS in the PSI group was more concentrated with absolute correction error within 1° and within 2° for 57.1% and 92.9%，compared to 20% and 50% in the control group.The total operation time，positioning osteotomy time，distraction correction time and fluoroscopy dose in the PSI group were significantly less than those in the control group.Conclusion  The novel 3D-Printed PSI based on "H"point is feasibility and accuracy with advantages in terms ofoperation time and radiation exposure for HTO.
2021 Vol. 27 (10): 941-950 [Abstract] ( 184 ) HTML (1 KB)  PDF (2133 KB)  ( 478 )
947 Correlation Between the Anatomical Morphology of Knee Joint and the Location of Anterior Cruciate Ligament Injury
Chen Yao 1，Yang Guofu 1*，Shi Lijun 2，et al
Objective  To explore the correlation between MRI measurement of lateral tibial plateau slope (LPS)，notch width index (NWI) and anterior cruciate ligament (ACL) injury site.Methods  A retrospective analysis was made of 40 cases without ACL injury and 80 cases of ACL injury diagnosed in our department from September 2018 to September 2020，including 45 males and 75 females.The average age was (30.08±9.95)years.The site of ACL injury was determined and recorded during knee arthroscopic surgery，and the patients were divided into three groups according to the site of injury，with 40 patients in each group.In the non-proximal group the ACL injury sites were far away from the femoral end.In the proximal group，ACL injury site were near the femur end.And in the control group，patients had intact ACL under knee arthroscopy.The relationship between LPS，NWI and ACL injury site was observed.Results  (1)LPS in the non-proximal group，proximal group and control group were (8.20±4.37)°，(6.34±3.33)° and (4.52±2.27)°，respectively，and the differences among the three groups were statistically significant (P＜0.05).LPS in patients with ACL injury were higher than those in the intact ACL group.Pairwise comparison of LPS among the three groups had statistical significance (P＜0.05).(2)NWI in the non-proximal group，proximal group and control group were (0.26±0.41)，(0.30±0.28) and (0.33±0.44)，respectively，and the differences among the three groups were statistically significant (P＜0.05).NWI in patients with ACL injury was lower than that in the intact ACL group.There were statistically significant differences in NWI among the three groups (P＜0.05).Conclusion  Both posterior dip Angle of tibial plateau and intercondylar fossa index are important anatomical factors leading to different injury sites of ACL，and patients with larger LPS and smaller NWI are more likely to injure the distal part of ACL.
2021 Vol. 27 (10): 947-950 [Abstract] ( 171 ) HTML (1 KB)  PDF (850 KB)  ( 195 )
951 Polyamide Properties Study for Selective Laser Sintering 3D Printed Cutting Guide
Xiang Weiwei 1，Huang Ye 2，Liu Guobin 3，et al
Objective  To study the mechanical，chemical properties and biological evaluation of a polyamide material used for selective laser sintering(SLS) 3D printing of cutting guide.Methods  Mechanical study included elongation at break，tensile modulus，tensile strength，vicat softening temperature，load deformation temperature and wearing.Chemical study included reducing substances，pH，heavy metals，evaporation residue and UV-absorption. Biological evaluation included vitro cytotoxicity test，skin sensitization test and intracutaneous reactivity test.The mechanical, chemical properties and biocompatibility were tested，and the results were evaluated.Results  Mechanical Property：elongation at break 7.8%~22.3%，tensile modulus 1 664~1 982 MPa，tensile strength 47.71~51.25 MPa，vicat softening temperature 163.2~166.0 ℃，load deformation temperature 66.2~75.2 ℃，and wearing 6.8~16.8 mg.Chemical Property：complied with GB193352003.Biological Evaluation：no potential toxicity to vitro cells，no skin sensitization，and no intracutaneous reactivity.Conclusion  The polyamide material has good mechanical，chemical properties and biocompatibility，which can be used to manufacture surgical 3D print cutting guide.
2021 Vol. 27 (10): 951-959 [Abstract] ( 180 ) HTML (1 KB)  PDF (557 KB)  ( 415 )
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