Achieving optimal alignment in total knee arthroplasty(TKA) is a critical factor in ensuring optimal outcomes and long-term implant survival. Traditionally, mechanical alignment has been favored to achieve neutral pos...Achieving optimal alignment in total knee arthroplasty(TKA) is a critical factor in ensuring optimal outcomes and long-term implant survival. Traditionally, mechanical alignment has been favored to achieve neutral postoperative joint alignment. However, contemporary approaches, such as kinematic alignments and hybrid techniques including adjusted mechanical, restricted kinematic, inverse kinematic, and functional alignments, are gaining attention for their ability to restore native joint kinematics and anatomical alignment, potentially leading to enhanced functional outcomes and greater patient satisfaction. The ongoing debate on optimal alignment strategies considers the following factors: long-term implant durability, functional improvement, and resolution of individual anatomical variations. Furthermore, advancements of computer-navigated and robotic-assisted surgery have augmented the precision in implant positioning and objective measurements of soft tissue balance. Despite ongoing debates on balancing implant longevity and functional outcomes, there is an increasing advocacy for personalized alignment strategies that are tailored to individual anatomical variations. This review evaluates the spectrum of various alignment techniques in TKA, including mechanical alignment, patient-specific kinematic approaches, and emerging hybrid methods. Each technique is scrutinized based on its fundamental principles, procedural techniques, inherent advantages, and potential limitations, while identifying significant clinical gaps that underscore the need for further investigation.展开更多
Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilatera...Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilateral total knee arthroplasty(TKA)on postoperative rehabilitation and costs in a Chinese population.Methods:This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24h(Group A)and 3761 patients who began ambulating later than 24h(Group B).The outcome measurements,such as length of stay(LOS),total hospitalization costs,dynamic pain level,knee flexion range of motion(ROM),results of the 12-Item Short Form Survey(SF-12),incidence of thromboembolic events and other complications,were recorded and compared.Results:The early ambulation group(Group A)had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group(Group B).There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B.In Group A,patients had significantly higher postoperative SF-12 scores than those in Group B.The incidence of deep venous thrombosis(DVT)and pulmonary infection was significantly lower in Group A than in Group B.The incidence of pulmonary embolism(PE)and other complications did not differ between the two groups.Conclusions:Early ambulation within 24h after TKA was associated with reduced LOS,improved knee function,lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.展开更多
Objective To investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty(TKA).Methods We prospectively studied thirty male and thirty ...Objective To investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty(TKA).Methods We prospectively studied thirty male and thirty female knee primary osteoarthritis patients receiving unilateral TKA with posterior stable-fixed plateau prosthesis at our hospital from March 2003 to March 2008.The age and body mass index of male and female patients were matched.The surgical and rehabilitation clinical factors were compared between two groups.Results There was no significant difference in postoperative hospitalization time,surgical tourniquet time,and wound drainage volume between two groups(P>0.05).The extension/flexion degrees of knee joint before operation,1-week,2-week and 1-year after operation for male patients were 6.0 ± 3.3 degrees/ 114.0 ± 10.0 degrees,2.0 ± 1.6 degrees/93.0 ± 7.4 degrees,0.6 ± 0.6 degrees/104.0 ± 9.9 degrees and 0.3 ± 0.5 degrees/125.0 ± 8.8 degrees,for female patients were 7.0 ± 3.4 degrees/112.0 ± 14.0 degrees,2.0 ± 1.3 degrees/89.0 ± 10.9 degrees,0.9 ± 0.8 degrees/101.0 ± 11.8 degrees,0.4 ± 0.5 degrees/124.0 ± 7.1 degrees.The range of motion before operation,1-week,2-week,and 1-year after operation for male patients was 108.0 ± 9.5 degrees,91.0 ± 7.1 degrees,103.0 ± 9.9 degrees,and 125.0 ± 8.9 degrees,for female patients was 105.0 ± 14.1 degrees,87.0 ± 11.4 degrees,100.0±11.9 degrees,and 124.0 ± 7.0 degrees.The preoperative and 1-year postoperative HSS scores were 55.8 ± 13.3 and 89.6 ± 6.7 for males and 54.5 ± 13.8 and 89.2 ± 4.1 for females.No significant statistical difference was observed between two gender groups in regards to degree of extension and flexion,range of motion and HSS score(P>0.05).Conclusions Gender does not influence postoperative knee function of osteoarthritis patients.TKA significantly improves knee joint function and relieve osteoarthritis-related pain.展开更多
Objective Total knee arthroplasty is one of the most common orthopedic surgeries.Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons.In this study,we evaluated the risk...Objective Total knee arthroplasty is one of the most common orthopedic surgeries.Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons.In this study,we evaluated the risk factors for severe complications after primary total knee arthroplasty.Methods We retrospectively collected clinical data of 2,974 patients who underwent primary total knee arthroplasty from July 2013 to June 2019 in our hospital.Postoperative complication≥gradeⅢwas defined as severe complication according to Clavien-Dindo classification system.Binary logistic regression was used to identify the predictive risk factors for severe complications.Results The complication rate after primary total knee arthroplasty was 6.8%and severe complication rate was 2.5%.Male(OR=2.178,95%CI:1.324-3.585,P=0.002),individuals above 75 years old(OR=1.936,95%CI:1.155-3.244,P=0.012),arrhythmia(OR=2.913,95%CI:1.350-6.285,P=0.006)and cerebrovascular disease(OR=2.804,95%CI:1.432-5.489,P=0.003)were predictive risk factors for severe complications after primary total knee arthroplasty.Conclusion Advanced age,male,arrhythmia,and cerebrovascular disease might be patients-related risk factors for postoperative severe complications after primary total knee arthroplasty.Special attention should be paid to patients with risk factors.展开更多
Objective To introduce a simple preoperative digital templating in uncemented total hip arthroplasty(THA) and to determine its accuracy for preoperative size selection of the prostheses.Methods A prospective study of ...Objective To introduce a simple preoperative digital templating in uncemented total hip arthroplasty(THA) and to determine its accuracy for preoperative size selection of the prostheses.Methods A prospective study of digital planned THAs was performed on 90 hips with different types of prostheses from August 2013 to Angust 2014.The plastic templates of different types of prostheses were scanned for desired digital templating and the scanned images were then processed to the transparent,digital templates using Photoshop software.We calibrated the scales of the digital templates with the preoperative radiographs,and then selected the right size of the component.The preoperatively digital planned component sizes were compared to the actual sizes used in the operation,as well as the preoperatively traditional planned sizes.Results In either cup or stem templating,no difference was found among the groups with different types of prostheses,and the accuracy of digital templating was statistically higher than traditional templating.In cup templating,digital planned and implanted cup sizes were identical in 43.33% of the cases,78.89% of the cup sizes were predicted within 1 size(± 2mm) and 95.56% were predicted within 2 sizes(±4 mm),all significantly higher than the results of traditional planned sizes(30.00%,P=0.044;61.11%,P=0.007;82.22%,P=0.004).The exact femoral stem size was predicted in 40.00% of cases using the digital templating,84.44% of stem sizes were predicted within 1 size,and 93.33% within 2 sizes,better than using traditional templating(25.56%,P=0.028;53.33%,P<0.001;77.77%,P=0.003).Conclusion This simple digital preoperative templating is an accurate and reproducible process to preoperatively predict the implant size of uncemented THA.展开更多
Objective The Patients with pelvic tumors were treated with tumor resection,hemi-pelvic allografting or artificial hemi-pelvic replacement for the improvement of their life quality.Methods Seven cases of pelvic tumor ...Objective The Patients with pelvic tumors were treated with tumor resection,hemi-pelvic allografting or artificial hemi-pelvic replacement for the improvement of their life quality.Methods Seven cases of pelvic tumor were treated with wide resection and hemi-pelvic allografting,and 35 cases with resection of pelvic tumors and artificial hemi-pelvic replacement.Results These 42 cases were all successfully operated upon without operative mortality.The results of long term following-up of 2.5 to 12 years(mean 5.4 years)showed that the increased and satisfactory functional recovery(50.0%).Conclusion Hemi-pelvic allografting or artificial hemi-pelvic replacement after wide resection of pelvic tumors can improve the survival rate of patients,as well as reconstruction of the pelvis and the hip joint with satisfactory function.展开更多
Type II heparin-induced thrombocytopenia （HIT） is a life-threatening adverse drug reaction initiated by heparin administration. We described a rare case of LMWH-induced HIT complicated with proven pulmonary embolism...Type II heparin-induced thrombocytopenia （HIT） is a life-threatening adverse drug reaction initiated by heparin administration. We described a rare case of LMWH-induced HIT complicated with proven pulmonary embolism （PE） in a 75-year-old male patient who hospitalized with diagnose of right knee osteoarthritis and was underwent total knee arthroplasty The patient was successfully treated with argatroban. Early recognition and timely altemative therapy are of great importance in the treatment of this severe disorder,展开更多
Objective To assess the effects of suction drainage versus nondrainage on the post-operative rehabilitation of patients receiving primary bilateral total knee arthroplasties(TKA).Methods A prospective study including ...Objective To assess the effects of suction drainage versus nondrainage on the post-operative rehabilitation of patients receiving primary bilateral total knee arthroplasties(TKA).Methods A prospective study including 40 patients was conducted.These patients were diagnosed with osteoarthritis and underwent primary bilateral TKA between October 2007 and September 2009 with the same operation team.A suction drainage was placed by randomization in only one knee for each patient,while the other knee as self-control.Pain visual analogue scale score,extremity swelling,wound healing,range of motion and incidence of early post-operative complications between the drained and nondrained group were compared statistically.Results Each patient was followed up for 12 months.Placing drainage did not relieve the pain,extremity swelling,ecchymosis,or reduce the incidence of early complications(all P>0.05).Conclusions Suction drainage in TKA does not exhibit substantial advantages in promoting post-operative rehabilitation after unsophisticated TKA,compared with nondrainage.On the other hand,it might complicate the surgical operation,and increase the incidence of post-operative hemorrhage and retrograde infection.Thus we do not recommend suction drainage in unsophisticated TKA.展开更多
Background: The purpose of this study was to compare the frequency of femoroacetabular impingement(FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis(OA).Methods: ...Background: The purpose of this study was to compare the frequency of femoroacetabular impingement(FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis(OA).Methods: Patients who underwent a primary total hip arthroplasty(THA) between January 1, 2015 and December 31, 2015 at a single Veteran’s Affairs Hospital were identified. Veterans were then matched 1:2 with civilian patients from our prospective outcome registry. The alpha angle and lateral center-edge angle(LCEA) were measured by a single evaluator. Independent t-tests were used to compare joint angles, and Fisher exact tests were used to compare the prevalence of cam(alpha angle ≥60°), pincer(LCEA ≥40°), or mixed-type pathologies.Results: Twenty-one veterans were matched 1:2 with civilian patients. The mean alpha angle did not significantly differ between groups(P=0.33) nor did the prevalence of cam deformities(P=0.79). The LCEAs were significantly greater in veterans than in civilians(P=0.04), and veterans also demonstrated a significantly greater prevalence of pincer and mixed-type deformities than civilians(P=0.025 and P=0.004, respectively).Conclusions: These results suggest that FAI is perhaps a more common mechanism in the progression of OA in a veteran population than in a civilian population, as pincer and mixed-type deformities were significantly more common among veterans than civilians. The forces borne by the hip during military training exceed normal physiologic conditions. In addition, the time between symptom onset and surgical correction may be 10–12 months longer for active military personnel than for civilians. The combination of increased physical demands and a protracted time to treatment highlights the need for better recognition of FAI in military members. Future studies are necessary to determine whether earlier intervention may prevent or delay the progression to end-stage OA and the need for total hip arthroplasty.展开更多
文摘Achieving optimal alignment in total knee arthroplasty(TKA) is a critical factor in ensuring optimal outcomes and long-term implant survival. Traditionally, mechanical alignment has been favored to achieve neutral postoperative joint alignment. However, contemporary approaches, such as kinematic alignments and hybrid techniques including adjusted mechanical, restricted kinematic, inverse kinematic, and functional alignments, are gaining attention for their ability to restore native joint kinematics and anatomical alignment, potentially leading to enhanced functional outcomes and greater patient satisfaction. The ongoing debate on optimal alignment strategies considers the following factors: long-term implant durability, functional improvement, and resolution of individual anatomical variations. Furthermore, advancements of computer-navigated and robotic-assisted surgery have augmented the precision in implant positioning and objective measurements of soft tissue balance. Despite ongoing debates on balancing implant longevity and functional outcomes, there is an increasing advocacy for personalized alignment strategies that are tailored to individual anatomical variations. This review evaluates the spectrum of various alignment techniques in TKA, including mechanical alignment, patient-specific kinematic approaches, and emerging hybrid methods. Each technique is scrutinized based on its fundamental principles, procedural techniques, inherent advantages, and potential limitations, while identifying significant clinical gaps that underscore the need for further investigation.
基金the National Health and Family Planning Commission of the People’s Republic of China(CN)program(201302007).
文摘Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilateral total knee arthroplasty(TKA)on postoperative rehabilitation and costs in a Chinese population.Methods:This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24h(Group A)and 3761 patients who began ambulating later than 24h(Group B).The outcome measurements,such as length of stay(LOS),total hospitalization costs,dynamic pain level,knee flexion range of motion(ROM),results of the 12-Item Short Form Survey(SF-12),incidence of thromboembolic events and other complications,were recorded and compared.Results:The early ambulation group(Group A)had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group(Group B).There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B.In Group A,patients had significantly higher postoperative SF-12 scores than those in Group B.The incidence of deep venous thrombosis(DVT)and pulmonary infection was significantly lower in Group A than in Group B.The incidence of pulmonary embolism(PE)and other complications did not differ between the two groups.Conclusions:Early ambulation within 24h after TKA was associated with reduced LOS,improved knee function,lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.
文摘Objective To investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty(TKA).Methods We prospectively studied thirty male and thirty female knee primary osteoarthritis patients receiving unilateral TKA with posterior stable-fixed plateau prosthesis at our hospital from March 2003 to March 2008.The age and body mass index of male and female patients were matched.The surgical and rehabilitation clinical factors were compared between two groups.Results There was no significant difference in postoperative hospitalization time,surgical tourniquet time,and wound drainage volume between two groups(P>0.05).The extension/flexion degrees of knee joint before operation,1-week,2-week and 1-year after operation for male patients were 6.0 ± 3.3 degrees/ 114.0 ± 10.0 degrees,2.0 ± 1.6 degrees/93.0 ± 7.4 degrees,0.6 ± 0.6 degrees/104.0 ± 9.9 degrees and 0.3 ± 0.5 degrees/125.0 ± 8.8 degrees,for female patients were 7.0 ± 3.4 degrees/112.0 ± 14.0 degrees,2.0 ± 1.3 degrees/89.0 ± 10.9 degrees,0.9 ± 0.8 degrees/101.0 ± 11.8 degrees,0.4 ± 0.5 degrees/124.0 ± 7.1 degrees.The range of motion before operation,1-week,2-week,and 1-year after operation for male patients was 108.0 ± 9.5 degrees,91.0 ± 7.1 degrees,103.0 ± 9.9 degrees,and 125.0 ± 8.9 degrees,for female patients was 105.0 ± 14.1 degrees,87.0 ± 11.4 degrees,100.0±11.9 degrees,and 124.0 ± 7.0 degrees.The preoperative and 1-year postoperative HSS scores were 55.8 ± 13.3 and 89.6 ± 6.7 for males and 54.5 ± 13.8 and 89.2 ± 4.1 for females.No significant statistical difference was observed between two gender groups in regards to degree of extension and flexion,range of motion and HSS score(P>0.05).Conclusions Gender does not influence postoperative knee function of osteoarthritis patients.TKA significantly improves knee joint function and relieve osteoarthritis-related pain.
文摘Objective Total knee arthroplasty is one of the most common orthopedic surgeries.Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons.In this study,we evaluated the risk factors for severe complications after primary total knee arthroplasty.Methods We retrospectively collected clinical data of 2,974 patients who underwent primary total knee arthroplasty from July 2013 to June 2019 in our hospital.Postoperative complication≥gradeⅢwas defined as severe complication according to Clavien-Dindo classification system.Binary logistic regression was used to identify the predictive risk factors for severe complications.Results The complication rate after primary total knee arthroplasty was 6.8%and severe complication rate was 2.5%.Male(OR=2.178,95%CI:1.324-3.585,P=0.002),individuals above 75 years old(OR=1.936,95%CI:1.155-3.244,P=0.012),arrhythmia(OR=2.913,95%CI:1.350-6.285,P=0.006)and cerebrovascular disease(OR=2.804,95%CI:1.432-5.489,P=0.003)were predictive risk factors for severe complications after primary total knee arthroplasty.Conclusion Advanced age,male,arrhythmia,and cerebrovascular disease might be patients-related risk factors for postoperative severe complications after primary total knee arthroplasty.Special attention should be paid to patients with risk factors.
基金Supported by the Health Research Program of Ministry of Health(201302007)
文摘Objective To introduce a simple preoperative digital templating in uncemented total hip arthroplasty(THA) and to determine its accuracy for preoperative size selection of the prostheses.Methods A prospective study of digital planned THAs was performed on 90 hips with different types of prostheses from August 2013 to Angust 2014.The plastic templates of different types of prostheses were scanned for desired digital templating and the scanned images were then processed to the transparent,digital templates using Photoshop software.We calibrated the scales of the digital templates with the preoperative radiographs,and then selected the right size of the component.The preoperatively digital planned component sizes were compared to the actual sizes used in the operation,as well as the preoperatively traditional planned sizes.Results In either cup or stem templating,no difference was found among the groups with different types of prostheses,and the accuracy of digital templating was statistically higher than traditional templating.In cup templating,digital planned and implanted cup sizes were identical in 43.33% of the cases,78.89% of the cup sizes were predicted within 1 size(± 2mm) and 95.56% were predicted within 2 sizes(±4 mm),all significantly higher than the results of traditional planned sizes(30.00%,P=0.044;61.11%,P=0.007;82.22%,P=0.004).The exact femoral stem size was predicted in 40.00% of cases using the digital templating,84.44% of stem sizes were predicted within 1 size,and 93.33% within 2 sizes,better than using traditional templating(25.56%,P=0.028;53.33%,P<0.001;77.77%,P=0.003).Conclusion This simple digital preoperative templating is an accurate and reproducible process to preoperatively predict the implant size of uncemented THA.
文摘Objective The Patients with pelvic tumors were treated with tumor resection,hemi-pelvic allografting or artificial hemi-pelvic replacement for the improvement of their life quality.Methods Seven cases of pelvic tumor were treated with wide resection and hemi-pelvic allografting,and 35 cases with resection of pelvic tumors and artificial hemi-pelvic replacement.Results These 42 cases were all successfully operated upon without operative mortality.The results of long term following-up of 2.5 to 12 years(mean 5.4 years)showed that the increased and satisfactory functional recovery(50.0%).Conclusion Hemi-pelvic allografting or artificial hemi-pelvic replacement after wide resection of pelvic tumors can improve the survival rate of patients,as well as reconstruction of the pelvis and the hip joint with satisfactory function.
文摘Type II heparin-induced thrombocytopenia （HIT） is a life-threatening adverse drug reaction initiated by heparin administration. We described a rare case of LMWH-induced HIT complicated with proven pulmonary embolism （PE） in a 75-year-old male patient who hospitalized with diagnose of right knee osteoarthritis and was underwent total knee arthroplasty The patient was successfully treated with argatroban. Early recognition and timely altemative therapy are of great importance in the treatment of this severe disorder,
文摘Objective To assess the effects of suction drainage versus nondrainage on the post-operative rehabilitation of patients receiving primary bilateral total knee arthroplasties(TKA).Methods A prospective study including 40 patients was conducted.These patients were diagnosed with osteoarthritis and underwent primary bilateral TKA between October 2007 and September 2009 with the same operation team.A suction drainage was placed by randomization in only one knee for each patient,while the other knee as self-control.Pain visual analogue scale score,extremity swelling,wound healing,range of motion and incidence of early post-operative complications between the drained and nondrained group were compared statistically.Results Each patient was followed up for 12 months.Placing drainage did not relieve the pain,extremity swelling,ecchymosis,or reduce the incidence of early complications(all P>0.05).Conclusions Suction drainage in TKA does not exhibit substantial advantages in promoting post-operative rehabilitation after unsophisticated TKA,compared with nondrainage.On the other hand,it might complicate the surgical operation,and increase the incidence of post-operative hemorrhage and retrograde infection.Thus we do not recommend suction drainage in unsophisticated TKA.
文摘Background: The purpose of this study was to compare the frequency of femoroacetabular impingement(FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis(OA).Methods: Patients who underwent a primary total hip arthroplasty(THA) between January 1, 2015 and December 31, 2015 at a single Veteran’s Affairs Hospital were identified. Veterans were then matched 1:2 with civilian patients from our prospective outcome registry. The alpha angle and lateral center-edge angle(LCEA) were measured by a single evaluator. Independent t-tests were used to compare joint angles, and Fisher exact tests were used to compare the prevalence of cam(alpha angle ≥60°), pincer(LCEA ≥40°), or mixed-type pathologies.Results: Twenty-one veterans were matched 1:2 with civilian patients. The mean alpha angle did not significantly differ between groups(P=0.33) nor did the prevalence of cam deformities(P=0.79). The LCEAs were significantly greater in veterans than in civilians(P=0.04), and veterans also demonstrated a significantly greater prevalence of pincer and mixed-type deformities than civilians(P=0.025 and P=0.004, respectively).Conclusions: These results suggest that FAI is perhaps a more common mechanism in the progression of OA in a veteran population than in a civilian population, as pincer and mixed-type deformities were significantly more common among veterans than civilians. The forces borne by the hip during military training exceed normal physiologic conditions. In addition, the time between symptom onset and surgical correction may be 10–12 months longer for active military personnel than for civilians. The combination of increased physical demands and a protracted time to treatment highlights the need for better recognition of FAI in military members. Future studies are necessary to determine whether earlier intervention may prevent or delay the progression to end-stage OA and the need for total hip arthroplasty.
