共查询到20条相似文献，搜索用时 171 毫秒
1.
Background
Malrotation of tibial and femoral components is a potential source of pain following total knee arthroplasty (TKA). This study aimed to 1) compare component rotation in TKA patients with unexplained pain versus a control group with well-functioning TKAs and 2) investigate the relationship between TKA component rotation and pain.Methods
Seventy one patients with unexplained pain after primary TKA were compared to a control cohort of 41 well functioning TKA patients. Both groups underwent post-operative computed tomography (CT) scans to assess component rotation. Findings were compared between the painful and control TKA groups.Results
We found no difference in femoral component rotation between the painful and control groups (mean 0.6° vs 1.0° external rotation (ER), p = 0.4), and no difference in tibial component rotation (mean 11.2° vs 9.5° internal rotation (IR), p = 0.3). Also, there was no difference in combined mal-rotation (tibial + femoral rotation) between the groups (mean 10.5° vs 8.5°IR, p = 0.25). Fifty-nine percent of patients in the painful group had tibial component rotation > 9°IR vs 49% in the control group.Conclusion
In the largest study yet on component rotation after TKA, we found no difference in the incidence of tibial, femoral, or combined component mal-rotation in painful versus well-functioning TKAs. Tibial component IR relative to the junction of the medial to middle thirds of the tibial tubercle appears to be common in patients with well-functioning TKAs. The significance of slight tibial IR should be interpreted with caution when evaluating the painful TKA.Level III retrospective case–control study. 相似文献2.
Background
Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA.Methods
A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization.Results
Approximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR) = 2.11, 95% CI = 1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR = 3.17, 95% CI = 2.26, 4.44 when both were coded ‘yes’). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR = 4.9, 95% CI = 2.2, 11.1).Conclusion
A variety of modifiable psychological factors impact people's expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure. 相似文献3.
Jesse C. Christensen Paul C. LaStayo Robin L. Marcus Gregory J. Stoddard K. Bo Foreman Ryan L. Mizner Christopher L. Peters Christopher E. Pelt 《The Knee》2018,25(1):73-82
Background
Abnormal knee mechanics frequently follow total knee arthroplasty (TKA) surgery with these deficits amplifying as task demands increase. Knee-kinetic biofeedback could provide a means of attenuating gait abnormalities. The purposes of this study were as follows: (1) to describe the gait characteristic differences between patients with TKA and non-TKA adults during level (low-demand) and decline (high-demand) walking; and (2) where differences existed, to determine the impact of knee-kinetic biofeedback on normalizing these abnormalities.Methods
Twenty participants six months following a primary TKA and 15 non-TKA peers underwent gait analysis testing during level and decline walking. Knee-kinetic biofeedback was implemented to patients with TKA to correct abnormal gait characteristics if observed.Results
Patients with TKA had lower knee extensor angular impulse (p < 0.001), vGRF (p = 0.001) and knee flexion motion (p = 0.005) compared to the non-TKA group during decline walking without biofeedback. Patients with TKA normalized their knee extensor angular impulse (p = 0.991) and peak vGRF (p = 0.299) during decline walking when exposed to biofeedback. No between-group differences were observed during level walking. Groups were similar in age, gender, body mass index, physical activity level, pain interference and depression scores (p > 0.05).Conclusion
Patients with TKA demonstrate abnormal gait characteristics during a high-demand walking task when compared to non-TKA peers. Our findings indicate that knee-kinetic biofeedback can induce immediate improvements in gait characteristics during a high-demand walking task. There may be a potential role for the use of visual knee-kinetic biofeedback techniques to improve gait abnormalities during high-demand tasks following TKA. 相似文献4.
Chin Tat Lim Stuart B. Goodman James I. Huddleston Alex H.S. Harris Subhrojyoti Bhowmick William J. Maloney Derek F. Amanatullah 《The Knee》2017,24(5):1182-1186
Background
Smoking is associated with early postoperative complications, increased length of hospital stay, and an increased risk of revision after total knee arthroplasty (TKA). However, the effect of smoking on time to revision TKA is unknown.Methods
A total of 619 primary TKAs referred to an academic tertiary center for revision TKA were retrospectively stratified according to the patient smoking status. Smoking status was then analyzed for associations with time to revision TKA using a Chi square test. The association was also analyzed according to the indication for revision TKA.Results
Smokers (37/41, 90%) have an increased risk of earlier revision for any reason compared to non-smokers (274/357, 77%, p = 0.031). Smokers (37/41, 90%) have an increased risk of earlier revision for any reason compared to ex-smokers (168/221, 76%, p = 0.028). Subgroup analysis did not reveal a difference in indication for revision TKA (p > 0.05).Conclusions
Smokers are at increased risk of earlier revision TKA when compared to non-smokers and ex-smokers. The risk for ex-smokers was similar to that of non-smokers. Smoking appears to have an all-or-none effect on earlier revision TKA as patients who smoked more did not have higher risk of early revision TKA. These results highlight the need for clinicians to urge patients not to begin smoking and encourage smokers to quit smoking prior to primary TKA. 相似文献5.
Jodie A. McClelland Kate E. Webster Alankar A. Ramteke Julian A. Feller 《The Knee》2017,24(3):651-656
Background
Computer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated.Methods
This study compared knee biomechanics during level walking of 121 participants: 39 with conventional TKA, 42 with computer-assisted navigation TKA and 40 unimpaired control participants.Results
Standing lower-limb alignment was significantly closer to ideal in participants with navigation TKA. During gait, when differences in walking speed were accounted for, participants with conventional TKA had less knee flexion during stance and swing than controls (P < 0.01), but there were no differences between participants with navigation TKA and controls for the same variables. Both groups of participants with TKA had lower knee adduction moments than controls (P < 0.01).Conclusions
In summary, there were fewer differences in the biomechanics of computer-assisted navigation TKA patients compared to controls than for patients with conventional TKA. Computer-assisted navigation TKA may restore biomechanics during walking that are closer to normal than conventional TKA. 相似文献6.
Olivia Unwin Mohammed Hassaballa James Murray William Harries Andrew Porteous 《The Knee》2017,24(2):454-459
Background
MIS TKA has been shown to offer a reduced in-patient stay, but no clinical difference at two years. Whilst there may be a benefit from earlier discharge, we need to ensure that there are no detrimental effects in the medium and long-term following MIS-TKA. To report the mid-term result from a prospective randomised controlled trial (RCT) comparing MIS-TKA with standard approach for TKA.Methods
Using knee score questionnaires, we collected patient reported outcome measures (PROMs) regarding pain and function. Sixty-six patients (from an eligible cohort of 83 patients) completed the mid-term postal follow-up.Results
There was no significant difference between groups for change in score from pre-operative to final follow-up in all three PROMs. Mean MIS and standard group improvement was: AKSS 53 and 51 (p = 0.7644), OKS 15 and 16 (p = 0.2341) or WOMAC 15 and 15 (p = 0.9900) respectively. Both groups showed improvement in pain and function with no significant difference between groups. There was no difference between groups for revision due to malalignment at a mean six year follow-up.Conclusions
In addition to the early benefits regarding hospital stay and complications, we have found that at a mean of six years there was no increase in malalignment, pain or function with MIS techniques. 相似文献7.
Christian Scheele Matthias F. Pietschmann Christian Schröder Thomas Grupp Melanie Holderied Volmar Jansson Peter E. Müller 《The Knee》2017,24(2):402-408
Background
Unicompartmental total knee arthroplasty (UKA) is a well-established treatment option for unicondylar osteoarthritis, and generally leads to better functional results than tricompartimental total knee arthroplasty (TKA). However, revision rates of UKAs are reported as being higher; a major reason for this is aseptic loosening of the tibial component due to implant–cement–bone interface fatigue. The objective of this study was to determine the effects of trabecular bone preparation, prior to implantation of tibial UKAs, on morphological and biomechanical outcomes in a cadaver study.Methods
Cemented UKAs were performed in 18 human cadaver knees after the bone bed was cleaned using pulsed lavage (Group A), conventional brush (Group B) or no cleaning at all (Group C, control). Morphologic cement penetration and primary stability were measured.Results
The area proportion under the tibial component without visible cement penetration was significantly higher in Group C (21.9%, SD 11.9) than in both Group A (7.1%, SD 5.8), and Group B (6.5%, SD 4.2) (P = 0.007). The overall cement penetration depth did not differ between groups. However, in the posterior part, cement penetration depth was significantly higher in Group B (1.9 mm, SD 0.3) than in both Group A (1.3 mm, SD 0.3) and Group C (1.4 mm, SD 0.3) (P = 0.015). The mode of preparation did not show a substantial effect on primary stability tested under dynamic compression-shear test conditions (P = 0.910).Conclusion
Bone preparation significantly enhances cement interdigitation. The application of a brush shows similar results compared with the application of pulsed lavage. 相似文献8.
Background
Unplanned hospital readmissions are indicators of the quality and performance of a health care system, but data on early readmission after primary total knee arthroplasty (TKA) in the Asian population are limited. The purpose of this study was to determine the causes, risk factors, and rate of unplanned readmission after primary TKA at a single institution in Korea.Methods
We analyzed all primary TKAs from 2004 to 2013 using the data from our institutional electronic database. A total of 4596 TKAs were performed on 3049 patients. All unplanned readmissions within 30 and 90 days of discharge were identified, categorized into arthroplasty-related, medical, and other orthopedic causes.Results
The overall unplanned readmission rate was 1.9% (n = 59) within 30 days and 3.3% (n = 101) within 90 days, and both the 30 and 90 day readmission rates remained stable over the entire study period. The majority of readmissions involved arthroplasty-related causes; the most common cause being wound problems, accounting for 22% (13/59) within 30 days and 24% (24/101) within 90 days. Age (P = 0.029) and hypertension (P = 0.021) were identified as risk factors for unplanned readmissions after TKA.Conclusion
This study demonstrates that unplanned readmissions after TKA are not infrequent in Korean patients and has identified wound complication as the most frequent cause of unplanned readmissions. Optimized care systems should be established to minimize unplanned readmissions, particularly for patients with high risk factors. 相似文献9.
Yoshinori Ishii Hideo Noguchi Junko Sato Hana Ishii Koji Todoroki Shin-ichi Toyabe 《The Knee》2017,24(5):1153-1159
Background
Proximal tibial bone mineral density (BMD) has been studied for its potential impact on subsidence and loosening of the tibial component after total knee arthroplasty (TKA). However, no known studies of proximal tibial BMD after TKA have evaluated the effect of major impact factors such as body weight (BW), muscle strength, and level of activity. We aim to determine whether factors such as level of activity, quadriceps strength, BW, gender, age, and prosthetic design affect proximal tibial BMD over the mid- to long-term following TKA.Methods
We evaluated 36 patients (72 knees) who were undergoing bilateral TKA performed by a single surgeon. Median follow up time was 115 months (range, 60–211 months) for a minimum of five years. We measured BMD in the proximal tibia and used a hand-held dynamometer to measure quadriceps isometric strength, recording the maximum value of three measurements for each patient.Results
Univariate analyses using Spearman's correlation coefficient for continuous variables revealed a weak negative correlation between age and BMD (r = ? 0.316, P = 0.007) and a moderate positive correlation between BW and BMD (r = 0.430, P < 0.001). However, no significant correlations were found between the other factors above and BMD for continuous and discrete variables. Based on multivariate analyses, only BW had a significant effect on BMD (β = 0.342, P = 0.003).Conclusions
BW is the most impact factor on the proximal tibial BMD after mid- to long-term follow up TKA. Therefore, the management of BW may contribute to prevention of decline of tibial BMD for TKA patients owing to aging. 相似文献10.
Charles Rivière Matthieu Ollivier Damien Girerd Jean Noël Argenson Sébastien Parratte 《The Knee》2017,24(3):627-633
Background
A principle of TKA is to achieve a neutral standing coronal alignment of the limb (HKA angle) to reduce risks of implant loosening, reduce polyethylene wear, and optimize patellar tracking. Several long-term studies have questioned this because the relationship between alignment and implant survivorship is weaker than previously reported. We hypothesize that standing HKA poorly predicts implant failure because it does not predict dynamic HKA, dynamic adduction moment, and loading of the knee during gait. Therefore, the aim of our study is to assess the relationship between the standing and the dynamic (gait activity) HKAs.Methods
A prospective study on a cohort of 35 patients treated with a posterior-stabilized TKA for primary osteoarthritis. Three months after surgery each patient had a long-leg radiograph and the limb was classified as neutrally aligned (17 patients), varus aligned (nine patients), or valgus aligned (four patients). Patients then performed a gait analysis for level walking.Results
Standing HKA has a moderate correlation with the peak dynamic varus (r = 0.318, p = 0.001) and the mean and peak adduction moments (r = 0.31 and r = ? 0.352 respectively). No significant correlation between standing HKA and the mean dynamic coronal alignment (r = 0.14, p = 0.449). No differences were found for dynamic frontal parameters (dynamic HKA and adduction moment) between patients defined as neutrally or varus aligned.Conclusions
The standing HKA after TKA was of little value to predict dynamic behaviour of the limb during gait, this may explain why standing coronal alignment after TKA may have limited influence on long-term implant fixation and wear. 相似文献11.
Khalid Jaber Shaun O&#x;Leary Ashley Pedler Michele Sterling Michael McAuliffe 《The Knee》2018,25(3):459-465
Background and objective
Persistent pain is reported in up to 34% of patients following total knee arthroplasty (TKA) for management of knee osteoarthritis (KOA). Persistent pain in this group is thought to be at least partly reflective of pain sensory hypersensitivity. The objective of this study was to evaluate sensory hypersensitivity, using mechanical and thermal quantitative sensory testing, in patients about to undergo TKA.Design and methods
Pressure pain thresholds (PPT) and cold pain thresholds (CPT) were recorded from 30 participants prior to their TKA, and compared with recordings taken from 30 healthy control participants of similar age and gender. Thresholds were recorded locally and remotely (other knee, deltoid) to the operative knee. Group comparisons (KOA, control, groups) were made using a general linear mixed models approach with age, gender, and body mass index (BMI) included as covariates. Pairwise comparisons were conducted with Bonferonni correction for multiple comparisons.Results
Significantly lower PPTs were at all measured sites in the KOA group compared to the control group (P < 0.001 at all sites, except the deltoid P = 0.004). Males demonstrated higher pain threshold compared to females, averaged over all sites, P = 0.02. There were no observed between-group differences in CPT (P = 0.122).Conclusions
This study suggested that some individuals about to undergo TKA for their advanced KOA demonstrated widespread mechanical sensory hypersensitivity. These findings have potentially important clinical implications regarding perioperative and longer-term pain management in these patients. 相似文献12.
Kyoung-Tak Kang Sae Kwang Kwon Juhyun Son Oh-Ryong Kwon Jun-Sang Lee Yong-Gon Koh 《The Knee》2018,25(5):903-914
Background
Postoperative changes of the femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) affect the biomechanics of the knee joint after fixed-bearing total knee arthroplasty (TKA). However, the biomechanics of mobile-bearing is not well known. Therefore, the aim of this study was to investigate whether alterations to the PCO and PTS affect the biomechanics for mobile-bearing TKA.Methods
We used a computational model for a knee joint that was validated using in vivo experiment data to evaluate the effects of the PCO and PTS on the tibiofemoral (TF) joint kinematics, patellofemoral (PF) contact stress, collateral ligament force and quadriceps force, for mobile-bearing TKA. The computational model was developed using ± 1-, ± 2- and ± 3-mm PCO models in the posterior direction and ? 3°, 0°, + 3°, and + 6° PTS models based on each of the PCO models.Results
The maximum PF contact stress, collateral ligament force and quadriceps force decreased as the PTS increased. In addition, the maximum PF contact stress and quadriceps force decreased, and the collateral ligament force increased as PCO translated in the posterior direction. This trend is consistent with that observed in any PCO and PTS.Conclusions
Our findings show the various effects of postoperative alterations in the PCO and PTS on the biomechanical results of mobile-bearing TKA. Based on the computational simulation, we suggest that orthopaedic surgeons intraoperatively conserve the patient's own anatomical PCO and PTS in mobile-bearing TKA. 相似文献13.
Background
The influence of the surgical approach on the position of the prosthetic components in revision of total knee arthroplasties (rTKA) is still not clear. This study compared the medial parapatellar approach (MPA) and lateral parapatellar subvastus approach with tibial tubercle osteotomy (LPA).Methods
Forty-two consecutive patients underwent rTKA from 2006 to 2016 with either MPA (n = 21) or LPA (n = 21) because of aseptic loosening, infection, malposition or instability (mean follow-up: 41.5 months). Revision TKA component position and leg alignment were assessed on three-dimensional CT (3D-CT) images and compared between groups using a t-test (p < 0.05). Rotation of rTKA components graded into internal, neutral or external rotation and rates of postoperative complications and revisions were compared between groups with a chi2-test (p < 0.05).Results
Group MPA and LPA showed no significant differences with respect to the femoral component (coronal: 0.6° vs 0.9°; sagittal: 7.5° vs 7.7°; transversal: 0.4° vs ? 0.2°), tibial component (coronal: 0.1° vs 0.3°; sagittal: 3.1° vs 1.6°; transversal: 6.9° vs 9.3°) and leg alignment (varus: 0.2° vs 1.1°) (p < 0.05). Group LPA showed a non-significant (p = 0.25) higher incidence of neutrally (28.6% vs 9.5%) and less internally (23.8% vs 38.1%) rotated tibial components. Rates of complication and revisions did not differ significantly.Conclusions
In contrast with primary TKA, the two approaches did not influence postoperative rTKA position. This can be explained with the more extensive approach at rTKA and means that no corrections of the orientation of the components are needed performing either MPA or LPA. 相似文献14.
Background
In total knee arthroplasty (TKA), the position of the patellar component can affect patellar tracking. However, the patellar component cannot always replicate the original high point of the patella because of anatomical variance. This study investigated whether altering the highest point of the patella can affect outcomes of primary TKA, especially in patients having a patella with a far-medialized median ridge.Methods
A retrospective review was performed for 177 knees (143 patients) treated with primary TKA between July 2011 and March 2014. Group 1 (34 knees) had the patellar component displaced over three millimeters from the median ridge, while Group 2 (143 knees) had the patellar component placed on the original median ridge position. The one-year follow-up outcomes were reviewed, including: patellar tilt angle, Knee Society Score, Feller Patellar Score, and modified Kujala Anterior Knee Pain Score.Results
Mean (± standard deviation) displacement of the patellar component in Group 1 was 3.97 ± 0.97 mm lateral to the original position of the median ridge, with a significant decrease in lateral patellar tilt angle (P < 0.001). Lateral patellar tilt showed a positive correlation with the medialization of the patellar component (P < 0.001, r = 0.401). Ability to rise from a chair was better in Group 1 (P = 0.025). There were no other between-group differences in other clinical outcomes.Conclusions
There should be no need for the patellar component to replicate the original highest point of the native patella in primary TKA. 相似文献15.
Background
Superficial wound complications occur in up to 10% of total knee arthroplasty (TKA) procedures and have been associated with periprosthetic joint infection. The ideal material for TKA closure should offer: 1) fast intraoperative application, 2) minimal wound complications and 3) removable by patients without assistance. We evaluated a novel, non-invasive, removable skin closure system for TKA to determine its effect on wound complications.Methods
We prospectively evaluated 221 consecutive TKA patients who received skin closure using a non-invasive zipper-like system (‘Zip’; Zip 16 Surgical Skin Closure System; Zipline Medical). All procedures were performed by a single surgeon using the mini-midvastus approach. Patients received two weeks of rivaroxaban postoperatively. Demographics, comorbidities, in-hospital complications and six-week wound evaluation were recorded. Data was compared to a cohort of 1001 patients from the same surgeon who received staples for closure and coumadin for thromboprophylaxis.Results
Zip patients had a significantly higher BMI (p = 0.001), incidence of diabetes (p = 0.035) and smoking (p = 0.005). Zip patients removed dressings themselves and did not report problems with dressing care. Rate of readmission for wound-related complications was significantly lower in the Zip closure group (p = 0.045). Overall readmission rates were similar between groups.Conclusions
In our experience, the Zip 16 Surgical Skin Closure System is easy to apply, avoids home care and has produced fewer wound complications compared to staples. Results have been positive despite the study cohort having a higher number of diabetic patients and using an anticoagulant associated with a higher risk of wound complications. 相似文献16.
Max Ettinger Peter Savov Omar Balubaid Henning Windhagen Tilman Calliess 《The Knee》2018,25(3):480-484
Background
Hyperextension of the femoral component and excessive slope of the tibial component may delay the cam–post engagement in semi-constrained revision total knee arthroplasty (TKA). Further, it may compromise the posterior condylar offset (PCO). No prior study has determined whether a short 50-mm stem, or longer stems (100 mm and 150 mm) lead to less hyperextension of the femoral component or excessive slope and its influence on the posterior condylar offset.Methods
Flexion/extension of the femoral component with respect to the sagittal femoral anatomic axis of the distal diaphysis (SFAA) and the tibial slope were measured from rotationally controlled lateral X-rays of 126 consecutive patients with a one- or two-stage revision TKA. Stems of 50 mm, 100 mm and 150 mm were analyzed. Further, reconstruction of the PCO with respect to stem length and component flexion was evaluated.Results
The average flexion (+) or extension (?) of the femoral component in the sagittal distal anatomical axis was ? 4.1° ± 2.8° (mean ± std) for components, which have been implanted with 50-mm stems and 1.1° ± 1.1° for components with 100- or 150-mm stems, respectively (P = 0.0001). The average slope of the tibial was 2.6° ± 1.5° for tibial trays with 50-mm stems, which was more than the 1.3° ± 1° for trays with 100-mm stems (P = 0.0001). The average PCO ratio was 0.8 ± 1.7 for femoral components with 50-mm stems, which was less than the 1.0 ± 1.7 for trays with 100-mm stems (P = 0.0001).Conclusions
Because 50-mm stems resulted in about three degree hyperextension of the femoral component with respect to the SFAA compared to 100-mm or 150-mm stems, the longer stems do not alter the natural femoral flexion and a delay of the cam–post engagement may be avoided. Further, a better reconstruction of the PCO may be archived with the use of longer stems. 相似文献17.
J. Ryan Martin Keith A. Fehring Chad D. Watts Daniel L. Levy Bryan D. Springer Raymond H. Kim 《The Knee》2017,24(4):863-868
Background
Semi-constrained, or varus–valgus constrained, implants are occasionally necessary to achieve stability in primary total knee arthroplasty (TKA). However, outcomes with these implants are largely unknown. Therefore, the primary goals of this study were to determine 1) can we identify preoperatively which patients might require a semi-constrained implant and 2) are there any clinical and or radiographic differences for those that require a semi-constrained implant?Methods
A multicenter retrospective study was performed to retrospectively review patients that had a Stryker Triathlon (Kalamazoo, MI) TKA with a Total Stabilized (TS) tibial insert (n = 75). This TS cohort was subsequently matched 1:1 based on age, gender, and BMI to a cohort of patients with the same primary TKA design with a PS insert (n = 75). Preoperative and postoperative radiographic and clinical data were compared between the two groups.Results
Preoperatively, the TS cohort had significantly greater varus (9.72 vs. 3.48; p = 0.0001) and valgus (14.1 vs. 7.57; p = 0.0001) deformity. Post-operatively, there were no statistically significant differences in revisions (p = 1), reoperations (p = 1), or complications (p = 1). Mean clinical and radiographic follow-ups were equivalent between groups (25.5 vs. 25.8 months, p = 0.8851).Conclusion
As suspected, use of a semi-constrained insert to achieve intraoperative coronal stability was most predicted by preoperative coronal deformity (either varus or valgus). Longer follow-up and larger patient cohorts are necessary to determine. 相似文献18.
Background
Total knee arthroplasty (TKA) has been successful for many younger patients, but some experience residual symptoms or dissatisfaction. We performed this study to assess the relationship between radiographic disease severity and patient demographic features on patient reported TKA outcome scores.Methods
We compared 100 TKAs performed for 82 patients ≤ 55 years old with 100 gender-matched TKAs performed for 85 patients between 65 and 75 years old. These study cases represented 25% and 21%, respectively, of TKAs performed between January 2006 and June 2011. Radiographic disease severity was determined from preoperative weight bearing AP and lateral radiographs. Patient reported outcome instruments (SF-12, Knee Society function, and WOMAC) were assessed for all patients within six months before surgery and postoperatively at a mean of 20 months after TKA.Results
Although younger patients had less mean articular cartilage loss (p < 0.01), osteoarthritis severity (p < 0.01), and Kellgren–Lawrence grade (p = 0.05), they reported lower preoperative scores (p < 0.01) exceeding the MCID for SF-12 mental health (8.3 points), WOMAC pain (12.1 points), and WOMAC physical function (6.9 points). While substantial improvement was noted, WOMAC pain scores remained lower than those reported by older TKA patients (11.5 points, p < 0.05).Conclusion
Younger patients with less severe radiographic arthritis experience significant improvement with TKA, but outcome scores do not match those attained by older patients with more severe radiographic disease. 相似文献19.
Body mass index as a predictor of outcome in total knee replace: A systemic review and meta-analysis
Background
To conduct a meta-analysis with randomized controlled trials (RCTs) published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of normal and high body mass index (BMI) to provide the predictive diagnosis for clinic.Methods
Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to February.RCTs comparing the benefits and risks of normal BMI with those of high BMI in primary total knee arthroplasty (TKA) were included. Statistical heterogeneity was quantitatively evaluated by X2 test with the significance set P < 0.10 or I2 > 50%.Results
Seven RCTs consisting of 33,778 patients were included. (6065 normal BMI patient; 27,713 high BMI). The results showed that high BMI was related to a greater increase in operative time, post-operative range of motion (ROM), post-operative Knee Society and function scores (KSS), infection rate (P < 0.1). No differences in pulmonary embolism and perioperative mortality rates were found between normal and high body mass index patients with follow-up ≥ 5 years (P > 0.1).Conclusions
Compared with normal BMI patients, high BMI patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between normal and high BMI about TKA. 相似文献20.
Suguru Nakamura Yukihide Minoda Shigeru Nakagawa Yoshinori Kadoya Susumu Takemura Akio Kobayashi Shigekazu Mizokawa Yoichi Ohta Sinji Takahashi Kazumasa Yamamura Hiroaki Nakamura 《The Knee》2017,24(2):434-438