全膝关节初次表面置换术治疗骨关节病(附52例随访疗效分析)

目的：(1)报告本院全膝关节初次表面置换术治疗骨关节病的临床特点和疗效。(2)探讨影响本院全膝关节初次表而置换术治疗骨关节病疗效的因素，为今后的临床工作提供经验与教训：方法：对52例全膝关节初次表面置换术进行随访，并用HSS评分系统进行分析，随访3～110个月，平均28．3个月。结果：手术优良率88．5％。病人术后在疼痛、功能及活动度等方面均有改善，尤其在缓解疼痛方面效果明显，但在关节活动度方面改善最少，有些甚至下降。结论：全膝关节初次表面置换术是治疗严重膝关节骨关节病的有效丁段；局部早期的并发症是影响本院全膝关节初次表面置换术近期疗效的主要因素?     

膝关节表面置换术治疗OA和RA的近期疗效分析

目的报告52例全膝关节表面置换术的疗效。方法对52例全膝关节表面置换术的患者进行随访,并用HSS评分系统进行分析。随访2~20个月,平均13个月。结果手术优良率94.2%,所有患者在疼痛、功能方面有明显改善。结论全膝关节置换术对严重的骨关节病和类风湿性关节炎的效果满意,为取得更好疗效有必要加强术前教育及术后的康复指导。     

全膝关节表面置换术治疗骨关节病--42例长期随访疗效分析

目的报告42例全膝关节表面置换术治疗骨关节病的长期疗效.方法对42例骨关节病全膝关节置换术的患者进行长期随访,并应用HSS膝关节评分系统进行分析;随访5年～14年,平均7年11个月.结果手术优良率为88%.病人术后在疼痛、功能及关节活动度等方面都有明显改善.尤其是在缓解疼痛方面效果显著.结论全膝关节表面置换术对治疗严重骨关节病效果满意.     

全膝关节初次表面置换术治疗骨关节病(附52例随访疗效分析)

目的:(1)报告本院全膝关节初次表面置换术治疗骨关节病的临床特点和疗效.(2)探讨影响本院全膝关节初次表面置换术治疗骨关节病疗效的因素,为今后的临床工作提供经验与教训.方法:对52例全膝关节初次表面置换术进行随访,并用HSS评分系统进行分析,随访3～110个月,平均28.3个月.结果:手术优良率88.5%.病人术后在疼痛、功能及活动度等方面均有改善,尤其在缓解疼痛方面效果明显,但在关节活动度方面改善最少,有些甚至下降.结论:全膝关节初次表面置换术是治疗严重膝关节骨关节病的有效手段;局部早期的并发症是影响本院全膝关节初次表面置换术近期疗效的主要因素.     

全膝关节置换术治疗类风湿性关节炎15例

目的。评价人工全膝关节置换术治疗严重类风湿性关节炎的效果．方法：对15例全膝关节置换术进行临床分析和总结，并采用美国Tohn．M．Insall评分标准进行分析。结果：手术优良率为93．3％，病人术后在疼痛、功能及关节活动度等方面都有明显改善，尤其是在缓解疼痛方面效果显。结论：全膝关节置换术是治疗严重类风湿性关节炎的有效方法。     

人工全膝关节置换术的适应证选择及疗效分析

目的：探讨人工全膝关节置换术的手术适应证及影响疗效的因素。方法：对20例24膝人工全膝关节置换术进行临床分析和总结。结果：人工全膝关节置换术后疼痛，关节功能及活动度分别较术前改善70%，57%和35%，结论：人工全膝关节置换术是治疗严重类风湿性关节炎和骨性关节炎的有效方法。     

类风湿性关节炎全膝关节置换的临床疗效观察

目的:观察人工全膝关节置换术治疗严重类风湿性关节炎的临床疗效.方法:我院2003年3月-2005年12月对11例严重类风湿关节炎患者行人工全膝关节置换术,平均随访13个月,按美国特种外科医院膝关节评分系统(HSS)进行疗效评定.结果:所有患者没有一例行翻修手术,X线显示所有置换假体植入位置满意,没有假体松动、移位现象出现.11个膝关节的术后情况比较满意.HSS评分平均指数从术前的41分提高到术后的90分.结论:人工全膝关节置换术可作为类风湿性关节炎患者保存关节功能,改善疼痛的一种有价值的治疗方法.     

类风湿性关节炎下肢畸形手术顺序选择的初步经验

复习１８例下肢多关节严重畸形的类风湿性关节炎病人手术治疗的初步经验，所有病人均有双侧人工全膝和全髋关节置换术的指征，除两例同时行一侧髋、膝关节置换术外，其余病人均只行人工全膝关节置换术，平均随访３６．３个月，采用文献中现有的评分方法，发现所有病人的病情均有明显改善。作者认为，人工全关节置换术在治疗严重类风湿性关节炎畸形的过程中，疗效是肯定的，但中晚期并发症较多，最大限度地推迟手术，并减少手术关节数     

人工全膝关节置换术治疗重症膝关节疾病的临床疗效

目的：探讨人工全膝关节置换术治疗严重膝关节疾病的临床疗效及方法。方法：2004年6月-2009年6月，对92例重症膝关节疾病（106膝）使用后稳定型TKA。其中9例（10膝）为类风湿性关节炎，3例（3膝）为创伤性关节炎，80例（93膝）为晚期严重骨性关节炎，5例（5膝）合并外翻畸形，50例（60膝）合并内翻畸形。所有患者进行10个月．5年（平均30个月）的随访，并应用HSS膝关节评分系统进行分析。结果：手术优良率为94．34％，患者术后在膝关节疼痛、功能及关节活动度等方面都有明显改善，提高了生活质量，各种并发症的发生率低。结论：人工全膝关节置换术是治疗严重膝关节疾病的有效方法，严格适应证的选择、正确进行TKA的手术操作、各种并发症的防治和积极术后康复锻炼是取得满意临床效果的保证。     

人工全膝关节置换术治疗类风湿性关节炎22例疗效观察

目的探讨人工全膝关节置换术(TKA)治疗类风湿性关节炎的临床疗效。方法 22例类风湿性关节炎采用TKA治疗,取膝前正中切口手术,假体均采用骨水泥固定,均未行髌骨置换。按美国特种外科医院膝关节评分系统(HSS)进行疗效评定。结果所有患者假体置入满意,无假体松动、移位发生。术后获平均11.2(9~14)个月随访,HSS评分从术前平均(41.69±1.39)分提高到术后平均(82.00±1.75)分,手术前后差异有统计学意义(P<0.01)。结论人工全膝关节置换术治疗类风湿性关节炎的疗效确切,能有效解除疼痛和改善患者的膝关节功能。     

Geometric total knee replacement for treatment of the rheumatoid knee

The results of fifty-four geometric total knee arthroplasties in forty-four patients with definite or classic rheumatoid arthritis were analyzed twenty-four to sixty-four months after the surgical procedure. There were no operative deaths, no postoperative infections, and no known pulmonary emboli. Three patients required additional operative procedures on the knee: one, a patellectomy for pain one year after arthroplasty; the second, resection of tibial bone and reinsertion of the tibial component to correct a flexion contracture; and the third, replacement of the tibial component because of loosening. The relief of pain and increase in ability to carry out the activities of daily living were dramatic in these patients, who, because of the limitations imposed by their rheumatoid arthritis, applied minimum stress on the prosthetic knees. Postoperatively, the average arc of knee flexion was 104 degrees.     

The efficacy of intra-articular analgesia after total knee arthroplasty in patients with rheumatoid arthritis and in patients with osteoarthritis

The pain relief provided by intra-articular injection of morphine plus bupivacaine after total knee arthroplasty (TKA) plus partial synovectomy in patients with rheumatoid arthritis was compared with pain relief after TKA alone in patients with osteoarthritis. There were lower pain scores, a much smaller requirement for systemic analgesics, longer duration until the first requirement of systemic analgesics, and improvement in the range of motion of the knee joint in the patients who received intra-articular injection of analgesics. There was more pronounced postoperative analgesia in the patients with rheumatoid arthritis than in the patients with osteoarthritis in the study groups that received intra-articular injection of analgesics.     

Lateral release for patellofemoral arthritis

Purpose: To determine the outcome of treatment of patients with symptomatic patellofemoral osteoarthritis by closed lateral patellar retinacular release. Type of Study: Retrospective study. Methods: Fifty patients who underwent 53 lateral retinacular release procedures between 1995 and 1999 for the treatment of symptomatic patellofemoral arthritis were assessed by questionnaire comprising the Oxford knee score, a visual analogue scale (VAS, 0-10) for pain, and questions relating to level of patient satisfaction. Patients were included in this study whether or not tibiofemoral arthritis was present, but lateral release was performed only in those for whom the anterior knee pain of patellofemoral arthritis appeared to predominate. Results: The average patient age was 53 years (range, 27 to 79 years). There were 14 men (28%) and 36 women (72%). Follow-up was a mean of 31 months (range, 12 to 65 months). Four patients underwent total knee replacement at 7, 14, 16, and 18 months after lateral release for recurrence of symptoms. In the remaining 49 knees, mean pain VAS was 3.8 ± 2.8. In 39 knees (80%), patients judged that they had experienced a reduction in pain compared with their preoperative state (2 were pain free), 8 (16%) were unchanged, and 2 (4%) were worse. The average Oxford knee score was 27 (range, 12-48). At follow-up, 33% of patients were very satisfied, 26% satisfied, and 41% dissatisfied with their knee. The presence of tibiofemoral disease did not affect any of the outcome measures. Two patients developed superficial infections of the arthroscopic port sites. There were no cases of hemarthrosis. Conclusions: Arthroscopic lateral release is effective in reducing the pain of symptomatic patellofemoral osteoarthritis and gives reasonable rates of patient satisfaction irrespective of the presence of tibiofemoral arthritis.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 4 (April), 2002: pp 399–403     

Early postoperative assessment technique: a time-to-remission technique after condylar replacement

Inconsistencies in reports of clinical outcome occur on many levels. Using life-table techniques for remission can increase reproducibility, facilitate comparisons with other studies, and answer patient questions about rehabilitation time. The complementary rate of Kaplan-Meier's cumulative survival rate was calculated for pain and knee mobility after unicondylar and bicondylar knee replacement in osteoarthritis and rheumatoid arthritis. Pain relief was quick, often within 2 months. Eventually, >50% had attained both pain alleviation and normal mobility. The probability of regaining at least 90 degrees flexion was greater than regaining 0 degrees extension. The probability of increasing the preoperative extension capacity was higher than that of increasing the flexion capacity.     

Comparison of patellar resurfacing versus nonresurfacing in total knee arthroplasty.

OBJECTIVES: To determine whether resurfacing the patellar component during total knee replacement (TKR) influences the clinical outcome. DESIGN: A retrospective study of data gathered prospectively during the recovery course of patients who underwent TKR with or without patellar resurfacing. SETTING: Victoria General Hospital, Halifax, NS. PATIENTS: One hundred and eighty-five patients operated on between 1992 and 1995. The inclusion criteria were (a) osteoarthritis, (b) replacement carried out by 2 independent surgeons, (c) no comorbid illness such as rheumatoid arthritis, cancer or infection, (d) pre- and postoperative attendance at the assessment clinics. INTERVENTION: TKR with (45) or without (140) patellar replacement. MAIN OUTCOME MEASURES: Range of motion (ROM), pain assessment, Hospital Severity Score (HSS) and complications. RESULTS: There was no statistical difference between the 2 groups with respect to ROM, pain, HSS and complications postoperatively. CONCLUSIONS: Resurfacing the patella during TKR does not seem to influence the clinical outcome with respect to ROM, pain and overall complications. The decision should be based on individual criteria, depending on the preoperative and intraoperative findings. Randomized clinical trials assessing ROM, pain, complications and cost-effectiveness with long-term follow-up are necessary to further investigate this controversial issue.     

Total knee arthroplasty in patients with rheumatoid arthritis. An overview

Total knee arthroplasty in patients with rheumatoid arthritis presents several unique challenges. Patients with rheumatoid arthritis often have additional medical, anesthetic, and global musculoskeletal problems that are not present in the patient with osteoarthritis. In terms of the knee, these patients usually have osteopenia and may present with an array of bone and soft tissue deformities, each of which can impact the initial success and long term durability of a total knee replacement. Despite these potential difficulties, the early and long term results of total knee arthroplasty in patients with rheumatoid arthritis have proven to be excellent.     

Hand surgery and quality of life.

The outcome in patients having surgery to the hand was assessed subjectively using a questionnaire that covered activities of daily living (ADL), hand pain and psychological well-being. The questionnaires were completed on average 6.9 months preoperatively and 20.6 months postoperatively by 15 patients with osteoarthritis undergoing trapeziectomy and 25 patients with rheumatoid arthritis undergoing Swanson arthroplasties of the metacarpophalangeal joints. Surgery resulted in significant improvements in reported ADL and hand pain, in both groups. Improvement in perception of hand function and health was only seen in the osteoarthritic group. There was no improvement in arthritis activity, mood or quality of life in either group. These results confirm that surgery for arthritis of the hand relieves pain and improves ADL. However, it has a greater effect in patients with localized osteoarthritis than in those with rheumatoid arthritis.     

Function of patellofemoral joints after total knee replacement with polyethylene patellar articular surface in osteoarthritis and rheumatoid arthritis

The function of 76 patellofemoral knee joints afer replacement with Kinemax condylar prostheses (Howmedica, UK) were evaluated. The indications for arthroplasty were knee destruction caused by rheumatoid arthritis (RA) in 33 cases and osteoarthritis in 35 patients. The average period of observation was 2.5 years. Anterior knee pain was recorded in 15 cases. In 2 cases it was caused by deep infection. In two other knees, the cause of the complaints was subluxation of the prosthetised patellae. In the other 11 cases, pain came from an active rheumatoid process and was less intense than before operation. Disorders of the patellar tracking were recorded in 13 joints even though only 2 were painful. Loosening of the patellar component was not recorded. Evaluation of knee function confirms the need to resurface the patella, especially in patients suffering from RA, and the necessity to be precise in arthroplasty procedure. Received: 11 August 2000; Accepted: 4 October 2000