Impact load transmission of the knee joint-influence of leg alignment and the role of meniscus and articular cartilage

OBJECTIVE. The objective of this study was to evaluate load transmission in the cancellous bone of the tibia under static and impact load.BACKGROUND. Abnormal transmission of loads may result in osteoarthritis and fractures. However, the role of the cancellous bone in these processes is not well understood.METHODS. The compressive stresses in the subchondral bone, epiphysis and diaphysis of the tibia of porcine knees were measured under static and impact load using mini-pressure transducers. The tests were performed using a drop-tower type testing machine in neutral, varus and valgus alignments. Tests were repeated after meniscectomy and again after removing the articular cartilage.RESULTS. In the intact knee in all alignments, the highest stress on the medial side was found in the epiphysis, and in the subchondral bone on the lateral side. After meniscectomy, a significant increase was observed in the stress in the subchondral bone on both sides. After the articular cartilage was also removed, the stress in the subchondral bone increased again, but slightly.CONCLUSION. The importance of the meniscus in load transmission is supported by this study. The contribution of the articular cartilage to load transmission is less than that of the meniscus.Relevance. The patterns of static and dynamic load transmission observed in this study correlate with the sites of insufficiency fractures of the medial tibial plateau and traumatic lateral tibial plateau fractures observed clinically. Examination of the load transmission is key to a more complete understanding of the causes of osteoarthritis and tibial plateau fractures.     

关节置换后下肢静脉血栓形成及髋膝关节病变中彩色多普勒超声的应用价值

目的:评价超声在人工关节置换后下肢深静脉血栓形成及髋膝骨关节病变中的临床应用价值.方法:检索中国生物医学文献数据库(CBM)、中文学术期刊全文数据库(CNKI),收集1993/2010发表的所有关于彩色多普勒超声用于关节置换后下肢深静脉血栓的自身对照和随机对照实验及高频超声检查膝骨关节病变的随机对照(或半随机对照)研究.排除重复性研究和Meta分析.结果:髋膝关节置换,共得到721例,756个行彩色多普勒超声检查下肢深静脉血栓的髋(膝)关节,膝骨关节病,共得到17个对照研究,1591个膝关节.所有研究均未描述是否采用了分配隐藏或盲法.结果显示:彩色多普勒超声诊断人工关节置换后下肢静脉血栓的敏感性好,特异性强.类风湿关节炎的超声特点以滑膜增厚为主,膝骨性关节炎以软骨及骨质破坏为主.结论:彩色多普勒超声能清楚观察关节置换后下肢深静脉血栓及静脉瓣膜功能,可作为髋膝关节置换前后监测下肢深静脉血栓形成的首选方法,可以对血栓进行随访观察,对于指导临床诊断和治疗提供可靠的依据.其敏感性强,特异性高,也为髋膝骨关节及周围软组织情况的临床诊断和治疗提供客观依据.     

一期双膝关节与单膝关节置换的早期评价

背景:膝关节置换一期双侧置换还是单膝分期置换一直存在着争议。目的:评价双膝关节疾病患者一期双侧全膝关节置换与选择性单侧全膝关节置换后早期临床疗效及SF-36健康问卷调查差异。方法:初次行全膝关节置换的患者144例190膝,均采用施乐辉公司假体行一期双膝全膝关节置换(双膝组)及一期选择性单膝全膝关节置换(单膝组)。观察患者膝关节置换前后活动范围、HSS评分及疼痛评分、置换后并发症及置换后SF-36量表调查结果。结果与结论:随访1年,9例失访,135例进入结果分析。膝关节置换后双膝组1例发生一过性腓总神经麻痹,1例获得性免疫缺陷综合征,1例发生切口愈合不良;单膝组发生2例切口愈合不良。膝关节置换后1年,SF-36量表调查,两组除生理职能比较差异有显著性意义(P<0.05)外,其余7方面比较差异均无显著性意义(P>0.05);两组活动范围比较差异无显著性意义(P>0.05);两组HSS评分比较差异无显著性意义(P>0.05);双膝组疼痛评分显著低于单膝组(P<0.05)。结果证实,双膝组膝关节置换后早期在疼痛评分方面优于单膝组,但SF-36量表评价、HSS膝关节功能评分及关节活动范围等方面较单膝组无明显优势。     

一期双膝关节与单膝关节置换的早期评价

背景：膝关节置换一期双侧置换还是单膝分期置换一直存在着争议。目的：评价双膝关节疾病患者一期双侧全膝关节置换与选择性单侧全膝关节置换后早期临床疗效及SF-36健康问卷调查差异。方法：初次行全膝关节置换的患者144例190膝,均采用施乐辉公司假体行一期双膝全膝关节置换（双膝组）及一期选择性单膝全膝关节置换（单膝组）。观察患者膝关节置换前后活动范围、HSS评分及疼痛评分、置换后并发症及置换后SF-36量表调查结果。结果与结论：随访1年,9例失访,135例进入结果分析。膝关节置换后双膝组1例发生一过性腓总神经麻痹,1例获得性免疫缺陷综合征,1例发生切口愈合不良;单膝组发生2例切口愈合不良。膝关节置换后1年,SF-36量表调查,两组除生理职能比较差异有显著性意义（P〈0.05）外,其余7方面比较差异均无显著性意义（P〉0.05）;两组活动范围比较差异无显著性意义（P〉0.05）;两组HSS评分比较差异无显著性意义（P〉0.05）;双膝组疼痛评分显著低于单膝组（P〈0.05）。结果证实,双膝组膝关节置换后早期在疼痛评分方面优于单膝组,但SF-36量表评价、HSS膝关节功能评分及关节活动范围等方面较单膝组无明显优势。     

Using hyaluronic acid drugs in local intra-articular therapy of osteoarthrosis in the knee joint

AIM: To assess efficacy of intraarticular injection of ostenil in knee joint osteoarthrosis. MATERIAL AND METHODS: Sixty patients with gonarthrosis of x-ray stage I-III (mean age 65 years, mean duration of the disease < 7 years) on chondroprotectors and nonsteroid anti-inflammatory drugs (NAD) in a standard dose received a course (3-5 weekly intra-articular injections) of 2 ml injections of ostenil. Assessment of the arthrologic status (VAS, Leken's index, WOMAC index, HAQ index, subjective and objective evaluation of the disease symptoms, need in NAD) was made initially, 5 weeks and 12 months after the treatment. RESULTS: Significant improvement was seen in 60% patients. Pain and stiffness in the knee joint relieved 2-fold. The function improved less. OA severity by Leken's index decreased by two degrees. 20% patients stopped intake of NAD, 32% had no need in taking NAD regularly. Subjective and objective assessment (by the patient and by the doctor) of the symptoms severity improved twice. Twelve months later the arthrological status worsened but not to the baseline. CONCLUSION: Hyaluronic acid drugs act long, are effective and safe for local intra-articular therapy of gonarthrosis.     

Total joint replacement of the hip and knee.

Total hip and knee replacements are among the most common orthopedic surgical procedures performed on patients with arthritis. The procedures are highly successful in appropriately selected patients. The authors approach total joint replacement from a medical perspective, emphasizing indications, contraindications, preoperative evaluation, clinical outcome, and potential complications.     

人工髋关节和膝关节置换术的护理进展

主要从术前健康状况综合评价及健康教育、术后早期并发症护理、术后康复方面,综述了人工髋关节、膝关节置换术的护理进展.     

人工髋关节和膝关节置换术的护理进展

主要从术前健康状况综合评价及健康教育、术后早期并发症护理、术后康复方面，综述了人工髋关节、膝关节置换术的护理进展。     

A pH-dependent mechanism of energy transformation in joint fluid cells in osteoarthrosis of the knee joint and benefits of chondroitinsulfate

AIM: To study bioenergetic processes in the synovial fluid (SF) in osteoarthrosis and to study relevant effects of chondroitinsulphate (structum). MATERIAL AND METHODS: Changes in bioenergy parameters of SF were analysed in the course of 3-month structum treatment of 15 osteoarthrosis (OA) patients. Classic enzymatic tests and polarographic test of SF cells oxygen absorption rate were used. Physiological-biochemical indices were compared at the height of the disease and after therapy. RESULTS: A significant shift of SF pH to the acid direction was found in OA patients. There was also transformation of bioenergetic processes with resultant loss of synovial cells energetics (low ATP and switch on of a reserve energetic mechanism of creatinephosphate consumption). Pharmacological correction of energy metabolism of SF cells was obtained due to action of chondroprotector structum. CONCLUSION: OA provokes bioenergetic changes in SF with activation of glycolysis, employment of reserve bioenergetic mechanisms, enhancement of creatinephosphate degradation, discoordination of respiration with oxidant phosphorilation. The pH shift to acid direction (from 7.4 to 6.85 in OA) is a trigger mechanism of OA. Replacement therapy with polyanion drug structum corrects pH in 3 months and bioenergetic parameters.     

全髋置换对膝关节运动状态的影响(英文)

背景:处在不同运动状态的人体下肢关节系统,其力学特性和关节变形量具有较大的差别.全髋置换是目前解决髋关节严重疾病的最终方法.明确置换前后人体下肢系统,特别是膝关节对置换的响应对于患者的康复训练具有积极意义.目的:通过对健康者和行全髋置换后19个月的患者,在相同的测试环境和测试方法下进行数据采集,对比分析髋关节置换对膝关节在运动中关节变形量的影响.方法:采用NDI公司的动态捕捉系统对行全髋术后19个月的患者进行测量,同时与患者身体状况相似的健康志愿者采用相同的测量仪器和测量方法进行实验.测量内容包括步长,步频,关节转角和关节位移曲线,并根据测量数据计算各关节的速度和加速度.结果与结论:由于髋关节置换对患者的自然关节状态进行了破坏,虽然置换后的步态没有太大的差别,但是通过实验数据可以发现,膝关节的变化量比正常状态下要大,说明人体自身进行了调节,通过增大膝关节的负荷,增加变形量来弥补由于髋关节手术所带来的损伤.     

Methylprednisolone reduces postoperative nausea in total knee and hip arthroplasty

What is known and objective: Total knee and hip joint replacement has a high risk of postoperative nausea and vomiting (PONV), and steroid cover is used for cases associated with autoimmune diseases. Our aim is to evaluate the antiemetic efficacy of methylprednisolone as steroid cover in patients undergoing the surgery. Methods: A prospective cohort study design was used. Sixty‐eight patients, aged between 20 and 80 years, were scheduled for a standardized general anaesthetic technique. Patients who were given methylprednisolone were assigned as the steroid cover group, and those who were not given methylprednisolone formed the non‐steroid cover group. PONV were assessment by direct questioning or spontaneous complaints by patients 1 week after surgery. Postoperative pain was evaluated using Visual Analog Scale (VAS) 1 and 3 days after surgery. Results and discussion: The incidence of nausea in the steroid cover group was significantly less than that in the non‐steroid cover group (adjusted odds ratio, 0·17, P = 0·021), but there was no significant difference in vomiting between the two groups. Postoperative pain VAS score was not significantly different between groups. What is new and conclusion: In total knee and hip arthroplasty, methylprednisolone is effective in preventing postoperative nausea; however, higher doses of methylprednisolone may be needed to prevent vomiting.     

退行性膝关节骨关节病患者的骨强度与骨密度的相关性研究

目的退行性膝关节骨关节病患者的骨强度与骨密度的相关性。方法组和对照组的患者均进行胫骨超声速率(SOS)和髋部骨密度(BMD)的测定。依据髋部BMD,再将研究组分为单纯退行性膝关节骨关节病组和合并骨质疏松症组。结果组和研究组的胫骨SOS和髋部BMD呈正相关,对照组的胫骨SOS和髋部BMD相关系数显著地高于研究组的相关系数,单纯组的相关系数没有显著性意义。结论退行性骨关节病患者的骨强度与骨密度呈正相关,但相关性较低,所以胫骨超声速率(SOS)测定仅能反映骨强度的情况,不能反映骨密度的情况。     

The impact of hip implant alignment on muscle and joint loading during dynamic activities

BackgroundComponent alignment is an important consideration in total hip arthroplasty. The impact of changes in alignment on muscle forces and joint contact forces during dynamic tasks are not well understood, and have the potential to influence surgical decision making. The objectives of this study were to assess the impact of femoral head/stem and cup component placement on hip muscle and joint contact forces during tasks of daily living and to identify which alignment parameters have the greatest impact on joint loading.MethodsUsing a series of strength-calibrated, subject-specific musculoskeletal models of patients performing gait, sit-to-stand and step down tasks, component alignments were perturbed and joint contact and muscle forces evaluated.FindingsBased on the range of alignments reported clinically, variation in head/stem anteversion-retroversion had the largest impact of any degree of freedom throughout all three tasks; average contact forces 413.5 (319.1) N during gait, 262.7 (256.4) N during sit to stand, and 572.7 (228.1) N during the step down task. The sensitivity of contact force to anteversion-retroversion of the head/stem was 31.5 N/° for gait, which was similar in magnitude to anterior-posterior position of the cup (34.6 N/m for gait). Additionally, superior-inferior cup alignment resulted in 16.4 (4.9)° of variation in the direction of the hip joint contact force across the three tasks, with the most inferior cup placements moving the force vector towards the cup equator at the point of peak joint contact force.InterpretationA quantitative understanding of the impact and potential tradeoffs when altering component alignment is valuable in supporting surgical decision making.     

髋膝关节置换术后深静脉血栓形成的预防及护理进展

髋膝关节置换术是我国近几年发展很快的一项新的矫形手术,能够有效缓解患者的疼痛、矫正畸形,重建一个接近正常功能的关节,改善患者总体生活质量,随着手术技术的不断成熟,越来越多的患者接受了髋膝关节置换术,但随之出现的并发症,其中深静脉血栓形成（DVT）是最常见的并发症,人工关节置换术后DVT的发生率为47．1％,     

Antibiotic use after cefuroxime prophylaxis in hip and knee joint replacement

The amount of additional antibiotics measured by defined daily dose (DDD) methods after 2651 hip and 362 knee replacements was assessed after prophylaxis with one or three doses (1502/1511 patients) of cefuroxime. No differences were observed between the two regimens with respect to total amount, type, indication, and duration of additional antibiotics. The incidence of joint sepsis did not differ significantly between the two trial arms, but the sample was too small for definite conclusions. There were 11.4 DDD/100 bed days of additional antibiotics used in 21% of patients after hip replacement and 15.7 DDD/100 bed days in 31% after knee replacement. For wound problems, 3.8 and 6.9 DDD/100 bed days were given in the hip- and knee-replacement groups. For distant infection, 6.5 DDD/100 bed days was administered in both groups. Duration of therapy varied only in relation to indication. Prescribed were penicillins (43% to 50%), sulfonamides (18%), cephalosporins (10% to 16%), and nitrofurantoin (8% to 13%); drug use was related to the type of infection.     

Physiotherapy in knee osteoarthrosis: Effect on pain and walking

Patients with knee osteoarthrosis are often referred for physiotherapy and many different types of treatment are given. The value of many of these treatments has been questioned. This study was intended to evaluate the effect of commonly used physiotherapy treatments in a training programme on patients with medial knee osteoarthrosis, scheduled for surgery. The results from this study also provide useful data for further evaluation of different physiotherapy treatments to this patient group. Thirty-four patients were randomised to physiotherapy three times a week for 5 weeks and the other 34 received no treatment. The training programme is described in detail. The patients were evaluated by clinical examination, step test, gait analysis and isokinetic measurements of thigh muscle strength before and after treatment. The patients in the treatment group experienced a feeling of overall improvement in the knee and the ability to descend steps improved when compared to the control group. There were no significant differences in gait, range of motion or isokinetic measurements of muscle strength between the groups. We conclude that physiotherapy as given here made our patients feel better and their ability to descend stairs improved. These improvements are beneficial to the patients and support the positive effects of exercises and activity. Whilst the objective improvements were small, suggesting that this treatment may not be justified, patients in the treatment group believed that they were improved.