Medium‐Term Clinical Results of High‐Flexion Knee Prostheses in Patients with Rheumatoid Arthritis

ObjectiveThis study was performed to evaluate the function and satisfaction outcome of patients with rheumatoid arthritis (RA) who underwent total knee arthroplasty (TKA) with high‐flexion prostheses.Materials and methodsTwenty‐two patients (35 knees) using high‐flexion prostheses (Zimmer, Warsaw, IN) were followed up for a period of 7–11 years from February 2007 to December 2009. Clinical and radiographic follow‐up was performed using Hospital for Special Surgery (HSS), Short‐Form 36 scores (SF‐36), American Knee Society score (KSS), and Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Patient satisfaction assessments took place at the final follow‐up sessions using the Marsh Satisfaction Questionnaire.ResultsThe average ROM improved from preoperative 68.43° ± 33.78° to 95.54° ± 7.03° at the final follow‐up. The HSS score and KSS score for pain improved from (46.49 ± 12.73) points to (85.46 ± 3.90) points and from 20.57 ± 5.91 points to 47.43 ± 3.51 points at the follow‐up evaluation, respectively. Physical Component Summary(PCS) and Physical Component Summary (MCS) scores were 45.38 and 52.56, respectively by the end of follow‐up. Deep venous thrombosis developed in one patient and one patient required surgical revision due to infection. There were no instances of prosthetic loosening. The satisfaction rate of patients was 95.5%.ConclusionAlthough this particular model of TKA did not yield high‐flexion angles (ie, 140°) required for kneeling, squatting, or rising from the floor, significant clinical and radiographic gains were evident in these patients with RA.     

Educational Attainment Affects the Early Rehabilitation of Total Knee Arthroplasty in Southwest China

ObjectiveTo assess if the educational level of patients in Southwestern China will affect the functional recovery after total knee arthroplasty (TKA).MethodsThis retrospective study included a total of 334 patients (48 males, 286 females, with an average age of 68 years, range from 51 to 84 years) who had undergone primary unilateral TKA from March 2017 to April 2018. Patients were screened for enrollment and classified into four groups (illiterate group, the primary school group, high school group, and university group) according to their educational attainment. All patients were monitored for at least 2 years after TKA. The primary outcome was determined using the Hospital for Special Surgery knee (HSS) score at the time of follow‐up. The secondary outcomes were determined using the 12‐Item Short Form Health Survey (SF‐12) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, the satisfaction level, and complications of the surgery.ResultsThree hundred and thirty‐four patients were divided into four groups based on their highest educational level: 83 patients in the illiteracy group, 84 in the primary school group, 91 in the high school group, and 76 in the university group. They were followed up for at least 2 years. For the primary outcome, patients with high school and university education had noteworthy better HSS scores on the surgical‐side knee than those in the primary school and illiterate groups (illiteracy group 86.71 ± 5.94 vs primary school group 85.36 ± 5.88 vs high school group 89.48 ± 3.66 vs university group 88.95 ± 3.55; P < 0.05). For secondary outcomes, the mental component summary (MCS) in the university group was significantly lower than the other three groups (P < 0.05). The results of WOMAC scores were consistent with the results of the HSS score: patients in the university group and the high school group had better results when compared with the other two groups (P < 0.05). There were no statistical differences in the comparison of additional indicators and complications among the four groups, but more patients (12 peoples, 15.8%) in the university group were dissatisfied with knee function after TKA.ConclusionIn Southwest China, patients with high school education or above can achieve better joint function after TKA but do not get better postoperative satisfaction, which may be related to the patients'' higher surgical expectations for social and mental needs.     

Modified Medial Collateral Ligament Indentation Technique in Total Knee Arthroplasty with Severe Type II Valgus Deformity

ObjectiveTo explore the feasibility and clinical efficacy of a modified medial collateral ligament indentation technique in total knee arthroplasty (TKA) with severe type II valgus deformity.MethodsConsecutive patients with Krackow type II valgus deformity >20° who underwent a primary unilateral TKA between May 2008 and June 2017 were studied retrospectively. A medial collateral ligament indentation technique was performed in 20 patients (MCLI group), and 23 patients received the routine lateral structures release technique (LSR group). Radiological parameters, such as the valgus angle (VA), and functional outcomes including the use of constraint implants, Knee Society Score (KSS), Knee Society Function score (KSF), and thickness of the polyethylene insert were compared between the two groups.ResultsA total of 43 consecutive patients had a minimum 2‐year follow‐up. The preoperative VA was comparable between the MCLI (23.5° ± 5.8°) and LSR groups (21.3° ± 3.2°, P = 0.134), as was the postoperative VA (1.1° ± 2.1° and 2.5° ± 3.0°, respectively, P = 0.084). The mean KSS and KSF scores in the MCLI group were 30.2 ± 4.8 and 38.8 ± 4.8, respectively, before surgery, and they increased to 91.3 ± 2.6 and 86.5 ± 2.4 at the last follow‐up. The scores in the LSR group were 31.5 ± 7.5 and 36.5 ± 7.8 before surgery and 92.4 ± 3.5 and 88.5 ± 3.6 at the last follow‐up. While no statistically significant differences in pre‐ or postoperative functional scores were found between the two groups, the MCLI group had thinner polyethylene inserts (9.5 ± 1.1 mm vs 12.9 ± 1.5 mm) and less use of constrained condylar inserts (15% vs 69.6%). During follow‐up, the MCLI group had fewer complications.ConclusionA modified MCLI technique can achieve good outcomes in TKA with type II valgus deformity of >20°. It can maintain a normal joint line level, reduce the use of constrained condylar knee prostheses, and is a reliable choice for severe genu valgum.     

Knee Scores of Patients with Non‐Lateral Compartmental Knee Osteoarthritis Undergoing Mobile,Fixed‐Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial

ObjectiveTo evaluate knee scores and clinical efficacies of patients with non‐lateral unicompartmental knee osteoarthritis (OA) who randomly underwent mobile‐bearing (MB) unicompartmental knee arthroplasty (UKA), fixed‐bearing (FB) UKA, and total knee arthroplasty (TKA).MethodsFrom September 2015 to February 2017, a prospective, randomized, parallel, single‐center trial of 180 patients (78 males and 102 females; 63.3 ± 6.9 years) with non‐lateral compartmental knee OA was performed in the first author‐affiliated hospital. The patients were randomly divided into three groups (each group included 60 patients) and received medial cemented Oxford phase 3 MB UKA, medial cemented Link FB UKA, or cemented DePuy Sigma PFC TKA, respectively. A similar perioperative management and fast‐track surgery program was carried out for all patients. The knee scores at 3‐year follow‐up after operation and clinical efficacies of these three groups of patients were recorded, investigated, and compared.ResultsPrimarily, compared to the TKA group, the UKA groups (MB UKA and FB UKA) had shorter operative time (median 63.2 < 67.1 min), less bleeding (8.6 < 30.0 mL), earlier resumption of walking without crutches (3.0 < 8.0 days) and walking up and down the stairs (5.0 < 10.0 days) (P < 0.001), higher FJS scores (78.0 > 74.5) (P = 0.007), better results in all knee scores (except VAS and KSS function scores) (P < 0.05), and a larger maximum flexion angle of the knee at the 3‐year follow‐up (123.0° > 96.0°) (P = 0.001). Secondarily, compared to the TKA group, the MB UKA group showed better results in the Western Ontario and McMaster Universities index (WOMAC) stiffness (83.6 > 79.6), WOMAC total (86.3 > 83.2), Oxford knee score (OKS) (20.0 < 23.0), Forgotten Joint Score (FJS) (78.5 > 74.5), and a larger maximum flexion angle of the knee (123.0 > 96.0) (P < 0.05). Moreover, the FB UKA group showed higher Hospital for Special Surgery Knee Score (HSS) (91.0 > 88.5), WOMAC stiffness (84.3 > 79.6), WOMAC function (85.2 > 81.7), WOMAC total scores (87.6 > 83.2), and a larger maximum flexion angle of the knee (119.0° > 96.0°) than the TKA group (P < 0.05). Overall, there was no significant difference in all knee scores and maximum flexion angles of the knee for the MB UKA and FB UKA groups (P > 0.05). There was one case with original bearing dislocation in MB UKA group. One patient with displacement of the femoral component caused by a fall injury, and another patient, who lost his life in a car accident, were involved in the FB UKA group. There was an infection case and an intermuscular vein thrombosis case in TKA group.ConclusionUKA showed more advantages than TKA; however, there was no significant difference between the MB UKA and FB UKA groups for treatment of non‐lateral compartmental knee OA.     

Effects of Judet Quadricepsplasty in the Treatment of Post‐traumatic Extension Contracture of the Knee

ObjectiveTo investigate the clinical outcomes and the affecting factors of Judet''s quadricepsplasty on the stiffness of post‐traumatic knee flexion.MethodsA retrospective survey was analyzed from June 2015 to October 2018. A total of 15 patients (eight males, seven females; mean age, 48.27 years) with extension contracture of the knee were treated by Judet''s quadricepsplasty. All cases were injuries induced by fracture trauma. The mean interval between the initial procedure and quadricepsplasty was 56.2 months (range, 13–276 months). The knee range of motion (ROM) was assessed with a goniometer. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). We evaluated Hospital for Special Surgery (HSS) score, Judet''s criteria, change in the degree of knee flexion, and complications.ResultsAll patients were followed up for 14 to 47 months, with an average of 31.53 months. The degree of flexion increased from 23.33° (range, 10°–50°) preoperatively to 107.33° (range, 100°–125°) intraoperatively, followed by a slight fall in the range of flexion in the late postoperative period, which reached an average of 95.33° (range, 60°–115°) in the last follow‐up. The knee joint function was assessed according to the Judet''s criteria, eight cases (53.33%) achieved excellent results, six (40%) good, one (6.67%) fair, and zero (0.00%) poor results at final follow‐up. The long‐term excellent and good rate was 93.33%. The range of flexion of the knee during operation and at the last time of follow‐up was better than that before surgery (P < 0.001). The final flexion was significantly lower than that measured at immediate postoperative (P < 0.001). The mean postoperative HSS score for the entire group was 93.73 (range, 89–96). Fifteen excellent results were obtained according to the HSS knee score. Skin infection was seen in one patient (6.67%). There were no complications such as deep sepsis, intraoperative rupture of the quadriceps tendon, fracture of the lateral femoral condyle, skin dehiscence.ConclusionJudet quadricepsplasty is an effective method to treat knee extension contracture and improve knee range of motion (ROM). It should be performed by an experienced orthopaedic surgeon and followed by physiotherapy with continuous passive motion (CPM). The knee ROM obtained with the surgery has an excellent long‐term effect.     

Medial Patellofemoral Ligament Reconstruction Using Suture Tape for Patellofemoral Joint Instability

ObjectiveTo describe a surgical technique using suture tape for reconstruction of the medial patellofemoral ligament (MPFL). This technique restores the stability of the reconstructed ligament and has excellent postoperative outcomes.MethodThis is a retrospective analysis. From January 2016 to June 2018, 17 patients underwent MPFL reconstruction using high‐strength suture (FiberTape; Arthrex) augmentation, with at least 12 months of follow up. There were 11 female and 6 male patients. The mean age at the time of MPFL reconstruction was 22.1 years (range 13–34 years). Clinical outcomes included pain level, knee range of motion, passive patellar hypermobility, and maltracking at follow‐up. The lateral patellofemoral angles, congruence angles, and patellar tilt angles were measured in a skyline view by CT at 30° of knee flexion at 12 months. Functional outcomes were assessed using the Lysholm knee scoring scale, the SF‐12 score, the Tegner score, and the Crosby and Insall grading system at yearly follow‐up.ResultNo patients were lost at the last follow up. One patient had recurrence of patellar dislocation and none of the others had serious complications. The success rate of MPFL repair for preventing recurrent dislocations was 94.1% (16 of 17 knees). Fifteen knees had full range of motion of more than 130°. At follow‐up, 2 knees were judged to have mild hypermobility and none had severe hypermobility or maltracking. Using the Crosby and Insall grading system, 12 knees (70.6%) were graded as excellent, 4 knees (23.5%) as good, 1 knee (5.9%) as fair to poor, and none as worse at the last follow‐up assessment. In all patients, the Lysholm knee score (55.12 ± 13.52 vs 79.88 ± 7.50, P < 0.01), the SF‐12 score (47 ± 9.53 vs 65.24 ± 12.82, P < 0.01), and the Tegner score (2.76 ± 1.39 vs 6.53 ± 1.70, P < 0.01) had improved at their 12‐month follow up. Compared with preoperative radiological findings, there was a significant improvement in lateral patellofemoral angle (−10.24 ± 7.10 vs 6 ± 5.43, P < 0.01), patellar tilt angle (26.53 ± 7.23 vs 9.88 ± 4.24, P < 0.01), and congruence angle (29.59 ± 11.95 vs −8.65 ± 4.86, P < 0.01).ConclusionThe use of FiberTape in MPFL reconstruction can improve the stability of the knee following surgery and has good midterm clinical results and low complication rates.     

Joint Awareness after Patellofemoral Arthroplasty Evaluated with the Forgotten Joint Score: A Comparison Study

ObjectiveThe aim of the present study was to compare the forgotten joint score (FJS) in patients with isolated patellofemoral osteoarthritis who underwent patellofemoral arthroplasty (PFA) versus those who underwent total knee arthroplasty (TKA) and to analyze the predictors of the FJS after PFA.MethodsFrom January 2014 to December 2017, a retrospective cohort study of 56 consecutive patients with isolated patellofemoral osteoarthritis underwent PFA and were included in the PFA group. The patients in the PFA group were matched in a 1:1 ratio based on age, sex, body mass index (BMI), and follow‐up duration; 56 patients with isolated patellofemoral osteoarthritis underwent cruciate‐retaining TKA (TKA group). The FJS, range of motion of the knee, and Knee Society Score were assessed at 1 and 3 years postoperatively. In addition, the associations between the potential influencing factors (age, sex, BMI, and preoperative Iwano score of the patellofemoral joint) and the FJS were analyzed using multiple linear regression in the PFA group.ResultsThere were no significant differences between the PFA and TKA groups regarding age (P = 0.316), sex (P = 0.832), BMI (P = 0.447), and follow‐up duration (P = 0.625). Postoperatively, the range of motion of the knee and Knee Society Score was significantly higher in the PFA group than the TKA group at both follow‐up points (P < 0.05). The PFA group had a significantly higher mean FJS than the TKA group at 1 year postoperatively (62.9 ± 12.3 vs 54.1 ± 14.2, P = 0.034) and 3 years postoperatively (63.3 ± 14.1 vs 55.6 ± 16.4, P = 0.042). In the PFA group, multiple linear regression analysis showed that older age was positively correlated with the FJS, while a higher BMI was negatively correlated with the FJS.ConclusionThe patients with isolated patellofemoral osteoarthritis who underwent PFA were more likely to forget the artificial joint and, consequently, may experience a higher degree of satisfaction. In addition, we identified two preoperative patient‐related factors (age and BMI) that may predict the FJS after PFA, which might help in chosing the most appropriate operation.     

A Mid-term Comparison of the Functional Outcomes of Medial Pivot and Rotating Platform Mobile-Bearing Total Knee Arthroplasty in the Indian Population

BackgroundBoth medial pivot (MP) and rotating platform (RP) mobile-bearing (MB) total knee arthroplasty (TKA) have been developed to better mimic the natural knee kinematics and femoral roll back in flexion. The purpose of this retrospective study was to compare the mid-term functional outcomes and range of motion (ROM) of MP and RP types of total knee arthroplasty.Methods116 patients (mean age of 66.3 years) undergoing TKA (52 Medial pivot design and 64 Rotating Platform design) were evaluated retrospectively with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee score, knee society score (KSS) with its subgroups namely, Knee Score (KSKS) and Functional Score (KSFS) and forgotten joint score (FJS) at a mean follow-up of 7.1 years. Range of motion (ROM) and tibiofemoral anatomic angle on the radiographs were also compared.ResultsMean ROM, WOMAC and KSKS improved significantly from pre-operative to postoperative knees in both the groups. There was, however, no significant difference between the two groups at the final follow-up. In contrast, mean KSFS score improved to 89.5 ± 8.1 in MP group and 86.3 ± 7.1 in RP Group (p = 0.025), while mean FJS was 85.6 ± 4.1 and 80.9 ± 5.4 in the MP and RP groups, respectively (p = < 0.0001).ConclusionSatisfactory clinical and functional outcomes can be obtained using either a MP or RP knee joint in tricompartmental osteoarthritis of knee. The MP design scores better on the KSFS score and FJS than the RP-TKA.     

Locking Plate Alone or in Combination with Cannulated Screws for Hoffa Fractures: A Retrospective Study

ObjectiveTo determine the efficacy of distal femur condyle locking plate (DFCLP) alone or in combination with cannulated screws for Hoffa fractures.MethodsIn this study, between May 2014 and February 2019, 13 patients between 26 and 64 years with isolated Hoffa fractures were enrolled during the study period and retrospectively analyzed. All patients underwent open reduction and internal fixation by DFCLP alone or in combination with cannulated screws followed by early active rehabilitation postoperatively. The primary outcome was evaluated using range of movement (ROM), Knee Society Score (KSS), International Knee Documentation Committee (IKDC) scoring system, and the fracture healing time of the patients during the 24‐month follow‐up period. Postoperative complications were also used to assess the patients’ conditions.ResultsA total of 13 patients completed the 24‐month follow‐up assessment and achieved bone re‐union at Hoffa fracture sites. The average follow‐up period was 24.5 months (ranging from 24 to 28 months). Six patients were treated by DFCLP in combination with cannulated screws and the remaining seven patients were treated by DFCLP alone. The mean ROM was determined as 119° (ranging from 100° to 130°). The mean KSS score was 87.9 (ranging from 80 to 92 points), with 11 patients evaluated as excellent, two as good, and zero bad cases. The mean IKDC score was 84.2 (ranging from 74.7 to 89.7 points), with 10 evaluated as excellent, three as good, and zero bad cases. The mean IKDC score was 83.3 for patients with medial Hoffa fractures and 84.4 for those with lateral Hoffa fractures. The average time to healing was 3.5 months (ranging from 3 to 4 months), and at month 3, the fracture healing was evident in seven patients (54%), and at month 4, fracture healing was seen in six patients (46%). It is worth mentioning that two patients suffered from knee joint stiffness and osteoarthritis during the 24 months follow‐up. Eleven patients (84.6%) achieved satisfactory knee joint function through early postoperative rehabilitation.ConclusionIn patients with Hoffa fractures, treatment with DFCLP alone or in combination with cannulated screws followed by early active rehabilitation resulted in great stability and satisfactory functional outcomes after 24 months. Our findings may provide surgeons with a new way to treat Hoffa fractures.     

Posteromedial Corner Release with the Knee in Figure‐of‐Four Position vs Conventional Position for Varus Knee Arthroplasty

ObjectiveTo introduce posteromedial corner release with the knee in the figure‐of‐four position versus the conventional position for varus knee arthroplasty.MethodsThis is a retrospective study. From March 2015 to September 2019, a series of 123 patients (139 knees) with varus knee were randomly and blindly allocated to experimental group (60 patients; 68 knees) and control group (57 patients; 65 knees). Patients in experimental group underwent posteromedial corner release with the knee in the figure‐of‐four position; and patients in control group with the knee in the conventional position. If soft tissue balance was not completely achieved or the medial gap was still tight, an additional loosening technique were used to achieve symmetric medial and lateral space in both groups. Time for soft tissue balancing was defined as the time from the start of the spacer test to the end of the balance test. Length of release was defined as the distance from the osteotomy surface of the tibial plateau to the farthest structures released. The rating system of Hospital for Special Surgery (HSS) knee score was used to evaluate the clinical results. Quantitative variables were described as mean and standard deviation, and compared by one‐way analysis of variance.ResultsThe mean age of experimental group and control group was 70.2 ± 8.7 years and 68.7 ± 6.2 years, respectively (P > 0.05). Preoperatively, the mean HSS score of the groups was 38.2 ± 11.3 and 39.1 ± 10.7, respectively (P > 0.05). The mean varus knee angle was 19.7° ± 9.3° and 19.3° ± 10.7°, respectively (P > 0.05). The mean time for soft tissue balancing was 8.4 ± 3.3 min and 11.3 ± 6.9 min in experimental and control group, respectively (P < 0.05). The mean length of releasing posteromedial corner structures was 35.5 ± 13.4 mm and 27.3 ± 9.7 mm in experimental and control group, respectively (P < 0.05). Additional special loosening techniques were performed in eight knees in experimental group and seven knees in control group. The HSS scores 5 years after surgery were 95.1 ± 16.9 and 94.8 ± 17.2 respectively (P > 0.05). No complications were found during the follow‐up time, and the clinical symptoms were observed to be significantly improved in the patients.ConclusionThe posteromedial corner can be released more extensively and thoroughly when the knee is placed in the figure‐of‐four position during varus knee arthroplasty.     

Non‐Anatomical Arthroscopic All‐Inside Repair of Medial Meniscus Posterior Root Tear to Posterior Cruciate Ligament for Patients with Normal Lower Limb Alignment

ObjectiveTo describe a non‐anatomical arthroscopic all‐inside repair of medial meniscus posterior root tear (MMPRT) to posterior cruciate ligament (PCL) technique for patients with normal lower limb alignment and to evaluate the short‐term clinical and radiologic outcomes.MethodsMMPRT directly to PCL was repaired with all‐inside horizontal mattress suturing technique rather than by the transtibial pullout suture technique or anchor suturing repair technique in 20 Laparade Type II MMPRT patients with normal lower limb alignment during 2018–2019. The clinical and radiological outcomes were evaluated retrospectively for at least 2 years follow‐up. The VAS score, Lysholm score, Tegner activity score were evaluated preoperatively and at the final follow‐up. The status of the medial meniscus posterior root were assessed on magnetic resonance imaging (MRI) preoperatively and at the final follow‐up.ResultsTwenty patients (mean age 54.5 ± 19.5 years) were included in the present study. The mean follow‐up duration was 32.5 ± 5.8 months. The VAS score was significantly decreased from preoperative 6.5 ± 1.5 to 2.1 ± 1.4 at the final follow‐up (P < 0.01). The mean Lysholm score was significantly improved from 43.7 ± 10.9 preoperatively to 85.7 ± 10.8 (P < 0.01). The median Tegner activity score was improved from 1.0 (range 1–4) to 3.0 (range 2–4, P < 0.01). On MRI, a total of 12 cases (60%) had complete healing, while eight cases (40%) had partial healing.ConclusionNon‐anatomical arthroscopic all‐inside repair of MMPRT to PCL may yield beneficial clinical outcomes and a higher rate of clinical healing in Type II MMPRT patients with normal lower limb alignment. It is an easy and reliable alternative technique to the transtibial pullout suture or anchor suture repair technique.     

Horizontal Rafting Plate for Treatment of the Tibial Plateau Fracture

ObjectiveThis study aimed to investigate the value of a horizontal rafting plate in treating tibial plateau fractures.MethodsThe data of 24 patients in whom a horizontal rafting plate was used to treat a tibial plateau fracture between October 2014 and January 2018 were retrospectively analyzed, including 16 males and 8 females, aged 21–63 years old, with an average of 40 ± 14.68 years. The fractures included 13 in the left knee and 11 in the right knee. The places where the horizontal rafting plate were used included the anterior margin of tibia, anterolateral tibia, and posterolateral tibia. All cases were followed up for 12–24 months, with an average follow‐up of 17.5 ± 5.0 months. At the last follow‐up, the Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation. The knee joint function was evaluated using the Rasmussen functional score. Computed tomography (CT) scanning and three‐dimensional reconstruction were performed preoperatively and postoperatively, with the quality of reduction of the fractured articular surface clarified by the final follow‐up. The flexion and extension abilities of the knee joint were also measured in the postoperative follow‐up.ResultsPreoperative CT scanning showed that the gap of the tibial plateau was 8.00 ± 1.40 (5–24) mm. The heights of the fracture of the articular surface at all three sites during the final follow‐ups were significantly different from the height before the surgery (P < 0.05). The vertical distance between the articular line and the highest point of the articular surface after reduction was 0.17 ± 0.05 mm. Anatomic reductions were obtained in 24 patients. The Rasmussen functional score after surgeries was 27.25 ± 0.94 points. Bony union was achieved in all the patients. According to the Rasmussen radiological criteria, the scores during the last follow‐up were as follows: the total score was 13–18 points, with an average of 16.00 ± 1.72 points; the scores were excellent in 17 cases and good in seven cases. Therefore, 100% of results were excellent or good. No infection or fracture nonunion was found.ConclusionUsing a horizontal plate can be an effective method for treating special types of fractures of the tibial plateau, including the anterior margin and anterolateral and posterolateral tibial plateau, with satisfactory treatment efficacy.     

Willingness to Have Total Knee Arthroplasty in Rural Areas of Northern China

ObjectiveTo evaluate willingness and its potential predictors to have total knee arthroplasty (TKA) among residents in rural areas of northern China.MethodsData were collected from two population‐based studies on osteoarthritis (OA) in northern China. Residents aged ≥ 50 years in randomly selected rural communities were recruited using a cluster survey method. Participants completed a home interview (including social‐demographic characteristics, clinical information, 12‐Item Short Form Health Surveys [SF‐12], and Visual Analog Scale [VAS] of knee pain), a physical examination, and bilateral weight‐bearing posteroanterior semi‐flexed view of radiographs of knees. Willingness to have TKA was queried by asking: “If you need to undergo total knee arthroplasty as judged by orthopaedic surgeons, are you willing to accept this operation?” Two trained investigators read all radiographs independently and reached an acceptable intra‐reader agreement. We fitted univariate and multivariate regressions adjusting for potential confounders to examine predictors of willingness to have TKA stratified by sex.ResultsA total of 2172 participants were included. The overall rate of willingness to have TKA was 33.8%. Men were more likely to be willing to have TKA than women with an odds ratio (OR) of 0.73 (95% confidence interval [CI]: 0.60–0.89, P = 0.002). A higher household income (OR: 2.34 for men and 1.77 for women, both P < 0.001), higher SF‐12 Physical Component Summary (PCS) score (OR: 1.02 for both gender, P = 0.04 for men and P = 0.01 for women), and being aware of TKA (OR: 2.55 for men and 2.65 for women, both P < 0.001) were associated with a higher willingness to have TKA. Other predictors of higher willingness to have TKA were younger age (OR: 0.66 for 60–70 years, P = 0.01; and 0.48 for >70 years, P = 0.003, respectively) and lower level of physical activity (OR: 0.57 for moderate, p = 0.04; and 0.62 for heavy, p = 0.04, respectively) among men and a higher education (OR: 1.45 for Junior school, P = 0.04; and 1.66 for high school and above, P = 0.02, respectively) and being overweight among women (OR: 1.38, P = 0.008), respectively. No significant difference was observed between willingness to have TKA and frequent knee pain, VAS of knee pain and Kellgren and Lawrence grades in both men and women.ConclusionsThe willingness to have TKA among rural residents of northern China was relatively low. Younger age, women, educational level, household income, physical function, and awareness of TKA were positively associated with willingness to have TKA.     

Effect of Preoperative Diabetes on the Achievement of Forgotten Knee Status in Patients with Total Knee Arthroplasty

BackgroundForgotten knee is the terminology which is used to describe a post-TKA patient who is completely unaware of his knee implant. The aim of the study is to determine whether preoperative diabetes negatively influences the achievement of forgotten knee status.MethodsThis is a retrospective cohort study. 300 patients (240 F:60 M) were studied. Patients were evaluated by an independent observer with FJS-12 score 2 weeks preop and at 6 weeks and 12 months after the operation. The patients with a FJS-12 score of ≥ 55 were considered to have achieved forgotten knee status. Out of 240 females, 96 had diabetes and out of 60 males, 18 had diabetes. Preoperative factors such as preop HBA1c, ROM, degree of deformity, VAS score and other associated co morbidities and postoperative factors such as HBA1c, ROM and hip–knee–ankle alignment were studied. Study was started with null hypothesis. The statistical difference was measured with Binominal proportion test and comparison of means t test.Results96 out of 144 non-diabetic females (66.67%) and 51 out of 96 diabetic females (53%) achieved forgotten knee status (statistically significant, p value = 0.0336, Binominal proportion test). 27 out of 42 (65%) non-diabetic males and 12 out 18 diabetic males (66%) achieved forgotten knee status (p value = 0.9411). The FJS-12 score at 1 year for non-diabetic females and diabetic females was 58.6 mean ± 12.6 SD and 53.8 ± 17.6, respectively, which is statistically significant, p value 0.0145. The FJS-12 at 1 year in non-diabetic and diabetic males was 60.1 ± 14.8 and 59.6 ± 17.3, respectively, p value = 0.9097.ConclusionDiabetic females have less chance of achieving a forgotten knee status than non-diabetic females. This understanding will help the operating surgeon in the preoperative patient counseling and modify the patient expectations.     

Comparison of Cruciate-Sacrificing vs Posterior-Stabilized Total Knee Replacement Using a Contemporary Total Knee System

BackgroundThe use of highly conforming polyethylene tibial inserts in cruciate-retaining total knee arthroplasty (TKA) often requires posterior cruciate ligament (PCL) release/sacrifice for balancing (CS TKA). The CS TKA relies on the posterior capsule, collateral ligaments, and articular conformity without a cam or post to achieve stability. Using prospectively collected data we compared clinical outcomes of CS TKA to posterior-stabilized (PS) TKA utilizing a contemporary TKA system.MethodsSixty-nine consecutive CS TKAs were compared to 45 consecutive PS TKAs at 2-year minimum follow-up. CS knees were balanced with the PCL released. Preoperative/postoperative range of motion (ROM), Knee Society Scores (KSS), stair function, and squatting ROM were analyzed.ResultsAt minimum 2-year follow up, CS and PS TKA demonstrated significant improvement in ROM (P < .001), KSS (Pain, P < .001; Function, P < .001), and KSS stair function (P < .001), with no revisions. There was no difference in preoperative to postoperative improvements for passive knee ROM (10° (0°-20°) vs 13° (5°-25°); P = .16), KSS Pain (34 (21-42) vs 38 (24-46); P = .22), KSS Function (35 (30-50) vs 35 (18-50); P = .34), and KSS stair function (10 (10-20) vs 10 (0-20); P = .37) for CS and PS TKA, respectively. CS TKA had higher squatting ROM (P = .02) at minimum 2-year follow-up compared to PS TKA.ConclusionBoth PS and CS TKA provided significant improvement in clinical outcomes, with no differences in passive ROM, KSS, or stair function postoperatively. Our data support that with proper articular conformity and balancing, cruciate-retaining TKA in a PCL-deficient knee (CS TKA) is appropriate. This may be design specific and further prospective randomized studies are needed to corroborate these findings.     

Comparison of Blood Loss between Open‐Box Prosthesis and Closed‐Box Prosthesis after Primary Total Knee Arthroplasty

ObjectiveTo compare the blood loss after procedures of primary unilateral or one‐stage bilateral total knee arthroplasty (TKA) caused by open‐box prosthesis and closed‐box prosthesis.MethodsThis was a retrospective study. Patients undergoing procedures of primary TKA between January 2017 and July 2020 in our institution were assessed for eligibility for this study. Those who were diagnosed with knee osteoarthritis and underwent primary unilateral or one‐stage bilateral TKA by using PFC Sigma PS150 (closed‐box prosthesis) or Vanguard (open‐box prosthesis) knee systems and had complete data of laboratory indexes on postoperative day (POD) 1, POD 3, and POD 5 were the interested population. At last 243 patients were enrolled, among which 88 patients were classified into the unilateral closed‐box group, 66 patients into the unilateral open‐box group, 47 patients into the one‐stage bilateral closed‐box group, and 42 patients into the one‐stage bilateral open‐box group. The perioperative management and operative techniques were almost the same for each patient, except the selection of prosthesis, which was decided according to surgeon''s preference. The baseline information, postoperative laboratory indexes tested on POD 1, POD 3, and POD 5 including hemoglobin, hematocrit, platelet, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR), the primary outcome measurements including the maximum decreased value of hemoglobin and the volume of total blood loss, and the secondary outcome measurements including the transfusion rate and the average transfused red blood cell (RBC) units were well compared between the open‐box group and the closed‐box group.ResultsThe baseline was comparable between groups, except higher preoperative levels of hemoglobin (134.43 g/L vs 126.51 g/L, P = 0.003) and hematocrit (39.92% vs 37.37%, P = 0.000) observed in the one‐stage bilateral open‐box group. The differences of postoperative coagulation function monitored by TT, PT, APTT, and INR were clinically irrelevant between groups. For patients receiving unilateral TKA, significantly higher value of decreased hemoglobin (26.06 g/L vs 21.05 g/L, P = 0.025) and significantly larger amount of total blood loss (920.34 mL vs 723.19 mL, P = 0.013) were observed in the open‐box group. For patients receiving one‐stage bilateral TKA, the open‐box prosthesis was observed to cause more hemoglobin drop (37.81 g/L vs 32.02 g/L, P = 0.071) and total blood loss (1327.26 mL vs 1177.42 mL, P = 0.247) compared to the closed‐box prosthesis, though the differences were not significant. The transfusion rate and the average transfused RBC units were not significantly different between the open‐box group and the closed‐box group no matte whether the patients were from the unilateral TKA group or from one‐stage bilateral TKA group.ConclusionThe use of open‐box prosthesis caused more hemoglobin drop and total blood loss than closed‐box prosthesis after primary unilateral or one‐stage bilateral TKA, resulting in comparable transfusion rate and average transfused RBC units between groups.     

Mid‐ and Long‐Term Follow‐Up Efficacy Analysis of 3D‐Printed Interbody Fusion Cages for Anterior Cervical Discectomy and Fusion

ObjectiveTo evaluate the safety and stability of 3D‐printed interbody fusion cages (3D‐printed cages) in anterior cervical discectomy and fusion (ACDF) by investigating the mid‐ and long‐term follow‐up outcomes.MethodsIn this prospective study, the clinical data of 30 patients with CSM admitted to the Second Hospital of Shanxi Medical University from May 2012 to May 2014 were analyzed. The cohort comprised 18 males and 12 females with an average age of 60.22 ± 3.2 years. All patients were examined by X‐ray, CT and MRI before the operation. A total of 30 cases of CSM were treated by ACDF with 3D printed cage implantation. Mid‐ and long‐term follow‐ups were performed after the surgery. Clinical efficacy was evaluated by comparing the JOA score, SF‐36 score, change in neurological function, cervical curvature index (CCI), vertebral intervertebral height (VIH) and fusion rate before the operation, 6 months after the operation, and at the last follow‐up.ResultsTwo of the 30 patients were lost to follow‐up. The remaining patients were followed up for 48–76 (65.23 ± 3.54) months. The patients recovered satisfactorily with a significant clinical effect. The JOA score increased meanfully and the improvement rate was 89.4% at the final follow‐up. The SF‐36 score increased significantly from pre‐ to postoperatively. The height of the intervertebral space at the last follow‐up was not statistically significantly different from that at 6 months after surgery (P > 0.05), showing that the height of the intervertebral space did not change much and the severity of cage subsidence (CS) decreased. The CCI improved from pre‐ to postoperatively. The CCI did not change much from the 6‐month follow‐up to the last follow‐up. and the cage rate (CR) was 100% at the 6‐month and last follow‐ups. No severe complications, such as spinal cord injury, esophageal fistula, cerebrospinal fluid leakage, cervical hematoma or wound infection, occurred in any of the patients.ConclusionThe clinical and radiological results show that the application of 3D‐printed cages in ACDF can significantly relieve symptoms. Moreover, 3D‐printed cages can restore the curvature of the cervical spine, effectively maintain the intervertebral height for a long time, and prevent complications related to postoperative subsidence.     

Effect of Resistance Training Combined with Beta‐Hydroxy‐Beta‐Methylbutyric Acid Supplements in Elderly Patients with Sarcopenia after Hip Replacement

ObjectivesTo evaluate the efficacy of resistance training (RT) combined with beta‐hydroxy‐beta‐methylbutyric acid (HMB) in the treatment of elderly patients with sarcopenia after hip replacement.MethodsFrom January 1, 2018 to December 31, 2018, 200 elderly patients (68 men, mean age 76.3 years and 137 women, mean age 79.1 years) who experienced femoral neck fracture with sarcopenia after hip arthroplasty were assigned to four groups: RT + HMB group, RT group, HMB group, and negative control group. Baseline data, body composition, grip strength, Barthel index (BI), Harris hip score (HHS), and visual analog scale score (VAS) were compared among the four groups before and 3 months after surgery.ResultsA total of 177 participants completed the trial, including 43 in the HMB + RT group, 44 in the HMB group, 45 in the RT group, and 45 in the negative control group. At the 3‐month follow‐up, the body composition and grip strength of the HMB + RT group and RT group were significantly improved compared with those before operation. The HMB group had no significant change, while the measures in the negative control group significantly decreased. Postoperative BI and HSS did not reach pre‐injury levels in any of the four groups, but postoperative VAS score was significantly improved. However, there was no significant difference in BI, HSS, or VAS among the four groups.ConclusionRT, with or without HMB supplementation, can effectively improve body composition and grip strength in elderly patients with sarcopenia after hip replacement at short‐term follow‐up. Simultaneously, use of exclusive HMB supplementation alone may also help to prevent decreases in muscle mass and grip strength in these patients.     

The Application of H‐Loop in Arthroscopic Knotless Double‐Row Rotator Cuff Repairs

ObjectiveTo determine the functional outcomes after a novel method of H‐loop knotless double‐row technique in patients with rotator cuff tears.MethodFrom June 2020 to September 2020, a total of six patients (five women, one man) with arthroscopic rotator cuff repair using the H‐loop knotless double‐row technique were enrolled in our study. The average age is 54 years (range: 50–61 years). The preoperative and final follow‐up clinical outcome were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), University of California Los Angeles (UCLA) score, and Constant–Murley score. The active shoulder range of motion (ROM) was also collected preoperatively and postoperatively at the final follow‐up (forward flexion and abduction). Accordingly, intraoperative and postoperative complications were observed as well.ResultThere were six patients that underwent arthroscopic rotator cuff repair using the H‐loop knotless double‐row technique. The average follow‐up period was 7.52 ± 0.70 months. The VAS, UCLA, ASES, and Constant–Murley scores improved from 5 ± 2.45, 15.67 ± 3.44, 47.67 ± 17.41 and 49.17 ± 8.98 preoperatively, to 0.83 ± 0.75, 36.27 ± 3.83, 91.67 ± 10.76 and 85.83 ± 4.31 at the final follow‐up, with statistical significances of P = 0.009, P < 0.001, P = 0.006, and P = 0.001, respectively. Meanwhile, the active shoulder ROM (forward flexion and abduction) improved from 135.00 ± 46.80 and 125 ± 56.48 preoperatively, to 173.67 ± 4.13 and 172 ± 3.27 at final follow‐up, respectively (P = 0.082, P = 0.088). During the follow‐up, there were no postoperative complications such as wound‐site infection, nerve or vessel damage, subcutaneous hematoma, and suture anchor problems.ConclusionWith the benefit of reducing the possibility of strangulation and blood supply affection for the rotator cuff, The H‐loop knotless double row technique may be an alternative method to significantly improve subjective functional outcomes and increase the healing rate of medium‐sized rotator cuff tears with degeneration issues and poor tissue quality.     

固定平台与旋转平台假体用于外翻膝的早期疗效观察

目的:比较外翻膝人工全膝关节置换术应用旋转平台和固定平台两型假体的早期临床疗效。方法:选取2011年1月至2013年12月吉林大学第一医院骨关节外科由同一医师进行初次人工膝关节置换的17例(23膝)进行回顾性随访研究,其中男2例,女15例;年龄48～75岁,平均61.5岁。术前诊断为骨性关节炎14例(19膝),类风湿性关节炎3例(4膝),所有膝关节有外翻畸形。其中9例(12膝)使用固定平台型假体(PFC Sigma),8例(11膝)使用旋转平台型假体(PFC Sigma RP).术前和术后随访行KSS、HSS、WOMAC评分,测量关节活动度、胫股角等指标,进行统计学分析。结果:所有患者获随访,时间6～36个月,平均25个月。两组患者膝外翻畸形均得到矫正,术后末次随访的KSS、HSS、WOMAC评分及膝关节活动度、胫股角较术前明显改善(P<0.01).其中固定平台组和旋转平台组在术后KSS、HSS、WOMAC评分以及胫骨角、膝关节活范围改善度方面比较,差异无统计学意义(P>0.05);而术后末次随访膝关活动范围固定平台组(101.8±8.8)°与旋转平台组(108.4±7.2)°差异有统计学意义(P<0.05).旋转平台组没有发现垫片脱位,两组术后均无感染、腓总神经麻痹、脱位、膝关节不稳等并发症发生,X线检查未见假体骨溶解及松动发生。结论:外翻膝人工全膝关节置换术使用旋转平台和固定平台型假体均能获得满意的早期临床效果,两者的近期临床疗效比较无明显差异。