Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis

Background

Utilization of unicompartmental knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) as alternatives to total knee arthroplasty (TKA) for unicompartmental knee osteoarthritis (OA) has increased. However, no single resource consolidates survivorship data between TKA and partial resurfacing options for each variant of unicompartmental OA. This meta-analysis compared survivorship between TKA and medial UKA (MUKA), lateral UKA (LUKA) and PFA using annual revision rate as a standardized metric.

全膝关节置换后局部浸润麻醉与股神经阻滞镇痛的Meta分析

背景:局部浸润麻醉和股神经阻滞是全膝关节置换后常用的镇痛方法。然而这两种镇痛模式孰优孰劣,目前尚无定论。目的:系统评价局部浸润麻醉和股神经阻滞在全膝关节置换后的镇痛效果。方法:检索Pubmed,EMBASE,the Cochrane Library and Web of Science和CBM数据库,纳入所有对比局部浸润麻醉对比股神经阻滞的随机对照试验。2名作者独立检索、纳入文献、提取数据。方法学质量评价参照Cochrane系统评价员手册5.1.0进行评价,出现不同意见时,由第3名作者商量决定。使用RevM an 5.3软件进行统计分析。结果与结论:(1)共纳入11个随机对照试验,共566例患者;(2)局部浸润麻醉组与股神经阻滞组在置换后24,48 h的安静状态下目测类比评分[MD.26,1.28),P>0.05;MD24 h=0.15,95%CI(-048 h=0.19,95%CI(-0.06,0.44),P>0.05]、活动状态下目测类比评分[MD_(24 h)=-0.01,95%CI(-0.51,0.48),P>0.05;MD_(48 h)=0.18,95%CI(-0.45,0.82),P>0.05]、镇痛药物使用量[MD_(24 h)=-2.23,95%CI(-5.63,1.16),P>0.05;MD_(48 h)=2.44,95%CI(-1.08,5.95),P>0.05]、住院时间[MD=0.05,95%CI(-0.40,0.50),P>0.05]、术后恶心呕吐[OR=1.09,95%CI(0.39,3.04),P>0.05]以及术后感染方面[OR=0.99,95%CI(0.44,2.59),P>0.05],差异均无显著性意义;(3)结果表明,局部浸润麻醉在全膝关节置换后镇痛效果方面与股神经阻滞相当,另外因其操作简便,局部浸润麻醉可作为全膝关节置换后的标准镇痛方法。     

全膝关节置换后持续股神经阻滞与持续硬膜外镇痛的Meta分析

背景：疼痛是全膝关节置换后阻碍患者早期恢复的重要原因,持续硬膜外镇痛和持续股神经阻滞均是全膝关节置换后镇痛的有效方法,但哪种方法镇痛效果更好且并发症较少一直存在争议。 目的：比较全膝关节置换后持续硬膜外镇痛与持续股神经阻滞的临床疗效及安全性。 方法：计算机检索Cochrane-Library、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang等数据库,同时检索学位论文、会议论文等,检索时间为各数据库建库至2014-10-01,纳入全膝关节置换后持续硬膜外镇痛与持续股神经阻滞的随机对照试验。采用Cochrane系统评价的方法进行评价,用RevMan 5.0软件进行统计学分析。 结果与结论：共纳入12篇随机对照试验,4篇英文,8篇中文,共680例患者,其中持续股神经阻滞组患者343例,持续硬膜外镇痛组患者337例。Meta分析结果显示,持续股神经阻滞组与持续硬膜外镇痛组在全膝关节置换后6,12,24,48 h的目测类比评分差异均无显著性意义;但与持续硬膜外镇痛组相比,持续股神经阻滞可减少恶心/呕吐(RR=0.36,95%CI：0.21-0.63,P=0.003)、尿潴留(RR=0.08,95%CI：0.04-0.16, P < 0.001)和头晕(RR=0.24,95%CI：0.06-0.99,P=0.05)的发生率。提示与硬膜外镇痛相比,全膝关节置换后持续股神经阻滞镇痛同样可以提供良好的镇痛效果,有利于患者早期功能恢复训练,且不良反应少,是一种安全、有效的镇痛方法。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

全膝关节置换过程中鸡尾酒疗法联合股神经阻滞的镇痛效果

背景:全膝关节置换是挽救膝关节功能的重要措施,但术后疼痛给患者造成极大痛苦.多模式镇痛背景下,鸡尾酒疗法、股神经阻滞被广泛用于临床,镇痛效果确切;但是两种方法同时使用的镇痛效果及安全性不明,因此需要更多的临床证据.目的:观察鸡尾酒疗法联合股神经阻滞对全膝关节置换后镇痛、功能恢复的影响及安全性,为临床提供参考.方法:纳入...     

关节局部注射罗哌卡因结合静脉PCA泵对全膝关节置换术后的镇痛研究

目的研究全膝关节置换术后关节周围注射罗哌卡因结合PCA泵的镇痛效果。方法选取择期行全膝关节置换手术患者90例,随机分为3组,每组30例（n=30）,第一组（A组）术后包括膝关节后关节囊和前侧切口周围组织浸润注射罗哌卡因,结合静脉PCA泵镇痛;第二组（B组）术后仅在前侧切口周围组织浸润注射罗哌卡因,而不注射后关节囊,结合静脉PCA泵镇痛。第三组（C组）术后仅采用静脉PCA泵镇痛。分别在术后2、12、24、48、72小时,以视觉模拟量表（visual analogue scale,VAS）评估患者术后的疼痛水平。结果术后2、12、24、48、72小时A、B、C组评分分别为2．0,2．1,4．9;2．7,2．6,5．5;3．5,3．4,4．6;2．4,2．5,3．8;1．4,1．4,2．8。A组和B组评分差异无统计学意义（P〉0．05）,A组和B组评分较C组差异有统计学意义（P〈0．05）。结论全膝关节置换术后应用罗哌卡因和静脉PCA泵能够有效缓解疼痛,后关节囊可不注射,镇痛效果优于单用PCA泵。     

全膝关节置换后局部浸润的持续镇痛效果

背景：多项研究证实了局部浸润镇痛法的优良镇痛效果,但从文献分析其最佳效果往往限于全膝关节置换后第1天或更短时间内。 目的：在全膝关节置换后较低浓度局麻药硬膜外镇痛的基础上应用局部浸润镇痛法,观察静息状态下和运动时的镇痛效果。 方法：将全膝关节置换患者分为对照组和局部浸润镇痛组,均给予口服非类固醇抗炎药塞来昔布和置换后低浓度甲磺酸罗哌卡因硬膜外镇痛。2组患者均选择腰硬联合麻醉下行全膝关节置换,置换过程中对照组给予150 mL生理盐水于关节周围注射,局部浸润镇痛组给予同等容量的混合药液,其中包括罗哌卡因300 mg、吗啡5 mg和肾上腺素10 μg。采用目测类比评分法评估2组患者置换后6,12,24,36,48 h的静止痛及运动痛,观察置换后恶心、呕吐、下肢麻木感和肌无力感的发生率及严重程度。记录患者置换后切口愈合情况。 结果与结论：除置换后48 h的静止痛在2组差异无显著性意义,局部浸润镇痛组患者运动痛、静止痛目测类比评分在各时间点均显著低于对照组(P < 0.05),局部浸润镇痛组在6,12 h的静止痛与运动痛差异无显著性意义。患者均未见恶心、呕吐症状,2组各2例患者主诉下肢曾有轻微的麻木感,但并未因肌无力影响功能锻炼。2组切口均为甲级愈合,无切口感染。提示联合口服非类固醇抗炎药和置换后低浓度甲磺酸罗哌卡因硬膜外镇痛,关节周围局部浸润镇痛技术可以在全膝关节置换后提供优良且持续的镇痛效果,且无镇痛相关不良反应出现。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Patellar resurfacing in total knee arthroplasty for osteoarthritis: a systematic review

A systematic review was performed to determine the advantages and disadvantages of patellar resurfacing during total knee replacement for osteoarthritis. Three randomised controlled studies were analysed. These studies recruited 302 knees and 235 knees (78%) were reviewed at least 5 years postoperatively (range 5–10 years). Patients undergoing patellar resurfacing received a cemented all polyethylene patella component. A patelloplasty was performed in some of the unresurfaced knees.

For the dichotomous data, odds ratios and 95% confidence intervals were calculated. Each outcome measure tested was assessed for heterogeneity using the Cochran Q test. If significant heterogeneity was present (p<0.10), data from the studies were not combined. If there was no significant heterogeneity, a combined odds ratio was calculated using a fixed effects model and a Z test was performed to test the overall effect.

Reoperation for patellofemoral problems was significantly more likely in the unresurfaced group (p=0.003). The overall rate for reoperation for a patellofemoral problem was 0.7% in the resurfaced group and 11% in the unresurfaced group. Study data on anterior knee pain could not be analysed together as there was significant heterogeneity. There was no difference between the two groups in terms of revision. This study found no mid- to long-term benefit to leaving the patella unresurfaced.     

Fracture of the oxidized zirconium femoral component after total knee arthroplasty

BackgroundFemoral component fracture is a rare complication of total knee arthroplasty (TKA).CaseWe report a case of oxidized zirconium (Oxinium) femoral component fracture after total knee arthroplasty. The fracture site was the junction of the central and medial flanges. The patellar component and polyethylene insert had delamination at the contact point of the fracture line, and the tibial tray had loosening at the medial side. There was no cement adherence at the component fracture site, suggesting that debonding had occurred at the cement-implant interface in this area. Examination with a scanning electron microscope revealed beach marks, which are characteristic findings of metal fatigue.ConclusionWe considered that the cause of femoral component fracture was a fatigue fracture due to poor fixation of the component to the bone caused by poor osteotomy technique or poor cementing technique. To our knowledge, this is the first case of Oxinium femoral component fracture.     

Component fracture in total knee arthroplasty

The records of 26 patients (27 knees) who sustained a fracture of a total condylar design total knee prosthesis were reviewed. Twenty-five fractures involved the tibial component and two involved the femoral component. Mean time to failure was 8.2 years for tibial components and 7.2 years for femoral components. The overall fracture prevalence rates were 0.33% and 0.03% for tibial and femoral components, respectively. Specific designs had increased fracture rates and revision arthroplasty increased the relative risk. Anatomic limb alignment exceeded 5 of varus or valgus in 24 of 25 knees with tibial component fractures. Lucencies were noted beneath all but one fractured tibial tray. However, 22 of 23 tibial components that had a keel or stem were well fixed distally and subsidence occurred only beneath the fractured portion of the prosthesis. Tibial component fractures are related to revision arthroplasty, prosthesis design, malalignment, and inadequate support beneath the tibial tray with good distal fixation.     

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.

膝关节力学平衡无线测量装置的研制

目的为更好的测量股骨-胫骨接触面的压力平衡状况,本研究开发一种新的膝关节力学平衡无线测量系统。方法本装置根据人工膝关节胫骨假体的外形和结构进行设计,将力学传感器和无线测量电路嵌入其中,在全膝关节置换(TKA)手术过程中替代胫骨假体试样,测量膝关节各个屈伸角度下股骨与胫骨间的作用力大小,帮助医生通过松解膝关节周围软组织来调节张力的平衡。结果测试结果表明,本装置具有较好的测量精度(r0.98,RMS=65g),能满足临床测量精度的要求。结论利用本装置测量股骨-胫骨接触面的压力平衡状况对确定假体安装位置以及选择合适膝关节的假体垫片具有指导意义。     

Effectiveness of continuous versus single injection femoral nerve block for total knee arthroplasty: A double blinded,randomized trial

Background

Effective analgesia following total knee arthroplasty (TKA) is important for maximizing patient satisfaction, early participation in physical therapy and reducing the hospital stay. This trial compared continuous catheter femoral nerve block (cFNB) to single injection femoral nerve block (sFNB) in terms of analgesia, opioid consumption, and participation in physical therapy and associated side effects.

Total knee arthroplasty following prior distal femoral fracture

Background: Femoral fracture may predispose the knee to the development of post-traumatic arthritis by either a direct intra-articular injury or residual limb malalignment. Malunion, intra-articular osseous defects, limb malalignment, retained internal fixation devices, and compromised surrounding soft tissues may in turn affect the outcome of total knee arthroplasty (TKA) in these patients. The aim of our study was to evaluate the result of TKA in patients with previous distal femoral fracture. Methods: The results of 48 cemented condylar total knee arthroplasties, performed between 1980 to 1998, in 47 patients with a previous distal femoral fracture were reviewed. There were 37 females and 10 males with an average age of 65 years (range, 19–84 years). Follow-up averaged 6.2 years (range, 2–16 years). No patients were lost to follow-up. Results: At the time of arthroplasty a femoral fracture non-union was present in three knees, all of which were treated with a long stem cemented femoral component and bone grafting. Malunion, defined as angulation greater than 10° in the coronal plain or greater than 15° in the sagittal plain, was present in 21 knees. Of these, six underwent distal femoral osteotomy during TKA. In the remaining 15 patients, with a malunion, the deformity was addressed by alterations in the orientation and location of bone resection. Other procedures were commonly needed at the time of arthroplasty and included: lateral retinacular release (22 knees), extensor mechanism realignment (eight knees), and collateral ligament reconstruction (two knees). The mean pre-operative Knee Society Scores were 40 (range, 0–80) for pain and 48 (range, 0–100) for function and improved significantly to a mean of 84 (range, 37–99) and 66 (range, 0–100) points, respectively, at the latest follow-up (P<0.001). The knee arc of motion improved from a pre-operative mean of 83–99° at the latest follow-up (P<0.004). Post-operative manipulation under anesthesia for poor motion was carried out in four knees. Two knees had aseptic loosening that required subsequent revisions. Three knees developed deep infection which was treated with debridement and retention of components in one knee, arthrodesis in another, and eventual amputation in one knee. Conclusions: Significant improvement in function and relief of pain is seen in the vast majority of patients with previous distal femoral fractures undergoing subsequent TKA. However, these patients are at increased risk for restricted motion and perioperative complications following TKA. Special efforts to preserve the vascularity of the skin and subcutaneous tissues, restore limb alignment, ensure correct component positioning, and achieve soft tissue balance may help minimize the problems identified in this study.     

Outcomes of cementless unicompartmental and total knee arthroplasty: A systematic review

Background

Aseptic loosening is a common failure mode in cemented unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This led to the development of cementless designs but the historical outcomes were poor. Recent developments in cementless designs have improved outcomes, but the current status is unknown. Therefore, a systematic review was performed to assess recent outcomes of cementless knee arthroplasty.

人工全膝关节研究新进展

膝关节是人体最大、解剖最复杂、对运动要求最高的关节之一。全膝关节置换术(total knee arthroplasty,TKA)在全世界每年以高于10%的比例增长。TKA是在全髋关节置换术的基础上发展起来的,经过近30的发展,取得了很大进展。本文对近年来假体类型的演变、假体几何外形与尺寸的研究,以及膝关节生物力学方面取得的突破进行了阐述;对目前TKA中存在争议的问题进行了讨论;并结合目前最新发展的技术,对TKA未来发展的方向进行了展望和预测。     

3D打印技术辅助全膝关节置换临床疗效的Meta分析

目的 对3D打印技术辅助全膝关节置换术与传统全膝关节置换术的临床疗效比较行Meta分析。方法 通过PubMed、Embase、Cochrane Library、中国知网、万方医学数据库等电子期刊数据库检索建库至2021年2月的比较3D打印辅助与传统全膝关节置换术临床疗效的随机对照试验。严格按照纳入标准和排除标准筛选文献进行质量评价,提取数据,采用RevMan 5.3软件对提取的数据进行Meta分析。对二分类变量评估其比值比（OR）及95%可信区间（CI）,对连续型变量计算其标准均值差（SMD）及95%区间（CI）,对统计结果进行综述。结果 共纳入39篇文献,2 443例患者,3D打印组1 209例,常规组1 234例,两组各指标行Meta分析后结果为：3D打印组的手术时间[SMD=-17.87,95%CI（-25.75,-10.00）,P<0.00001]和术中出血量[SMD=-123.65,95%CI（-182.92,-64.38）,P<0.0001]比常规组少;3D打印组的术后KSS评分比常规组高[SMD=2.83,95%CI（0.70,4.96）,P=0.009];3D打印组的术后VAS评分比常规组低[SMD=-0.36,95%CI（-0.64,-0.08）,P=0.01];3D打印组术后髋膝踝角（HKA）较常规组准确,提高了手术准确度[SMD=1.03,95%CI（0.11,1.95）,P=0.03];3D打印组术后aMFTA比常规组低,提高了手术准确度[SMD=-0.84,95%CI（-1.30,-0.37）,P=0.0004];3D打印组术后aLDFA比常规组高,提高了手术准确度[SMD=0.69,95%CI（0.16,1.22）,P=0.01]; 3D打印组术后并发症较常规组少[OR=0.44,95%CI（0.22,0.91）,P=0.03];以上指标的差异均具有统计学意义。结论 3D打印辅助TKA比常规TKA的短期临床效果更好,明显提高手术的有效率、术后力线精准度,改善术后膝关节功能,无明显不良反应,值得广泛推广。     

A randomized controlled trial comparing the efficacies of ketorolac and parecoxib for early pain management after total knee arthroplasty

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to reduce pain after orthopedic surgery. Currently, selective COX-2 inhibitors can provide effective pain reduction with less platelet inhibition compared with conventional NSAIDs. We aimed to compare the analgesic effect and perioperative blood loss (PBL) after total knee arthroplasty (TKA) between ketorolac and parecoxib administration.MethodsWe conducted a prospective randomized controlled study of 100 unilateral TKAs. The ketorolac group of 50 patients received an intraoperative periarticular injection (PAI) with 100 mg of bupivacaine and 30 mg of ketorolac. Afterwards, 30 mg of ketorolac was intravenously injected every 12 h until 48 h. In the parecoxib group of 50 patients, 20 mg of parecoxib was added to PAI, and the first intravenous dose was 20 mg followed by 40 mg every 12 h. The primary outcomes were visual analog scales (VASs) of postoperative pain, amount of morphine consumption, PBL, and blood transfusion rate.ResultsThe ketorolac group had a significantly lower VAS pain score than the parecoxib group at 6 h after TKA (2.38 ± 2.52 vs. 4.12 ± 2.86, P < 0.01). Thereafter, the VAS of both groups and total morphine consumption at 24 and 48 h were comparable. The PBLs of the ketorolac and parecoxib groups were 529.72 ± 263.02 and 402.40 ± 191.47 ml, respectively (P = 0.01). However, the blood transfusion rates between groups were not different.ConclusionParecoxib provides comparable analgesic effects to ketorolac. Additionally, perioperative use of parecoxib is safe and is associated with significantly less blood loss after TKA.     

Tourniquet time in total knee arthroplasty

Background

Whether the arterial tourniquet in total knee arthroplasty (TKA) is a friend or a foe is still debated.Longer ischemia causes hypoxic damage; yet short duration of a tourniquet may influence outcome. Understanding the time-dependent influence of the tourniquet in TKA patients could improve the overall outcome and safety. The purpose of the study was to measure the tourniquet-induced time-dependent alterations in skeletal muscle metabolism in TKA to establish a ‘safe tourniquet time.’

Patellofemoral arthroplasty conversion to total knee arthroplasty: Retrieval analysis and clinical correlation

Background

Patellofemoral arthroplasty (PFA) can be a successful, bone-sparing treatment for isolated patellofemoral arthritis. However, progression of tibio-femoral arthritis or incorrect indications may predispose patients to early conversion to total knee arthroplasty (TKA). The purpose of this study was to review the clinical cases and perform retrieval analysis of PFA conversions to TKA at our institution.

Prospective sequential comparison of femoral roll-back between cruciate-retaining and posterior-stabilized total knee arthroplasty using an intra-operative sensor

BackgroundImplant design and surgical techniques affect postoperative knee kinematics in total knee arthroplasty (TKA). This study aimed to compare femoral roll-back between cruciate-retaining (CR) and posterior-stabilized (PS) TKA in the same knee by objectively quantifying the contact point kinematics of the tibiofemoral joint using a sensor.MethodsIn the present prospective study, we used an intraoperative sensor to compare medial and lateral roll-back during 0-120° knee flexion in 33 knees that underwent CR and PS TKA. We also examined the relationship between mediolateral balance and the lateral-to-medial roll-back ratio. We defined the contact percentage position as the vertical length to the contact point divided by the anteroposterior length of the tibial plate.ResultsThe roll-back percentage following PS TKA (19.8 ± 5.1%) was significantly higher than that after CR TKA in both the medial (19.8 ± 5.1% versus 7.1 ± 2.5%, P < 0.001) and lateral (26.8% ± 3.8% versus 18.7 ± 3.8%, P < 0.001) compartments. The medial contact pressure at 90° was significantly correlated with the increased lateral-to-medial roll-back ratio in both CR and PS TKA (both P < 0.001).ConclusionPS TKA resulted in a higher percentage of femoral roll-back in the medial and lateral compartments than CR TKA. CR TKA caused a higher lateral-to-medial roll-back ratio compared to PS TKA. To reproduce medial pivot knee motion similar to that of a normal knee, the medial soft tissue needed to be balanced more tightly than the lateral soft tissue during TKA. These findings provide some clinical evidence of TKA design selection and proper mediolateral balancing for successful TKA.