Total knee arthroplasty for osteoarthritis of the knee

The indication, preoperative condition, surgical technique and postoperative rehabilitation of total knee arthroplasty for osteoarthritis are summarized. I think the point of contributing to the success of total knee arthroplasty are to discuss the preoperative condition, to know well the instrument, to do the accurate osteotomy and to obtain the correct soft tissue balancing.     

Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

The case of a patient who previously had permanent acupuncture needles placed in the knee joint and had been doing well, with no evidence of infection, but who eventually underwent a revision total knee arthroplasty due to acupuncture needle-associated prosthetic infection is presented. The microorganism responsible for the infection was Enterococcus faecalis, a bacterium which rarely causes infection following arthroplasty. This case should be highlighted to increase the awareness of healthcare providers to acupuncture-associated subclinical infection that may be exacerbated by surgical manipulation.     

Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

Abstract

The case of a patient who previously had permanent acupuncture needles placed in the knee joint and had been doing well, with no evidence of infection, but who eventually underwent a revision total knee arthroplasty due to acupuncture needle-associated prosthetic infection is presented. The microorganism responsible for the infection was Enterococcus faecalis, a bacterium which rarely causes infection following arthroplasty. This case should be highlighted to increase the awareness of healthcare providers to acupuncture-associated subclinical infection that may be exacerbated by surgical manipulation.     

关节退变情况及其与膝关节疼痛的相关性研究

目的探讨中老年膝关节疼痛患者膝关节内的病变特点及其临床意义。方法2012年1月至2012年12月间年龄〉40岁患者膝关节镜检查证实具有Ⅳ度软骨退变性损伤的病例纳入前瞻性序贯研究,剔除重度滑膜炎需做滑膜切除的病例;术前记录性别、年龄、侧别、体质量指数（BMI）和Lysholm评分;术中记录Ⅳ度软骨退变性损伤累及的关节面部位,是否存在内外侧半月板退变性损伤、是否存在游离体、是否存在陈旧性前后交叉韧带断裂。对全部数据进行统计学分析,P〈0．05为差异有统计学意义。结果共161例纳入研究,男31例,女130例;年龄（62．98±7．93）岁,BMI（26．39±3．41）kg／m。,术前Lysholm评分（45．34±15．65）分。关节间室至少一侧关节面有Ⅳ度软骨退变性损伤：髌股间室88．8％、内侧间室57．8％、外侧间室24．8％;内侧半月板退变性损伤70．8％;外侧半月板退变性损伤25．5％;关节游离体47．8％;陈旧性前交叉韧带断裂3．7％;陈旧性后交叉韧带断裂0．6％。术前Lysholm评分与性别（P=0．006）、年龄（P=0．040）、股骨内髁Ⅳ度软骨退变性损伤（P=0．032）统计学相关;BMI与内侧半月板退变性损伤（P=0．002,r=0．246）、股骨内髁Ⅳ度软骨退变性损伤（P=0．004,r=0．223）存在统计学相关性。结论在与退变有关的膝关节疼痛病例中,髌股间室软骨退变性损伤是较多见的病变,陈旧性前后交叉韧带断裂是较少见的病变。除了软骨退变性损伤之外,内侧半月板退变性损伤可能是疼痛显著的另一重要因素。女性、年龄较高者和股骨内髁发生Ⅳ度软骨退变性损伤者术前评分较低,症状更显著。BMI较高者内侧半月板和股骨内髁Ⅳ度软骨退变性损伤发生率较高。     

Denuded subchondral bone and knee pain in persons with knee osteoarthritis

Objective

It is unclear how articular cartilage loss contributes to pain in patients with knee osteoarthritis (OA). Full‐thickness cartilage defects expose the subchondral bone plate. The relationship between denuded bone and pain has not been examined. The aim of this study was to investigate whether the percent of denuded bone is associated with moderate‐to‐severe knee pain or frequent knee pain and longitudinally with frequent knee pain 2 years after the baseline evaluation.

Methods

We studied 182 persons with knee OA (305 knees). Applying specialized magnetic resonance imaging techniques, manual segmentation was used to compute cartilage‐covered and denuded bone areas for each surface. Moderate‐to‐severe knee pain was defined as a score of ≥40 mm on a knee‐specific 100‐mm visual analog scale, and frequent knee pain was defined as pain on most days during the past month. Logistic regression and generalized estimating equations were used in analyses, adjusting for age, sex, body mass index, and bone marrow lesions.

Results

Cross‐sectional analyses revealed that moderate‐to‐severe knee pain was associated with percent denuded bone in the medial compartment (adjusted odds ratio [OR] 3.90, 95% confidence interval [95% CI] 1.33–11.47), in the medial and patellar surfaces together, and in the lateral and patellar surfaces. Frequent knee pain was associated with percent denuded bone in the patellar surface (adjusted OR 3.11, 95% CI 1.24–7.81), in the medial and patellar surfaces, and in the lateral and patellar surfaces. Longitudinal analyses (in 168 knees without frequent knee pain at baseline) revealed that percent denuded bone in the medial and patellar surfaces was associated with frequent incident knee pain (adjusted OR 4.19, 95% CI 1.56–11.22).

Conclusion

These results support a relationship between subchondral bone plate exposure and prevalent and incident knee pain in patients with knee OA.

     

单髁膝置换术与全膝关节置换术治疗膝关节内侧间室骨关节炎的近期疗效比较

目的探讨单髁膝置换术(UKA)与全膝关节置换术(TKA)治疗膝关节内侧间室骨关节炎的近期疗效。方法回顾性分析2017-01～2017-10对因膝关节内侧间室骨关节炎行UKA治疗患者15例(15膝),选取同期行TKA治疗患者30例(34膝)作为对照组。术前评估并记录两组患者的疼痛视觉模拟评分(VAS)、美国特种外科医院(HSS)评分、膝关节活动度(ROM),记录手术时间、术中出血量、术后3 d血红蛋白(Hb)下降量、术后3个月及1年VAS评分、HSS评分、ROM。结果所有患者手术顺利完成。两组患者年龄、体重指数(BMI)比较差异无统计学意义(P0.05)。UKA组手术时间、术中出血量、术后3 d Hb下降量、VAS评分均低于TKA组,而HSS评分、ROM高于TKA组,差异均有统计学意义(P0.05)。结论膝关节内侧间室骨关节炎的手术治疗选择UKA更优于TKA,UKA具有手术时间短、术中出血量少、术后恢复快、功能恢复良好等优点,能够取得良好的近期疗效。     

Comparison of Latest and Innovative Silica-Based Consolidants for Volcanic Stones

This research explores the new perspectives in conservation and protection of two macroporous tuff stones, widely employed in the architectural heritage of Campania region, characterized by highly heterogeneous rock fabric and texture and a variable mineralogical composition that represent crucial factors responsible for their weak durability. The consolidation treatments were performed with a recently and widely used suspension of nano-silica crystals in water and with a lithium silicate solution that has received up to now scarce attention as a consolidant agent. Physical investigations (open porosity, Hg porosimetry, water absorption), morphological observations (SEM analyses) and visual appearance test (colorimetric measurements), along with assessments of performance indicators such as ultrasonic pulse velocity, surface cohesion test (peeling test) and durability test (salt crystallization), were carried out to investigate the consolidation effectiveness. Overall, lithium silicate consolidant showed a better behavior in terms of superficial cohesion, a most successful strengthening action and a considerable enhancement of salt resistance.     

Comparison of femoral sagittal axis between navigated total knee arthroplasty and conventional total knee arthroplasty in patients with knee osteoarthritis

To compare femoral sagittal axis between navigated total knee arthroplasty (TKA) and conventional TKA.A total of 136 cases were assigned to group 1 (navigated TKA) and 77 cases were assigned to group 2 (conventional TKA). Specifically, this study targeted patients with degenerative osteoarthritis. Only patients with primary TKA were analyzed. Hip knee ankle angle and lateral femoral bowing were measured using preoperative scanogram. Anterior femoral bowing was measured using preoperative femoral lateral X rays. The presence of anterior femoral notching and the insertion angle of the femoral implant with respect to the anatomical sagittal plane of the distal femur were checked using postoperative lateral knee X rays. Student t-test was used to compare the difference in the position of the sagittal plane of the femoral implant between the navigated TKA group and the conventional TKA group.When comparing the 2 groups, the sagittal axis of the femoral implant was more extended than the anatomical sagittal plane axis of the distal femur in group 1 than in group 2 (P = .01). There was a significant negative correlation between the value of anterior femoral bowing and the degree of flexion to the sagittal plane of the femoral implant in group 1 (correlation coefficient: –0.40, P = .01). The occurrence of anterior femoral notching was significantly higher in group 1 than in group 2.During navigated TKA, imageless navigation does not consider the anatomical variation of the femoral shaft. Therefore, surgeons should take into consideration that when performing navigated TKA, a femoral implant could be inserted more extended for the anatomical sagittal axis of the distal femur than for the conventional TKA. Also, surgeon should know that the degree of extension insertion of the femoral implant increases as femoral anterior bowing increases.     

The risk of contralateral total knee arthroplasty after knee replacement for osteoarthritis

OBJECTIVE: Osteoarthritis (OA) is the most common indication for total knee arthroplasty (TKA), but the rate of contralateral disease progression after unilateral TKA as well as risk factors that may predict progression have not been determined. We assessed the overall rate of contralateral knee replacement after initial TKA for OA as a marker of progression to advanced symptomatic OA. METHODS: A total of 117 consecutive patients undergoing unilateral TKA for OA between 1983 and 1988 were evaluated and followed longitudinally for up to 14 years. Evaluation of potential risk factors for progression to contralateral TKA included age, sex, side of surgery, body mass index (BMI), and Kellgren-Lawrence (K-L) grade. RESULTS: The contralateral knee progressed to TKA in 31 patients, yielding an overall 10-year risk of contralateral TKA of 37.2%. The baseline K-L grade of the contralateral knee was strongly correlated with future risk of TKA (p < 0.001). Mean survival times were similar for those with grade II (131.7 mo) and grade III (127.6 mo); patients with grade IV, however, had a mean survival of 80.5 months, with an overall 10-year risk of TKA of 62.7%. Age, sex, side of initial TKA, and BMI were not risk factors for progression to contralateral TKA. CONCLUSION: In this cohort, the K-L grading scale was a highly significant predictor for progression of contralateral OA to TKA. These data may provide important information to patients undergoing TKA, and shed light on the natural history of contralateral OA after TKA.