The pattern of cartilage damage in antero‐medial osteoarthritis of the knee and its relationship to the anterior cruciate ligament

Within antero‐medial gonarthrosis (AMG) of the knee, there is a spectrum of damage seen in the functionally intact anterior cruciate ligament (ACL). Our aim was to correlate the degree of ACL damage to the geographical extent and degree of cartilage loss on the tibial plateau. Ninety tibial plateaus resected during unicompartmental arthroplasty were photographed and digitally mapped. The ACL damage was graded (0: normal, 1: synovium loss, 2: longitudinal splits), and dimensions of full thickness cartilage loss and damage recorded. The percentage of full thickness loss in patients with a normal ACL was compared to those with a damaged, but functionally intact ligament. All specimens showed similar elliptical loss of cartilage in the antero‐medial part of the tibial plateau. A total of 45(50%) patients had a macroscopically normal ACL, 21(23%) had synovial loss, and 24(27%) had longitudinal splits. An increase in the area of cartilage damage was seen with progressive ACL damage (p < 0.001). The area of macroscopically normal cartilage found posteriorly did not change. This study demonstrates that phenotypic distribution of cartilage damage in AMG is highly reproducible with a pattern of increasing cartilage erosion associated with increasing ACL damage. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 908–913, 2013     

胫骨高位截骨术与单髁置换术治疗膝内侧间室骨关节炎的疗效

目的 探讨胫骨高位截骨术(HTO)与单髁置换术(UKA)治疗膝内侧间室骨关节炎的疗效.方法 将60例膝内侧间室骨关节炎患者按治疗方法的不同分为HTO组和UKA组,每组30例.比较术中出血量、手术时间、术后引流量、并发症发生情况.记录两组术前及末次随访时疼痛VAS评分、Tegner膝关节运动评分、HSS评分.结果 患者均...     

Decision support needs of patients choosing between unicompartmental and total knee arthroplasty for advanced medial compartment osteoarthritis of the knee

Patients with isolated medial knee osteoarthritis are often candidates for both unicompartmental knee arthroplasty and total knee arthroplasty and must choose between these 2 options. We interviewed 20 such patients to describe their decision support needs and 14 knee arthroplasty surgeons to describe their requirements in supporting patients' decision making. Patients and surgeons both desired active patient participation in the decision. Of 14 surgeons, 13 identified a knowledgeable patient as the most important factor in facilitating decision making, but many worried about confusing patients from information overload. Patients, on the other hand, demonstrated poor knowledge of the advantages and disadvantages of each surgical option, and 17 of 20 desired supplemental educational resources. Thus, most patients choosing between unicompartmental knee arthroplasty and total knee arthroplasty would appreciate and benefit from a decision support intervention.     

微创单髁置换术治疗膝内侧间室骨性关节炎的早期并发症

[目的]回顾性分析微创单髁置换术后的早期并发症。[方法]从2005年5月～2010年1月,共有52例患者(56膝)在本院接受微创单髁置换术,其中男19例(21膝),女33例(35膝),平均年龄65.2岁(46～78岁),单侧48例,双侧4例,体重平均68.3 kg(55～80 kg),身高平均162.2 cm(148～178 cm),BMI平均26.4(19.6～34.6)。所用假体均为骨水泥型Oxford phase 3代。[结果]52例患者获得完整随访,随访平均18.3个月(12～31个月)。1例术后X线摄片发现内侧胫骨平台轻度劈裂,但骨折无明显移位,1例发生可移动半月板衬垫后方脱位。无1例发生浅表或深部感染、脂肪栓塞或下肢深静脉血栓、假体松动等并发症。末次随访HSS评分和膝关节活动度明显增加,下肢力线内翻畸形明显减少。[结论]微创单髁置换术治疗早期单间室骨性关节炎疗效确切,功能恢复满意,但是手术技巧的熟练掌握和规范的术后康复训练指导非常必要。     

膝关节单髁置换术治疗严重内侧间室骨性关节炎

[目的]探讨膝关节单髁置换术治疗严重内侧间室骨性关节炎的疗效与手术技术。[方法]回顾性分析2008年5月～2009年6月采用膝关节单髁置换术治疗18例(18膝)严重内侧间室骨性关节炎患者的资料,对患者术前、术后膝关节疼痛及关节活动度进行评估(HSS评分法),并测量术后膝关节力线与术前测量结果比较,分析术前病例的选择及手术技术。[结果]术后平均随访18个月(12～24个月),所有病例术后随访时关节内侧间室负重和静息性疼痛症状明显减轻或消失,膝关节活动度达到平均100°(0°～120°);术后力线为平均内翻2°(0°～内翻5°)。HSS评分由术前68分(60～76分)增至85分(78～90分),优良率达89%。[结论]膝关节单髁置换术治疗严重内侧间室骨性关节炎具有较好的疗效,术前病例选择和术中在C型臂机监视下手术操作至关重要。     

移动平台单髁置换术治疗膝关节内侧间室骨性关节炎

目的评估移动平台单髁置换术治疗膝关节内侧间室骨性关节炎的临床疗效。方法回顾性分析自2011-10—2013—01使用Oxford Phase Ⅲ移动平台单髁系统治疗膝关节内侧间室骨性关节炎47例（50膝）．观察术后下肢力线、膝关节活动度和并发症,采用Oxford及AKS评分对手术前后膝关节功能进行评估。结果47例均获得随访,平均随访13（6～21）个月。未发生假体周围感染、假体周围骨折、下肢深静脉血栓、医源性神经血管损伤。2例出现内衬脱位,行翻修术,无感染。术后测量下肢力线平均内翻1．2°。Oxford评分：术前平均（24．6±1．9）分,术后平均（41．3±3．5）分。AKS疼痛评分：术前平均（50．5±3．9）分,术后平均（86．9±4．9）分。AKS功能评分：术前平均（47．0±6．6）分,术后平均（86．4±9．4）分。术后Oxford、AKS评分较术前明显提高,差异均有统计学意义（P〈0．05）。术后无伸直受限,最大屈曲度平均（121．0±6．7）°。结论移动平台单髁置换术治疗膝关节内侧间室骨性关节炎短期效果良好,但中远期疗效需进一步随访。     

小切口单髁置换术治疗膝关节内侧间室骨关节炎94膝的中短期疗效研究

[目的]探讨小切口单髁置换术治疗膝关节内侧间室骨性关节炎的中短期疗效与手术技术。[方法]回顾性分析本院2003年1月～2010年6月收治的87例(94膝)经小切口单髁置换术治疗的膝关节内侧间室骨性关节炎患者的资料。对患者膝关节疼痛VAS评分、关节活动度、膝关节HSS评分、关节力线等进行评估分析,分析单髁关节置换临床效果、遇到的问题及应对方法。[结果]术后平均随访3.4年(6个月～7年),返修2例,无感染、深静脉血栓、假体脱位等,HSS评分由术前61.05分增至92.67分,优良率达92%。VAS评分由术前6.46分降至2.80分。术后疼痛缓解率94%。膝屈曲度平均达127.53°。术后力线平均内翻2°。[结论]小切口单髁置换术治疗膝关节内侧间室骨性关节炎中短期疗效满意,具有创伤小、恢复快、症状改善明显、术后功能良好等特点。     

外侧单髁置换术治疗外侧间室膝骨关节炎的研究进展

随着关节外科"保膝理念"及手术技术的发展,外侧单髁置换术(UKA)已成为治疗膝关节外侧间室骨关节炎的有效方法。外侧间室膝骨关节炎发病率低,其具有与内侧间室不同的解剖和运动学特性,这2个因素增加了外侧UKA手术的挑战性,因此外侧UKA的临床疗效一直存在争议。随着治疗理念、手术技术和假体设计的不断改进和更新,外侧UKA术后...     

不均匀沉降术与全膝关节置换术治疗内侧间室膝关节骨性关节炎的对比分析

目的评价不均匀沉降术与全膝关节置换术(TKA)治疗内侧间室膝关节骨性关节炎(KOA)的临床效果。方法 34例KOA患者,左膝14例,右膝20例,均为内侧间室受累为主的KOA患者。根据手术方法的不同将34例患者分为不均匀沉降术组(16例,观察组)和TKA组(18例,对照组),对两组患者术后膝关节疼痛缓解程度、HSS膝关节评分以及住院时间和治疗费用进行比较。结果 34例患者术后均获随访,随访时间12~36个月,平均(15.00±6.17)个月。观察组患者术后VAS评分、术后优良率、HSS评分虽劣于对照组,但组间比较差异无统计学意义(P0.05);观察组治疗费用、住院时间少于对照组,差异有统计学意义(P0.05)。结论应用不均匀沉降术治疗内侧间室KOA,有创伤小、操作简单、住院时间短、费用低廉、疗效确切。     

Oxford单髁置换治疗膝内侧间室骨性关节炎

目的探讨Oxford单髁置换(UKA)治疗膝内侧间室骨关节炎的临床疗效。方法采用Oxford UKA治疗25例膝内侧间室骨关节炎患者(26膝)。采用膝关节功能HSS评分评价疗效。结果 25例患者均获随访,时间8~16个月。术后患膝关节疼痛均明显缓解,关节活动度改善,生活质量提高。术后2周、3个月、6个月膝关节功能HSS评分、膝关节活动度均较术前增加,差异均有统计学意义(P0.01),术后2周、3个月、6个月膝关节屈曲挛缩度数均较术前减少,差异均有统计学意义(P0.01)。结论 Oxford UKA治疗膝内侧间室骨关节炎,具有术后功能恢复良好、并发症少等优点。     

膝关节外侧间室软骨退变对膝关节内侧单髁置换手术的影响

目的探讨膝关节合并外侧间室软骨轻度退变是否可行膝关节单髁置换术(UKA)及3.0T MRI在UKA病例选择的应用。方法笔者自2013-11—2015-08共诊治60例膝关节外侧间室软骨退变,根据术前X线片检查结果的Kellgren-Lawrence分级进行分组。A组:内侧间室软骨退变≥3级,前交叉韧带无明显损伤,外侧间室和髌股关节软骨退变0级,行UKA;B组:内侧软骨≥3级,外侧软骨1级。再通过膝关节3.0T MRI的Recht分级、美国医学会关节韧带损伤分度结果分组,B1组:内侧软骨≥Ⅲ级,外侧软骨损伤Ⅰ~Ⅱ级,关节韧带无明显损伤,行UKA;B2组:内侧软骨≥Ⅲ级,可合并外侧软骨损伤Ⅱ级、关节韧带≥Ⅰ°,行全膝关节置换术。结果共43例行UKA。UKA术后所有随访平均11.8(6~18)个月。A组(35例)、B1组(8例)末次随访KSS评分均较术前有所改善,差异有统计学意义(P0.05)。对2组间术后疼痛评分比较行方差齐性检验,方差不齐,差异无统计学意义(F=2.770,P=0.102);对2组术后功能评分比较行方差齐性检验,方差不齐,差异无统计学意义(F=1.102,P=0.299)。结论膝关节内侧间室软骨严重退变合并外侧间室软骨Ⅰ~Ⅱ级退变对UKA术后短期疗效未见明显影响。     

Oxford Ⅲ单髁系统治疗膝关节内侧间室退变的中期疗效

目的评价OxfordⅢ单髁系统治疗膝关节内侧间室退变的中期临床疗效。方法 2008年12月-2010年8月,收治26例(32膝)膝关节内侧间室退变患者,其中11例(14膝)获2年以上随访。男7例(9膝),女4例(5膝);年龄50～74岁,平均62.4岁。左侧6膝,右侧8膝。均为退行性关节炎,病程5～23年,平均11.6年。患者均有明确关节内侧间室负重疼痛和压痛。内侧间室骨性关节炎根据Ahlback分期标准,Ⅱ期4膝,Ⅲ期10膝。膝关节均伴内翻畸形;无主、被动屈伸活动受限。手术取髌内侧旁切口,采用OxfordⅢ单髁系统行膝关节内侧间室单髁置换手术。结果术后切口均Ⅰ期愈合。术后1～3个月5例出现切口下方局部鹅足疼痛症状,给予保守治疗,术后6个月复查症状均消失。术后11例(14膝)均获随访,随访时间24～30个月,平均27.5个月。随访期间无假体松动、移位,对侧间室和髌股关节病变、感染等并发症发生。末次随访时膝关节学会评分系统(KSS)评分、美国西部Ontario与McMaster大学骨关节炎指数评分(WOMAC)评分、膝关节活动度与术前比较,差异均有统计学意义(P<0.05)。末次随访时股胫角较术前改善(P<0.05),但仍为轻度内翻;胫骨平台内翻角较术前有所增大,但无统计学意义(P>0.05);胫骨内髁后倾角明显较术前减小,差异有统计学意义(P<0.05)。结论 OxfordⅢ单髁系统治疗膝关节内侧间室退变中期疗效满意,创伤小、恢复快;远期疗效尚需进一步观察。     

Fixed‐bearing medial unicompartmental knee arthroplasty restores neither the medial pivoting behavior nor the ligament forces of the intact knee in passive flexion

Medial unicompartmental knee arthroplasty (UKA) is an accepted treatment for isolated medial osteoarthritis. However, using an improper thickness for the tibial component may contribute to early failure of the prosthesis or disease progression in the unreplaced lateral compartment. Little is known of the effect of insert thickness on both knee kinematics and ligament forces. Therefore, a computational model of the tibiofemoral joint was used to determine how non‐conforming, fixed bearing medial UKA affects tibiofemoral kinematics, and tension in the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) during passive knee flexion. Fixed bearing medial UKA could not maintain the medial pivoting that occurred in the intact knee from 0° to 30° of passive flexion. Abnormal anterior–posterior (AP) translations of the femoral condyles relative to the tibia delayed coupled internal tibial rotation, which occurred in the intact knee from 0° to 30° of flexion, but occurred from 30° to 90° of flexion following UKA. Increasing or decreasing tibial insert thickness following medial UKA also failed to restore the medial pivoting behavior of the intact knee despite modulating MCL and ACL forces. Reduced AP constraint in non‐conforming medial UKA relative to the intact knee leads to abnormal condylar translations regardless of insert thickness even with intact cruciate and collateral ligaments. This finding suggests that the conformity of the medial compartment as driven by the medial meniscus and articular morphology plays an important role in controlling AP condylar translations in the intact tibiofemoral joint during passive flexion. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1868–1875, 2018.

     

固定平台单髁置换术治疗膝关节内侧骨关节炎

目的：探讨采用固定平台假体膝关节单髁置换术治疗膝关节内侧单间室骨性关节炎的早期临床疗效。方法：自2015年1月至2017年12月,采用固定平台单髁置换术治疗62例膝关节内侧间室骨性关节炎患者,其中男19例,女43例;年龄47~83（65.3±8.2）岁;病程5~72（19.4±14.3）个月。观察术后并发症情况,并采用VAS评分评价疼痛缓解程度,HSS膝关节评分评价临床疗效。结果：62例患者均获得随访,时间4~40（19.9±10.2）个月。所有患者切口愈合良好,无须术后输血,住院时间2~10（3.5±1.6） d。术后未发生脱位、感染、松动或假体周围骨折等并发症,1例患者术后1个月并发胫后静脉血栓。HSS评分由术前的69.9±7.2提高至末次随访时的90.1±7.4;其中优51例,良9例,可2例;VAS评分由术前的3.8±0.9降至末次随访时的1.1±0.9。结论：固定平台单髁关节置换术治疗膝关节内侧单间室骨性关节炎术后住院时间短,并发症低,可以获得较好的早期临床疗效。     

Effect of center of pressure modulation on knee adduction moment in medial compartment knee osteoarthritis

The knee adduction moment (KAM) provides a major contribution to the elevated load in the medial compartment of the knee. An abnormally high KAM has been linked with the progression of knee osteoarthritis (OA). Footwear‐generated biomechanical manipulations reduce the magnitude of this moment by conveying a more laterally shifted trajectory of the foot's center of pressure (COP), reducing the distance between the ground reaction force and the center of the knee joint, thus lowering the magnitude of the torque. We sought to examine the outcome of a COP shift in a cohort of female patients suffering from medial knee OA. Twenty‐two female patients suffering from medial compartment knee OA underwent successive gait analysis testing and direct pedobarographic examination of the COP trajectory with a foot‐worn biomechanical device allowing controlled manipulation of the COP. Modulation of the COP coronal trajectory from medial to lateral offset resulted in a significant reduction of the KAM. This trend was demonstrated in subjects with mild‐to‐moderate OA and in patients suffering from severe stages of the disease. Our results indicate that controlled manipulation of knee coronal kinetics in individuals suffering from medial knee OA can be facilitated by customized COP modification. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1668–1674, 2011     

Static knee alignment is associated with the risk of unicompartmental knee cartilage defects

Although knee malalignment is a risk factor for the progression of unicompartmental knee osteoarthritis (OA), it is unclear how this relationship is mediated. Cartilage defects are known to predate cartilage loss and the onset of knee OA, and it may be that knee malalignment increases the risk of unicompartmental knee cartilage defects. Knee radiographs and MRI were performed on a total of 202 subjects, 36.6% of whom had radiographic knee OA, to determine the relationship between static knee alignment and knee cartilage defects. Analyses were performed for the entire cohort, as well as for healthy and OA subgroups. For every 1° increase in a valgus direction, there was an associated reduced risk of the presence of cartilage defects in the medial compartment of subjects with knee OA (p = 0.02), healthy subjects (p = 0.002), and the combined (p < 0.001) group. Moreover, for every 1° increase in a valgus direction, there was an associated increased risk of the presence of lateral cartilage defects in the OA group (p = 0.006), although the relationship between change toward genu valgum and lateral compartment cartilage defects did not persist for the healthy group (p = 0.16). This cross‐sectional study has demonstrated that knee alignment is associated with the risk for compartment specific knee cartilage defects in both healthy and arthritic people. Given that the natural history of cartilage volume reduction appears to be predated by the presence of cartilage defects, whether knee alignment affects the longitudinal progression from cartilage defects to cartilage loss requires further examination. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:225–230, 2008     

Effects of lateral‐offset sole shoes on knee adduction moment in women with medial compartment knee osteoarthritis

This study aimed to determine the impact of wearing a lateral‐offset sole shoe (LOSS) on knee adduction moment (KAM) in patients with medial knee osteoarthritis (OA). From December 2012 to November 2016, patients with medial knee OA were recruited. Ninety‐three knees (50 left, 43 right) of 93 female patients were analyzed. The first peak KAMs were measured with patients (i) walking barefoot; (ii) walking in conventional shoes; and (iii) walking in LOSSs. The patients had grade 1 (n = 19), grade 2 (n = 49), grade 3 (n = 20), and grade 4 (n = 5) knee OA. First peak KAMs differed significantly in all three conditions (p = 0.031). In the post hoc analysis, first peak KAMs were significantly lower during LOSS walking than during conventional shoe walking (p = 0.001), but there were no differences in peak KAMs between barefoot and LOSS walking (p = 0.784). In the subgroup analysis, patients with grades 2 and 3 OA showed significantly lower first peak KAMs during LOSS walking than during conventional shoe walking (p = 0.029 and p = 0.011, respectively). Both the peak eversion ankle angle and moment of barefoot walking showed a significant increase compared with LOSS and conventional shoe walking, while there was no significant difference between LOSS and conventional shoe walking (p = 0.612 and p = 0.197, respectively). Our results suggest that LOSS wearing caused significant KAM reductions compared with conventional shoe wearing. Since LOSS wearing does not cause changes in the peak eversion ankle angle and moment during the load response, it may be an effective method to reduce the KAM in women with knee OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1694–1700, 2018.

     

The relationship between reductions in knee loading and immediate pain response whilst wearing lateral wedged insoles in knee osteoarthritis

Studies of lateral wedge insoles (LWIs) in medial knee osteoarthritis (OA) have shown reductions in the average external knee adduction moment (EKAM) but no lessening of knee pain. Some treated patients actually experience increases in the EKAM which could explain the overall absence of pain response. We examined whether, in patients with painful medial OA, reductions in the EKAM were associated with lessening of knee pain. Each patient underwent gait analysis whilst walking in a control shoe and two LWI's. We evaluated the relationship between change in EKAM and change in knee pain using Spearman Rank Correlation coefficients and tested whether dichotomizing patients into biomechanical responders (decreased EKAM) and non‐responders (increased EKAM) would identify those with reductions in knee pain. In 70 patients studied, the EKAM was reduced in both LWIs versus control shoe (?5.21% and ?6.29% for typical and supported wedges, respectively). The change in EKAM using LWIs was not significantly associated with the direction of knee pain change. Further, 54% were biomechanical responders, but these persons did not have more knee pain reduction than non‐responders. Whilst LWIs reduce EKAM, there is no clearcut relationship between change in medial load when wearing LWIs and corresponding change in knee pain. © 2014 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 32:1147–1154, 2014.