共查询到20条相似文献，搜索用时 31 毫秒
1.
Background
While surgical reconstruction restores mechanical stability following anterior cruciate ligament (ACL) rupture, many experience early-onset osteoarthritis despite surgery. Neurophysiological changes are hypothesized to contribute to knee osteoarthritis progression. Proprioceptive deficits have been reported following ACL injury/reconstruction; however, vibration perception threshold (VPT) has been less studied. This study explored relationships between pain, VPT, proprioception, function, and strength following ACL-reconstruction.Methods
Twenty individuals (27?±?6 years; 10 males) (standard deviation) status-post ACL-reconstruction were compared with a control group. Measurements included VPT, proprioception (threshold to detect passive movement), pain, function (Knee Outcome Survey (KOS)) and isometric quadriceps strength. Group differences were assessed using Mann-Whitney U tests, side-to-side differences with Wilcoxon Signed Rank tests, and associations evaluated using Spearman correlations.Results
The ACL-reconstruction group had minor functional deficits (15?±?11%) and resting pain (1.8?±?1.7). Impaired VPT and proprioception (hypoesthesia) were demonstrated on surgical compared to contralateral and control limbs (p?≤?0.008). Proprioception was significantly different between contralateral and control knees, but not VPT. Surgical knee proprioceptive deficits and VPT deficits were positively correlated (ρ?=?0.462, p?=?0.047) but not in controls (ρ?=??0.042, p?=?0.862). Strength was negatively correlated to pain (ρ?=??0.589; p?=?0.006), but not to KOS scores, proprioception or VPT (p?≥?0.099).Conclusion
Proprioceptive deficits following ACL injury have been ascribed to loss of afferent input from the torn ligament. Alternatively, multi-modality as well as contralateral sensory deficits suggest a spinal/supraspinal source of neurophysiological findings which may predispose to early osteoarthritis.Level of evidence
III. 相似文献2.
Jesse C. Christensen Ryan L. Mizner K. Bo Foreman Paul C. LaStayo Christopher L. Peters Christopher E. Pelt 《The Knee》2019,26(1):79-87
Background
Nearly all patients with total knee arthroplasty show aberrant movement patterns during tasks requiring greater joint demand compared to matched peers. Greater movement compensation leads to increased loading onto other joints, decreased functional capacity and limited reserve for independence later in life. Understanding how preoperative predictors contribute to postoperative aberrant movement patterns is needed to make better decisions for patients considering total knee arthroplasty.Methods
Forty-seven patients were tested preoperatively and six months following primary total knee arthroplasty. Demographic (age, sex, body mass), self-reported (knee pain, perception of physical performance, physical activity level), physical performance (quadriceps strength, lower limb power and timed stair climbing) and surgical metrics were collected as predictor variables. Three-dimensional models based on joint mechanic asymmetry during a decline walking task were collected at six months postoperatively. Decline walking is a preferred means to assess the surgical knee's contribution to limb performance during high-demand tasks. Bootstrap inclusion fraction was employed to compare the stability of each predictor variable prior to the final regression model.Results
Preoperative quadriceps strength (β?=?0.33; p?=?0.04) showed a significant relationship with knee extensor angular impulse during loading phase. No other predictor variable had any meaningful relationship with aberrant movement patterns (p?>?0.05).Conclusion
Our findings highlight patients' preoperative quadriceps strength as a meaningful predictor of postoperative performance. Preoperative quadriceps strength should be addressed when considering the knee's ability to contribute to higher demanding mobility tasks following surgery. 相似文献3.
Sophie Heywood Jodie McClelland Paula Geigle Ann Rahmann Elizabeth Villalta Benjamin Mentiplay Ross Clark 《The Knee》2019,26(1):61-72
Background
Closed kinetic chain and plyometric exercises are commonly used in aquatic rehabilitation because they are believed to reduce joint loading whilst replicating functional tasks. However, the forces and relationship to land-based functional movement is unknown. This study aims to compare vertical ground reaction force during squats, calf raises and jumping in older adults with and without knee osteoarthritis on land and in water.Methods
Forty one participants (Healthy n?=?21; Knee osteoarthritis n?=?20; Age 68.5 (4.4) years) completed squats and calf raises at slow, medium and maximal speeds and jumping at maximal speed on land and in waist and chest depth water. Vertical ground reaction force and pain rating was measured in each environment.Results
Force in all exercises was significantly greater on land than in chest depth water (p?<?0.005). Peak force was significantly greater at maximal speed compared to slow speed (p?<?0.001). The pattern of force in squats at slow speed in water was different to on land, with force highest at the start and end of the exercise and decreasing in the central phase. Pain ratings were significantly lower (p?<?0.001) in water compared to on land in squats.Conclusions
Closed kinetic chain exercises offer inherently different loading in an aquatic environment. Body weight squats and calf raises in water could be defined as either neuromotor or low load, high velocity training. Maximal speed exercise in water produces higher relative load compared to slow speed and minimal pain providing an opportunity for clinicians to use greater speed to address power deficits. 相似文献4.
Matthias Steinwachs Nicola Cavalcanti Santhosh Mauuva Venkatesh Reddy Clement Werner Daniel Tschopp Hema N. Choudur 《The Knee》2019,26(1):174-184
Background
CARGEL (Smith & Nephew Inc.), a chitosan-based polymer scaffolding biomaterial, has been used since 2012 for treating articular cartilage lesions. Limited data are available on patient outcomes following CARGEL treatment. This study aimed to describe short-term clinical and radiographic outcomes in a cohort of patients treated with CARGEL and microfracture surgery for articular cartilage defects in the knee.Methods
A retrospective cohort study was conducted of consecutive patients with articular cartilage defects who had undergone microfracture surgery with CARGEL, or in patellar lesions microfracture and CARGEL plus Chondro-Gide (at SportsClinic Zurich). Study outcomes included reoperations, infections, allergic reactions, pain, swelling, range of motion, and tissue quality and quantity. Ethics approval was obtained from the local ethics committee on 05/09/2017 (Basec. Nr: 2017-01441).Results
A total of 91 participants, with 93 treated lesions, consenting to chart review were included. No participants required reoperation due to complications on the index lesion. Fifteen participants had second-look surgery on the index knee for other reasons, allowing for visual confirmation of cartilage repair. No study participants experienced a post-surgical infection or suffered an allergic reaction. No significant changes in range of motion or T2 values were observed from pre-treatment to post-treatment follow-up. However, significant decreases were found in pain (P?<?0.001) and swelling (P?<?0.001), along with significant increases in MOCART II scores (P?<?0.001). Similar results were found in a subgroup of patients with patellar lesions.Conclusions
Patients treated with CARGEL experienced few postoperative complications and reported promising reductions in pain and swelling after treatment.Level of evidence
IV 相似文献5.
Background
The primary aim was to assess survival of opening wedge high tibial osteotomy (HTO) for medial compartment osteoarthritis. The secondary aim was to identify independent predictors of early conversion to total knee arthroplasty (TKA).Methods
During the 18-year period (1994–2011) 111 opening wedge HTO were performed at the study centre. Mean age was 45 years (range 18–68) and the majority male (84%). Mean follow-up was 12 (range six to 21) years. Failure was defined as conversion to TKA. Kaplan–Meier, Cox regression and receiver operating curve (ROC) analyses were performed.Results
Forty (36.0%) HTO failed at a mean of 6.3 years (range one to 15). By Kaplan–Meier analysis, the five-year survival rate was 84% (95% confidence interval (CI) 82.6–85.4), 10-year rate 65% (95% CI 63.5–66.5) and 15-year rate 55% (95% CI 53.3–56.7). Cox regression analysis identified older age (hazard ratio (HR) 1.07 for each additional year, 95% CI 1.03–1.11, p b 0.001) and female gender (HR 2.37, 95% CI 1.06–5.33, p?=?0.04) as independent predictors of failure. ROC analysis identified a threshold age of 47 years above which the risk of failure increased significantly (area under curve 0.72, 95% CI 0.62–0.81, p b 0.001). Cox regression analysis, adjusting for covariates, identified a significantly greater (HR 2.49, 95% CI 1.26–4.91, p?=?0.01) risk of failure in patients aged 47 years old or more.Conclusion
The risk of early conversion to TKA is significantly increased in females and those older than 47. These risk factors should be considered pre-operatively when planning intervention for isolated medial compartment osteoarthritis. 相似文献6.
Jae S. You Anne R. Wright Ian Hasegawa Brandon Kobayashi Matthew Kawahara Jordan Wang Cass K. Nakasone 《The Knee》2019,26(1):228-239
Background
Tibial osseous defects can present a serious challenge in primary total knee arthroplasty. We describe a technique of using porous tantalum cones along with primary arthroplasty implants to address large tibial osseous defects in primary total knee arthroplasty and present the short-term results.Methods
We present 17 cases (15 patients) in which primary total knee implants and porous tantalum cones were used to address large tibial bony defects. Clinical results were evaluated using Knee Society Scores, pre- and postoperative knee range of motion, and serial radiographs.Results
At an average of 3.5?years of follow-up, all 17 knees had functioning implants with stable metaphyseal cones demonstrating radiographic evidence of osteointegration. At a minimum follow-up of two years, no patient had signs of osteolysis, instability, infection, or systemic complications. All 15 patients had excellent results with an average post-operative Knee Society Score of 94.6. Knee flexion improved by an average of 12.0° and knee extension improved to neutral in all patients.Conclusion
Primary total knee arthroplasty with porous tantalum cone augmentation produced excellent short-term results and should be considered an effective method for addressing large tibial osseous defects in primary total knee arthroplasty. 相似文献7.
Tiana Raoul Shahnaz Klouche Baptiste Guerrier Badr El-Hariri Serge Herman Antoine Gerometta Nicolas Lefevre Yoann Bohu 《The Knee》2019,26(1):155-164
Background
The decision to return to sport following anterior cruciate ligament (ACL) reconstruction should not only be based on time since surgery. This study aimed to assess, using isokinetic and neuromuscular (hops) testing in a large group, postoperative objective functional recovery of the knee. The secondary objective was to determine the relationship between psychological, functional scores, and these postoperative tests.Methods
This prospective study included athletes who underwent surgery between 2013 and 2016 for an isolated full-thickness ACL tear. They received a complete evaluation of functional performance of the knee by isokinetic tests performed on a dynamometer to measure quadriceps and hamstring strength, and neuromuscular assessment based on single-leg hop tests. The main judgment criterion was satisfactory functional recovery (yes/no) defined as a difference of ≤ 10% both in the quadriceps 60°/s and the single hop at a minimum of four months of follow-up.Results
A total of 234 athletes were analyzed. The mean age was 28.4?±?8.6?years. At 6.5?±?1.7?months mean follow-up, 44 (18.5%) patients had satisfactory functional recovery of the knee. The correlations between isokinetic/hop tests and the different scores were variable. During follow-up, two patients presented with a graft tear and two with a contralateral ACL tear, all in the group with unsatisfactory functional recovery.Conclusion
At a mean of six months after ACL reconstruction, objective functional recovery of the knee was generally unsatisfactory and this seemed to be a risk factor for recurrent tears.Level of evidence
IV; case series. 相似文献8.
David Latz Erik Schiffner Johannes Schneppendahl Konstantin Klein Lisa Oezel Lars Fabian Seiler Pascal Jungbluth Robert Alexander Kaufmann Joachim Windolf Sebastian Viktor Gehrmann 《The Knee》2019,26(1):33-39
Background
One of the most important activities of daily living is operating a motor vehicle. With increasing age the prevalence of musculoskeletal disorders such as knee osteoarthritis may interfere with an individual's ability to do so safely. Physicians are tasked with determining a patient's ability to drive and yet the necessary joint range of motion required for driving a car has not been characterized.Methods
The range of motion of the right and left knees was recorded using electrogoniometers in 20 healthy subjects while driving a car on three route types (a) city streets, b) country roads and c) highways). Special emphasis was placed on the left knee associated with changing a gear.Results
The range of motion while driving is 40–80° for the right and 20–85° flexion for the left knee. A significant difference was noted for each side (p?<?0.01) with a higher flexion occurring in the left knee (p?<?0.01). The average position of the knee while changing a gear (beginning, maximum, ending) was: right: 55°±10°, 62°±10°, 53°±10°; left: 67°±7°, 39°±8°, 66°±8° (mean flexion±standard deviation).Conclusion
This study characterized the knee range of motion that occurs while driving a car. Our data suggests that common driving activities such as accelerating a vehicle or braking can be achieved with the right knee through a limited range of motion. The greater range of motion and the higher flexion of the left knee are mainly attributed to the gear changing. The present data may benefit physicians in their evaluation of driving capability. 相似文献9.
Background
A large majority of anterior cruciate ligament (ACL) injuries are non-contact, most often occurring during a landing or change of direction. Recent research indicates that cognitive factors may be involved in non-contact ACL injuries. The aim of this study was to determine if a game-situation perceptual–cognitive load leads to altered landing kinematics in physically fatigued female athletes.Methods
Nineteen female recreational athletes were recruited to perform a series of jumping and landing trials. In a first phase, eight trials were performed in an isolated condition and eight were performed while participants performed a perceptual–cognitive task. Before a second identical phase, participants underwent a muscular fatigue protocol. Knee-joint kinematics were recorded and compared between conditions using paired t-tests.Results
Muscle fatigue led to statistically significant increases in peak knee abduction and peak internal knee rotation as well as a decrease in maximum knee flexion, when comparing conditions without the perceptual–cognitive task. The perceptual–cognitive task had no statistically significant effect on any knee rotations, either pre- or post-fatigue. However, a subgroup of 12 athletes showed a significant increase in knee abduction in the presence of the perceptual–cognitive task, only in the fatigued condition.Conclusion
A perceptual–cognitive task combined with muscle fatigue alters knee kinematics of landing for a subset of recreational athletes, potentially increasing the risk of ACL rupture. Further studies are necessary to confirm this finding and to identify characteristics of at-risk individuals to target them for injury prevention protocols. 相似文献10.
Cedric Maillot Anthony Leong Ciara Harman Alberto Morelli Richard Mospan Justin Cobb Charles Rivière 《The Knee》2019,26(1):106-114
Background
The kinematic alignment (KA) technique for total knee arthroplasty (TKA) is an emerging implant positioning philosophy that aims to restore constitutional knee anatomy to improve knee kinematics. At present, the KA technique aims to reconstruct native femorotibial (FT) joint alignment, however there is still insufficient consideration towards the inter-individual trochlear anatomy variability. Poor trochlear restoration may compromise clinical outcomes. Our study aimed at assessing the anatomical relationship between the native trochlea and other FT anatomical parameters.Methods
Fifty-eight preoperative CT scans of low-grade knee arthritic patients were segmented to create 3D bone models. The FT and the PF anatomical parameters were measured using in-house software. Values were compared between different groups of lower limb and FT joint line (JL) orientation, and correlations between FT and PF anatomical parameters were assessed.Results
We were unable to detect any significant correlation between groove orientation (frontal and axial) or groove radius and either the hip–knee–ankle (HKA), or the lateral distal femoral (LDFA), or the medial proximal tibial (MPTA), or the FTJL-mechanical axis (FTJLMAA) Angles. When considering the correlation within sub-groups of limb or JL orientation, we only found a positive correlation (r?=?0.464, p?=?0.022) in the varus lower limb (HKA?≤?180°) sub-group between groove frontal orientation and LDFA.Conclusion
Our study shows that the determination of several limb, knee, and JL parameters is of poor value to predict individual trochlea anatomy. This raises the issue of how to improve femoral component design to achieve individualised FT and PF anatomical restoration with KATKA.Level of evidence
Level 1 – computational study. 相似文献11.
Kristoffer W. Barfod Julian A. Feller Taylor Hartwig Brian M. Devitt Kate E. Webster 《The Knee》2019,26(1):149-154
Background
Knee extensor strength and single limb hop for distance have been suggested as useful measures to evaluate readiness to return to sport after anterior cruciate ligament (ACL) reconstruction.The aim of the study was to examine the association between knee extensor strength and single leg hop for distance following ACL reconstruction and to determine the proportion of patients with knee extensor strength symmetry deficits at six and 12 months.Methods
From December 2013 to December 2015 69 patients aged 14 to 45 undergoing primary ACL reconstruction were recruited. Isokinetic concentric knee extensor strength testing and single limb hop for distance were performed six and 12 months postoperatively. Satisfactory knee extensor strength was defined as a leg symmetry index (LSI) ≥85%.Results
At six months 27.5% (19/69) of patients had recovered satisfactory knee extensor strength in the injured leg, improving to 46.4% (32/69) at 12 months. Recovery of satisfactory strength was associated with hopping distance. Hop symmetry was achieved considerably faster than knee extensor symmetry, with 66.7% (46/69) of patients demonstrating satisfactory hopping symmetry at six months, 89.9% (62/69) at 12 months. Recovery of hopping distance was not associated with knee extensor strength.Conclusions
Single leg hop test cannot be used as a surrogate measure for knee extensor strength as no association was found between hop tests and knee extensor strength. Less than one in three patients at six months and one in two at 12 months had recovered satisfactory knee extensor strength. 相似文献12.
Background
Total knee arthroplasty (TKA) remains the gold standard for end-stage knee osteoarthritis. The prevalence of stiffness after this procedure described in literature varies from 1.3% to 5.3%. The causes of arthrofibrosis after total knee arthroplasty are multifactorial. Revision TKA is a successful procedure when performed for loosening, instability, mechanical implant failure, or infection. The results of revision TKA for idiopathic arthrofibrosis and stiffening are however less favorable.Purpose
It has been the authors' impression that the poor results in arthrofibrosis could be in part related to the use of traditional PS or CCK-type revision implants. Our hypothesis is that better results can be achieved in case a rotating hinge design (RHK) is used. The reason could be that RHK designs allow for much more aggressive capsuloligament debridement and therefore more adequate fibrosis removal, while securing optimal implant stability, tibiofemoral rotational freedom, and flexion-extension space stability. The purpose of our study was to investigate in our database whether this hypothesis is correct.Methods
Retrospectively, 40 patients with the defined range of knee motion were identified. Patients with underlying mechanical malalignment, component malposition, soft-tissue imbalance or infections were excluded. Twenty-two patients received a hinged-type prosthetic device (18 Zimmer RHK, four Stryker RHK) and 18 patients received a less constrained condylar type prosthetic device (17 Legion CCK, one Vanguard CCK).Results
Preoperative data were similar for RHK as CCK-type implants except for knee pain score, which was significantly worse for the RHK group (36 vs 44, p?=?0.049). At two years of follow-up, compared to CCK, the RHK group demonstrated significantly better postoperative results for knee function scores (68.9 vs 54.2, p?=?0.0015), knee function improvement (22.8 vs 4.8, p?=?0.0015), knee pain improvement (26.4 vs 9.4, p?=?0.0050), greater maximal flexion (99.9° vs 81.4°, p?=?0.0005), better maximal extension (? 1.9° vs ? 6.2°, p?=?0.0447), greater flexion gain (35.8° vs 14.2°, p?=?0.0002), and greater extension gain (8.6° vs 2.0°, p?=?0.0083).Conclusion
Our data show that revision arthroplasty of the stiff knee using a rotating hinged device can provide excellent results in selected cases. To date, this is the first study to describe the difference in outcome between revision total knee arthroplasty for idiopathic arthrofibrosis using a hinged or a constrained condylar knee device. 相似文献13.
Background
There are limited reports about management of Knee flexion contracture (KFC) in haemophiliacs with Ilizarov technique. The aim of this study was to retrospectively analyzed the results of Ilizarov technique to treat KFC.Methods
Six patients with haemophilia A and one with haemophilia B were included in this study, with an average age of 17?years old. The mean preoperative KFC and flexion angle of the knee were 58?±?21° (mean ± standard deviation) and 127?±?12°, respectively. Preoperative HSS score (hospital for special surgery knee score) was 51?±?4. The average time of follow-up was 39.3?±?23.3?months.Results
All the patients achieved full correction of flexion contracture at the end of distraction and maintained at the last follow-up. The mean flexion angle at the end of distraction and at the last follow-up were 41?±?35° and 38?±?19° respectively, which were significantly lower than preoperative flexion angle. The mean HSS score at the end of distraction and at the last follow-up were 65?±?4 and 64?±?2 respectively, which were significantly higher than the preoperative HSS score. One patient suffered from transient numbness of left leg, and all the patients had loss of range of knee flexion at last follow-up.Conclusions
Ilizarov is an effective and safe procedure to treat KFC in haemophiliacs. However, loss of knee flexion was the most common complication. 相似文献14.
Annemie Smeets Bart Malfait Bart Dingenen Mark A. Robinson Jos Vanrenterghem Koen Peers Stefaan Nijs Styn Vereecken Filip Staes Sabine Verschueren 《The Knee》2019,26(1):40-51
Background
There is limited evidence on neuromuscular risk factors for anterior cruciate ligament (ACL) injuries, with most work mainly focusing on hamstrings and quadriceps muscle strength. This prospective pilot study explored if neuromuscular activation patterns of the quadriceps and hamstrings during a drop vertical jump influence ACL injury risk.Methods
Forty-six female athletes performed a drop vertical jump at baseline. Injuries were monitored throughout a one-year follow-up. Neuromuscular activation patterns of the vastus medialis, vastus lateralis, hamstrings medialis and hamstrings lateralis, and selected landing kinematic and kinetic profiles (knee flexion, knee abduction and hip flexion angles, and knee abduction moments), were compared between athletes who sustained a non-contact ACL injury and those who remained injury free. Electromyogram vector fields were created to represent neuromuscular activation patterns of muscle pairs around the knee joint rather than only considering individual muscle activations, and compared using Statistical Parametric Mapping.Results
Four athletes sustained an ACL injury. Significantly greater {hamstrings medials, hamstrings lateralis}, {vastus lateralis, hamstrings lateralis} and {hamstrings lateralis, vastus medialis} activations, mainly due to greater hamstrings lateralis activation, were found in the injured group around peak loading and just before take-off (P?<?0.001). No group differences were found in knee flexion, knee abduction and hip flexion angles, or knee abduction moments.Conclusions
This pilot study revealed initial evidence that athletes already showed altered neuromuscular activation patterns prior to sustaining an ACL injury, namely increased lateral and posterior muscle activations. 相似文献15.
Salman Nazary-Moghadam Mahyar Salavati Ali Esteki Behnam Akhbari Sohrab Keyhani Afsaneh Zeinalzadeh 《The Knee》2019,26(1):88-96
Background
Several investigations have studied gait variability of individuals with anterior cruciate ligament (ACL) deficiency; however, the effect of dual-tasking on the gait variability of these individuals remained unclear. The aim of the present study was to determine the effect of gait speed and dual-tasking on knee flexion–extension variability in subjects with and without ACL deficiency.Methods
The knee flexion–extension Lyapunov exponent (LyE) was measured in 22 ACL-deficient (Mean±SD) (25.95?±?4.69?years) and 22 healthy subjects (24.18?±?3.32?years). They walked at three levels of gait speed in isolation or concurrently with a cognitive task.Results
Repeated-measure analyses of variance (ANOVAs) demonstrated that the interaction of group by gait speed was statistically significant. As the gait speed increased from low to high, the knee flexion–extension LyE significantly decreased for the subjects with ACL deficiency (effect size: 0.57, P?=?0.01). The interaction of group by cognitive load was not statistically significant (P?=?0.07). In addition, the ACL-deficient subjects had statistically slower reaction times than healthy subjects during the dual-task compared with the single-task condition.Conclusions
The ACL-deficient and healthy individuals had a tendency to maintain safe gait. It seems that the ACL-deficient subjects sacrificed the cognitive task more than the healthy individuals to pay more attention toward gait. Additionally, it seems that the gait speed was more challenging than cognitive load on the stride-to-stride variability in the individuals with ACL deficiency. 相似文献16.
Background
The effect of the changes in the femoral posterior condylar offset (PCO) on anterior–posterior (AP) translation and internal–external (IE) rotation in cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) remains unknown. The purpose of this study was to compare the kinematics in CR and PS TKA with respect to the difference in prosthetic design and PCO change through a computational simulation.Methods
We developed three-dimensional finite element models with the different PCOs of ± 1, ± 2 and ± 3?mm in the posterior direction using CR and PS TKA. We performed the simulation with different PCOs under a deep knee bend condition and evaluated the kinematics for the AP and IE in CR and PS TKA.Results
The more tibiofemoral (TF) translation in the posterior direction was found as PCO translated in posterior direction for both CR and PS TKA compared to the neutral position. However, the change of the AP translation with respect to the PCO change in CR TKA was greater than PS TKA. The more TF external rotation was found as PCO translated in the anterior direction for both CR and PS TKA compared to the neutral position. However, unlike the TF translation, the TF rotation was not influenced by the PCO change in both CR and PS TKA.Conclusion
The PCO magnitude was influenced by a postoperative change in the kinematics in CR TKA although a relatively smaller effect was observed in PS TKA. Hence, surgeons should be aware of the PCO change, especially for CR TKA. 相似文献17.
Background
The purpose of this retrospective cohort study was to investigate the influence of parameters of malalignment on knee function 5?years post TKA and, additionally, to explore alterations in patellar height after TKA.Methods
All 661 patients undergoing TKA between 2010 and 2011 were considered for inclusion. Preoperative and 1-year postoperative short-leg radiographs were assessed for malalignment parameters: coronal tibial angle (cTA), sagittal tibial angle (sTA), femoral flexion angle (FFA) and mediolateral tibial mismatch. Patellar height was measured using the modified Insall-Salvati ratio. We determined improvements in knee function utilizing the Knee Society Score (Function score, KSS-F), Oxford Knee Score (OKS) and Algofunctional index (AI). Influences of malalignment parameters were analyzed univariate and selected (p?<?0.10) for multivariate linear regression analysis. Inter-observer reproducibility was assessed by test–retest analysis of 30 randomly selected radiographs and calculation of an intra-class correlation coefficient (ICC) for all radiographic parameters.Results
Three-hundred and four patients were included. Multivariate regression showed degrees of cTA malalignment to be significantly associated with only the KSS-F (β?=?? 3.52). Correction of coronal deformity was stronger associated with knee function (KSS-F β?=?2.81; AI β?=?? 0.36). Patellar height was significantly reduced after TKA (1.51 vs 1.44). Decrease of patellar height was weakly associated with the OKS (β?=?10.69). ICC scores were: cTA 0.81, sTA 0.57, IS 0.72, FFA 0.75.Conclusion
Postoperative coronal tibial plate alignment and correction of preoperative coronal deformity are associated with improved knee function 5?years post TKA. Decrease in patellar height was weakly associated with knee function. Short-leg radiography can be a sufficient screening tool for prosthesis alignment. 相似文献18.
N.D. Clement L.C. Walker K. Merrie M. Bardgett D. Weir J. Holland D.J. Deehan 《The Knee》2019,26(1):258-266
Background
The primary aim of this study was to assess whether patients dissatisfied with both recreational activities and overall outcome were different to those dissatisfied with recreational activities but satisfied with their overall outcome one year after total knee arthroplasty (TKA).Methods
A retrospective cohort consisting of 3324 primary TKA were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form (SF) 12 scores were collected pre-operatively and one year post-operatively. Overall patient satisfaction and satisfaction with recreational activities were assessed at one year.Results
The rate of patient satisfaction with recreational activities (n?=?2672, 80.4%) was significantly (odds ratio (OR) 0.47, 95% confidence intervals (CI) 0.41 to 0.54, p?<?0.001) lower than satisfaction with the overall outcome (n?=?2982, 89.7%). When adjusting for confounding variables older age (OR 1.03, p?=?0.008), increasing BMI (OR 1.05, p?=?0.01) and absence of hypertension (OR 0.66, p?=?0.02) were independent predictors of being dissatisfied with recreational activities in isolation. The one-year components and total WOMAC scores were significant (p?<?0.001) predictors of satisfaction with recreational activities and were reliable with an area under the curve of ≥ 0.82Conclusion
Patients of older age, higher BMI and without hypertension are more likely to be dissatisfied with recreational activities despite being satisfied with their overall outcome. 相似文献19.
J. Fürmetz J. Sass T. Ferreira J. Jalali L. Kovacs F. Mück N. Degen P.H. Thaller 《The Knee》2019,26(1):185-193