Hy-Flex II total knee system and range of motion

We developed the Hy-Flex II total knee and ligament balancing system (Hy-Flex II total knee) which provides (1) a flexion angle of at least 120 degrees or more, (2) a range of motion (ROM) comparable to or greater than that before surgery, and (3) occasional full flexion. The system design has several features: small posterior femoral condyle radius, a 4 degrees posterior tilting of the tibial joint surface, and equal tension of the bilateral soft tissues obtained by using a ligament tensor. From September 1997 to June 1999, Hy-Flex II total knee arthroplasty was carried out on 114 joints of 84 patients with rheumatoid arthritis. One year after surgery, the average flexion in our series was 122.1 degrees +/-15.0 degrees. The number of knees operated on which had a flexion angle of 120 degrees or greater was 82 (71.9%) 1 year after surgery among the total of 114 knees. In total, 94 (82.5%) joints obtained the same level or better than the preoperative flexion; 26 (22.8%) attained full flexion 4 weeks after the operation and 15 (13.1%), 1 year after the operation. These results suggest that this system will be able to achieve our aims in almost all rheumatoid knees.     

Gonarthrosis and empyema in geriatric patients. Combined synovectomy and KTEP implantation procedure

ISSUE: Is a one stage procedures with open synovectomy and implantation of cemented knee endoprostheses in patients with empyemas of the knee and concomitant osteoarthritis suitable to reduce morbidity and increase early mobility? METHOD: Three female patients (age [symbol: see text] 88 yrs.) with acute empyema of arthritic knee joints (Pathogen: Staph. aureus) were treated with open synovectomies and implantations of cemented TKA's in a one stage procedure at mean 3 days (1-6) after admission. After 4.6 months (3-6) we carried out the last clinical and radiographic examination and after 15 months (11-21) a telephone questionnaire. RESULTS: The mean operation time was 2.4 hrs. (2-3), the perioperative blood loss at mean 1040 cc (800-1180 cc) and patients received 4 units blood (4-5). Parenteral antibiotics were administered for at mean 21 days (18-25 d). 33 days (27-39) after surgery the patients could be discharged, all of them ambulated with a walker, the operated joints had no signs of infection and blood parameters i.e. leucocyte count, crp and ESR dropped. At the time of the latest follow up examination there were neither clinical nor radiographic any signs that infections recurred. Two patients ambulated with crutches, one still with a walker. The HSS-Score increased from preop. 54 pts. up to 80 pts. at the follow up. CONCLUSION: Due to our results, a one stage procedure with open synovectomy and implantation of cemented total knee endoprostheses seems to be a considerable alternative for the treatment of geriatric patients suffering from knee empyema and severe osteoarthritis.     

Bone Mineral Density in the Proximal Femur and Contralateral Knee After Total Knee Arthroplasty

Osteoarthrosis (OA) is often associated with pain and disability, which are relieved after total knee arthroplasty (TKA), but the nature of bone changes associated with OA is controversial. We examined preoperative hip and contralateral knee bone mineral density (BMD) in patients requiring TKA and monitored the BMD changes postoperatively. Sixty-nine patients, scheduled to have TKA for osteoarthrotic knees, had both hips and contralateral knee BMD measured by dual-energy X-ray absorptiometry (DXA) at the time of operation (baseline) and at 1 yr after operation. X-rays of the knee joints were also taken to evaluate the severity of OA. Preoperatively, 27% and 38% of the patients had total hip BMD Z-score more than 1 SD in the operated side and contralateral hips, respectively. In all regions of interest (ROI), the mean baseline BMD of the affected side proximal femur was significantly lower than that of the contralateral side (p < 0.0005-0.019). The severity of OA was not associated with BMD. During 1-yr follow-up, the postoperative knee status and the physical activity of the patients (AKS score) improved. However, neither the hip nor the nonoperated knee BMDs increased. Knee OA is associated with significantly lower BMD values in the affected side compared with the contralateral hip, and these levels remained similar or decreased during a 1-yr follow-up. We conclude that improved mobility after TKA does not improve the effects of preoperative disuse-associated bone loss in the short term.     

关节镜下前交叉韧带重建术后膝关节皮温变化的研究

目的探讨关节镜下前交叉韧带(anterior cruciate ligament,ACL)重建术后膝关节皮温变化的特点。方法2015年7月~2016年10月我院63例ACL重建,检测术前和术后3、6、12周(23例)双侧膝关节及周围皮肤温度,观察术后膝关节肿胀情况。结果健侧膝关节术前膝前方皮温低于膝内侧、膝外侧、髌骨上缘上方10 cm处大腿以及髌骨下缘下方10 cm处小腿皮温(P<0.05)。患侧术前、术后3和6周膝前与膝内侧温差差异有显著性(χ^2=41.608,P=0.000),术后3周患侧膝前和膝内侧温度接近,温差明显小于术前(P=0.000),术后6周温差与术前差异无显著性(P=0.069)。不同时间(术前、术后3和6周)膝前、膝内和外侧和大腿患侧皮温明显高于健侧(P<0.05),小腿患侧和健侧差异无显著性(P>0.05)。术后12周仅39.1%(9/23)的患者双侧膝前温度差>1℃。术后3、6周膝关节肿胀患者较不肿患者膝前温差明显升高(Z=-3.821,P=0.000;t=-5.181,P=0.000)。结论正常膝关节膝前方皮温较低,关节镜下ACL重建术后3、6周时皮温高于健侧,12周时接近正常。     

Vicon运动捕捉系统对单侧膝关节置换术后双侧膝关节生物力学的评价

目的探讨双侧膝关节骨关节炎患者单侧膝关节置换术后膝关节生物力学情况。方法应用Vicon运动捕捉系统采集30例双侧膝关节骨关节炎单侧膝关节置换术后行走数据,比较手术侧与非手术侧膝关节生物力学差异。结果手术侧与非手术侧膝关节生物力学存在明显差异。手术侧矢状面膝关节最大屈曲度、最大伸展度及最大活动范围较未手术侧增大(P<0.05);手术侧冠状面膝关节最大内翻度较未手术侧减小(P<0.05),手术侧冠状面膝关节最大外翻度较未手术侧增大(P<0.05);手术侧膝关节角速度和角加速度较未手术侧增快(P<0.05);手术侧膝关节屈曲力矩峰值较未手术侧增大(P<0.05),手术侧膝关节伸展力矩峰值较未手术侧减小(P<0.05);手术侧膝关节前后方向和垂直方向受力较未手术侧增大(P<0.05),手术侧膝关节左右方向受力较未手术侧减小(P<0.05)。结论采用Vicon运动捕捉系统对单侧膝关节置换术患者进行双侧膝关节生物力学评价可以准确地判断手术疗效和预测非手术侧手术时机。     

不同康复途径对膝关节脱位术后康复训练的影响

目的了解不同康复途径对膝关节脱位手术后康复训练效果的影响。 方法回顾性研究中国人民解放军联勤保障部队第九〇八医院2015年10月至2018年9月膝关节脱位合并韧带损伤的患者。按照纳入、排除标准，共纳入67例研究对象，根据术后患者康复锻炼的途径，分为2组，远程指导组39人、机构康复组28人。比较术后1年2组患者膝关节Lysholm评分、国际膝关节文献委员会膝关节评估表(简称IKDC评分)、关节活动度(ROM)、术后康复训练直接花费，行t检验，记录切口感染、急性骨筋膜室综合征、手术相关血管神经损伤等并发症情况。 结果2组患者术后1年的膝关节Lysholm评分(t＝－1.722)、IKDC评分(t＝－1.184)、ROM(t＝－1.695)大致相当(P>0.05)；但远程指导组术后康复训练直接花费(t＝－73.509)比机构康复组患者明显降低(P<0.05)。远程指导组中有2例(5.12%)、机构康复组中有1例(3.57%)出现手术切口红肿，均予以抗生素抗感染、伤口换药后治愈，随访期间未发现膝关节感染；所有患者均未出现骨筋膜室综合征或手术相关血管神经损伤。 结论膝关节脱位合并韧带损伤手术后采取远程视频指导下的康复训练，与在康复机构进行训练相比较，可以取得一致的膝关节功能恢复，但花费明显降低。     

Unicompartmental knee replacement in osteoarthritis: an 8-year follow-up

Between 1972 and 1974, 34 patients with medial osteoarthritis in the knee were operated on with unicompartmental femorotibial replacement. Four patients were reoperated on, three of whom had had a McIntosh inlay prior to the operation. Seven patients had died and two were lost at the follow-up which took place on average 8 years (7-10 years) after the operation. Of 21 re-examined knees, 14 were rated as successful or acceptable.     

Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden

During a validation process of the Swedish Knee Arthroplasty Register (SKAR), living registered patients were sent a questionnaire to ask if they had been reoperated on. This gave an opportunity to pose a simple four-point question with respect to patient satisfaction which 95% of patients answered. We analyzed the answers of patients operated on between 1981 and 1995 and found that only 8% of the patients were dissatisfied regarding their knee arthroplasty 2-17 years postoperatively. The satisfaction rate was constant, regardless of when the operation had been performed during the 15-year period. The proportion of satisfied patients was affected by the preoperative diagnosis, patients operated on for a long-standing disease more often being satisfied than those with a short disease-duration. There was no difference in proportions of satisfied patients, whether they had primarily been operated on with a total knee arthroplasty (TKA) or a medial unicompartmental arthroplasty (UKA). For TKAs performed with primary patellar resurfacing, there was a higher ratio of satisfied patients than for TKAs not resurfaced, but this increased ratio diminished with time passed since the primary operation. Unrevised knees had a higher proportion of satisfied patients than knees that had been subject to revision, and among patients revised for medial UKA, the proportion of satisfied patients was higher than among patients revised for TKA. We conclude that satisfaction after knee arthroplasty is stable and long-lasting in unrevised cases and that even after revision most patients are satisfied.     

Patient satisfaction after knee arthroplasty: A report on 27,372 knees operated on between 1981 and 1995 in Sweden

During a validation process of the Swedish Knee Arthroplasty Register (SKAR), living registered patients were sent a questionnaire to ask if they had been reoperated on. This gave an opportunity to pose a simple four-point question with respect to patient satisfaction which 95% of patients answered. We analyzed the answers of patients operated on between 1981 and 1995 and found that only 8% of the patients were dissatisfied regarding their knee arthroplasty 2-17 years postoperatively. The satisfaction rate was constant, regardless of when the operation had been performed during the 15-year period. The proportion of satisfied patients was affected by the preoperative diagnosis, patients operated on for a long-standing disease more often being satisfied than those with a short disease-duration. There was no difference in proportions of satisfied patients, whether they had primarily been operated on with a total knee arthroplasty (TKA) or a medial unicompartmental arthroplasty (UKA). For TKAs performed with primary patellar resurfacing, there was a higher ratio of satisfied patients than for TKAs not resurfaced, but this increased ratio diminished with time passed since the primary operation. Unrevised knees had a higher proportion of satisfied patients than knees that had been subject to revision, and among patients revised for medial UKA, the proportion of satisfied patients was higher than among patients revised for TKA. We conclude that satisfaction after knee arthroplasty is stable and long-lasting in unrevised cases and that even after revision most patients are satisfied.     

Patient satisfaction after knee arthroplasty: A report on 27,372 knees operated on between 1981 and 1995 in Sweden

During a validation process of the Swedish Knee Arthroplasty Register (SKAR), living registered patients were sent a questionnaire to ask if they had been reoperated on. This gave an opportunity to pose a simple four-point question with respect to patient satisfaction which 95% of patients answered. We analyzed the answers of patients operated on between 1981 and 1995 and found that only 8% of the patients were dissatisfied regarding their knee arthroplasty 2-17 years postoperatively. The satisfaction rate was constant, regardless of when the operation had been performed during the 15-year period. The proportion of satisfied patients was affected by the preoperative diagnosis, patients operated on for a long-standing disease more often being satisfied than those with a short disease-duration. There was no difference in proportions of satisfied patients, whether they had primarily been operated on with a total knee arthroplasty (TKA) or a medial unicompartmental arthroplasty (UKA). For TKAs performed with primary patellar resurfacing, there was a higher ratio of satisfied patients than for TKAs not resurfaced, but this increased ratio diminished with time passed since the primary operation. Unrevised knees had a higher proportion of satisfied patients than knees that had been subject to revision, and among patients revised for medial UKA, the proportion of satisfied patients was higher than among patients revised for TKA. We conclude that satisfaction after knee arthroplasty is stable and long-lasting in unrevised cases and that even after revision most patients are satisfied.     

Results of the Elmslie-Trillat procedure in cases of patella(sub)luxation related to chondral pathology

Between May 1981 and December 1993, 120 patients (126 knee joints) were operated using the Elsmlie-Trillat procedure because of patella(sub)luxation. 79 patients were reviewed at an average follow up of 4.1 (1-13.6) years. 46 women and 33 men were operated with an average age at operation of 26.9 (14-59) years. The examination included Bentley's Score, radiological parameters (e. g. grading of patella dislocation), grading of chondromalacia and patient characteristics (e. g. age, pre-operative time). 64 knee joints (70. 3 %) were evaluated 'very good' and 'good', using the score of Bentley. There were significantly worse results in cases with higher grading of chondromalacia (p <0.0036), longer pre-operative time (p < 0.012) and older patients (p < 0.0023). The worst and most highly significant results were in these patients with prior knee surgery (p < 0.0001). A good patella relocation correlated with improved results (p < 0.001). There was no difference in cases with patella dislocation and/or patellasubluxation. In conclusion, the Elmslie-Trillat procedure should be carried out 'in the correct manner and at an early stage'. To optimise the therapy in cases of patella dislocation the high number of operation techniques should be analysed and used regarding risk groups.     

腰椎退行性病变合并下肢关节退变性关节病治疗方法探讨

目的：探讨中老年患者腰椎及下肢关节退变性疾病的相互关系、诊断和治疗方法。方法：回顾自`1997年11月-2002年5月收治的腰椎退变合并髋或膝关节退变性疾病的患者50例，男14例，女36例；平均年龄60.5岁（45-76岁）。腰椎病变中，单纯腰椎管狭窄13例，腰椎管狭窄合并腰椎滑脱12例，腰椎管狭窄合并退变性脊柱侧凸25例。关节病变中膝关节骨关节炎40例58膝，骨关节骨关节炎6例10髋，髋、膝关节同时病变者4例6膝5髋。结果：所有患者均接受腰椎手术，包括L1前路减压植骨“z“形钢板内固定5例，其余45例全部行后路减压，伴节段性不稳者行椎弓根内固定术。50例患者中，11例（14个关节）先于腰椎手术行关节镜或关节置换，关节和腰椎手术间隔时间平均为9.7个月(1.5-29个月)；3例（3膝）关节置换后于腰椎手术，平均手术间隔时间17.3个月（4-36个月）；3例（3髋）在一次麻醉下同时行腰椎手术和髋关节置换。其余未行关节手术的33例患者中，12例因腰椎术后症状缓解而未行任何处理,21例腰椎术后关节病变行保守治疗后症状缓解。全部患者平均随访14.2个月（3-45个月）。与术前相比，平均膝关节HSS评分、髋关节Harris评分和腰椎JOA评分分别提高了38.2、42.5和17.8分。结论：同时合并腰椎和关节退变性疾病的中老年患者，最重要的是先作出明确的诊断，认清引起不同症状的原因。先解决主要疾病，必要时分阶段手术解决腰椎和关节病变。     

Outcome of arthroscopic meniscectomy a 13-year physical and radiographic follow-up of 43 patients under 23 years of age

We reexamined 43 patients with stable knees at a mean of 13 years after arthroscopic meniscectomy. The patients had a maximum age of 22 years at the operation and no patient had had previous surgery on the involved knee. At the follow-up examination, no differences in range of motion, muscle strength or tibial A/P displacement were seen between the operated and the nonoperated knees and 36 patients had no problem with their knee in daily life. Radiographic changes were found in the operated knee in 20 patients and in the nonoperated knee in 5 patients. 8 patients had a reduction of the joint space on the involved side, but none had more severe changes. Cartilage fibrillation at the index arthroscopy did not increase the radiographic changes at follow-up, but radiographic changes were commoner after subtotal meniscectomy (7/8) than after partial meniscectomy (17/35). These findings are similar to previous studies of arthroscopic meniscectomy of medium duration and do not differ considerably from studies of open meniscectomy.     

中老年人半月板损伤的关节镜诊断治疗

目的总结中老年人半月板损伤的特点及关节镜下治疗的效果. 方法 2001年10 月～2004年5月,对52例57膝半月板损伤患者行关节镜下诊断与治疗.其中男20例,女32例,年龄52～78岁,平均65岁.膝关节病史1～21年.关节镜下见半月板水平破裂19膝,退行性破裂13膝,复合型破裂9膝,纵形破裂5膝,斜形破裂4膝,横形破裂4膝,瓣形破裂3膝.镜下缝合3膝,行半月板全切或部分切除54膝. 结果术后患者均获随访6～15个月,平均9个月.按董天祥等膝关节镜下疗效评价标准：优39膝,良12膝,中6膝,优良率89.5%. 结论中老年人半月板损伤症状体征不典型,关节镜下半月板治疗疗效满意且创伤小.     

Ten-year survival analysis of the PFC total knee arthroplasty-a surgeon’s first 99 replacements

Ninety-seven patients with 99 total knee arthroplasties were operated on by a surgeon in the first 3 years of his surgical career. Complete survival data were available for all 99 knees. The cases were reviewed at a minimum of 10 years after their initial operation, but as 37 patients had died before reaching 10 years, the average follow-up was 8 years 8 months with a maximum of 12 years 4 months. Ninety-one patients had osteoarthritis, five had rheumatoid arthritis, and three had juvenile chronic arthritis. No patients were lost to follow-up. Four required revision. The 10-year survival rate, using revision for all causes as an end-point, was 94.96%. The survival rate for aseptic loosening was 97.04%. The survival rate for loose joints that had not been revised was 94.13%. Three of the four revisions occurred in the first 6 patients operated upon, suggesting there may be a learning curve for surgeons at this stage in their career.     

Simultaneous bilateral total knee arthroplasty

Total knee arthroplasty (TKA) was performed simultaneously on both knees by two teams in a single procedure. The study population consisted of 74 patients (148 knee joints) with osteoarthritis (OA) or rheumatoid arthritis (RA). The peri- and postoperative results were compared with those in a group of 22 OA and RA patients (44 knee joints) who underwent staged operation during one hospital stay. Comparisons were made of functional score and range of motion (ROM) before and after operation, mean total blood loss, operative time, duration of hospital stay, and operative and postoperative complications. The simultaneous performance of bilateral procedures did not influence the functional score, ROM after operation, or mean intra- and postoperative blood loss. Nor was incidence of operative and postoperative complications increased compared with that in the staged operation group. The operative time in the simultaneous TKA group was significantly shorter than the time that would have been required had separate procedures been performed on both knees. Simultaneous bilateral TKA is beneficial for the patient.     

关节镜下治疗不同时期胫骨髁间棘骨折

目的评价关节镜治疗早期及延期胫骨髁间棘骨折的手术方法及疗效。方法关节镜下治疗33例胫骨髁间棘骨折,其中早期手术（≤2周）17例,延期手术（〉2周）16例,比较两组膝关节功能恢复程度。结果 33例均获随访,时间26~28个月。骨折临床愈合时间6~9个月。无感染、关节强直等并发症发生。X线片显示33例均达解剖复位。关节功能恢复按Lysholm标准评定：早期手术组优秀15例,满意2例;延期手术组优秀8例,满意6例,差2例;两组比较差异有统计学意义（P〈0.05）。结论关节镜下治疗胫骨髁间棘骨折是一种非常有效的方法,早期手术（≤2周）比延期手术（〉2周）膝关节功能恢复更好。     

Effusions in the knee in elderly patients who were operated on for fracture of the hip

The incidence of an effusion in the knee in 155 consecutive elderly patients who had been operated on for a proximal femoral fracture was studied. The preoperative incidence had been 7.7 per cent in the ipsilateral knee and 1.3 per cent in the contralateral knee. Postoperatively, fifty patients (32.3 per cent) had an effusion on the ipsilateral side. In seven of them, the effusion had been present before the operation. All of the effusions subsided completely within three weeks after the operation. Results of the laboratory analysis of a specimen of the effused material from eight patients who were chosen at random showed non-inflammatory fluid. Probably the effusions were traumatic in origin, and it is likely that they were a response to stresses that had been incurred during the operation or at the time of fracture.     

盐酸氨基葡萄糖治疗膝退行性骨性关节炎的临床观察

目的 评价盐酸氨基葡萄糖治疗膝退行性骨性关节炎 (degenerative osteoarthritis,DOA) 的临床疗效. 方法 2006 年2月-2007 年1月,采用盐酸氨基葡萄糖治疗60例膝DOA患者.男15例,女45例;年龄 41～67岁,平均 57.5 岁.病程6个月～3年.每日2次,每次750 mg,6周为1个疗程,4个月后重复1个疗程.所有患者经过2个疗程治疗后,采用国际 DOA 的评分标准 --Lequesne 指数评定膝关节休息痛、运动痛、压痛、关节活动度、晨僵及行走能力. 结果 治疗期间3例患者产生不良反应,发生率为5%,未作特殊处理后恢复.60 例患者均获随访 8～11个月,平均9.6个月.经治疗后,31例DOA各种临床症状完全消失,治愈率为 51.7%;27 例临床症状有不同程度减轻,好转率为45.0%;总有效率为 96.7%.膝关节休息痛、运动痛、压痛、关节活动度、晨僵及行走能力治疗后评分分别为(0.5±0.2)、(0.7±0.4)、(0.8±0.3)、(0.9±0.4)、(0.6±0.3)及(0.9±0.4) 分,治疗前各项评分为( 1.6±0.5)、(2.1±0.4)、(2.2±0.5)、(1.8±0.6)、(1.7±0.4)及(2.0±0.4)分,治疗前后比较差异有统计学意义(P<0.01). 结论 盐酸氨基葡萄糖对治疗膝 DOA 具有缓解临床症状,改善关节功能的作用.     

Total replacement of the femur with simultaneous total hip and knee joint endoprostheses with plasma sprayed ceramic coating

A method of prosthetic replacement using total femur incorporating its total hip and knee joints is reported. On the surface of the titanium endoprosthesis was plasma-sprayed a ceramic coating to prevent loosening of the prosthesis. It can preserve the limb and restore the function in a short period. It can be used in certain non-malignant tumours and diseases of the bone with extensively destructive lesions of the entire femur. This method was used in 3 patients with good results. The operated patients were followed-up for 32-70 (mean 54) months. Types of procedures and advantages of the operation are presented.