Understanding online ratings of joint arthroplasty surgeons: A national cross-sectional analysis

BackgroundPatient reviews provide an important referral source for physicians and an opportunity to improve practice performance. This study's objective was to characterize the online reviews of hip and knee arthroplasty surgeons published by three of the industry's leading platforms.MethodsA random sample of 1000 hip and knee arthroplasty surgeons across all 50 US states (10 hip and 10 knee surgeons per state) was generated using Google Search. A total of 7842 online reviews posted for those surgeons on Healthgrades, Vitals, and Google were analyzed. A range of surgeons, affiliated hospitals, and reviewer attributes was compared to identify significant predictors of patient satisfaction.ResultsThe study cohort had 98.1% male surgeons with a mean age of 53.55 ± 8.94 years and mean experience of 26.43 ± 9.21 years. Younger age (p < 0.001), shorter years of experience (p < 0.001), and arthroplasty fellowship training (p < 0.001) were associated with more positive ratings. Reviewer anonymity, observed in 30.93% of all reviews, tended to correlate with more negative ratings (p < 0.001). Overall, 86.93% of patient remarks were positive, and only 74.81% of remarks centered on physician attributes. The five leading components of patient satisfaction were perceptions of physician competence (34.81%, p < 0.001), bedside manner (23.83%, p = 0.002), and communication (16.17%, p = 0.94); interactions with physician extenders (14.75%, p < 0.001); and wait time (2.73%, p < 0.001).ConclusionWhile most ratings of hip and knee arthroplasty surgeons were positive, more than a quarter of reviews were either not directly related to the individual surgeons or were submitted anonymously. Caution is advised regarding overreliance on patient experience surveys as predictors of physician performance.     

感染后关节的初次人工关节置换术

目的：探讨关节感染后骨关节炎患者行初次人工关节置换术的特点及治疗原则。方法：回顾性研究既往有关节感染史的8例初次全髋和全膝关节置换术病例，其中化脓性感染6例，结核性感染2例。全髋关节置换6例，手术时平均年龄38．1岁(24—51岁)，感染平均静止22．0年(6—30年)。全膝关节置换2例。行关节置换术前，常规进行白细胞计数、血沉、C反应蛋白等检查以除外活动性感染。术后随访2-11年。结果：既往有髋关节感染者患肢均有明显短缩畸形．股骨上段发育异常，并伴有屈曲挛缩畸形。所有患者术前均无活动性感染。化脓性感染的6例，5例感染静止20年以上者均无感染复发：1例感染静止6个月后行全膝关节置换者，术后9个月感染复发，结核感染的2例术后均无感染复发。1例全髋关节置换患者在术后1年出现假体柄无菌性松动，其余患者功能良好，结论：关节感染后骨关节炎患者年龄相对较轻．关节置换手术难度较大，易出现并发症，术前应先排除活动性感染．在感染静止相当一段时间后进行一期置换．可以取得较好的临床效果。     

初次全髋关节置换术后5年以上随访结果

目的对本组行初次全髋关节置换术（THA）5年以上的患者进行临床及影像学随访,探讨其疗效、并发症及其影响因素。方法对北京协和医院骨科2006年以前行THA并具有完整临床资料的248例（285髋）患者进行临床及影像学随访。截至末次随访时,174例（198髋）获得随访,随访率为70.2%,随访时间平均为7.6年（5.5~11.6年）。临床随访包括术前术后Harris评分及各种并发症。影像学评估包括双侧髋关节正位（或骨盆正位）、患髋侧位片,判断人工假体位置、假体周围骨质以及并发症情况。结果术前Harris评分平均为34.4分（0~86分）,末次随访时平均为88分（35~99分）,优良率为88.5%。术后假体总的生存率为97.1%。术后并发症包括跛行（9例）、异位骨化（8髋）、脱位（7例）、假体松动（2例）和感染（3例）等。结论本组病例整体疗效满意、假体生存期长,随访率偏低、病例数偏少,因此有待于进一步随访。     

关节感染后继发性骨关节炎人工关节置换治疗的初步探讨

目的探讨关节感染后继发骨关节炎患者行初次人工关节置换术的特点及治疗原则。方法回顾性分析既往有关节感染史的15例初次全髋和全膝关节置换术病例,其中化脓性感染5例,结核性感染10例。全髋关节置换7例,全膝关节置换8例,手术时平均年龄（53．5±7．7）岁,感染平均静止（41．5±35．8）个月。行关节置换术前常规进行白细胞计数、血沉、c反应蛋白检查,并穿刺取关节液、滑膜组织等进行细菌培养以明确感染活动状态。结果所有病例术前白细胞计数、血沉、c反应蛋白正常,关节液、滑膜组织细菌培养阴性,组织学检查明确关节无活动性感染。采用一期关节置换,无论膝关节还是髋关节,均获得满意的关节功能恢复,术后随访（2．6±1．6）年,随访过程中均未出现感染复发。结论关节感染后继发骨关节炎病例,通过血清免疫学检查、关节液、滑膜组织细菌培养、组织学检查排除活动性感染,保持静息状态相当一段时间后行一期关节置换,可明显改善关节活动功能,取得较好的临床效果。     

Robotic arm-assisted arthroplasty: The latest developments

Joint arthroplasty is an effective method for treating end-stage joint lesions and damages. Robotic arm-assisted arthroplasty, a rapidly developing technology that combines navigation technology, minimally invasive technology, and precise control technology of the robotic arm, can achieve accurate preoperative planning, optimal selection of implants, minimally invasive surgery, precise osteotomy, and accurate placement of the artificial joint. It has the characteristics of high accuracy and stability, and thus is more and more widely used in the field of joint surgery. In this paper, we systematically reviewed the application and clinical efficacy of robotic arm-assisted technology in hip and knee arthroplasty to provide reference for its future promotion.     

Cost benefit analysis of the use of tranexamic acid in primary lower limb arthroplasty: A retrospective cohort study

AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid (TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients (control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients (TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken.RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender (P = 0.47), proportion of total hip replacement to total knee replacement (P = 0.25) or pre-operative haemoglobin (P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2% (P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55 g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group (P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group (P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.     

非骨水泥型髋假体进行髋关节翻修的四年随访研究

目的　评价非骨水泥型髋关节系统治疗人工全髋关节翻修术的术后中期临床随访效果。方法　自1996年11月至2001年1月,对55例56髋关节行翻修术,采用了Zweymüller非骨水泥人工髋关节系统,年龄30~80岁,平均59岁。均有至少两年以上的临床和放射学追踪资料,平均随访时间4年。结果　32例32髋得到随访, 23例24髋失访。有3例出现围手术期并发症: 1例为假体取出时大转子骨折, 1例为术后2d脱位并成功闭合复位, 1例为伤口深部感染需要再次清创。无髋臼及股骨柄假体需要再度翻修。Harris评分由术前平均40 6分提高到最末次随访平均80 4分。X线片示髋臼和股骨柄假体位置满意,无松动和感染征象,周围骨质内向长入。结论　中期临床结果显示,初次用骨水泥和非骨水泥固定人工髋关节置换失败的病例,若髋臼环完整,使用非骨水泥型髋关节假体可以获得良好的临床效果。     

Two-stage arthroplasty for septic arthritis of the hip and knee: A systematic review on infection control and clinical functional outcomes

IntroductionSeptic arthritis of the native hip and knee joint poses particular challenges to orthopedic surgeons. Patients often suffer from several comorbidities, and it could be challenging to find a balance between infection control and adequate function. Two-stage arthroplasty has been addressed as a reliable solution, however the literature on the topic is composed of case series with small sample size. This systematic review aimed to analyze data on infection control and clinical functional outcomes of patients who underwent two-stage arthroplasty for septic arthritis of the hip and knee.MethodsAn electronic search of studies published from January 1st, 2000, to June 1st, 2021, was conducted using eight different databases. Following the Cochrane Handbook of Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Revies and Meta-analysis two authors reviewed the available literature and reference lists to identify papers eligible for inclusion.ResultsA total of 21 studies were included, involving 435 procedures. The mean age was 57.3 ± 6.2 (45.8–71.8) years. The mean follow-up was 53.7 ± 18.6 (12–86.7) months. The mean infection eradication was 93.3 ± 6.4%. Mean Harris Hip Score improved from 32.1 ± 10.6 (11.5–42.9) to 87.5 ± 5.7 (80.6–97.8). Mean Knee Society Score improved from 42.9 ± 7.6 (35.9–58.0) to 86.1 ± 5.4 (80.1–96.0).ConclusionsTwo-stage arthroplasty for hip and knee septic arthritis provided high infection control rate and excellent function. Further high-quality studies should be oriented on providing a validated algorithm for diagnosis and treatment of this condition.Level of evidenceLevel IV, systematic review of Level III and IV studies.     

羊膜移植髋关节成形术的临床研究

目的：了解胎盘羊膜经冷藏保存后及植入人体髋关节后的组织学改变。方法：对新鲜羊膜,冷藏保存1个月、2个月、3个月、半年、1年的羊膜以及植入髋关节的羊膜活检后经光镜及电镜检查。结果：冷藏羊膜上皮细胞的胞膜及核心膜保存完整,而细胞核心、细胞质和细胞器均发生不同程度的退变。植入髋关节的羊膜先化生为纤维软骨,4个月左右开始化生为透明软骨并形成新的关节囊,内补滑膜组织,1年左右可化生为类透明软骨。结论：胎盘羊膜植入人体髋关节后在持续活动的刺激下可化生为透明软骨,对关节功能的恢复可起到重要作用。本研究结果为髋关节成形术又增加了一个新方法。     

Computer assisted total knee arthroplasty: 2.5 years follow-up of 200 cases

IntroductionComputer assisted surgery in total knee arthroplasty (TKA) should improve accuracy of both femoral and tibial components placement. This study evaluated the functional outcomes of computer navigated total knee arthroplasty through the Knee Society Score (KSS) and Tegner Lysholm Knee Scoring Scale (TLKSS).Materials and methodsBetween September 2007 and February 2013, 180 patients (200 knees; 109 females and 71 males; mean age: 64 years) undergoing computer-assisted TKA were recruited. Plain radiographs and CT scans were performed post-operatively to evaluate alignment. The clinical outcomes were measured using the KSS and TLKSS pre-operatively and after 6, 12 and 36 months.ResultsThe mean follow-up duration was 2.5 years. The mean tourniquet time was 72 ± 13.4 min, and patients received an average of 0.6 ± 0.82 units of blood after surgery. The average preoperative KSS functional score of 44.6 ± 13.7 improved to 80.4 ± 16.4 after 2 years. The average preoperative TLKSS improved to 71.4 ± 13.5 after 2 years. The mechanical axis was within ±3° in all patients. No axial malalignments were observed on TC Scan. Three patients (1.6% of cases) required revision.ConclusionComputer assisted TKA allows reproducible alignment and kinematics, reducing outliers, provides ligament balancing and ensures good short term outcomes in terms of KSS functional score and TLKSS.     

Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced femoral neck fractures in patients over 70 years old

Objective:Total hip arthroplasty (THA)and hemiarthroplasty (HA) are effective methods currendy used to treat femoral neck fracture in elderly patients,but the two options remain controversial in patien...     

Pre-operative patient education reduces length of stay after knee joint arthroplasty

INTRODUCTION

The aim of this study was to evaluate the impact of a pre-operative education programme on length of hospital stay after surgery for primary and revision knee arthroplasty patients. The programme was introduced at our hospital in October 2006 to encourage patients to play an active role in their recovery process after surgery.

PATIENTS AND METHODS

A multidisciplinary team educated knee arthroplasty patients about their care pathway, knee surgery, pain management, expected discharge goals, in-patient and out-patient arthroplasty rehabilitation. Prospective data were collected from 472 consecutive patients who underwent (primary or revision) knee arthroplasty in the period between January 2006 and November 2007. Patients were separated into two groups, one that received conventional pre-operative treatment (n = 150; Conventional group) and another that received the pre-operative education (n = 322; Education group). Length of hospital stay was compare using the Mann Whitney U test. In-patient complications, hospital re-admissions within 24 h and 3 months of hospital discharge were compared using the chi-squared test.

RESULTS

The mean length of stay was significantly reduced from 7 days in the Conventional group to 5 days in the Education group (P < 0.01). In addition, 20% more patients were discharged early (within 1–4 days) in the Education group compared to the Conventional group (P < 0.01). There was no difference in the percentage of in-patient complications and re-admissions in 24 h (P = 1.00) and 3 months of discharge (P = 0.92) between the two groups.

CONCLUSIONS

The results suggest that pre-operative education is a safe and effective method of reducing length of stay for knee arthroplasty patients.     

Total knee arthroplasty in the valgus knee

Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10 % of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.     

髋关节牵伸器在重度髋关节发育不良关节成形术中的应用

目的 探讨髋关节牵伸器在重度髋关节发育不良关节成形术中的应用价值.方法 2006年4月至2008年10月对6例(9髋)CroweⅣ型髋关节发育不良及1例(2髋)髋内翻继发髋关节发育不良患者行关节成形术,男2例,女5例;年龄12～5岁,平均30岁.术前用自行研制的髋关节牵伸器牵伸髋关节,首次牵开1.0～2.0 cm,次日开始以1 mm/d速度缓慢牵伸,直至股骨头降至真臼旋转中心水平.更换为皮牵引,重量3kg,牵引针眼愈合后行关节置换术6例(10髋)、臼盖成形术1例(1髋).结果 6例(9髋)的股骨头或大转子顶端牵伸至真臼旋转中心水平.牵伸距离4.0～5.5 cm,平均4.45 cm;牵伸时间30～60 d,平均43 d.无坐骨神经损伤及针眼严重感染发生.关节成形术中未行软组织松解及股骨短缩截骨.1例(2髋)在一侧髋关节牵伸至6.0 cm时加快牵伸速度为1.25 mm/d,12 h后出现腓深神经不全损伤.行分期全髋关节置换,术中股骨短缩截骨3 cm,腓深神经不全损伤半年后恢复.全部患者随访1.5～3.0年,平均2.5年.均获得双下肢等长,臀中肌肌力增加1～2级.Harris髋关节评分由术前平均56.2分提高至术后1年92.2分.结论 髋关节牵伸器可将股骨头牵伸至真臼旋转中心水平,行关节成形术时无须软组织松解及股骨短缩截骨,可减少创伤,缩短手术时间,改善外展肌功能.应严格按照1mm/d速度牵伸,以免引起神经损伤.     

膝关节单髁置换术治疗晚期膝关节自发性骨坏死

 目的 探讨膝关节单髁置换术治疗晚期膝关节自发性骨坏死的手术技术与疗效。方法 回顾性分析2009年1月至2013年6月收治的27例（27膝）采用膝关节单髁置换术治疗的晚期膝关节自发性骨坏死患者的病例资料。男12例,女15例;年龄52~82岁,平均（64.6±8.6）岁。体重指数18.0~30.2 kg/m²,平均（24.2±2.9） kg/m²。左侧13例,右侧14例。均发生在内侧间室,位于股骨远端内侧髁25例,胫骨内侧平台2例。Mont膝关节骨坏死分期Ⅲ期11例,Ⅳ期16例。采用Biomet公司第3代Oxford单髁假体行膝关节单髁置换术。术后3、6、12个月及以后每年随访1次。对患者满意率、膝关节疼痛视觉模拟评分（visual analogue scale,VAS）、关节活动度、HSS膝关节评分进行评估。结果 全部病例随访6~59个月,平均27.8个月。随访期间无感染、假体脱位、假体松动、下肢静脉血栓形成、肺栓塞、心脑血管意外、创伤后精神障碍等并发症发生。1例于术后3年发生车祸致胫骨平台外侧骨折及股骨内侧髁撕脱骨折而行翻修术。1例出现股骨假体旋转超过10°,1例出现胫骨下透光线。末次随访时患者满意率为96.3%（26/27）;疼痛VAS评分由术前（6.9±0.9）分降至（2.0±1.1）分;HSS膝关节评分由术前（61.3±9.7）分增至（93.0±4.8）分,优良率96.3%（26/27）;膝关节活动度为125.7°±9.6°;股胫角为177.7°±3.1°。结论 膝关节单髁置换术治疗晚期膝关节自发性骨坏死近期疗效满意,具有创伤小、症状改善明显、术后关节功能良好的特点。     

Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program.

BACKGROUND: Deep wound infection (DWI) in total knee (TKA) and total hip (THA) arthroplasty has been shown to highly correlate with superficial surgical site infection (SSSI). Although several studies have reported hospital factors that predispose to SSSI, patient factors have not been clearly elucidated. METHODS: All patients undergoing TKA (n = 1181) and THA (n = 1124) surgery during the period 1977-1995 at our institution were observed at the end of a 30-day post-operative period. Thirty-three patients that developed SSSI during this period constituted the study group. The control group was composed of 64 matched subjects that did not develop SSSI. A chart review was applied to abstract DWI cases during the first 18 post-operative months for the study group and for an average of 6.7 years for the control group (range 5-18.2 years). Potential risk factors for SSSI were used as predictors of SSSI in a logistic regression analysis. RESULTS: During the 18-month observation period 19 out of the 33 study subjects (58%) developed DWI. No DWI was registered in the control group (the difference was significant, p < 0.0001). Of the nine pre-operative, five intra-operative, and five postoperative factors examined, only hematoma formation (odds ratio = 11.8; p = 0.001) and days of post-operative drainage (odds ratio = 1.32; p = 0.01) were significant predictors of SSSI. The cases consumed more health care resources at all stages of the medical process. CONCLUSIONS: Our results (1) confirm the strong correlation between the probability of developing DWI and SSSI; (2) indicate that hematoma formation and persistent post-operative drainage increase the risk of SSSI. We hypothesize that post-operative monitoring of patients for hematoma and persistent drainage enables earlier intervention that may lower the risk of developing SSSI and subsequent DWI.     

全髋关节及全膝关节置换术后隐性失血的临床影响

目的探讨人工全髋关节置换术（THA）和人工全膝关节置换术（TKA）术后隐性失血的相关机制及对临床的影响.方法2001年3月至2005年5月,行THA 61例,其中男22例,女39例;年龄61～79岁,平均68岁.同期行TKA73例,其中男23例,女50例;年龄65～77岁,平均73岁.所有病例均为初次行单侧关节置换的患者,24h补液总量不超过2000ml.通过Gross方程,根据身高、体重和手术前后的红细胞压积（Hct）计算所有患者的总失血量,减去显性失血部分后即得隐性失血.结果THA组的总失血量平均为1520ml,隐性失血量为482 ml（32%）;TKA组的总失血量平均为1508 ml,隐性失血量为776 ml（52%）,两组的隐性失血量比较差异有统计学意义（P＜0.01）.TKA组中使用引流血回输患者的总失血量平均为1625 ml,隐性失血量为774ml（48%）;未使用引流血回输患者的总失血量平均为1345 ml,隐性失血量为783 ml（58%）,两组的隐性失血量相比差异无统计学意义;THA与TKA肥胖组和非肥胖组的隐性失血量相比差异均无统计学意义.结论TKA隐性失血远较THA高,且使用引流血回输仍不能完全满足机体恢复体循环的需要,应特别注意及时补充血容量.对隐性失血的正确认识有助于提高临床评估能力,帮助关节置换患者度过围手术期.     

初次髋膝关节置换术中不留置尿管的可行性和安全性研究

目的探讨单侧初次髋或膝关节置换术中不常规留置尿管的可行性及安全性,以减少不必要的导尿,提高患者就医舒适度和满意度。 方法本文回顾性分析中日友好医院骨关节外科2015年11月至2016年10月期间109例无明显尿潴留高危因素、无术前尿路感染、无尿路刺激征及重度肝肾功能不全、且接受单侧初次髋或膝关节置换术、术中不留置尿管(NIC)患者的资料。根据配对条件,与同期行常规术前留置尿管(IC)的单侧初次髋或膝关节置换患者按照1 ∶1进行配对研究,应用SPSS 19.0统计学软件对正态分布计量资料采用配对t检验,非正态分布计量资料采用Wilcoxon符号秩和检验,计数资料采用χ²检验分析比较两组患者术后的尿潴留、二次尿潴留、尿管相关膀胱不适、尿路刺激症、尿路感染、不良事件发生率,以及术后住院时间及患者满意度,分析并评价不留置尿管在单侧初次髋、膝关节置换术中的可行性及安全性。 结果两组患者术后尿潴留、二次尿潴留、尿路感染发生率比较,差异无统计学意义(P>0.05),NIC组术后尿管相关膀胱不适、尿路刺激征、不良事件发生率及术后住院时间均明显低于IC组,而患者满意度高于IC组,两组比较差异有统计学意义(χ²＝10.844,P<0.05),单侧初次髋或膝关节置换术中不必要的导尿高达81.7%。 结论初次髋或膝关节置换术中不常规留置尿管安全可靠,能有效减少尿管相关膀胱不适、尿路刺激征及不良事件的发生,同时可缩短术后住院时间,提高患者早期满意度。     

全髋或膝关节置换术后高C反应蛋白与假体周围感染相关性的研究

目的探讨行初次单侧全髋关节置换术(THA)或全膝关节置换术(TKA)术后的骨关节炎(OA)患者,出院时C反应蛋白(CRP)水平和发生假体周围感染(PJI)的关联性。 方法2013年01月至2015年12月,东南大学附属中大医院骨科共收治480例因OA行初次单侧THA或TKA术的患者。纳入标准为术前CRP水平正常;排除标准包括术前有感染病史者、合并有糖尿病、恶性肿瘤等。根据出院时血清CRP水平,分为高CRP组(273例)和正常CRP组(207例)。所有患者出院时血象和体温正常、伤口清洁干燥,出院后不使用任何抗生素或非甾体抗炎药(NSAIDs)。统计随访期间内发生PJI的例数和时间。计量资料采用t检验,PJI发病率的比较采用卡方检验或Fisher确切概率法。 结果两组患者的性别、年龄和出院时间的差异比较均无统计学意义(P>0.05)。415例患者获得随访,随访时间平均(18± 3)个月。两组在末次随访时各有3例、2例患者发生了PJI,发病率差异比较无统计学意义(χ²＝0.023,P>0.05)。 结论行初次单侧THA或TKA术后的OA患者,出院时CRP水平和PJI发病率可能无关联性,但应加强对出院时CRP水平较高患者的密切随访。     

Press fit condylar Sigma total knee arthroplasty: 7–9 years results

Objective  This study reports the first clinical and radiological results at 7–9 years for the DePuy Pressed Fit Condylar Sigma total knee arthroplasty (TKA). Methods  A total of 318 consecutive Sigma TKAs were performed in 275 patients between October 1998 and March 2000. Results  Of 318 knees, 225 (193 patients) were alive at final review. Six knees (five patients) were lost to follow up. Seven knees (2.2%) were revised, six for infection within 2 years and one at 59 months who underwent isolated change of polyethylene insert. The 9-year survival was 97.7% with revision for any reason and 99.6% with endpoint revision for aseptic failure. The mean American Knee Society Knee Score was 84 ± 16 at 7–9 years compared with 33/100 pre-operatively. Of 140 radiographs, 48 knees had non-progressive radiolucent lines but none showed radiological evidence of loosening. Conclusion  These results suggest that the Sigma TKA gives excellent clinical results up to 9 years.