全膝关节表面置换治疗老年严重膝骨关节炎的临床体会

目的作者报道了用全膝关节表面置换治疗老年性严重膝骨关节炎的临床体会。方法我院自１９９６年３月～１９９８年４月对１０例６０岁以上的严重膝骨关节炎的患者进行了全膝关节表面置换,均采用进口非限制性膝关节假体。结果经过６～３０个月随访,采用ＨＳＳ膝关节评分系统,术后所有患者在关节疼痛、功能及活动度均有明显改善,没有１例发生感染及深静脉栓塞。结论全膝关节表面置换对老年性严重膝骨关节炎治疗效果满意。     

A case of spontaneous hemoarthrosis after a total knee arthroplasty

A 63-year-old woman with osteoarthritis had undergone right total knee arthroplasty. Nineteen months later, the patient presented with a recurrent hemoarthrosis. Open arthrotomy revealed hypertrophic synovium with small clots in the suprapatellar pouch, but entrapment of synovial tissues could not be observed. Histological examination of the extirpated specimen showed fibrous hypertrophy of synovium. The patient has no symptoms 51 months after surgery.     

A case of spontaneous hemoarthrosis after a total knee arthroplasty

Abstract

A 63-year-old woman with osteoarthritis had undergone right total knee arthroplasty. Nineteen months later, the patient presented with a recurrent hemoarthrosis. Open arthrotomy revealed hypertrophic synovium with small clots in the suprapatellar pouch, but entrapment of synovial tissues could not be observed. Histological examination of the extirpated specimen showed fibrous hypertrophy of synovium. The patient has no symptoms 51 months after surgery.     

Risk factors for knee osteoarthritis in Morocco. A case control study

Osteoarthritis (OA) of the knee is the most common form of arthritis. A positive association between obesity and several occupational factors and knee OA has been observed in previous studies in populations of different ethnicity. The aim of this study was to examine the relation between knee OA and body weight and occupational factors in a Moroccan sample of patients with knee OA. Our cases were consecutive patients diagnosed in our department with knee OA utilizing radiography in a 1-year period. No cases displayed established causes of secondary OA. Controls were selected randomly from the general population and were individually matched to each case for age and sex. Interviews were obtained from 95 cases and controls. Detailed information on general health status, height, weight, smoking habits, specific physical loads from occupation and housework, and sports activities was collected. The risk of knee OA increased with higher body mass index, odds ratio (OR) = 3.12 (95% confidence interval [CI] = 1.67–5.81; p < 0.0001). Sitting more than 3 h/day and climbing stairs more than 50 steps/day were associated with decreased risk of knee OA, OR = 0.29 (95% CI = 0.15–0.56; p = 0.02) and 0.48 (95% CI = 0.26–0.91; p < 0.0001), respectively. Overweight is a risk factor for knee OA, whereas sitting and climbing stairs are inversely associated with knee OA.     

旋转平台人工全膝关节系统在全膝关节置换术中的应用研究

目的探讨旋转平台人工膝关节置换术（TKA）的临床疗效。方法对21例患者（25膝）行TKA,采用正中切口髌旁内侧入路,对髌骨行去神经化和修复术,安装假体,膝关节均未进行髌骨置换。术后复查X线观察假体固定情况,采用美国膝关节学会评分（KSS评分）评定膝评分及膝功能评分,观察并发症（旋转平台脱位、翻修或感染）发生情况。结果本组随访时间25—37个月（平均28．2个月）,X线显示假体均无松动、无髌骨脱位;膝评分为94分（82～98分）,功能评分为94分（66—99分）;未出现并发症。结论旋转平台人工全膝关节系统用于TKA近期疗效确切,尤适于年轻、活动量大者;其长期疗效有待进一步观察。     

全膝关节表面置换术治疗结核性膝关节强直或僵硬(附10例报告)

目的 探讨全膝关节表面置换治疗膝关节结核强直或僵硬膝的临床应用可行性。方法 回顾性分析2011年10月至2015年7月我院收治的膝关节结核强直或僵硬膝患者10例,行全膝表面置换术,术前充分评估膝关节功能及结核控制情况,对膝关节结核控制良好,骨缺损不影响假体稳定,无窦道混合感染存在者,行实验室及膝关节MRI、X线、CT扫描等影像学检查,规范化抗结核药物治疗后,行全膝表面置换术,术后继续行正规抗结核药物治疗,随访评估关节假体稳定性、膝关节功能[美国特种外科医院膝关节评分 (hospital for special surgery knee score, 简称 “HSS 评分”)]及关节活动度,关节结核的复发情况。结果 10例患者中,强直膝3例,僵硬膝7例;其中活动期膝关节结核4例,病程4~9个月;陈旧性膝关节结核6例,病程20~41个月;术后全部获24~41个月随访,平均(35.4±9.6)个月;手术时间90~118min,平均(102.0±8.5)min;患者术前膝关节僵硬角度15.0°~55.0°,至末次随访,膝关节屈膝角度恢复至95.0°~120.0°,平均(105.0±14.8)°;伸直角度恢复至-5.0°~10.0°,平均(0.5±7.0)°;术前膝关节HSS评分为(46.6±16.2)分,术后恢复至(79.6±9.6)分。至末次随访,全部假体未见松动,结核无复发。结论 在个体化正规抗结核治疗的前提下,采用普通表面膝关节置换治疗结核性膝关节强直或僵硬疗效确定、临床可行,但需严格掌握手术适应证。     

人工全膝关节置换术股骨胫骨假体匹配情况分析

目的分析人工全膝关节置换术股骨假体与胫骨假体不匹配的情况,初步探讨其发生原因和解决方式。方法回顾性分析2001年5月～2008年5月我科施行的2347例初次人工全膝关节置换术股骨假体与胫骨假体的匹配率,并分析不同性别、不同假体匹配率的差异。结果2347例人工全膝关节置换术中,股骨胫骨假体的匹配率为（56．2±16．5）％,其中男性患者匹配率为62．4％,女性患者匹配率为55．1％（P〈0．01）。股骨胫骨假体型号不匹配共1029例,其中F〉T占76．3％,F〈T占23．7％。结论接受人工全膝关节置换术的病例股骨假体与胫骨假体匹配率低,女性患者更低于男性患者。在不匹配的病例中,大部分情况是股骨假体型号大于胫骨假体型号。     

Incidence of total knee and hip replacement for osteoarthritis in relation to the metabolic syndrome and its components: A prospective cohort study

Objective

To examine whether components of metabolic syndrome (MetS), either singly or additively, were associated with the incidence of severe knee and hip OA, and whether these associations were independent of obesity assessed by body mass index (BMI).

Methods

Twenty thousand, four hundred and thirty participants who had blood lipids, anthropometric and blood pressure measurements during 2003–2007 were selected from the Melbourne Collaborative Cohort Study. MetS was defined as central obesity assessed by waist circumference and any two of raised triglyceride level, reduced HDL cholesterol level, hypertension or impaired fasting glycaemia. The incidence of total knee and hip replacement was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry.

Results

Six hundred and sixty participants had knee OA and 562 had hip OA. After adjustment for age, gender, country of birth, education, physical activity and BMI, central obesity [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.25–2.01] and hypertension (1.24, 1.05–1.48) were associated with increased risk of knee OA. The accumulation of MetS components was associated with knee OA risk, independent of BMI: one component, 2.12 (1.15–3.91); two components, 2.92 (1.60–5.33) and three or more components, 3.09 (1.68–5.69). No statistically significant associations were observed for hip OA.

Conclusion

Cumulative number of MetS components and central obesity and hypertension were associated with increased risk of severe knee OA, independent of BMI. No associations were observed with severe hip OA. These findings suggest that the pathogenesis of knee and hip OA differ and that targeting the management of MetS may reduce the risk of knee OA.     

人工全膝关节置换术治疗严重膝骨关节炎(附41例报告)

对41例(64膝)膝骨关节炎(OA)患者施行人工全膝关节置换术(TKA)，术后平均随访11．6个月，并应用HSS膝关节评分系统进行分析。结果：患者术后在疼痛、功能及关节活动度等方面均有明显改善，缓解疼痛效果尤为显著。综和评定：优48膝(75％)，良12膝(18．75％)，可2膝(3．13％)．差2膝(3．12％)，优良率为93．75％。其中12例24膝同时行双TKA，采用自体血回输；41膝行髌骨置换，3膝(7．31％)术后出现髌前不适和疼痛；23膝未行髌骨置换，3膝(13．04％)出现髌前不适和疼痛。41例中，有4例(9．8％)术后下肢发生深静脉血栓形成，不保留后交叉韧带(PCL)的后方稳定型假体55膝中，综合评定可者2膝，差者1膝；保留PCL型假体9膝中，1膝综合评定差。认为TKA治疗严重膝骨关节病效果满意，术后有效的康复措施和功能锻炼甚为重要。     

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.     

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.     

Saline washout for knee osteoarthritis: Results of a controlled study

Summary Twenty patients with persistent symptoms due to osteoarthritis of the knee were randomly allocated to a saline washout or control group. Both groups showed improvement. Knee washout conferred no more benefit than intra-articular saline injection.     

Obesity,metabolic abnormality,and knee osteoarthritis: A cross-sectional study in Korean women

Abstract

Background. This study aimed to analyze the association between knee osteoarthritis and four body size phenotypes defined by the presence or absence of metabolic abnormality and obesity.

Mehods. This was a cross-sectional study using data from 1,549 female participants of the Fifth Korean National Health and Nutrition Examination Survey. Knee osteoarthritis was defined as a Kellgren–Lawrence grade of ≥ 2. Metabolically abnormal state was defined as presence of more than one abnormality among five metabolic risk factors. Obesity was defined using body mass index. Participants were grouped into one of the four body size phenotypes: metabolically healthy normal weight (MHNW), metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO).

Results. The distribution of each body size phenotype was as follows: MHNW 54.7%, MANW 30.7%, MHO 4.3%, and MAO 10.3%. Prevalence of symptomatic knee osteoarthritis was higher in MANW than in MHNW, and in MAO than in MHO. In multivariable analysis, the association between symptomatic knee osteoarthritis and the body size phenotypes was as follows (OR [95% CI]): MHNW 1.00 (reference), MANW 1.54 (1.15–2.07), MHO 1.61 (0.83–3.13), and MAO 3.47 (2.35–5.14).

Conclusions. Obesity showed closest association with knee osteoarthritis when accompanied by metabolic abnormality.     

Three-dimensional limb lengthening after total knee arthroplasty in a simulation study

Abstract

Objectives: Limb lengthening after total knee arthroplasty (TKA) has been reported in some cases, all of which were evaluated using two-dimensional images. To our knowledge, no case has been evaluated using three-dimensional (3D) images. We investigated 3D limb lengthening after TKA.

Methods: We simulated 100 varus knees using 3D templating software. Virtual TKA was performed to maintain the original joint line by conducting a measured-resection technique. We examined the relationships of 3D distance between the femoral head center and ankle center before and after TKA, degree of hip–knee–ankle angle (HKA) improvement, and degree of flexion contracture angle improvement.

Results: All cases showed limb lengthening (average, 9.4?±?6.0?mm). The coefficients of correlation with limb lengthening and the degree of HKA improvement and the degree of flexion contracture angle improvement were good (0.730 and 0.751, respectively). The correlation between the degree of total improvement (the degree of HKA improvement?+?the degree of flexion contracture angle improvement) and limb lengthening was strong (r?=?0.896).

Conclusion: The expected limb lengthening when performing measured-resection TKA is expressed as 0.58?×?(the degree of HKA improvement?+?the degree of flexion contracture angle improvement) mm and is a useful index.     

Association of metabolic syndrome with knee and hand osteoarthritis: A community-based study of women

Objective

It is unclear whether the association between osteoarthritis (OA) and metabolic syndrome (MetS) varies with the site of the affected joint and the presence of pain. Our aim was to describe the association between MetS and radiographic OA (ROA) affecting the knee or the hand in the presence or absence of concurrent joint pain.

Prospective study of pulmonary embolism after total hip or knee arthroplasty]

We investigated the incidence of pulmonary embolism after total hip or knee arthroplasty. Arterial pO2 while the patient was breathing room air was measured at pre-operative day and 5 post-operative day using a Blood Gas Analyzer. Selection of patients for perfusion/ventilation scan during this study was dependent on the results of arterial blood gas determination that was more than 10 mmHg depression Of arterial pO2 level after surgery. More than depression of that was occurred in 11 patients (17.7%). Eight of them (72.7%) detected abnormalities (V/Q mismatch) in perfusion/ventilation scan, and we diagnosed them PE. More than 70% of PE was detected by only estimating the pre and post-operative arterial pO2. It was concluded that the estimation of arterial pO2 (pre and post-operation) was useful for the detection of PE, and combining estimation of arterial pO2 with the clinical feature evaluation method, low-invasive diagnosis and rapid treatment should be possible.