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91.
A linkage guide was devised for use in conjunction with knee arthroplasty instruments to achieve proper component rotation. The femoral component was rotationally aligned to the surgical epicondylar axis using one guide. The other guides were used after all bone surfaces were cut and soft tissue balancing was completed. A Kirschner wire was guided into the proximal tibial aspect parallel to the sagittal plane of the femoral component with the patella in its normal position and the knee in full extension. The wire was used as a reference to determine tibial component rotation. The relative rotational alignment of 21 knees in 19 patients who had undergone cruciate-retaining total knee arthroplasty utilizing this guide was assessed using the modified Eckhoff method. The results of radiographic analysis were compared with those in a control group of 25 knees where the guide was not employed. The external rotation of the femoral component relative to the tibial component was 1.3° ± 2.0° (mean ± SD) in the guided group and 1.1° ± 4.4° in the control group. The relative rotational angle was significantly more consistent using the guide. Implant malrotation can be reduced using our technique. 相似文献
92.
Richard D. Scott 《Journal of orthopaedic science》1996,1(6):384-389
The patello-femoral articulation accounts for a significant number of the complications that occur after total knee replacements
and which require re-operation. These include problems with stability, component wear, fracture, loosening, and osteonecrosis.
With careful attention to prosthetic design and surgical technique, these complications can be minimized.
Guest Lecture presented at the 26th meeting of the Japanese Society for Replacement Arthroplasty in Tokyo on February 2, 1996 相似文献
93.
Osteoarthritis of the knee is the leading cause of disability in the elderly. This localized, painful condition is oftenaccompanied by decreased elastoviscosity of the intraarticular synovial fluid due to decreased hyaluronan molecular weight and/or concentration. Viscosupplementation attempts to restore viscoelastic homeostasis to the arthritic joint to reduce pain and restore function. Recently, two low-molecular weight (MW) hyaluronans and one cross-linked high-MW hyaluronan(hylan) have been approved for the intraarticular treatment of this disease in the United States. Five weekly intraarticular injections are recommended for both low-MW hyaluronans. They have been proven effective in reducing knee pain in mild to moderate disease, equivalent to NSAIDS. They are as effective as corticosteroids, are of slower onset, and have longer duration of effect. Three weekly injections are recommended for the hylan product. It has been proven effective in mild to advanced disease and is as or more effective than NSAIDS and more effective than corticosteroids. Definitive comparative studies of these products have not been published. Viscosupplementation has been shown to be very safe. Local transient knee pain and/or swelling (2–4%) per injection, without long-term sequelae have been the only significant adverse events No systemic effects, viral transmission, drug interaction, or mortality have been associated with this treatment. It is recommended that viscosupplementation be considered after the failure of exercise and local or systemic analgesic treatment in the elderly osteoarthritic knee, particularly when gastrointestinal, renal, or cardiovascular comorbidities or drug interactions may exist. 相似文献
94.
Toshikazu Tanaka Peter C Amadio Chunfeng Zhao Mark E Zobitz Kai-Nan An 《Journal of orthopaedic research》2006,24(4):757-762
While attrition from sharp bony surfaces is the most common cause of extensor digiti minimi (EDM) tendon rupture, the etiology of other cases of spontaneous EDM tendon rupture is still unknown. Friction within the compartment may play a role, especially with ulna dislocation. The purpose of this study was to compare gliding resistance of the EDM tendon with that of a tendon which rarely ruptures spontaneously, the extensor digitorum communis of the middle finger (EDC III) tendon, under various wrist and ulna head positions. Eight fresh frozen cadavers were used. Gliding resistance between the tendon and its sheath in each compartment was measured in five different wrist positions and three different ulna head positions. Gliding resistance of the EDM tendon (0.13 +/- 0.03 N) was significantly greater than the EDC III tendon (0.09 +/- 0.03 N) (p < 0.05). For the EDM tendon, the gliding resistance in ulnar deviation or pronation was higher than the gliding resistance in neutral, radial deviation, or supination (p < 0.05), and the gliding resistance with ulnar lengthening (over 6 mm) or dorsal ulnar dislocation (over 9 mm) was higher than in neutral ulnar head positioning. For the EDC III tendon, the gliding resistance in ulnar deviation was significantly higher than the gliding resistance in neutral, radial deviation, or supination, or dorsal dislocation with ulnar lengthening (p < 0.05). Wrist ulnar deviation, ulnar dorsal dislocation (over 9 mm), and ulnar lengthening (over 6 mm) increased the gliding resistance of the EDM tendon. In patients at risk for EDM rupture, such as those with rheumatoid arthritis or distal radioulnar joint osteoarthritis, avoiding such positions may be advantageous. 相似文献
95.
H. Roos L. Dahlberg L. S. Lohmander 《Scandinavian journal of medicine & science in sports》1993,3(2):127-130
The concentration of cartilage proteoglycan fragments in knee joint fluid was measured before and after one event of physical exercise in 33 healthy athletes. Nine athletes ran on a treadmill for 60 min, 16 ran on road for 80 min and 8 played one soccer game (90 min). Before exercise, the levels of proteoglycan fragments in the athlete joint fluid were lower than in a previously analyzed reference group. After exercise, the concentration of proteoglycan fragments increased in all of the 7 athletes that could be directly compared before and after exercise. This increased concentration of proteoglycan fragments in the joint fluid could be an effect of mechanical loading of the cartilage in combination with a possible high turn-over rate of the cartilage matrix in the athletes. 相似文献
96.
目的 研究自体富血小板血浆(platelet rich plasma, PRP)注射联合依托考昔治疗膝关节骨性关节炎(knee osteoarthritis, KOA)的效果及对细胞因子的影响。方法 选取KOA患者68例,按照随机数字表法分为单一组和联合组,每组34例。单一组采用依托考昔治疗,联合组采用自体PRP注射联合依托考昔治疗。治疗6周后比较2组疗效,治疗前、治疗6周后比较2组骨关节炎指数[西安大略和麦克马斯特大学骨关节指数(Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC评分)]、膝关节功能Lysholm评分(Lyshom Knee Rsting System)、生活质量[膝关节骨性关节炎严重性指数(Index of Severity Forosteo Arthritis, ISOA评分)]及细胞因子[白细胞介素1β(interleukin-1β,IL-1β)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(high sensitivity C... 相似文献
97.
术后快速康复对全膝关节置换术后功能的影响 《首都医科大学学报》2023,44(1):167-171
目的 通过对比全膝关节置换术(total knee arthroplasty, TKA)患者术后功能结果,探讨术后快速康复(enhanced recovery after surgery, ERAS)方案对TKA术后功能的影响。方法 以首都医科大学附属北京朝阳医院2010年1月1日到2021年12月31日1 881例诊断为膝关节骨关节炎的住院患者为研究对象,根据是否应用ERAS方案分为ERAS组和对照组。收集两组患者基本信息、术前和术后1个月的膝关节活动度、美国膝关节协会评分(American Knee Society Score, KSS)、西大略湖和麦克马斯特大学骨关节炎评分(the Western Ontario and McMaster Universities, WOMAC)以及术后1个月患者满意度。结果 实施术后快速康复方案后,ERAS组住院时间及住院费用明显低于对照组,组间差异有统计学意义(P<0.01)。术后1个月,ERAS组患者KSS临床和功能评分以及膝关节活动度明显优于对照组,患者术后满意度明显高于对照组,组间差异有统计学意义(P<0.05);而术后1个... 相似文献
98.
99.
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100.
《The Knee》2022
BackgroundKnee osteoarthritis (KOA) is increasingly prevalent in North American society. The significant societal burden it represents makes it essential to promote and target new treatments in earlier phases of the disease. Among others, subchondroplasty is a newly documented technique using calcium phosphate injection targeting the osteochondral lesions preceding KOA, also known as Bone Marrow Lesions (BMLs). This article aimed to review the existing literature on clinical and radiological outcomes of subchondroplasty in the treatment of BMLs in KOA.MethodA systematic review was performed using PubMed, Embase, Medline and Cochrane Database of Systematic Reviews. Studies on calcium phosphate injections into BMLs for KOA and its clinical and radiological outcomes were screened and reviewed by independent evaluators.ResultsAfter screening, ten articles were included, totaling 540 patients. Follow-up ranged from 6 months to 7 years. Overall, the procedure showed significant functional and quality of life improvement, as well as pain relief, as shown by Patients-Reported Outcomes Measures (PROMs). There were very few complications reported, the most important being leakage of calcium phosphate outside the targeted site. Conversion rate to total knee arthroplasty (TKA) ranged from 14 % to 30 % at 2 years post-procedure. Long term radiological outcomes have been poorly documented.ConclusionsSubchondroplasty is a promising avenue for the treatment of KOA. However, quality evidence is still required before any real conclusions and practical management guidelines can be drawn. Prospective, randomized studies with a control group and a rigorous assessment of long-term clinical and radiological outcomes are recommended. 相似文献