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knee awareness and functionality after simultaneous bilateral vs unilateral total knee arthroplasty

World Journal of Orthopedics 2016年第3期7卷 195-201页

作者： Roshan Latifi Morten Grove Thomsen Thomas Kallemose Henrik Husted Anders Troelsen Department of Orthopedic Surgery Copenhagen University Hospital Hvidovre Clinical Research Center Copenhagen University Hospital Hvidovre

AIM: To investigate knee awareness and functional outcomes in patients treated with simultaneous bilateral vs unilateral total knee arthroplasty(TKA).METHODS: Through a database search, we identified 210 patients who had undergone unilateral TKA(UTKA) and 65 patients who had undergone simultaneous bilateral TKA(SBTKA) at our institution between 2010 and 2012. All TKAs were cemented and cruciate retaining. The mean follow-up period was 3.2(2 to 4) years. All the patients had symptomatic and debilitating unilateral or bilateral osteoarthritis for which all conservative and non-surgical treatments were failed, thus preoperatively the patients had poor functionality. All patients were asked to complete Forgotten Joint Score(FJS) and Oxford knee Score(OKS) questionnaires. The patients were matched according to age, gender, year of surgery, Kellgren-Lawrence score and pre- andpostoperative overall knee alignment. The FJS and OKS questionnaire results of the two groups were then compared. RESULTS: A mixed-effects model was used to analyze differences between SBTKA and UTKA. OKS: The mean difference in the OKS between the patients who had undergone SBTKA and those who had undergone UTKA was 1.5, which was not statistically significant(CI =-0.9:4.0, P-value = 0.228). The mean OKS of the SBTKA patients was 37.6(SD = 9.0), and the mean OKS of the UTKA patients was 36.1(SD = 9.9). FJS: The mean difference in the FJS between the patients who had undergone SBTKA and those who had undergone UTKA was 2.3, which was not statistically significant(CI =-6.2:10.8, P-value = 0.593). The mean FJS of the SBTKA patients was 59.9(SD = 27.5), and the mean FJS of the UTKA patients was 57.5(SD = 28.8). CONCLUSION: SBTKA and UTKA patients exhibited similar joint functionality and knee awareness. Our results support the use of SBTKA in selected patients suffering from clinically symptomatic bilateral osteoarthritis.

关键词： Unilateral total knee arthroplasty knee awareness Patient-reported outcomes Simultaneous bilateral total knee arthroplasty Forgotten Joint Score

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Evaluation of knees in Asymptomatic Amateur Ice Hockey Players Using 3.0-T Magnetic Resonance Imaging：A Case-Control Study

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Chinese Medical Journal 2018年第9期131卷 1038-1044页

作者： Xiao-Dan Chang Pei Yang Xin-Yan Mu Wei-Li Ma Mo Zhou Department of Radiology Affiliated Zhongshan Hospital of Dalian University Dalian Liaoning 116001 China

Background：Research on the changes to knee structures in asymptomatic amateur ice hockey players （AAIHPs） has been limited.We aimed to assess the performance of the knees in AAIHPs using 3.0-T magnetic resonance imaging （MRI）.Methods：A total of 71 asymptomatic knees （32 AAIHPs and 39 age-and sex-matched controls） were imaged using a 3.0-T MRI scanner at the Affiliated Zhongshan Hospital of Dalian University in April 2017.Two experienced musculoskeletal radiologists were blinded to assess all MRI findings,including bursae around the knee,bone marrow edema （BME）,meniscal signal changes,and articular cartilage and ligament damage.Any disagreements were resolved by a third professor of musculoskeletal radiology.Categorical variables were compared using the Chi-square test and continuous variables using the Student＇s t-test or Mann-Whitney U-test.Results：The most common finding was fluid-filled bursae surrounding the knee.In the AAIHP group,which totaled 32 knees and 416 bursae,155 （37％） fluid-filled bursae were present.In the control group,there were a total of 39 knees and 507 bursae,and 91（18％） fluid-filled bursae were present.There was a significant difference in the number of fluid-filled bursae between the two groups （P ＜ 0.05）.However,in AAIHPs,the prevalence of meniscal signal changes （16 knees,50％） was higher than in the control group （2 knees,5％;P ＜ 0.001）.Importantly,15 of the 19 were grade Ⅱ signals.Other changes were only found in AAIHPs.Articular cartilage lesions were detected in 47％ of their knees,predominantly at the patellofemoral joint,and BME was found in 34％ of their knees.Conclusion：The MRI findings of knees in AAIHPs mainly manifested as self-protection reaction,and proper ice hockey exercise could be advocated.

关键词： Articular Cartilage Hockey knee Magnetic Resonance Imaging Meniscus

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Re-revision surgery for re-recurrent valgus deformity after revision total knee arthroplasty in a patient with a severe valgus deformity: A case report

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World Journal of Clinical Cases 2019年第21期7卷 3562-3568页

作者： Yin-Qiao Du Jing-Yang Sun Ming Ni Yong-Gang Zhou Department of Orthopedics General Hospital of Chinese People’s Liberation Army

BACKGROUND A recurrent valgus deformity was a common complication after total knee arthroplasty(TKA)in patients with valgus deformity.However,re-revision surgery for re-recurrent valgus deformity after revision TKA in patients with valgus deformity before primary TKA was uncommon.CASE SUMMARY We reported a 72-year-old female patient with two recurrent valgus deformities after TKA for a valgus knee deformity who underwent two revision surgeries to rectify the deformity.In the re-revision surgery,bone defects were successfully reconstructed by the augments and cement in combination with screws and a sleeve.An appropriate neutral alignment of the lower limb was restored by the perfect femoral entry point and the long diaphyseal cementless stem.Adequate fixation of the metaphysis and diaphysis of the femur was obtained by the sleeve and long diaphyseal cementless stem.The patient was pain-free and deformityfree for 2.5 years.CONCLUSION The management of bone defects,the choice of the stem and the femoral entry point were of vital importance in the revision or re-revision TKA for a recurrent valgus deformity.

关键词： Revision total knee arthroplasty Valgus deformity Bone defects Recurrent Case report

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Arthroscopy combined with unicondylar knee arthroplasty for treatment of isolated unicompartmental knee arthritis: A long-term comparison

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World Journal of Clinical Cases 2019年第24期7卷 4196-4207页

作者： Hao-Ran Wang Zhong-Li Li Ji Li Yu-Xing Wang Zhi-Dong Zhao Wei Li Department of Orthopedics General Hospital of People’s Liberation Army

BACKGROUND knee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty(UKA) is one of the effective methods for the treatment of severe unicompartmental knee arthritis. This surgical approach gives us the capacity to explore all the articular cavities and plays a vital role in UKA patient selection. However, some scholars think that the surgical procedure is traumatic and may increase the rate of surgical infection, and its clinical efficacy needs further study.AIM To compare the clinical effect of arthroscopy combined with UKA and UKA alone for patients suffering from unicompartmental osteoarthritis(OA).METHODS A retrospective study was conducted on patients who were diagnosed with unicompartmental OA(Kellgren–Laurence grade ≥ III) and underwent UKA between October 2012 and November 2006. The patients were followed at 3, 6,and 12 mo and every 2 years thereafter. During each follow-up, the radiographic materials, the range of motion of knee and hospital for special surgery(HSS)score, knee society score and knee function score as recorded, and the modes and time of failure and revision details were collected as well.RESULTS Data on 104 patients(118 knees), including 54 patients(60 knees) in the arthroscopy combined with UKA group(group A) and 51(58 knees) in UKA alone group(group B) were collected during an average follow-up duration of 7.25 years, excluding the cases who were lost to follow-up. At the final follow-up,3(5.0%) of 60 knees in group A compared with 4(6.9%) of 58 knees in group B failed and converted to total knee arthroplasty, with no statistically significant difference between the two groups(P = 0.933). The percentage of patients receiving blood transfusion was 40% in group A, significantly lower than that in group B(67.2%;P = 0.003). Total volume of blood transfusion in group A was also significantly lower than that of group B(P = 0.001). Both groups improved significan

关键词： Arthroscopy Unicondylar knee arthroplasty Osteoarthritis knee Follow-up studies

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Comparison of intra-articular injection of parecoxib vs oral administration of celecoxib for the clinical efficacy in the treatment of early knee osteoarthritis

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World Journal of Clinical Cases 2019年第23期7卷 3971-3979页

作者： Lu Lu Yu Xie Ke Gan Xiao-Wen Huang Department of Rheumatology Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Province Hospital of Chinese Medicine)Nanjing 210029Jiangsu ProvinceChina Department of Orthopedics First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital)Nanjing 210029Jiangsu ProvinceChina

BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with bef

关键词： knee osteoarthritis Intra-articular injection Parecoxib Non-steroid antiinflammatory drugs

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Elevated levels of interleukin-1β, interleukin-6, tumor necrosis factor-α and vascular endothelial growth factor in patients with knee articular cartilage injury

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World Journal of Clinical Cases 2019年第11期7卷 1262-1269页

作者： Zhen-Wei Wang Le Chen Xiao-Rui Hao Zhen-An Qu Shi-Bo Huang Xiao-Jun Ma Jian-Chuan Wang Wei-Ming Wang Department of Sports Medicine Affiliated Zhongshan Hospital of Dalian University

BACKGROUND Inflammatory cytokines play a vital role in the occurrence of osteoarticular injury and inflammation. Whether inflammation-associated factors interleukin-1β(IL- 1β), IL-6, tumor necrosis factor-α(TNF-α) and vascular endothelial growth factor (VEGF) are involved in the pathogenesis of keen articular cartilage injury remains poorly understood. AIM To measure the levels of inflammatory factors [IL-1β, IL-6, TNF-α and VEGF] in patients with knee articular cartilage injury. METHODS Fifty-five patients with knee articular cartilage injury were selected as patient groups, who were divided into three grades [mild (n = 20), moderate (n = 19) and severe (n = 16)] according to disease severity and X-ray examinations. Meanwhile, 30 healthy individuals who underwent physical examination were selected as the control group. The levels of IL-1β, IL-6, TNF-α and VEGF were measured by ELISA and immunohistochemical staining. RESULTS Compared with the control group, patient groups displayed significantly higher levels of IL-1β, IL-6, TNF-α and VEGF, and the extent of increase was directly proportional to the severity of injury (P knee articular cartilage injury, and are associated with the disease severity, indicating they might play an important role in the occurrence and development of knee articular cartilage injury. Furthermore, therapeutically targeting them might be a novel

关键词： knee articular cartilage injury Interleukin-1β Interleukin-6 Tumor necrosis factor-α Vascular endothelial growth factor

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Analysis of the Biotribological Behavior for the Stainless Steel/Polyethylene Contact Using a knee Prosthesis Simulator

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Journal of Bionic Engineering 2012年第1期9卷 59-65页

作者： M. Boujelbene S. Dhouibi M. Kharrat M. Dammak Laboratoire des Systkmes Electromeeaniques Ecole Nationale d＇Ingenieurs de Sfax Route de Soukra km 35 B.P. 1173 3038 Sfax Tunisia Institut Superieur de Gestion Industrielle de Sfax Route de Mharza Km 15 B.P. 954 3018 Sfax Tunisia Faeulte des Sciences de Gafsa Campus Universitaire Sidi Ahmed Zarrouk 2112 Gafsa Tunisia Institut Preparatoire aux Etudes d＇Ingenieurs de Sfax Route de Menzel Chaker Km 05 B.P. 1172 3018 Sfax Tunisia

In this work, a friction and wear simulator was used to reproduce the Anterior-Posterior （AP） sliding and the Flex- ion-Extension （FE） rotation generated in the knee joint during human gait cycle. We chose to simplify the contact geometry between the Total knee Arthroplasty （TKA） femoral component and tibial insert. A 304L stainless steel cylinder which replaces the femoral component was loaded onto a flat High Density Polyethylene （HDPE） block which replaces the tibial insert. The tribological behavior of the considered contact was analyzed by tracking the number of cycles, the friction coefficient, the roughness of the wear track on HDPE, the HDPE weight loss and the damage mechanisms. The friction coefficient shows a gradual increase with the number of cycles for both AP and FE kinematics. The evolution of friction coefficient with the number of cycles is not affected by the value of the imposed normal load in the case of AP sliding. For the FE rotation, decreased friction coefficient is obtained when the imposed normal load increases. For both considered AP and FE kinematics, the roughness of the wear track on the HDPE is not affected by the imposed normal load. It shows a progressive decrease when the number of cycles increases. The wear of HDPE obeys the Archard law and the wear coefficient increases with the normal force. For a given value of normal load, the obtained wear coefficient for the AP sliding is larger than that obtained for FE rotation. A predominant adhesive wear mechanism was identified for both AP and FE kinematics. Under the same normal load, damage development in terms of plastic deformation, micro-cracking and debonding is more pronounced for the AP sliding if compared with the FE rotation. For a given kinematics, the damage severity increases with the normal load. This finding is in good agreement with the predicted values of the wear coefficient according to the Archard law.

关键词： knee prosthesis polyethylene friction wear gait cycle

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Gait analysis of children with spastic hemiplegic cerebral palsy

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Neural Regeneration Research 2012年第20期7卷 1578-1584页

作者： Xin Wang Yuexi Wang Department of Human Sports Science Shenyang Sport University Shenyang 110102 Liaoning Province China Recuperate Center Shengjing Hospital of China Medical University Shenyang 110021 Liaoning Province China

An experiment was carried out in the key laboratory for Technique Diagnosis and Function Assessment of Winter Sports of China to investigate the differences in gait characteristics between healthy children and children with spastic hemiplegic cerebral palsy. With permission of their parents, 200 healthy children aged 3 to 6 years in the kindergarten of Northeastern University were enrolled in this experiment. Twenty children aged 3 to 6 years with spastic hemiplegic cerebral palsy from Shengjing Hospital, China were also enrolled in this experiment. Standard data were collected by simultaneously recording gait information from two digital cameras. DVracker was used to analyze the standard data. The children with hemiplegic cerebra palsy had a longer gait cycle, slower walking speed, and longer support phase than did the healthy children. The support phase was longer than the swing phase in the children with hemiplegic cerebral palsy. There were significant differences in the angles of the hip, knee, and ankle joint between children with cerebral palsy and healthy children at the moment of touching the ground and buffering, and during pedal extension. Children with hemiplegic cerebral palsy had poor motor coordination during walking, which basically resulted in a short stride, high stride frequency to maintain speed, more obvious swing, and poor stability.

关键词： gait analysis children spastic hemiplegic cerebral palsy walking hip knee ankle neuralregeneration

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Static and Dynamic Analysis of Osteoarthritic and Orthotic Human knee

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Journal of Bionic Engineering 2019年第3期16卷 514-525页

作者： Daniela Tarnita Doina Pisla Ionut Geonea Calin Vaida Marius Catana Danut Nicolae Tarnita University of Craiova Faculty of Mechanics Calea Bucuresti no. 107 200512 Craiova Romania Technical University Cluj Napoca CESTER - Research Centre for the Robot Simulation and Testing Memorandumului str. no. 28400114 Cluj-Napoca Romania INAS Nicolae Romanescu Blvd 37C 200738 Craiova Romania University of Medicine and Pharmacy Craiova & Emergency Hospital Craiova Craiova Petru Rares str. no. 2 200349 Romania

The first objective of this paper is to study the influence of the orthotic device on the maximum values of stresses in knee cartilages by using Ansys Workbench 14.5 software and applying the Finite Element Analysis (FEA) on a virtual assembly composed by an orthotic device and osteoarthritic knee (OAK). The second objective consists into quantifying and investigating the nonlinear motion of the human knee joint for OAK patients, with and without the orthotic device mounted on OAK, using tools of dynamics stability analysis. The short Lyapunov Exponents (LEs) are calculated, as measures of human knee and ankle joints stability, based on the experimental time series collected by using the biometrics acquisition system during walking on horizontal and inclined treadmills from a sample of healthy subjects and a sample of patients suffering by OAK disease. The values of LEs obtained for OAK patients are larger on the inclined treadmill than on horizontal treadmill and are larger than those obtained for healthy knees, being associated with more divergence and less stability. The results confirm that the influence of an orthotic device mounted on OAK on its stability is significant, the values obtained for LEs being smaller than those calculated for OAK, and closer to the values of normal knees of patients and of healthy subjects.

关键词： osteoarthritic knee bioinspired orthosis finite element method gait stability Lyapunov exponents

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Limb length discrepancy after total knee arthroplasty: A systematic review and meta-analysis

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World Journal of Clinical Cases 2021年第2期9卷 357-371页

作者： Sujit Kumar Tripathy Siddharth Satyakam Pradhan Paulson Varghese Prabhudev Prasad Purudappa Sandeep Velagada Tarun Goyal Bijnya Birajita Panda Jagadeesh Vanyambadi Department of Orthopaedics All India Institute of Medical SciencesBhubaneswar 751019OdishaIndia Department of Orthopedics VA Boston Health careBostonMassachusetts 02130United States Department of Orthopaedics All India Institute of Medical SciencesBathinda 209201India Department of Ophthalmology SCB Medical CollegeCuttack 751019India Department of Orthopaedics Salford Royal NHS Foundation TrustSalford M68HDUnited Kingdom

BACKGROUND Limb length discrepancy(LLD)after total knee arthroplasty(TKA)has been considered as one of the reasons for the unsatisfactory outcome.However,there is no consensus about the extent of LLD that can be considered as clinically relevant.AIM To evaluate the incidence of radiographic LLD and its impact on functional outcome following TKA.METHODS All randomized-controlled trial and observational studies on LLD in TKA,published till 22nd June 2020,were systematically searched and reviewed.The primary outcome was“limb lengthening or LLD after TKA”.The secondary outcomes included“assessment of LLD in varus/valgus deformity”and“impact of LLD on the functional outcome”.RESULTS Of 45 retrieved studies,qualitative and quantitative assessment of data was performed from eight studies and six studies,respectively.Five studies(n=1551)reported the average limb lengthening of 5.98 mm.The LLD after TKA was ranging from 0.4±10 mm to 15.3±2.88 mm.The incidence of postoperative radiographic LLD was reported in 44%to 83.3%of patients.There was no difference in the preoperative and postoperative LLD(MD-1.23;95%CI:-3.72,1.27;P=0.34).Pooled data of two studies(n=219)revealed significant limb lengthening in valgus deformity than varus(MD-2.69;95%CI:-5.11,0.27;P=0.03).The pooled data of three studies(n=611)showed significantly worse functional outcome in patients with LLD of≥10 mm compared to<10 mm(standard MD 0.58;95%CI:0.06,1.10;P=0.03).CONCLUSION Limb lengthening after TKA is common,and it is significantly more in valgus than varus deformity.Significant LLD(≥10 mm)is associated with suboptimal functional outcome.

关键词： Arthroplasty knee Replacement Limb length Joint diseases Surgery

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