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Mid-term outcomes of a kinematically designed cruciate retaining total knee arthroplasty

World Journal of Orthopedics 2024年第2期15卷 118-128页

作者： Jonathan L Katzman Akram A Habibi Muhammad A Haider Casey Cardillo Ivan Fernandez-Madrid Morteza Meftah Ran Schwarzkopf Department of Orthopedic Surgery Division of Adult Reconstructive SurgeryNYU Langone Orthopedic HospitalNYU Langone HealthNew YorkNY 10010United States

BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rat

关键词： total knee arthroplasty Cruciate retaining Kinematic design Survivorship Bearing material Prosthetic design Clinical outcomes Patient-reported outcome measures

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Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty

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World Journal of Orthopedics 2024年第2期15卷 180-191页

作者： Hui Feng Ming-Li Feng Jing-Bo Cheng Xiang Zhang Hai-Cheng Tao Department of Orthopaedic Surgery Xuanwu HospitalCapital Medical UniversityBeijing 100053China

BACKGROUND total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective procedure,patient dissatisfaction is as high as 50%.knee pain after TKA is a significant cause of patient dissatisfaction;the most common location for residual pain is the anterior region.Between 4%and 40%of patients have anterior knee pain(AKP).AIM To investigate the effect of various TKA procedures on postoperative AKP.METHODS We searched PubMed,EMBASE,and Cochrane from January 2000 to September 2022.Randomized controlled trials with one intervention in the experimental group and no corresponding intervention(or other interventions)in the control group were collected.Two researchers independently read the title and abstract of the studies,preliminarily screened the articles,and read the full text in detail according to the selection criteria.Conflicts were resolved by consultation with a third researcher.And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.RESULTS There were 25 randomized controlled trials;13 were comparative studies with or without patellar resurfacing.The meta-analysis showed no significant difference between the experimental and control groups(P=0.61).Six studies were comparative studies of circumpatellar denervation vs non-denervation,divided into three subgroups for meta-analysis.The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups(P=0.31,P=0.50).One subgroup meta-analysis showed a significant difference between the experimental and control groups(P=0.001).Two studies compared fixed-bearing TKA and mobile-bearing TKA;the results meta-analysis showed no significant difference between the experimental and control groups(P=0.630).Two studies compared lateral retinacular release vs non-release;the meta-analysis showed a significant difference between the experimental and c

关键词： total knee arthroplasty Anterior knee pain knee osteoarthritis Interventions Meta-analysis

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Mortality rate after total knee arthroplasty or total hip arthroplasty in patients with a history of liver transplant

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World Journal of Orthopedics 2024年第4期15卷 310-311页

作者： E Carlos Rodriguez-Merchan Department of Orthopedic Surgery La Paz University Hospital-IdiPazMadrid 28046Spain

In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.

关键词： Liver transplant total knee arthroplasty total hip arthroplasty Results Mortality

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Single-center experience with knee+^(TM) augmented reality navigation system in primary total knee arthroplasty

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World Journal of Orthopedics 2024年第3期15卷 247-256页

作者： Evangelos Sakellariou Panagiotis Alevrogiannis Fani Alevrogianni Athanasios Galanis Michail Vavourakis Panagiotis Karampinas Panagiotis Gavriil John Vlamis Stavros Alevrogiannis The 3^(rd)Department of Orthopaedic Surgery National&Kapodistrian University of AthensKAT General HospitalAthens 14561Greece The 1^(st)Department of Orthopaedic Surgery National&Kapodistrian University of AthensAttikon General HospitalAthens 14561Greece Department of Anesthesiology KAT General HospitalAthens 14561Greece Department of Robotic Hip&knee Orthopaedic Surgery Metropolitan General HospitalAthens 14561Greece

BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolving with the employment of augmented reality.Yet,the accuracy of augmented reality navigation systems has not been determined.AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty(TKA),utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.METHODS From May 2021 to December 2021,30 patients,25 women and five men,under-went a primary unilateral TKA.Revision cases were excluded.A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment.All patients were operated on by the same team,without a tourniquet,utilizing three distinct prostheses with the assistance of the knee+™augmented reality navigation system in every operation.Postoperatively,the same radiographic exam protocol was executed to evaluate the implants’position,orientation and coronal plane alignment.We recorded measurements in 3 stages regarding femoral varus and flexion,tibial varus and posterior slope.Firstly,the expected values from the Augmented Reality system were documented.Then we calculated the same values after each cut and finally,the same measurements were recorded radiolo-gically after the operations.Concerning statistical analysis,Lin’s concordance correlation coefficient was estimated,while Wilcoxon Signed Rank Test was performed when needed.RESULTS A statistically significant difference was observed regarding mean expected values and radiographic mea-surements for femoral flexion measurements only(Z score=2.67,P value=0.01).Nonetheless,this difference was statistically significantly lower than 1 degree(Z score=-4.21,P value<0.01).In terms of discrepancies in the calculations of expected values and controlled measurements,a s

关键词： Augmented reality Orthopedics total knee arthroplasty Robotics knee Navigation

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Long-term clinical outcomes following total knee arthroplasty in patients with hemophilic arthropathy:a single-surgeon cohort after a 10-to 17-year follow-up

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Chinese Medical Journal 2023年第12期136卷 1478-1484页

作者： Bin Feng Yingjie Wang Xiying Dong Zeng Li Jin Lin Xisheng Weng Department of Orthopedic Surgery State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Division of Joint Osteopathy and Traumatology Center of Orthopedics SurgeryGuangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesSchool of MedicineSouth China University of TechnologyGuangzhouGuangdong 510000China

Background:total knee arthroplasty(TKA)can reduce severe joint pain and improve functional disability in hemophilia.However,the long-term outcomes have rarely been reported in China.Therefore,this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic arthropathy.Methods:We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020,with at least 10 years of follow-up.The clinical results,patellar scores,patients’overall satisfaction ratings,and radiological findings were evaluated.Revision surgery for implants during the follow-up period was recorded.Results:Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 years.Their Hospital for Special Surgery knee Score improved from an average of 45.8 to 85.9.The average flexion contracture statistically significantly decreased from 18.1°to 4.2°.The range of motion(ROM)improved from 60.6°to 84.8°.All the patients accepted patelloplasty,and the patients’patellar score improved from 7.8 preoperatively to 24.9 at the last follow-up.There was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures,except for a better ROM at follow-up in the unilateral group.Mild and enduring anterior knee pain was reported in seven knees(19%).The annual bleeding event was 2.7 times/year at the last follow-up.A total of 25 patients with 35 TKAs were satisfied with the procedure(97%).Revision surgery was performed in seven knees,with 10-and 15-year prosthesis survival rates of 85.8%and 75.7%,respectively.Conclusions:TKA is an effective procedure for patients with end-stage hemophilic arthropathy,which relieves pain,improves knee functions,decreases flexion contracture,and provides a high rate of satisfaction after more than ten years of follow-up.

关键词： Hemophilic arthropathy total knee arthroplasty Patelloplasty Satisfaction Long-term outcome

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Low-level laser acupuncture reduces postoperative pain and morphine consumption in older patients with total knee arthroplasty: A randomized placebo-controlled trial

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Journal of Integrative Medicine 2022年第4期20卷 321-328页

作者： Chiung-Hui Huang Mei-Ling Yeh Fang-Pey Chen Daphne Wu Department of Nursing Taipei Veterans General HospitalTaipei City 11217TaiwanChina School of Nursing National Taipei University of Nursing and Health SciencesTaipei City 11219TaiwanChina Center for Traditional Medicine Taipei Veterans General HospitalTaipei City 11217TaiwanChina Scool of Nursing National Taipei University of Nursing and Health Sciences and School of MedicineTaipei City 11217TaiwanChina

Background: Patients commonly develop postoperative pain after total knee arthroplasty(TKA).Acupuncture-related techniques and low-level laser therapy could be beneficial for pain management for older individuals.Objective: To examine the effect of low-level laser acupuncture(LA) in reducing postoperative pain, painrelated interference in daily life, morphine consumption, and morphine-related side effects in older patients with knee osteoarthritis who underwent TKA.Design, setting, participants and intervention: A single-blind randomized placebo-controlled trial was conducted. Patients(N = 82) were recruited and randomly assigned via a computer-generated list to the LA group or a placebo group. The LA group received low-level laser therapy at Sanyinjiao(SP6), Taixi(KI3),Kunlun(BL60), Fengshi(GB31), Futu(ST32) and Neiguan(PC6) after TKA, while the placebo acupuncture group received the same treatment procedure without laser energy output.Main outcome measures: The primary outcome was postoperative pain intensity, and it was measured at baseline and hours 2, 6, 10, 24, 48 and 72 after TKA. The secondary outcomes, including relative pain,postoperative pain-related interference in daily life and morphine consumption, were measured at hours24, 48 and 72 after TKA.Results: Generalized estimating equations revealed significant between-group differences in pain intensity(P = 0.01), and trend differences in pain intensity for the LA group starting at hours 10 to 72(P < 0.05)and morphine consumption at hours 48 and 72(P < 0.05). The changes in pain-related interference in daily life were significant(P < 0.05) at 72 h, with the exception of the parameters for worst pain, mood,and sleep. Nausea and vomiting side effects from morphine had significant between-group differences at hours 10 and 24(P < 0.05).Conclusion: Low-level LA gradually reduced older patients’ postoperative pain intensity and morphine consumption within the first 72 h after their TKA for osteoarthritis. Low-level LA may have benefits as an adjuvant pain man

关键词： Acupuncture Morphine Low-level laser Older patients Osteoarthritis Pain total knee arthroplasty Randomized controlled trial

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Long-term results of synovectomy in total knee arthroplasty:a prospective,randomized controlled trial

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Chinese Medical Journal 2023年第1期136卷 73-81页

作者： Weinan Zeng Zeping Yu Simeng Wang Anjing Chen Yiping Zeng Qingjun Yang Yujuan Li Qi Li Zongke Zhou Department of Orthopedics Orthopedic Research InstituteWest China HospitalSichuan UniversityChengduSichuan 610041China Department of Orthopedics Chongqing General HospitalUniversity of Chinese Academy of SciencesChongqing 400014China Department of Radiology West China HospitalSichuan UniversityChengduSichuan 610041China

Background:Synovectomy has been introduced into total knee arthroplasty(TKA)with the aim of relieving pain and inflammation of the synovium.However,there are no long-term,comparative data to evaluate the effect of synovectomy in TKA.This study was aimed at assessing pain,function,and complications in patients undergoing synovectomy during TKA for osteoarthritis(OA)at long-term follow-up.Methods:This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA.Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA.The overall efficacy of both strategies was evaluated by determination of blood loss,the knee Society score(KSS),and knee inflammation conditions during a 3-month postoperative period.The postoperative pain,range of motion(ROM),and complications were sequentially evaluated to compare the two groups until 10 years after surgery.Results:At the 10-year follow-up,both groups had a similarly significantly improved ROM(114.88±9.84°vs.114.02±9.43°,t=0.221,P=0.815)and pain relief with no differences between the two groups(1.0[1.0]vs.1.0[1.5],U=789.500,P=0.613).Similar changes in total blood loss,KSS,and knee inflammation were found in both groups during 3 months postoperatively(P>0.05).Additionally,there was no significant difference regarding complications and satisfaction between the two groups(P>0.05).Conclusions:Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain,ROM,and satisfaction during a 10-year follow-up.In addition,it may not result in more blood loss and increased incidence of long-term complications.Based on our long-term findings,it should not be performed routinely.Trial registration:Chinese Clinical Trial Registry,ChiCTR-INR-16008245;https://***/showproj.aspx?proj=13334.

关键词： Randomized controlled trial Synovectomy Clinical outcomes total knee arthroplasty

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Length of stay and inpatient charges of total knee arthroplasty in China:analysis of a national database

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Chinese Medical Journal 2023年第17期136卷 2050-2057页

作者： Huizhong Long Chao Zeng Ying Shi Haibo Wang Dongxing Xie Guanghua Lei Department of Orthopedics Xiangya HospitalCentral South UniversityChangshaHunan 410008China Hunan Key Laboratory of Joint Degeneration and Injury ChangshaHunan 410008China Hunan Engineering Research Center for Osteoarthritis ChangshaHunan 410008China National Clinical Research Center for Geriatric Disorders Xiangya HospitalCentral South UniversityChangshaHunan 410008China China Standard Medical Information Research Center ShenzhenGuangdong 518054China Clinical Trial Unit First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouGuangdong 510080China

Background:There are limited data on the resource utilization of total knee arthroplasty(TKA)in China.This study aimed to examine the length of stay(LOS)and inpatient charges of TKA in China,and to investigate their determinants.Methods:We included patients undergoing primary TKA in the Hospital Quality Monitoring System in China between 2013 and 2019.LOS and inpatient charges were obtained,and their associated factors were further assessed using multivariable linear regression.Results:A total of 184,363 TKAs were included.The LOS decreased from 10.8 days in 2013 to 9.3 days in 2019.The admission-to-surgery interval decreased from 4.6 to 4.2 days.The mean inpatient charges were 61,208.3 Chinese Yuan.Inpatient charges reached a peak in 2016,after which a gradual decrease was observed.Implant and material charges accounted for a dominating percentage,but they exhibited a downward trend,whereas labor-related charges gradually increased.Single marital status,non-osteoarthritis indication,and comorbidity were associated with longer LOS and higher inpatient charges.Female sex and younger age were associated with higher inpatient charges.There were apparent varieties of LOS and inpatient charges among provincial or non-provincial hospitals,hospitals with various TKA volume,or in different geographic regions.Conclusions:The LOS following TKA in China appeared to be long,but it was shortened during the time period of 2013 to 2019.The inpatient charges dominated by implant and material charges exhibited a downward trend.However,there were apparent sociodemographic and hospital-related discrepancies of resource utilization.The observed statistics can lead to more efficient resource utilization of TKA in China.

关键词： total knee arthroplasty China Length of stay Inpatient charges

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Effect of Wrist-Ankle Acupuncture on Postoperative Analgesia after total knee arthroplasty

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Chinese Journal of Integrative Medicine 2023年第3期29卷 253-257页

作者： CAO Hai-tao ZHANG Wan LUO Cheng ZHAO Hong-bo LIU Jian-ming Department of Trauma the Second Hospital of TangshanTangshanHebei Province(063000)China Department of Medical Service North China University of Science and Technology Affiliated HospitalTangshanHebei Province(063000)China Department of Geriatric Orthopedics The Second Hospital of TangshanTangshanHebei Province(063000)China Department of Joint Surgery the Second Hospital of TangshanTangshanHebei Province(063000)China Department of Thoracic Surgery Tangshan People’s HospitalNorth China University of Science and TechnologyTangshanHebei Province(063000)China

Objective:To evaluate the effect of wrist-ankle acupuncture(WAA)in pain and functional recovery after total knee arthroplasty(TKA).Methods:From June to September 2020,94 participants were included from the Second Hospital of Tangshan and randomly assigned to the WAA group(47 cases)and the sham WAA group(47 cases)by a random number table,receiving real or sham WAA treatment,respectively.The primary outcome measure involved the visual analogue scale(VAS)scores at rest and in motion.The secondary outcomes involved the range of motion(ROM)of the knee joints,straight-leg raising time,postoperative weight-bearing time,sufentanil consumption within 48 h of patient-controlled analgesia(PCA)pump,length of hospital stay,and postoperative complications.Results:The VAS scores on the 3rd,5th,and 7th postoperative days at rest and in motion was significantly lower in the WAA group than that of the sham WAA group(P0.05).Conclusions:WAA could alleviate post-TKA pain,improve knee joint function,and reduce the sufentanil consumption within 48 h of PCA pump.WAA is a safe and effective treatment in the perioperative analgesic management for TKA.

关键词： wrist-ankle acupuncture total knee arthroplasty postoperative analgesia

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Biomechanical Effects of Tibial Stems with Different Structures on Human knee Joint after total knee arthroplasty: A Finite Element Analysis

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Journal of Bionic Engineering 2022年第1期19卷 197-208页

作者： Meng Zhang Kaiwen Zhang He Gong Department of Engineering Mechanics Nanling CampusJilin UniversityChangchun130025China

Porous structure in orthopedic prosthesis may reduce micromotion and increase the service life of implants.The purposes of this study were to compare the influence of the tibial stems with solid and porous structures in total knee arthroplasty(TKA)on knee joint and prostheses,and to improve the mechanical stability of the host bone by seeking favorable structure for the tibial stem.The Finite Element(FE)models of TKA knee with four different structures in the middle segment of the tibial stem(i.e.,solid,cubic,truncated cubic,and octahedral structures)were constructed.The distributions of von Mises stress in the knee joint,tibial prosthesis and proximal tibia,and the compressive stresses of the tibial prosthesis and ultra-high-molecular-weight polyethylene for the four FE models were analyzed.The results showed that the tibial stem filled with the octahedral structure has the best mechanical performance among the above four types of tibial stems.It could effectively reduce the stress concentration and stress shielding effects,and provide an improved mechanical environment for knee joint after TKA.This study would shed some lights on the design and fabrication of porous implants targeted to biomedical applications.

关键词： total knee arthroplasty Tibial stem Porous structure Finite element analysis Mechanical performance

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