Journal of Joint Surgery and Research最新文献_第3页

Surgical intervention should be considered for sciatic nerve palsy following total hip arthroplasty using a posterolateral approach 采用后外侧入路进行全髋关节置换术后，应考虑对坐骨神经麻痹进行手术干预

Journal of Joint Surgery and Research

Pub Date : 2024-08-08 DOI: 10.1016/j.jjoisr.2024.07.002

Kazunari Ishida , Nao Shibanuma , Tomoyuki Matsumoto , Yuichi Kuroda , Naoki Nakano , Masahiro Kurosaka , Ryosuke Kuroda , Shinya Hayashi

Purpose

This single-center study aimed to determine whether surgical neurolysis influences muscle power recovery in sciatic nerve palsy following total hip arthroplasty (THA).

Methods

Among 1912 THAs performed between 2007 and 2019, a total of 1575 THAs using a posterolateral approach (primary THA, 1483 cases; revision THA, 92 cases) were retrospectively reviewed. Subjects who showed sciatic nerve palsy with motor disturbance were extracted. Demographic data, muscle power, and sensory disturbance at the onset of palsy and at final follow-up were examined. Subjects were divided into two groups (conservative treatment group and surgical treatment group) and clinical outcomes were compared between the two groups. Positive recovery was defined as muscle power greater than Manual Muscle Test grade 3.

Results

Thirteen cases (0.8%), including eight in the conservative treatment group and five in the surgical treatment group, showed post-operative sciatic nerve palsy. Four cases (80.0%) in the surgical treatment group achieved full muscle power recovery. All three subjects who received surgical treatment on the day of onset of palsy achieved full muscle power and sensory recovery. More patients recovered muscle power in the surgical treatment group than in the conservative treatment group.

Conclusion

Muscle power recovery was found in 80.0% of cases in the surgical treatment group and 12.5% of the conservative treatment group. All cases that received surgical intervention on the onset day of palsy achieved full muscle power and sensory recovery, whereas no cases achieved full muscle power recovery in the conservative treatment group. Immediate surgical intervention should be considered for sciatic nerve palsy following THA using a posterolateral approach.

目的本项单中心研究旨在确定手术神经溶解是否会影响全髋关节置换术（THA）后坐骨神经麻痹患者的肌力恢复。方法回顾性分析了 2007 年至 2019 年间实施的 1912 例 THA 中，采用后外侧入路的 1575 例 THA（初次 THA，1483 例；翻修 THA，92 例）。提取了出现坐骨神经麻痹并伴有运动障碍的受试者。对麻痹发生时和最终随访时的人口统计学数据、肌肉力量和感觉障碍进行了研究。受试者被分为两组（保守治疗组和手术治疗组），并对两组的临床结果进行比较。结果13例（0.8%）出现术后坐骨神经麻痹，其中保守治疗组8例，手术治疗组5例。手术治疗组有 4 例（80.0%）患者的肌肉力量完全恢复。在麻痹发生当天接受手术治疗的三名受试者全部实现了肌力和感觉的完全恢复。手术治疗组的肌力恢复率高于保守治疗组。所有在瘫痪发病当天接受手术治疗的病例都实现了完全的肌力和感觉恢复，而保守治疗组则没有病例实现完全的肌力恢复。采用后外侧入路进行 THA 后出现坐骨神经麻痹时，应考虑立即进行手术干预。

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引用次数: 0

Clinical outcomes of total knee arthroplasty for valgus knees caused by hip diseases: Coxitis knees and long leg arthropathies 髋关节疾病所致膝内翻的全膝关节置换术临床疗效：关节炎膝关节和长腿关节病

Journal of Joint Surgery and Research

Pub Date : 2024-07-20 DOI: 10.1016/j.jjoisr.2024.06.007

Kensuke Wada, Yuichi Kuroda, Naoki Nakano, Masanori Tsubosaka, Tomoyuki Kamenaga, Shinya Hayashi, Ryosuke Kuroda, Tomoyuki Matsumoto

Purpose

Coxitis knees and long leg arthropathies are similar pathological conditions; however, their clinical outcomes after total knee arthroplasty (TKA) have rarely been reported. The present study aimed to investigate clinical outcomes after TKA for these knee conditions, namely valgus knees caused by hip disease.

Methods

This retrospective cohort study included 19 TKAs performed on valgus knees caused by hip osteoarthritis (OA). Two years post-operatively, clinical outcomes, including range of motion and 2011 Knee Society Score (2011KSS), were assessed and were compared with pre-operative values. Pre-operative knee phenotypes, including lateral distal femoral angle and medial proximal tibial angle, were assessed, and their associations with clinical outcomes were investigated.

Results

All subscales of the 2011KSS improved significantly post-operatively (P < 0.05). There was also a significant improvement in extension post-operatively (P < 0.05). The mean femorotibial angle improved post-operatively from 157.7° to 175.2°(P < 0.05). There were five coxitis knee patients who had knee OA on the ipsilateral side of the hip, and five long leg arthropathy patients who had knee OA on the contralateral side of the hip.

Conclusions

Satisfactory clinical outcomes were observed after TKA for valgus knees caused by hip OA, such as coxitis knees and long leg arthropathies.

目的膝髋关节炎和长腿关节病是类似的病理情况，但它们在全膝关节置换术（TKA）后的临床疗效却鲜有报道。本研究旨在探讨这些膝关节疾病（即由髋关节疾病引起的膝关节外翻）的全膝关节置换术后临床疗效。方法这项回顾性队列研究纳入了19例由髋关节骨关节炎（OA）引起的膝关节外翻的全膝关节置换术。对术后两年的临床结果（包括活动范围和 2011 膝关节社会评分（2011KSS））进行了评估，并与术前值进行了比较。对术前膝关节表型（包括股骨远端外侧角和胫骨近端内侧角）进行了评估，并研究了它们与临床结果的关系。结果 2011KSS 的所有分量表在术后均有显著改善（P < 0.05）。术后伸展能力也有明显改善（P< 0.05）。术后股胫夹角平均值从157.7°增至175.2°（P <0.05）。结论对于髋关节OA引起的膝内翻，如膝外翻和长腿关节病，TKA术后临床疗效令人满意。

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引用次数: 0

Comparison of intravenous and periarticular administration of dexamethasone in total knee arthroplasty 全膝关节置换术中静脉注射地塞米松与关节周围注射地塞米松的比较

Journal of Joint Surgery and Research

Pub Date : 2024-07-20 DOI: 10.1016/j.jjoisr.2024.07.001

Hibiki Kakiage , Kazuhisa Hatayama , Masanori Terauchi , Atsufumi Oshima , Shogo Hashimoto , Hirotaka Chikuda

Purpose

Corticosteroids are widely used in total knee arthroplasty (TKA) to ameliorate post-operative pain. This study compared the effects of intravenous administration (IVA) and periarticular injection (PAI) of dexamethasone on pain, nausea, and blood glucose levels following TKA.

Methods

An institutional database was used to retrospectively examine two cohorts of patients who had undergone unilateral TKA from August 2018 to September 2020. The IVA group (n = 50) received 10 mg dexamethasone 1 h before surgery and 24 h after surgery. The PAI group (n = 50) received 10 mg dexamethasone during surgery. Pain scores at rest and during walking as well as nausea scores were recorded using the 0–10 numerical rating scale after surgery. Fasting blood glucose (FBG) levels were measured post-operatively.

Results

A total of 100 patients were enrolled (mean age, 71 years; 86% female). The rest pain score 24 h post-operatively was significantly lower in the PAI group than in the IVA group (3.3 vs. 4.3; absolute difference 1.0, 95% confidence interval, 0.4–1.3; P = 0.007). The nausea score did not differ markedly between groups. FBG was significantly higher in the PAI group than in the IVA group in the morning of post-operative Day 1.

Conclusion

PAI with dexamethasone was found to control pain more effectively at 24 h than IVA. FBG on the morning of post-operative Day 1 was significantly higher in the PAI group. Level of evidence, III; retrospective cohort.

目的皮质类固醇广泛用于全膝关节置换术（TKA），以减轻术后疼痛。本研究比较了地塞米松静脉给药（IVA）和关节周围注射（PAI）对 TKA 术后疼痛、恶心和血糖水平的影响。方法利用机构数据库回顾性研究了 2018 年 8 月至 2020 年 9 月期间接受单侧 TKA 的两组患者。IVA 组（n = 50）在术前 1 小时和术后 24 小时接受 10 毫克地塞米松。PAI 组（n = 50）在手术期间接受 10 毫克地塞米松。术后使用 0-10 数字评分表记录休息时和行走时的疼痛评分以及恶心评分。术后测量空腹血糖（FBG）水平。PAI 组术后 24 小时的静息痛评分明显低于 IVA 组（3.3 对 4.3；绝对差异 1.0，95% 置信区间 0.4-1.3；P = 0.007）。恶心评分在各组之间没有明显差异。术后第 1 天早晨，PAI 组的 FBG 明显高于 IVA 组。PAI组术后第1天早晨的FBG明显高于IVA组。证据等级，III；回顾性队列。

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引用次数: 0

Relationship between hip contact force during gait and patient-reported outcome measures 6 months after total hip arthroplasty 全髋关节置换术后 6 个月步态中的髋关节接触力与患者报告的结果指标之间的关系

Journal of Joint Surgery and Research

Pub Date : 2024-07-08 DOI: 10.1016/j.jjoisr.2024.06.005

Yasushi Kurihara , Hironori Ohsugi , Tomonari Tosaka , Tadamitsu Matsuda , Yoshikazu Tsuneizumi , Tadashi Tsukeoka

Purpose

Evaluating the hip contact force (HCF) during gait is important for assessing treatment outcomes after total hip arthroplasty (THA). This study investigated the relationship between patient-reported outcome measures (PROMs) and HCF during gait after THA as well as gait biomechanical factors affecting HCF during gait in relation to PROMs.

Methods

In total, 29 female patients who underwent THA with a 6-month follow-up were included in this study. Musculoskeletal model analysis was performed to obtain the first and second peak values of the HCF during gait and the minimum value between both peaks. PROMs were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). The relationship between JHEQ and selected HCFs and between the HCF and gait biomechanical factors was examined.

Results

The second peak value of HCF was positively related to the total JHEQ, movement, and mental health scores (r = −0.551, 0.410, and 0.495, respectively). A positive relationship was found between the second peak value of the HCF and hip flexion–extension range of motion (r = 0.518), maximum hip abduction moment (r = 0.432), and maximum knee extension moment (r = 0.417). A negative relationship was found between the second peak value of the HCF and the maximum knee abduction moment (r = −0.458).

Conclusions

The second peak value of HCF during gait after THA was related to PROMs. The second peak value was related to the hip flexion–extension range of motion, maximum hip abduction moment, and maximum knee extension and abduction moment.

目的评估步态过程中的髋关节接触力（HCF）对于评估全髋关节置换术（THA）后的治疗效果非常重要。本研究调查了患者报告的结果指标（PROMs）与全髋关节置换术后步态过程中髋关节接触力（HCF）之间的关系，以及影响步态过程中髋关节接触力（HCF）的步态生物力学因素与患者报告的结果指标之间的关系。通过肌肉骨骼模型分析，得出步态过程中 HCF 的第一和第二个峰值，以及两个峰值之间的最小值。使用日本骨科协会髋关节疾病评估问卷（JHEQ）对PROM进行评估。结果HCF的第二个峰值与JHEQ总分、运动和心理健康得分呈正相关（r=-0.551、0.410和0.495）。HCF的第二个峰值与髋关节屈伸活动范围（r = 0.518）、最大髋关节外展力矩（r = 0.432）和最大膝关节伸展力矩（r = 0.417）之间存在正相关关系。结论 THA术后步态过程中HCF的第二个峰值与PROMs有关。第二峰值与髋关节屈伸运动范围、最大髋关节外展力矩、最大膝关节外展和内收力矩有关。

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引用次数: 0

Comorbid frailty and sarcopenia in older patients after total hip arthroplasty: An observational study 全髋关节置换术后老年患者合并虚弱和肌肉疏松症：观察研究

Journal of Joint Surgery and Research

Pub Date : 2024-07-04 DOI: 10.1016/j.jjoisr.2024.06.004

Takashi Ikeda , Kazunari Ninomiya , Koji Suzuki , Kazuo Hirakawa

Purpose

Frailty and sarcopenia may progressively worsen physical function, and studies have noted the frequent presence of sarcopenia in patients who undergo total hip arthroplasty (THA). This study aimed to examine the prevalence of comorbid frailty and sarcopenia in older patients undergoing THA and to determine the impact of these conditions on lower limb strength and hip function.

Methods

Patients aged ≥65 years who had undergone THA at least 1 year previously were divided into five groups according to the presence and severity of frailty and sarcopenia. Lower limb strength [hip abductor (HA) and knee extensor (KE)], balance, and hip function were compared.

Results

Sarcopenia and frailty affected lower limb muscle strength and hip function in a staircase-like manner, with mean ± standard deviation values for the five groups as follows: HA muscle strength (in Nm/body weight), robust 0.80 ± 0.23, pre-frail + non-sarcopenia 0.69 ± 0.17, pre-frail + sarcopenia 0.58 ± 0.20, frail + non-sarcopenia 0.54 ± 0.16, frail + sarcopenia 0.50 ± 0.16; KE muscle strength (in kgf/body weight), robust 1.17 ± 0.23, pre-frail + non-sarcopenia 1.03 ± 0.32, pre-frail + sarcopenia 0.90 ± 0.31, frail + non-sarcopenia 0.84 ± 0.27, frail + sarcopenia 0.74 ± 0.21; and Harris Hip Score, robust 96.8 ± 4.6, pre-frail + non-sarcopenia 94.3 ± 7.9, pre-frail + sarcopenia 88.6 ± 9.6, frail + non-sarcopenia 87.5 ± 10.3, frail + sarcopenia 83.5 ± 8.6.

Conclusion

Progression of sarcopenia and frailty affects lower limb muscle strength and physical function in a staircase-like fashion, suggesting the need to assess the cumulative effects of the two. Among this population, rather than interventions to improve muscle strength and balance in specific areas, interventions to maintain a comprehensive level of physical fitness and muscle mass (including nutrition and lifestyle changes) may be necessary.

目的虚弱和肌肉疏松症可能会使身体功能逐渐恶化，有研究指出，接受全髋关节置换术（THA）的患者中经常出现肌肉疏松症。本研究旨在检查接受全髋关节置换术的老年患者中合并虚弱和肌肉疏松症的患病率，并确定这些情况对下肢力量和髋关节功能的影响。方法根据虚弱和肌肉疏松症的存在和严重程度，将至少一年前接受过全髋关节置换术的年龄≥65 岁的患者分为五组。结果肌肉疏松症和虚弱对下肢肌力和髋关节功能的影响呈阶梯状，五组的平均值（±标准差）如下：HA肌力（牛顿米/体重），强壮组 0.80 ± 0.23，虚弱前 + 非肌肉疏松组 0.69 ± 0.17，虚弱前 + 肌肉疏松组 0.58 ± 0.20，虚弱 + 非肌肉疏松组 0.54 ± 0.16，虚弱 + 肌肉疏松组 0.50 ± 0.16；KE 肌肉力量（千克力/体重），健壮 1.17 ± 0.23，虚弱前期 + 非肌肉疏松 1.03 ± 0.32，虚弱前期 + 肌肉疏松 0.90 ± 0.31，虚弱 + 非肌肉疏松 0.84 ± 0.27，虚弱＋肌肉疏松症 0.74 ± 0.21；哈里斯髋关节评分，强壮 96.8 ± 4.6，虚弱前＋非肌肉疏松症 94.3 ± 7.9，虚弱前＋肌肉疏松症 88.6 ± 9.6，虚弱＋非肌肉疏松症 87.5 ± 10.结论肌肉疏松症和虚弱的发展会以阶梯式的方式影响下肢肌肉力量和身体功能，这表明有必要评估两者的累积效应。在这类人群中，与其采取干预措施来改善特定部位的肌肉力量和平衡，不如采取干预措施来保持全面的体能和肌肉质量水平（包括营养和生活方式的改变）。

{"title":"Comorbid frailty and sarcopenia in older patients after total hip arthroplasty: An observational study","authors":"Takashi Ikeda , Kazunari Ninomiya , Koji Suzuki , Kazuo Hirakawa","doi":"10.1016/j.jjoisr.2024.06.004","DOIUrl":"https://doi.org/10.1016/j.jjoisr.2024.06.004","url":null,"abstract":"<div><h3>Purpose</h3><p>Frailty and sarcopenia may progressively worsen physical function, and studies have noted the frequent presence of sarcopenia in patients who undergo total hip arthroplasty (THA). This study aimed to examine the prevalence of comorbid frailty and sarcopenia in older patients undergoing THA and to determine the impact of these conditions on lower limb strength and hip function.</p></div><div><h3>Methods</h3><p>Patients aged ≥65 years who had undergone THA at least 1 year previously were divided into five groups according to the presence and severity of frailty and sarcopenia. Lower limb strength [hip abductor (HA) and knee extensor (KE)], balance, and hip function were compared.</p></div><div><h3>Results</h3><p>Sarcopenia and frailty affected lower limb muscle strength and hip function in a staircase-like manner, with mean ± standard deviation values for the five groups as follows: HA muscle strength (in Nm/body weight), robust 0.80 ± 0.23, pre-frail + non-sarcopenia 0.69 ± 0.17, pre-frail + sarcopenia 0.58 ± 0.20, frail + non-sarcopenia 0.54 ± 0.16, frail + sarcopenia 0.50 ± 0.16; KE muscle strength (in kgf/body weight), robust 1.17 ± 0.23, pre-frail + non-sarcopenia 1.03 ± 0.32, pre-frail + sarcopenia 0.90 ± 0.31, frail + non-sarcopenia 0.84 ± 0.27, frail + sarcopenia 0.74 ± 0.21; and Harris Hip Score, robust 96.8 ± 4.6, pre-frail + non-sarcopenia 94.3 ± 7.9, pre-frail + sarcopenia 88.6 ± 9.6, frail + non-sarcopenia 87.5 ± 10.3, frail + sarcopenia 83.5 ± 8.6.</p></div><div><h3>Conclusion</h3><p>Progression of sarcopenia and frailty affects lower limb muscle strength and physical function in a staircase-like fashion, suggesting the need to assess the cumulative effects of the two. Among this population, rather than interventions to improve muscle strength and balance in specific areas, interventions to maintain a comprehensive level of physical fitness and muscle mass (including nutrition and lifestyle changes) may be necessary.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 3","pages":"Pages 123-128"},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705124000161/pdfft?md5=d6caafb120ee35126f7cd6387954bd1a&pid=1-s2.0-S2949705124000161-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141540017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical course and risk factors for post-operative onset lateral hinge fracture following medial opening-wedge distal tibial tuberosity osteotomy 胫骨远端结节内侧开口楔形截骨术后外侧铰链骨折的临床过程和风险因素

Journal of Joint Surgery and Research

Pub Date : 2024-07-03 DOI: 10.1016/j.jjoisr.2024.06.006

Hiroyasu Ogawa , Yutaka Nakamura , Masaya Sengoku , Tetsuya Shimokawa , Kazuichiro Ohnishi , Haruhiko Akiyama

Purpose

This study aimed to investigate the clinical outcomes of and risk factors for post-operative onset lateral hinge fracture (LHF) following medial opening-wedge distal tibial tuberosity osteotomy (DTO).

Methods

A total of 68 patients who underwent DTO were stratified into non-LHF and post-operative onset LHF groups. The groups were compared in terms of radiographic parameters, including the hip–knee–ankle (HKA) angle, and were clinically evaluated using the Knee Society Score (KSS) and 2011KSS. Multiple logistic regression analysis was performed to identify risk factors for post-operative onset LHF.

Results

The non-LHF and post-operative onset LHF groups included 53 and 15 patients, respectively. The post-operative HKA angle was significantly smaller (valgus) in the post-operative onset LHF group than in the non-LHF group (P = 0.005). Knee and function scores were significantly lower in the post-operative onset LHF group than the non-LHF group at 6 months (P = 0.002 for each comparison). All 2011KSS subscores were significantly lower in the post-operative onset LHF group than the non-LHF group at 6 months (P = 0.001, 0.010, 0.013, and 0.013, respectively). Post-operative HKA angle was a risk factor for post-operative onset LHF (odds ratio = 0.589, 95% confidence interval 0.392–0.886; P = 0.011).

Conclusions

Post-operative weight bearing may be delayed to prevent post-operative onset LHF, especially in patients with post-operative large valgus knee alignment.

目的本研究旨在探讨胫骨远端结节内侧开刃截骨术（DTO）术后发生外侧铰链骨折（LHF）的临床结果和风险因素。方法将68例接受DTO手术的患者分为非LHF组和术后发生LHF组。比较两组患者的影像学参数，包括髋-膝-踝（HKA）角度，并使用膝关节社会评分（KSS）和 2011KSS 进行临床评估。结果非 LHF 组和术后 LHF 组分别有 53 名和 15 名患者。术后发病 LHF 组的 HKA 角度（外翻）明显小于非 LHF 组（P = 0.005）。术后 6 个月时，发病 LHF 组的膝关节和功能评分明显低于非 LHF 组（每次比较的 P = 0.002）。术后 6 个月时，发病 LHF 组的所有 2011KSS 子评分均明显低于非 LHF 组（P = 0.001、0.010、0.013 和 0.013）。术后 HKA 角度是术后 LHF 发病的风险因素（几率比 = 0.589，95% 置信区间 0.392-0.886; P = 0.011）。

{"title":"Clinical course and risk factors for post-operative onset lateral hinge fracture following medial opening-wedge distal tibial tuberosity osteotomy","authors":"Hiroyasu Ogawa , Yutaka Nakamura , Masaya Sengoku , Tetsuya Shimokawa , Kazuichiro Ohnishi , Haruhiko Akiyama","doi":"10.1016/j.jjoisr.2024.06.006","DOIUrl":"https://doi.org/10.1016/j.jjoisr.2024.06.006","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to investigate the clinical outcomes of and risk factors for post-operative onset lateral hinge fracture (LHF) following medial opening-wedge distal tibial tuberosity osteotomy (DTO).</p></div><div><h3>Methods</h3><p>A total of 68 patients who underwent DTO were stratified into non-LHF and post-operative onset LHF groups. The groups were compared in terms of radiographic parameters, including the hip–knee–ankle (HKA) angle, and were clinically evaluated using the Knee Society Score (KSS) and 2011KSS. Multiple logistic regression analysis was performed to identify risk factors for post-operative onset LHF.</p></div><div><h3>Results</h3><p>The non-LHF and post-operative onset LHF groups included 53 and 15 patients, respectively. The post-operative HKA angle was significantly smaller (valgus) in the post-operative onset LHF group than in the non-LHF group (<em>P</em> = 0.005). Knee and function scores were significantly lower in the post-operative onset LHF group than the non-LHF group at 6 months (<em>P</em> = 0.002 for each comparison). All 2011KSS subscores were significantly lower in the post-operative onset LHF group than the non-LHF group at 6 months (<em>P</em> = 0.001, 0.010, 0.013, and 0.013, respectively). Post-operative HKA angle was a risk factor for post-operative onset LHF (odds ratio = 0.589, 95% confidence interval 0.392–0.886; <em>P</em> = 0.011).</p></div><div><h3>Conclusions</h3><p>Post-operative weight bearing may be delayed to prevent post-operative onset LHF, especially in patients with post-operative large valgus knee alignment.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 3","pages":"Pages 117-122"},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705124000185/pdfft?md5=d82304c216faad030de78a274f01bd86&pid=1-s2.0-S2949705124000185-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141540016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prognostic power of criteria for symptomatic early knee osteoarthritis from a 2-year longitudinal observation of the Iwaki cohort study 从岩城队列研究的两年纵向观察中得出的无症状早期膝关节骨性关节炎标准的预后能力

Journal of Joint Surgery and Research

Pub Date : 2024-06-23 DOI: 10.1016/j.jjoisr.2024.06.001

Eiji Sasaki , Daisuke Chiba , Seiya Ota , Yuka Kimura , Gentaro Kumagai , Eiichi Tsuda , Yoshiko Takahashi , Takuro Iwane , Yasuyuki Ishibashi

Purpose

This study aimed to investigate whether symptomatic early knee osteoarthritis (EKOA) effectively predicts the incidence of definitive knee osteoarthritis (DKOA) in the general Japanese population.

Methods

A total of 133 women from the Japanese Iwaki cohort study were enrolled and followed-up over 2 years in order to calculate the rate of progression of EKOA to DKOA. Weight-bearing anteroposterior bilateral knee radiographs and magnetic resonance imaging (MRI) were conducted at baseline and follow-up. Radiographs were classified according to the Kellgren–Lawrence grade. The presence of cartilage lesion, bone marrow lesions, attrition, cysts, osteophytes, and meniscal lesions was evaluated according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Logistic regression analyses were performed to determine the predictive power of EKOA.

Results

Of 25 women with EKOA, 15 (60%) progressed to DKOA over 2 years, showing a relative risk (RR) of 1.44 compared with the non-osteoarthritis (non-OA) group (P = 0.120). Logistic regression analysis showed associations of EKOA (P = 0.048) and high body mass index (P < 0.001) with progression to DKOA. Combined EKOA and meniscal lesions increased the RR for osteoarthritis incidence to 2.32 (P = 0.004) compared with the non-OA group. Also, meniscus and bone marrow lesion scores on MRI of the EKOA group maintained high scores over 2 years.

Conclusions

The prognostic power of EKOA criteria was confirmed with a RR of 1.44. The combination of symptomatic EKOA criteria and MRI-detected meniscal lesions was a valuable predictor of progression to DKOA over 2 years in women without radiographic abnormalities.

目的本研究旨在探讨无症状早期膝关节骨性关节炎（EKOA）是否能有效预测日本普通人群中明确膝关节骨性关节炎（DKOA）的发病率。方法从日本磐城队列研究中选取了 133 名女性，对她们进行了为期 2 年的随访，以计算 EKOA 发展为 DKOA 的比率。在基线和随访期间进行了双侧膝关节负重前后位X光片和磁共振成像（MRI）检查。根据 Kellgren-Lawrence 分级对射线照片进行分类。软骨病变、骨髓病变、萎缩、囊肿、骨质增生和半月板病变根据全组织磁共振成像评分（WORMS）进行评估。结果在25名患有EKOA的女性中，15人（60%）在2年内发展为DKOA，与非骨关节炎（非OA）组相比，相对风险（RR）为1.44（P = 0.120）。逻辑回归分析显示，EKOA（P = 0.048）和高体重指数（P < 0.001）与进展为 DKOA 有关。与非 OA 组相比，合并 EKOA 和半月板病变会使骨关节炎发病率的 RR 增至 2.32（P = 0.004）。此外，EKOA 组的半月板和骨髓病变 MRI 得分在 2 年内保持高分。无症状的EKOA标准和MRI检测到的半月板病变相结合，是预测无放射学异常的女性在2年内发展为DKOA的重要指标。

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引用次数: 0

Relationship between intra-operative joint gap and knee flexion angle after posterior-stabilized total knee arthroplasty 后稳定全膝关节置换术后术中关节间隙与膝关节屈曲角度的关系

Journal of Joint Surgery and Research

Pub Date : 2024-06-22 DOI: 10.1016/j.jjoisr.2024.06.003

Sachiyuki Tsukada, Hiroyuki Ogawa, Masayoshi Saito, Takuya Kusakabe, Masahiro Nishino, Naoyuki Hirasawa

Purpose

Conflicting evidence exists about the appropriate intra-operative soft tissue balance in posterior-stabilized (PS) total knee arthroplasty (TKA). The purpose of this prospective observational study was to investigate the impact of intra-operative soft tissue balance on post-operative knee flexion angle.

Methods

A single surgeon performed 164 TKAs using a single brand of PS prosthesis via the subvastus approach without using a pneumatic tourniquet. Intra-operative soft tissue balance was quantified as the gaps between the femoral component and tibial osteotomy surface with the knee flexed at 0°, 30°, 90°, and 120° with the patellofemoral joint reduced. Multiple regression analyses were employed to identify independent predictors of knee flexion angle 1 year after TKA.

Result

The pre-operative knee flexion angle and the gap difference between 120° and 0° flexion were positively correlated with knee flexion angle 1 year after TKA [β = 0.37, 95% confidence interval (CI) 0.26–0.48, P < 0.001; and β = 1.09, 95% CI 0.04–2.14, P = 0.042, respectively]. There was no correlation with knee flexion angle 1 year after TKA for the gap difference between 30° flexion and 0° flexion and between 90° flexion and 0° flexion.

Conclusions

Intra-operative soft tissue balance at 120° flexion may affect the post-operative knee flexion angle in PS-TKA.

目的在后稳定（PS）全膝关节置换术（TKA）中，关于术中软组织平衡的适当性存在着相互矛盾的证据。这项前瞻性观察研究的目的是调查术中软组织平衡对术后膝关节屈曲角度的影响。方法由一名外科医生在不使用气动止血带的情况下，通过腹股沟下入路使用单一品牌的 PS 假体进行了 164 例 TKA 手术。术中软组织平衡量化为膝关节屈曲 0°、30°、90° 和 120°，髌股关节缩小时股骨组件与胫骨截骨面之间的间隙。结果术前膝关节屈曲角度和屈曲120°与0°之间的间隙差与TKA术后1年的膝关节屈曲角度呈正相关[β=0.37，95%置信区间（CI）0.26-0.48，P< 0.001；β=1.09，95%置信区间（CI）0.04-2.14，P=0.042]。屈曲30°和屈曲0°之间以及屈曲90°和屈曲0°之间的间隙差与TKA术后1年的膝关节屈曲角度无相关性。

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引用次数: 0

Accuracy of acetabular cup placement in total hip arthroplasty using an augmented reality navigation “pin-less” system: A pilot study 使用增强现实导航 "无针 "系统进行全髋关节置换术中髋臼杯置入的准确性：试点研究

Journal of Joint Surgery and Research

Pub Date : 2024-06-21 DOI: 10.1016/j.jjoisr.2024.06.002

Tetsuya Kimura , Tatsuya Tamaki , Hiroyuki Ogawa

Purpose

Currently, there is limited information regarding the utilization of pin-less augmented reality (AR) assistance in total hip arthroplasty (THA). This preliminary study aimed to evaluate the precision of acetabular cup placement in THA utilizing the AR Navigation “Pin-less” System (Pin-less AR navigation, prototype).

Methods

A total of 72 consecutive primary THAs in 58 patients were categorized into two groups: the Pin-less AR navigation group and the conventional group. All THAs were conducted via the direct anterior approach. First, the absolute value of difference between the intra-operative and post-operative angles (absolute difference) was calculated in the Pin-less AR navigation group. Second, the absolute value of error between the post-operative angles and the target angles (absolute target error) was assessed both in the Pin-less AR navigation group and the conventional group.

Results

The absolute difference in inclination and anteversion angles was 2.2 ± 1.4° and 2.4 ± 1.5°, respectively. The absolute target error in the Pin-less AR navigation group versus the conventional group was 1.9 ± 1.5° versus 4.2 ± 2.7° in inclination (P < 0.001) and 2.3 ± 1.5° versus 3.1 ± 2.1° in anteversion (P = 0.092). The percentage of acetabular cups placed within ±5° from the target angles was significantly higher in the Pin-less AR navigation group (90.3%) compared with the conventional group (52.6%) (P < 0.001).

Conclusions

This study demonstrates that Pin-less AR navigation yielded generally accurate acetabular cup positioning, surpassing the conventional method. Further research is warranted to thoroughly evaluate Pin-less AR navigation.

目的目前，有关在全髋关节置换术（THA）中使用无针增强现实（AR）辅助的信息非常有限。本初步研究旨在评估在全髋关节置换术中使用 "无针 "AR 导航系统（Pin-less AR navigation，原型）进行髋臼杯置放的精确度。方法将 58 名患者的 72 例连续全髋关节置换术分为两组：无针 AR 导航组和传统组。所有 THAs 均通过直接前路进行。首先，计算无针孔 AR 导航组术中和术后角度差的绝对值（绝对差）。其次，评估了无针孔 AR 导航组和传统组术后角度与目标角度之间误差的绝对值（绝对目标误差）。结果倾角和前内翻角度的绝对差值分别为 2.2 ± 1.4° 和 2.4 ± 1.5°。无针 AR 导航组与传统组的绝对目标误差分别为：倾斜 1.9 ± 1.5° 对 4.2 ± 2.7°（P < 0.001），内翻 2.3 ± 1.5° 对 3.1 ± 2.1°（P = 0.092）。与传统方法组（52.6%）相比，无针孔 AR 导航组（90.3%）放置的髋臼杯与目标角度的距离在 ±5° 以内的比例明显更高（P < 0.001）。有必要开展进一步研究，对无针式 AR 导航进行全面评估。

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引用次数: 0

Method for defining the horizontal plane in fluoroscopic kinematic analysis 在透视运动学分析中定义水平面的方法

Journal of Joint Surgery and Research

Pub Date : 2024-06-21 DOI: 10.1016/j.jjoisr.2024.05.002

Takahiro Arakawa , Kenichi Kono , Tetsuya Tomita , Takaharu Yamazaki , Masashi Tamaki , Shoji Konda , Teruya Ishibashi , Ryota Yamagami , Kohei Kawaguchi , Tomofumi Kage , Ryo Murakami , Hiroshi Inui , Shuji Taketomi , Sakae Tanaka

Purpose

In vivo kinematics of skeletal joints and prostheses is affected by gravity; therefore, absolute tilt must be taken into account. However, current fluoroscopic kinematic analysis cannot measure the tilt. This study introduces and validates a method for defining the horizontal plane in fluoroscopy systems to measure the tilt of an object.

Methods

A rectangular metal plate (200 × 200 × 10 mm) with a flatness of 0.03/100 mm was horizontally adjusted using a leveler (sensitivity of 0.02° and accuracy of ±0.06°), and its three-dimensional coordinate was calculated from a two-dimensional fluoroscopic image. A coordinate calculation formula was developed, with precision and accuracy assessed via computer simulations. Actual fluoroscopic tests included four aspects: accuracy under the same condition; accuracy under different X-ray tube height; reproducibility when changing X-ray tube height; and reproducibility when the flat panel was tilted and returned.

Results

The theoretical measurement error indicated by the computer simulations was 0.0 ± 0.2° on the xy-plane and 0.0 ± 0.0° on the yz-plane. The actual experimental results showed that the horizontal plane tilt was measured to be −0.2 ± 0.1° tilt on the xy-plane and 0.3 ± 0.0° tilt on the yz-plane for the device used in this study. The F-test showed no significant differences between the computer simulations and the actual experiments. There were no significant differences between the four actual tests.

Conclusions

This method enables the horizontal plane to be defined and the tilt of an object to be measured in fluoroscopic kinematic analysis.

目的骨骼关节和假体的体内运动学受重力影响，因此必须考虑绝对倾斜。然而，目前的透视运动学分析无法测量倾斜度。本研究介绍并验证了一种在透视系统中定义水平面以测量物体倾斜度的方法。方法使用水平仪（灵敏度为 0.02°，精确度为 ±0.06°）水平调整平整度为 0.03/100 mm 的矩形金属板（200 × 200 × 10 mm），并根据二维透视图像计算其三维坐标。我们开发了一个坐标计算公式，并通过计算机模拟对精确度和准确性进行了评估。实际透视测试包括四个方面：相同条件下的精确度；不同 X 射线管高度下的精确度；改变 X 射线管高度时的再现性；平板倾斜和返回时的再现性。实际实验结果表明，本研究中使用的设备在 xy 平面上测得的水平面倾斜度为 -0.2 ± 0.1°，在 yz 平面上测得的水平面倾斜度为 0.3 ± 0.0°。F 检验表明，计算机模拟与实际实验之间没有显著差异。结论这种方法可以在透视运动学分析中定义水平面并测量物体的倾斜度。

{"title":"Method for defining the horizontal plane in fluoroscopic kinematic analysis","authors":"Takahiro Arakawa , Kenichi Kono , Tetsuya Tomita , Takaharu Yamazaki , Masashi Tamaki , Shoji Konda , Teruya Ishibashi , Ryota Yamagami , Kohei Kawaguchi , Tomofumi Kage , Ryo Murakami , Hiroshi Inui , Shuji Taketomi , Sakae Tanaka","doi":"10.1016/j.jjoisr.2024.05.002","DOIUrl":"https://doi.org/10.1016/j.jjoisr.2024.05.002","url":null,"abstract":"<div><h3>Purpose</h3><p><em>In vivo</em> kinematics of skeletal joints and prostheses is affected by gravity; therefore, absolute tilt must be taken into account. However, current fluoroscopic kinematic analysis cannot measure the tilt. This study introduces and validates a method for defining the horizontal plane in fluoroscopy systems to measure the tilt of an object.</p></div><div><h3>Methods</h3><p>A rectangular metal plate (200 × 200 × 10 mm) with a flatness of 0.03/100 mm was horizontally adjusted using a leveler (sensitivity of 0.02° and accuracy of ±0.06°), and its three-dimensional coordinate was calculated from a two-dimensional fluoroscopic image. A coordinate calculation formula was developed, with precision and accuracy assessed via computer simulations. Actual fluoroscopic tests included four aspects: accuracy under the same condition; accuracy under different X-ray tube height; reproducibility when changing X-ray tube height; and reproducibility when the flat panel was tilted and returned.</p></div><div><h3>Results</h3><p>The theoretical measurement error indicated by the computer simulations was 0.0 ± 0.2° on the <em>xy</em>-plane and 0.0 ± 0.0° on the <em>yz</em>-plane. The actual experimental results showed that the horizontal plane tilt was measured to be −0.2 ± 0.1° tilt on the <em>xy</em>-plane and 0.3 ± 0.0° tilt on the <em>yz</em>-plane for the device used in this study. The <em>F</em>-test showed no significant differences between the computer simulations and the actual experiments. There were no significant differences between the four actual tests.</p></div><div><h3>Conclusions</h3><p>This method enables the horizontal plane to be defined and the tilt of an object to be measured in fluoroscopic kinematic analysis.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 3","pages":"Pages 99-105"},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705124000124/pdfft?md5=8b505a1b580116ed9979df6473ddb3bc&pid=1-s2.0-S2949705124000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141439349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0