Journal of Joint Surgery and Research最新文献

Purpose

This multicenter prospective study aimed to evaluate the accuracy of the cup alignment of an accelerometer-based portable navigation system (AP navigation) for a total hip arthroplasty (THA) in spine position.

Methods

This study prospectively enrolled 324 THAs using supine position in 9 hospitals. An AP navigation was used for cup fixation and the intraoperative navigation data (cup alignment, pelvic tilt, and pelvic rotation) were recorded. Computed tomography (CT) of the pelvis was performed 2 weeks post-operatively and cup alignment was measured on 3D-CT images.

Result

The accuracy (absolute difference in cup alignment between the intraoperative navigation record and postoperative 3D-CT measurements) was 3 ​± ​3° (mean ​± ​standard deviation) for cup inclination and 3 ​± ​3° for cup anteversion. The pelvis tilted anteriorly in 148 hips (46%) and posteriorly in 162 hips (50%), and did not tilt in 14 hips (4%). The pelvis rotated toward the operating side in 179 hips (55%), toward the contralateral side in 112 hips (35%), and did not rotate in 33 hips (10%). Multiple regression analysis showed that the patients’ characteristics (sex, body mass index, diagnosis, Crowe classification, laterality, intraoperative pelvic tilt, intraoperative pelvic rotation, and cup size) and the surgical factors (approach, preparation time, number of screws, and institution) did not affect the accuracy of the navigation system.

Conclusions

This is the first prospective multicenter study of this navigation system. The accuracy was not affected by patient characteristics, surgical factors, or substantial pelvic movement during cup fixation.

Purpose

Using navigation systems during total hip arthroplasty (THA) has been reported to be useful for preventing acetabular cup malpositioning. However, only few studies have reported on the application of navigation systems to THA at low-volume hospitals owing to cost and usage complexity. Therefore, the aim of this study was to determine whether smartphone-based portable navigation using augmented reality technology would enable low-volume surgeons to perform acetabular cup placement more accurately than with the conventional manual technique.

Methods

We retrospectively compared acetabular cup placement between the navigation (n ​= ​28) and conventional (n ​= ​24) groups. The acetabular cup inclination and anteversion angles were measured using computed tomography (CT)-based planning software. Furthermore, the absolute difference between the postoperative and target angles was compared between the groups.

Results

The absolute difference between the postoperative and target angles of cup inclination was 2.6° ​± ​2.3° in the navigation group and 5.6° ​± ​5.2° in the conventional group (p ​< ​0.01). Additionally, the cup anteversion was 3.2° ​± ​3.0° in the navigation group and 9.4° ​± ​7.1° in the conventional group (p ​< ​0.01).

Conclusions

Using a smartphone-based portable navigation system could allow for appropriate cup placement even by low-volume surgeons.

Purpose

Outcomes after combination of anterior cruciate ligament (ACL) reconstruction (ACLR) with unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO) have been widely reported, but previous systematic reviews have included articles published before 2000 and do not necessarily reflect recent trends. We conducted a thorough investigation to address (1): What are the recent surgical trends in simultaneous ACLR and UKA or HTO? and (2) What are the issues in these surgeries? based on a comprehensive systematic analysis.

Methods

A systematic surveillance was performed in accordance with the PRISMA guideline. The inclusion criteria were as follows: simultaneous ACLR and UKA or HTO for medial osteoarthritis (OA) with ACL deficiency; clinical outcomes and complications recorded; publication date after 2000.

A total of 1466 potentially relevant articles were identified; after exclusions, 31 articles that included 744 knees were analyzed. Fourteen articles included 330 knees underwent simultaneous ACLR and UKA (UKA group) and 17 articles included 414 knees underwent simultaneous ACLR and HTO (HTO group).

Results

Overall, complications were found in 14 knees (4.2%) in the UKA group and 47 knees (11.3%) in the HTO group. Re-rupture of the ACL was observed in only the HTO group (6 knees: 1.4%). Revision to TKA occurred in 8 knees (2.4%) in the UKA group and 1 knee (0.2%) in the HTO group. No standardized outcome measures for clinical assessment were used for all studies.

Conclusion

The systematic surveillance of studies published since 2000 on the outcomes and complications of simultaneous ACLR and UKA or HTO for medial OA with ACL deficiency indicates an increasing number of reports on simultaneous ACLR and HTO or UKA in recent years. Favorable clinical results were achieved in both treatment groups.

Purpose

Total knee arthroplasty (TKA) reduces knee pain to improve knee function for painful knee osteoarthritis and provides excellent long-term survivorship. However, approximately 20% of patients remain dissatisfied. To improve patient satisfaction, several modifications of knee alignment have recently been introduced. The aim of this paper is to review various alignment techniques.

Methods

Principles, surgical techniques, and clinical results of various alignment techniques for TKA were searched in the PubMed database.

Results

Mechanical alignment aims to cut perpendicular to the mechanical axes of the femur and tibia in the coronal plane. The threshold of the deviation from the mechanical axis for long-term survivorship is still unknown. Anatomical alignment aims at neutral alignment but 2–3 varus joint line relative to the mechanical axis. Although catastrophic polyethylene wear was reported in the 1990s, excellent mid-term clinical results were recently reported using surgical robots. Kinematic alignment aims to restore the pre-arthritic native limb alignment and avoid soft tissue release. To avoid excessive alignment deviation, some modification such as inverse kinematic, restricted kinematic, and modified kinematic alignments are also introduced. Equal or better clinical scores have been reported in short term. Functional alignment TKA aims to restore pre-arthritic alignment and achieve balanced soft tissue tension by adjusting bone resections using robotic-assisted technology.

Conclusion

Wide range of clinical results exist for new alignment techniques in the short term. The safe range of alignment for long-term survivorship remains unknown. Further high-quality studies should be performed to warrant the widespread use of new alignment techniques.

Purpose

Knee joint line orientation (KJLO), an essential component of knee kinematics, has recently been of interest as a clinical parameter, but the factors that determine this are unknown. This study aims to clarify the effect of mechanical axis inclination of the lower limb on KJLO after total knee arthroplasty.

Methods

The study included 95 knees of 95 patients who underwent kinematically aligned total knee arthroplasty in which two postoperative whole-leg standing radiographs (open and closed stance) were evaluated. We measured hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, KJLO, joint line convergence angle, ankle joint line orientation and the inclination angle of lower limb mechanical axis (θ); the amount of change in each measurement was defined as delta (Δ). The correlation between ΔKJLO and each measured value was analysed, and a multiple linear regression analysis was performed to identify significant factors related to ΔKJLO.

Results

The open and closed stance radiographs had differences in KJLO (3.4 ​± ​2.2° vs. −0.2 ​± ​2.3°,p ​< ​0.001), ankle joint line orientation (−3.3 ​± ​4.4° vs. −6.8 ​± ​4.1°, p ​< ​0.001) and θ (−0.3 ​± ​1.6 vs. 3.3 ​± ​1.5, p ​< ​0.001). We found that Δθ determined ΔKJLO, with a strong negative correlation (r ​= ​−0.847, p ​< ​0.001). According to the ΔKJLO equation, ΔKJLO (°) ​= ​0.361 ​− ​0.898 ​× ​θ (°), KJLO changed by 0.9° per 1° of θ.

Conclusion

The KJLO after total knee arthroplasty is affected by the mechanical axis inclination of the lower limb; KJLO changed by 0.9° per 1° of θ.

Purpose

Meniscus injury and meniscus extrusion cause meniscus dysfunction, which then leads to the initiation and progression of knee osteoarthritis. Meniscus preservation surgery therefore plays an important role in preventing long-term cartilage degeneration. The purpose of this paper was to review the current information about meniscus preservation surgeries, such as meniscal repair and centralization.

Methods

We reviewed recent articles related to meniscus preservation surgery. We compiled sections for some special meniscus pathologies, including ramp lesion, discoid lateral meniscus, degenerative meniscus tear, posterior root tear, and meniscus extrusion.

Results

Reoperation rates are higher after meniscal repair compared with arthroscopic partial meniscectomy; however, long-term follow-up studies have demonstrated better clinical outcomes and less severe degenerative changes for meniscal repair than for partial meniscectomy. Therefore, meniscal repair should be considered the first option for any meniscus injury when surgical intervention is necessary. Posterior root tears of the meniscus substantially affect meniscal hoop function and accelerate cartilage degeneration and accompanying meniscus extrusion. Therefore, surgical repair should be considered as early as possible. A centralization procedure has been developed to reduce meniscus extrusion and improve meniscus hoop function. Long-term follow-up should also be considered essential for the prevention of osteoarthritis.

Conclusions

Meniscus preservation surgery provides satisfactory clinical outcomes at short- and mid-term follow-up. Further understanding of meniscus pathology and continued development of surgical techniques will improve the outcomes of meniscus preservation surgery. The long-term efficacy of these procedures should also be confirmed to validate this treatment strategy for meniscus dysfunction.

Purpose

Proximal tibial plateau/distal tibial rotational realignment, which is defined as tibial rotational realignment (TRR), is uncertain in open-wedge high tibial osteotomy (OWHTO). This study descriptively analysed TRR outliers in OWHTO, and also examined influence of TRR on the patellar cartilage at a 1-year postoperative examination.

Methods

In total, 206 consecutive cases with computer-navigated OWHTO were reviewed. Patellar cartilage aggravation was evaluated in reference to the International Cartilage Repair Society grade (ICRS) at a 1-year postoperative arthroscopic view. Also, the lateral patella tilt correction and the Iwano classification deterioration grades were examined using axial radiographic views at a 1-year postoperative follow-up visit.

Results

The TRR ranged from −12° (the distal tibia was externally rotated based on the proximal tibia) to 13° (internal rotation (IR): the distal tibia was internally rotated based on the proximal tibia) with mean 1.9° IR and standard deviation 5.4°. The inter-quantile range (IQR) was 8°, suggesting that there was no outlier in this cohort, (outliers were defined as either more than Q3+1.5IQR (upper limit: 18°), or Q1-1.5IQR (lower limit: −14°)). In univariate regression models, the TRR did not exhibit any significant influence to the patellar cartilage damage (odds ratio (OR) 1.047, 95% confidence interval (95%CI) 0.976–1.122), the patella tilt correction (OR 1.010, 95%CI 0.953–1.071), or the Iwano classification degradation scale (OR 1.041, 95%CI 0.971–1.116).

Conclusion

We found no outlier in the TRR with OWHTO, and an insignificant negative impact of the TRR with OWHTO on the patellar cartilage in the 1-year follow-up examinations.

Purpose

Soft-tissue tension is an important factor for preventing dislocations after total hip arthroplasty. The purpose of this study was to evaluate the effects of anterior capsule repair for preventing dislocation during primary total hip arthroplasty using the anterolateral approach in the supine position (ALS).

Methods

This study retrospectively compared the clinical and radiographic outcomes between patients who underwent total hip arthroplasty via the ALS with or without anterior capsule repair at our institute. The cup (radiographic inclination and radiographic anteversion) and stem alignment, operative time, clinical score, and complication were evaluated.

Results

Among the 393 hips evaluated, 193 and 200 belonged to the resection and repair groups, respectively. There were significant differences in the inclination and anteversion of the cup and flexion insertion of the stem (42.3° vs. 40.3°, 15.8° vs. 19.8°, and 27.5% vs. 34.0%, respectively). No significant differences in operative time and postoperative Japanese Orthopedic Association hip score were noted. Early dislocation was more common in the resection group compared to the repair group (2 hips vs. 0 hip, respectively), albeit not significantly (1.03% vs. 0%, p ​= ​0.241).

Conclusion

Our results demonstrated that the clinical benefit of the anterior capsule repair for preventing dislocation was limited in ALS.

Purpose

The advantage of total hip arthroplasty (THA) in an anterior approach compared with a posterior approach in terms of early postoperative pain and function and lowering dislocation risks is controversial. This study aimed to identify whether THA using the anterior approach lowers costs compared with the posterior approach.

Methods

We identified 294 patients who underwent primary THA and compared the cost of total inpatient stay, inpatient length of stay (LOS), cost of operating room, and the rates of discharged patients, complications, and reoperation between the anterior and posterior approaches using propensity score matching analysis.

Results

One-to-one matching resulted in 135 pairs of patients who underwent THA using both approaches. The cost of total inpatient stay was significantly lower in the anterior approach (anterior vs. posterior [1,322,800 vs. 1,445,219 yen]; p ​= ​0.04). Furthermore, in the anterior approach, the inpatient LOS was shorter (anterior vs. posterior [19.9 vs. 25.0 days]; p ​< ​0.001). However, there was no significant difference in the cost of the operating room and the rates of patients discharged home, total complications (anterior vs. posterior [5.2 vs. 11.1 ​%]; p ​= ​0.08), or revisions between the two approaches.

Conclusions

Using propensity score matching, the current study demonstrated that THA in the anterior approach shortened inpatient LOS and rendered an 8 ​% reduction in the total inpatient cost compared with the posterior approach.

Purpose

The treatment of cartilage injury is challenging owing to its low self-healing capacity. Here we describe a literature review of the current diagnostic methods, surgical treatment options, and techniques for knee cartilage injuries, including possible future treatments and augmentations.

Methods

Studies describing surgical techniques for knee cartilage injuries were searched and arbitrarily selected in PubMed. Possible future treatments and augmentations, growth factors, and cell-based treatments are also discussed.

Results

Surgical options for cartilage injury, such as microfracture, osteochondral autografts or allografts, and autologous chondrocyte implantation, are well-established methods with overall satisfactory short- and long-term outcomes. However, the limitations and disadvantages of these treatments, such as repair with fibrous cartilage, donor site morbidity, and two-step surgery, have raised concerns. Various surgical treatments or augmentations have been developed to overcome these limitations, including autologous matrix-induced chondrogenesis, bone marrow aspirate concentrate, particulate chondrocyte implantation, and particulate juvenile allograft chondrocytes, and promising short-to mid-term results have been reported. Additionally, numerous studies are underway on the augmentation of biological healing including growth factor and stem cell therapies.

Conclusions

Although treating cartilage injuries remains challenging, advancements have been made. It is advisable for surgeons and clinicians to update their surgical techniques and knowledge of cartilage repair and regeneration to better treat patients with knee cartilage injuries.