Journal of Joint Surgery and Research最新文献_第9页

Fluoro HIP, a new software for intraoperative evaluation of the cup angles based on fluoroscopic images Fluoro HIP，一种基于透视图像的杯角术中评估新软件

Journal of Joint Surgery and Research

Pub Date : 2024-03-12 DOI: 10.1016/j.jjoisr.2024.02.002

Hiroki Kobayashi , Hiroyuki Ogawa , Kazuki Nakamura , Taro Yamashita , Keisuke Horiuchi , Kazuhiro Chiba

Purpose

Despite its clinical benefits, intraoperative navigation is currently used only in approximately 20% of total hip arthroplasties (THA) partly due to the high cost of the systems and time-consuming preoperative preparation. By providing a simpler and less expensive alternative, the use of intraoperative navigation is likely to increase among surgeons. In this study, we sought to validate the accuracy and utility of Fluoro HIP, a newly developed cup angle measurement software that runs on iOS devices.

Methods

Twenty-seven patients who underwent primary total hip arthroplasty between June and September 2022 were included in the study. All patients underwent surgery in the supine position. Inclination and anteversion angles were determined using Fluoro HIP software based on the fluoroscopic images captured during surgery. Navigation errors were calculated by comparing with the values obtained from postoperative CT images.

Results

The inclination and anteversion angles measured were 38.7 ± 3.9 and 15.0 ± 3.1°, respectively. The absolute value errors were 2.7 ± 1.9 and 3.0 ± 2.1° for the inclination and anteversion, respectively. Although Fluoro HIP software-based system may not be as precise as the conventional CT-based or portable navigation systems, the intraoperative evaluation of the cup angles by this system was considered to have acceptable accuracy and reproducibility for most THA cases performed in the supine position. Most importantly, our system requires no preoperative preparation and is significantly less expensive than other types of navigation systems currently in use.

Conclusion

The Fluoro HIP software-based system is a highly cost-effective and affordable alternative to the conventional navigation systems.

目的尽管术中导航具有临床优势，但目前仅在约 20% 的全髋关节置换术（THA）中使用，部分原因是系统成本高昂和术前准备耗时。通过提供更简单、更便宜的替代方案，术中导航在外科医生中的使用可能会增加。在这项研究中，我们试图验证新开发的可在 iOS 设备上运行的杯角测量软件 Fluoro HIP 的准确性和实用性。所有患者均在仰卧位接受手术。根据手术过程中捕获的透视图像，使用 Fluoro HIP 软件确定倾斜角和内翻角。结果测得的倾斜角和前内翻角分别为 38.7 ± 3.9 和 15.0 ± 3.1°。倾角和内翻角的绝对值误差分别为 2.7 ± 1.9 和 3.0 ± 2.1°。虽然基于Fluoro HIP软件的系统可能不如传统的基于CT或便携式导航系统精确，但对于大多数仰卧位进行的THA病例而言，该系统对髋臼杯角度的术中评估具有可接受的准确性和可重复性。最重要的是，我们的系统不需要术前准备，而且价格明显低于目前使用的其他类型导航系统。

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引用次数: 0

Learning curve of minimally invasive anterolateral approach in supine position for total hip arthroplasty 仰卧位微创前外侧入路全髋关节置换术的学习曲线

Journal of Joint Surgery and Research

Pub Date : 2024-03-06 DOI: 10.1016/j.jjoisr.2024.02.001

Hiroshi Inui, Isao Nakasone, Takahito Kanazawa, Tetsu Yamashita, Yu Tanuma, Kazuo Saita

Background

Total hip arthroplasty (THA) using minimally invasive anterolateral approach in the supine position (ALS) is reported to achieve good clinical outcomes including lower dislocation rates and early clinical recovery. However, minimally invasive ALS THA is technically challenging, especially among surgeons who are newly introduced to these techniques. This study aimed to evaluate the learning curves associated with minimally invasive ALS THA.

Methods

This study divided 720 primary THAs with a minimally invasive ALS approach into three groups based on the number of previous procedures per surgeon (A:1–100, B:101–200, C: >201). Surgical time and perioperative complications were compared among the three groups.

Results

Perioperative complications were seen in 8.0% of patients, including periprosthetic fractures (4.2%), surgical site infection (1.3%), stem subsidence (1.0%), nerve palsy (0.6%), dislocation (0.4%), major bleeding (0.4%), and liner malseating (0.1%). The rate of perioperative complications in each group was 8.6% (30 patients), 10.9% (22 patients), and 3.5% (6 patients) in groups A, B, and C, respectively. Group C has a significantly lower rate than other groups. Group B has significantly higher surgical site infection rate than other groups. No statistically significant difference was found in the surgical times among the three groups.

Conclusion

The learning curve associated with minimally invasive ALS THA was approximately 200 cases in terms of perioperative complications. Moderately experienced surgeons should always pay careful attention to avoid complications during ALS THA until they perform >200 cases.

背景据报道，采用仰卧位微创前外侧入路（ALS）进行全髋关节置换术（THA）可获得良好的临床效果，包括较低的脱位率和早期临床恢复。然而，微创仰卧位前外侧入路 THA 在技术上具有一定的挑战性，尤其是对于刚刚接触这些技术的外科医生而言。本研究旨在评估与微创 ALS THA 相关的学习曲线。本研究根据每位外科医生之前的手术次数将 720 例采用微创 ALS 方法的初次 THA 分成三组（A:1-100，B:101-200，C:>201）。结果8.0%的患者出现围手术期并发症，包括假体周围骨折（4.2%）、手术部位感染（1.3%）、骨干下沉（1.0%）、神经麻痹（0.6%）、脱位（0.4%）、大出血（0.4%）和衬垫错位（0.1%）。A 组、B 组和 C 组围手术期并发症发生率分别为 8.6%（30 名患者）、10.9%（22 名患者）和 3.5%（6 名患者）。C 组的并发症发生率明显低于其他组。B 组的手术部位感染率明显高于其他组。结论就围术期并发症而言，与微创 ALS THA 相关的学习曲线约为 200 例。经验丰富的外科医生在完成 200 例 ALS THA 之前，应始终注意避免并发症的发生。

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引用次数: 0

Anatomical landmark for medialized patellar component in TKA 全膝关节置换术中髌骨组件内侧化的解剖标志

Journal of Joint Surgery and Research

Pub Date : 2024-01-23 DOI: 10.1016/j.jjoisr.2023.12.002

Ryosuke Tsurui , Shinya Kawahara , Satoshi Hamai , Yukio Akasaki , Hidetoshi Tsushima , Yasuhiko Kokubu , Taro Mawatari , Yasuharu Nakashima

Purpose

The aim of this study was to show a concrete setting landmark in two component types of round and anatomical oval shapes using three-dimensional (3D) simulation analyses in total knee arthroplasty (TKA).

Methods

The patellar resection surface was simulated three-dimensionally using preoperative CT data of 54 patients (68 knees) who underwent TKA with varus knee osteoarthritis. The mediolateral position of the original patellar ridge was examined. The round and anatomical oval patellar components were aligned in the following cases: medial edge setting, patellar ridge setting, maximal size setting. The component ridge position from the medial edge and size in each case were examined.

Results

The original patellar ridge was located nearly 40% from the medial edge. In aligning the component to reproduce the original patellar ridge, the medial bone width uncovered with the component was nearly 4 mm in both designs. The component size was significantly smaller as the component was placed more medially. In selecting the maximal size, the round component was aligned more laterally than the original patellar ridge. In contrast, the anatomical oval component enabled to be concomitant with a more appropriate position and size.

Conclusion

The position where the medial bone width uncovered with the component was nearly 4 mm, not the medial edge, was found as the best place to reproduce the original patellar ridge in both round and anatomical oval components. Specifically, the anatomical oval component might be more favorable with respect to the component position and size.

目的本研究的目的是通过三维模拟分析，显示全膝关节置换术（TKA）中圆形和解剖学椭圆形两种组件类型的具体设置地标。方法使用 54 名膝关节骨关节炎患者（68 膝）的术前 CT 数据，对髌骨切除面进行三维模拟。检查了原始髌骨脊的内外侧位置。在以下情况下对圆形和解剖学椭圆形髌骨组件进行了对齐：内侧边缘设置、髌嵴设置、最大尺寸设置。结果原始髌骨脊距内侧边缘近 40%。在对齐组件以再现原始髌骨脊时，两种设计中组件所覆盖的内侧骨宽度都接近 4 毫米。当组件放置在更内侧时，组件尺寸明显变小。在选择最大尺寸时，圆形组件比原始髌嵴更偏向外侧。结论无论是圆形还是解剖学椭圆形组件，其再现原始髌嵴的最佳位置都是组件覆盖的内侧骨宽度接近 4 毫米的位置，而不是内侧边缘。具体而言，解剖椭圆形组件在组件位置和尺寸方面可能更为有利。

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引用次数: 0

Appreciation to reviewers in 2022–2023 对 2022-2023 年审查员的感谢

Journal of Joint Surgery and Research

Pub Date : 2024-01-13 DOI: 10.1016/j.jjoisr.2024.01.001

引用次数: 0

Implant fixation of primary total hip arthroplasty using a cementless cup for osteoarthritis secondary to developmental dysplasia of the hip: A prospective multicenter study in Japan 使用无骨水泥髋臼杯进行初次全髋关节置换术的植入固定，治疗继发于髋关节发育不良的骨关节炎：日本前瞻性多中心研究

Journal of Joint Surgery and Research

Pub Date : 2024-01-06 DOI: 10.1016/j.jjoisr.2023.12.001

Ayumi Kaneuji , Hiroshi Imai , Ryo Sugama , Yoichi Ohta , Kiyokazu Fukui , Eiji Takahashi , Haruhiko Akiyama , Takaki Miyagawa , Junya Yoshitani , Hideki Fujii , Ayano Amagami , Minoru Watanabe , Takayuki Honda , Akihiko Maeda , Yoshihiro Nakamura , Naofumi Taniguchi , Jiro Ichikawa , David W. Fawley , Junko Yasuda

Purpose

This prospective multicenter study investigated the implant fixation of a cementless cup in primary total hip arthroplasty (THA) for osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) in Japanese patients.

Methods

Ten hospitals in Japan were enrolled in this study. The cohort comprised 267 hips in 228 Japanese patients who underwent primary THA for OA secondary to DDH. An acetabular cup with advanced in-growth, GRIPTION™ coating, was used in all patients. Mean age at surgery was 66.9 (range 45–89) years, and 201 patients (239 hips) were female. Of these patients, 89.1 % (238/267) was Crowe group I. Radiolucent lines around the cup, osteolysis, cup migration, grafted bone status, and clinical scores were evaluated preoperatively and at 6 months, 1 year, and 2 years postoperatively. Adverse events were evaluated throughout the study. Implant survivorship was assessed using the Kaplan–Meier method.

Results

Nine hips had radiolucent lines ≥2 mm that resolved by 6 months. All cups showed bone in-growth and no cups loosened. At 2 years, the bone grafts had remodeled and incorporated in 68 % (43/63) of hips. There were four systemic and five surgical site events, and one procedure-related dislocation. The survivorship with cup revision as the endpoint was 99.6 % (95 % confidence interval, 97.3–99.9). All clinical scores were improved at 2 years compared with preoperatively (p < 0.01).

Conclusions

An advanced in-growth coated cup showed good fixation without complications in primary THA, even in patients with OA secondary to DDH.

目的本前瞻性多中心研究调查了日本患者在髋关节发育不良（DDH）继发骨关节炎（OA）的初次全髋关节置换术（THA）中无骨水泥髋臼杯的植入固定情况。228名日本患者的267个髋关节因继发于DDH的OA而接受了初级THA手术。所有患者均使用了先进的内生长GRIPTION™涂层髋臼杯。手术时的平均年龄为66.9岁（45-89岁），201名患者（239个髋关节）为女性。术前、术后 6 个月、1 年和 2 年对髋臼杯周围的放射线、骨溶解、髋臼杯移位、移植骨状况和临床评分进行了评估。在整个研究过程中都对不良事件进行了评估。采用卡普兰-梅耶法评估植入物的存活率。所有骨杯均显示骨质增生，无骨杯松动。2年后，68%的髋关节（43/63）的植骨已经重塑并融合。发生了四起全身事件和五起手术部位事件，以及一起与手术相关的脱位。以髋臼杯翻修为终点的存活率为99.6%（95%置信区间，97.3-99.9）。结论先进的内生长涂层髋臼杯在初次全髋关节置换术中显示出良好的固定效果，无并发症，即使是继发于DDH的OA患者也不例外。

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引用次数: 0

Five-year clinical and radiographic outcomes of Accolade TMZF and Accolade II stem use 使用Accolade TMZF和Accolade II的5年临床和放射学结果

Journal of Joint Surgery and Research

Pub Date : 2023-12-06 DOI: 10.1016/j.jjoisr.2023.09.004

Ken Ueoka , Tamon Kabata , Yoshitomo Kajino , Daisuke Inoue , Takaaki Ohmori , Yuki Yamamuro , Atsushi Taninaka , Tomoyuki Kataoka , Yu Yanagi , Yoshitomo Saiki , Musashi Ima , Hiroyuki Tsuchiya

Purpose

Although good mid-term results of the first- and second-generation cementless stems have been reported, no study has compared outcomes between generations. This study aimed to compare the mid-term results of Accolade Ti–12Mo–6Zr–2Fe (TMZF) and Accolade II over a 5-year period.

Methods

This retrospective, single-institution, single-surgeon observational study included patients who underwent primary total hip arthroplasty using the Accolade TMZF (n = 71, group I) or Accolade II (n = 73, group II) between January 2009 and July 2015. Revision and conversion cases were excluded. Functional evaluations were performed using the Japanese Orthopaedic Association hip (JOA) score. Radiographic evaluations were performed using anteroposterior radiographs. Spot welds, radiolucency, cortical hypertrophy, and stress shielding around the stem were assessed for each Gruen zone. Subsidence and stem alignment were evaluated.

Results

The 5-year postoperative stem survival rate was 100% in both groups. The JOA score improved from 44.0 ± 10.2 to 90.6 ± 7.6 in group I and from 49.1 ± 10.1 to 91.7 ± 6.6 in group II. There were no significant differences in preoperative and postoperative JOA scores and subscale scores in either group. Significant spot welds were observed in group II in Gruen zones 3 and 5. Stress shielding progressed over time in both groups, and the prevalence of grade 3 shielding was significantly lower in group II (p = 0.028).

Conclusion

Both stems had a survival rate of 100%. The incidence of severe stress shielding seemed to be lower with Accolade II, but further investigations should be needed.

目的:虽然第一代和第二代无骨水泥假体的中期结果良好，但没有研究比较两代之间的结果。本研究旨在比较Accolade Ti-12Mo-6Zr-2Fe (TMZF)和Accolade II在5年期间的中期结果。方法本回顾性、单机构、单外科医生观察性研究纳入2009年1月至2015年7月期间使用Accolade TMZF (n = 71，组I)或Accolade II (n = 73，组II)行原发性全髋关节置换术的患者。修订和转换案例被排除在外。使用日本骨科协会髋关节(JOA)评分进行功能评估。使用正位x线片进行放射学评估。评估每个格伦区周围的点焊、放射透光度、皮质肥大和应力屏蔽。沉降和杆对中进行了评价。结果两组患者术后5年茎干存活率均为100%。第一组JOA评分由44.0±10.2提高到90.6±7.6，第二组由49.1±10.1提高到91.7±6.6。两组患者术前、术后JOA评分及亚量表评分均无显著差异。II组在Gruen区3和5观察到明显的点焊。随着时间的推移，应力屏蔽在两组中都有所进展，iii级屏蔽的患病率明显低于II组(p = 0.028)。结论两组干细胞成活率均为100%。严重应力屏蔽的发生率似乎较低，但需要进一步的调查。

{"title":"Five-year clinical and radiographic outcomes of Accolade TMZF and Accolade II stem use","authors":"Ken Ueoka , Tamon Kabata , Yoshitomo Kajino , Daisuke Inoue , Takaaki Ohmori , Yuki Yamamuro , Atsushi Taninaka , Tomoyuki Kataoka , Yu Yanagi , Yoshitomo Saiki , Musashi Ima , Hiroyuki Tsuchiya","doi":"10.1016/j.jjoisr.2023.09.004","DOIUrl":"10.1016/j.jjoisr.2023.09.004","url":null,"abstract":"<div><h3>Purpose</h3><p>Although good mid-term results of the first- and second-generation cementless stems have been reported, no study has compared outcomes between generations. This study aimed to compare the mid-term results of Accolade Ti–12Mo–6Zr–2Fe (TMZF) and Accolade II over a 5-year period.</p></div><div><h3>Methods</h3><p>This retrospective, single-institution, single-surgeon observational study included patients who underwent primary total hip arthroplasty using the Accolade TMZF (n = 71, group I) or Accolade II (n = 73, group II) between January 2009 and July 2015. Revision and conversion cases were excluded. Functional evaluations were performed using the Japanese Orthopaedic Association hip (JOA) score. Radiographic evaluations were performed using anteroposterior radiographs. Spot welds, radiolucency, cortical hypertrophy, and stress shielding around the stem were assessed for each Gruen zone. Subsidence and stem alignment were evaluated.</p></div><div><h3>Results</h3><p>The 5-year postoperative stem survival rate was 100% in both groups. The JOA score improved from 44.0 ± 10.2 to 90.6 ± 7.6 in group I and from 49.1 ± 10.1 to 91.7 ± 6.6 in group II. There were no significant differences in preoperative and postoperative JOA scores and subscale scores in either group. Significant spot welds were observed in group II in Gruen zones 3 and 5. Stress shielding progressed over time in both groups, and the prevalence of grade 3 shielding was significantly lower in group II (p = 0.028).</p></div><div><h3>Conclusion</h3><p>Both stems had a survival rate of 100%. The incidence of severe stress shielding seemed to be lower with Accolade II, but further investigations should be needed.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 1","pages":"Pages 7-12"},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705123000324/pdfft?md5=72147711666367a3c038fd66d6ca3e8c&pid=1-s2.0-S2949705123000324-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138502044","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

Preserved posterior cruciate ligament contributed to knee sagittal stability, but not to rollback and deep knee flexion in cruciate-retaining total knee arthroplasty with a cruciate-substituting insert 保留后十字韧带有助于膝关节矢状位稳定性，但对保留十字韧带的全膝关节置换术中膝关节的回退和深度屈曲不起作用

Journal of Joint Surgery and Research

Pub Date : 2023-12-06 DOI: 10.1016/j.jjoisr.2023.09.005

Seiju Hayashi, Satoshi Miyazaki

Purpose

No previous report has compared the differences in postoperative functional outcomes between posterior cruciate ligament (PCL)-retaining (CR-) and PCL-sacrificing (CS-) total knee arthroplasty (TKA) with detailed intraoperative consideration of joint gap and balance. The purpose of this study was to evaluate the in vivo function of preserved PCL in TKA by comparing postoperative functional outcomes between CR- and CS-TKA with a cruciate-substituting insert (CS-insert), considering intraoperative influence factors, such as the posterior tibial slope, posterior condylar offset, joint gap, joint balance, and joint laxity.

Methods

A total of 55 knees in 38 patients (27 knees from 18 patients in the CR group, and 28 knees from 20 patients in the CS group) were analyzed. Fluoroscopic evaluation under anesthesia in sagittal laxity, rollback amount, and the maximum flexion angles were compared between the groups.

Results

There were no significant differences in intraoperative or postoperative all measurement values between the two groups, but the sagittal laxity was significantly smaller in the CR group [5.4% ± 4.5% (2.4 ± 2.1 mm)] than in the CS group [9.0 ± 3.8% (4.0 ± 1.7 mm)] (P < 0.01). There were no significant differences in the amount of rollback and postoperative maximum knee flexion angle between the groups.

Conclusions

Preserved PCL in TKA with a CS-insert contributed to knee sagittal stability, but not to rollback and deep knee flexion.

先前的报道比较了保留后交叉韧带(PCL) (CR-)和牺牲后交叉韧带(CS-)全膝关节置换术(TKA)术后功能结果的差异，术中详细考虑了关节间隙和平衡。本研究的目的是通过比较CR-和CS-TKA的术后功能结果，评估保留PCL在TKA中的体内功能，并考虑术中影响因素，如胫骨后斜度、后髁偏移、关节间隙、关节平衡和关节松弛。方法对38例患者共55个膝关节进行分析，其中CR组18例27个膝关节，CS组20例28个膝关节。比较麻醉下透视评价两组间矢状面松弛度、回滚量、最大屈曲角度。结果两组术中、术后各项测量值差异无统计学意义，但CR组矢状面松弛度[5.4%±4.5%(2.4±2.1 mm)]明显小于CS组[9.0±3.8%(4.0±1.7 mm)] (P <0.01)。两组间膝关节回退量和术后最大屈曲角度无显著差异。结论在全膝关节置换术中保留PCL与cs -插入物有助于膝关节矢状位稳定，但对膝关节回退和深度屈曲没有作用。

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引用次数: 0

Reliability of kinematic waveforms during gait analysis with total hip arthroplasty patients 全髋关节置换术患者步态分析中运动学波形的可靠性

Journal of Joint Surgery and Research

Pub Date : 2023-12-06 DOI: 10.1016/j.jjoisr.2023.11.003

Ben Langley , Henrike Greaves , Chris Whelton , Richard Page , Mary Cramp , Stewart C. Morrison , Paola Dey , Tim Board

Purpose

The aim of the study was to determine the test-retest reliability of lower limb kinematic waveforms derived from 3D gait analysis (3DGA) in patients following total hip arthroplasty (THA).

Methods

Eight (7 M:1F; age: 70 ± 7 years; height: 1.68 ± 0.11 m; mass: 85 ± 20 kg) adults with a unilateral THA attended test and retest sessions. 3DGA was undertaken with participants walking at a self-selected pace along a 7 m walkway within each session. The standard error or the measurement (SEM) was calculated for hip, knee and ankle joint angles in all three planes, over the walking gait cycle.

Results

The SEM ranged from 2.9 to 4.1°, 2.7–3.7° and 1.9–3.9°, in the sagittal, frontal and traverse planes at the hip. At the knee the SEM ranged from 1.6 to 4.2°, 1.0–1.9° and 1.3–2.9° in the sagittal, frontal and transverse planes, respectively. While the SEM ranged from 0.7 to 2.0°, 1.2–2.3° and 2.9–4.0° in the sagittal, frontal and transverse planes at the ankle.

Conclusions

The findings demonstrate that 3DGA provides a reliable means of quantifying lower limb kinematics over the walking gait cycle in patients following THA, with all SEM values below the 5° threshold previously suggested to identify clinically meaningful differences. The SEM values reported may aid in the interpretation of changes in lower limb kinematics in patients following THA.

目的研究全髋关节置换术(THA)患者下肢三维步态分析(3DGA)所得下肢运动波形的重测可靠性。方法:7 M:1F;年龄:70±7岁;高度:1.68±0.11 m;体重:85±20 kg)单侧THA患者参加了检查和复查。在3DGA中，参与者以自己选择的速度沿着7米长的人行道行走。计算了三个平面的髋关节、膝关节和踝关节角度在步行周期内的测量标准误差(SEM)。结果髋关节矢状面、正位面和横位面扫描电镜(SEM)范围为2.9 ~ 4.1°、2.7 ~ 3.7°和1.9 ~ 3.9°。膝关节矢状面、正位面和横面扫描电镜分别为1.6 ~ 4.2°、1.0 ~ 1.9°和1.3 ~ 2.9°。踝关节矢状面、正位面和横位的扫描电镜范围为0.7 ~ 2.0°、1.2 ~ 2.3°和2.9 ~ 4.0°。研究结果表明，3DGA提供了一种可靠的方法来量化THA后患者在步行步态周期中的下肢运动学，所有扫描电镜值都低于先前建议的5°阈值，以识别临床有意义的差异。报道的扫描电镜值可能有助于解释THA后患者下肢运动学的变化。

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引用次数: 0

Gram staining of the preoperative joint aspiration for the diagnosis of infection after total knee arthroplasty 术前关节抽吸革兰氏染色诊断全膝关节置换术后感染

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.07.005

Yasuo Kunugiza , Masashi Tamaki , Takashi Miyamoto , Shigeyoshi Tsuji , Koichiro Takahi , Masataka Nishikawa , Ayanori Yoshida , Koji Nomura , Keiji Iwamoto , Toshitaka Fujito , Kentaro Toge , Teruya Ishibashi , Seiji Okada , Tetsuya Tomita

Purpose

Gram staining of joint fluid for the diagnosis of postoperative joint infection after total knee arthroplasty is considered to have limited efficacy because of the low sensitivity. However, the specificity of the gram staining is reported to be high in most reports. This study aimed to evaluate the sensitivity and specificity of the gram staining when used on the aspirated joint fluid in patients with suspected postoperative knee joint infection after total knee arthroplasty.

Methods

We retrospectively reviewed the reports of synovial fluid samples retrieved from suspected infected joints at eight hospitals between 2012 and 2019. A total of 179 samples of aspirated joint fluid from knee joints (80 culture-positive samples and 99 culture-negative samples) were evaluated in this study.

Results

Of the 80 gram stains performed on samples from infected patients, there were 60 true positives and 20 false negatives. In contrast, of the 99 stains performed on samples from aseptic knees, there were 99 true negatives and no false positives. The sensitivity and specificity for detecting periprosthetic knee infections were 75.0% and 100.0%, respectively. Further, we divided infected samples into the early aspiration group (within 14 days) and the late aspiration group (15 days or more) based on the duration between the onset of symptoms and aspiration. The sensitivity of the gram staining was 84.2% and 41.2% in the first and second groups, respectively.

Conclusions

In this study, gram staining of preoperatively aspirated joint fluid for the infected periprosthetic knee joint with short-lived symptoms showed high sensitivity.

目的关节液革兰氏染色诊断全膝关节置换术后关节感染由于敏感性低，疗效有限。然而，据报道，在大多数报告中，革兰氏染色的特异性很高。本研究旨在评估全膝关节置换术后疑似膝关节感染患者在抽吸关节液时使用革兰氏染色的敏感性和特异性。方法我们回顾性回顾了2012年至2019年间8家医院从疑似感染关节中提取的滑膜液样本的报告。本研究共评估了179份膝关节抽吸关节液样本（80份培养阳性样本和99份培养阴性样本）。结果在对感染患者的80克样本进行的染色中，有60个真阳性，20个假阴性。相反，在无菌膝盖样本上进行的99次染色中，有99次真阴性，没有假阳性。检测膝关节假体周围感染的敏感性和特异性分别为75.0%和100.0%。此外，我们根据症状出现和抽吸之间的持续时间，将感染样本分为早期抽吸组（14天内）和晚期抽吸组（15天或更长时间）。第一组和第二组的革兰氏染色敏感性分别为84.2%和41.2%。结论在本研究中，术前吸出的关节液对感染并伴有短暂症状的人工膝关节周围关节的革兰氏染色显示出较高的敏感性。

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引用次数: 0

Clinical evaluation of hip joint diseases: total hip arthroplasty to support patients’ quality of life 髋关节疾病的临床评价：全髋关节置换术支持患者生活质量

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2022.12.004

Satoshi Yamate , Satoshi Hamai , Stephen Lyman , Toshiki Konishi , Shinya Kawahara , Ryosuke Yamaguchi , Daisuke Hara , Goro Motomura

Purpose

In Japan's super-aged society, medical care supporting the patients' quality of life (QOL) is becoming increasingly important. This study aimed to evaluate the current applications of patient-reported outcome measures (PROMs), with a focus on Japanese patients with hip osteoarthritis (OA) undergoing total hip arthroplasty (THA).

Methods

We reviewed the literature on PROMs, with a focus on (i) available guidelines, (ii) validated questionnaires in Japanese-version, and (iii) methods to assess responsiveness and interpretation.

Results

Several guidelines were available, including a checklist for methodological quality, the study protocol, and reporting of PROMs. The Short-Form 36/12-Item Health Survey is used for multidimensional evaluation. The EuroQol 5 dimension (EQ-5D) is the most commonly used preference-based utility. To assess disease-specific QOL in patients with hip OA undergoing THA, the Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Hip Score, Hip Disability and Osteoarthritis Outcome Score, Forgotten Joint Score-12, and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire are used. The Central Sensitization Inventory can be used to assess central sensitivity syndrome. Ikigai-9 is used to assess ikigai (a comprehensive concept that gives meaning to life) and is also validated in English. The smallest detectable change (SDC) can be used to evaluate responsiveness. The minimal important change, minimal clinically important difference, and patient acceptable symptom state can be used to aid in interpreting results.

Conclusions

Several instruments and techniques are established to facilitate shared decision-making for Japanese patients undergoing THA to support their QOL. This review provides a broad overview of PROMs that can benefit future studies.

目的在日本的超高龄社会中，支持患者生活质量的医疗保健越来越重要。本研究旨在评估患者报告结果测量（PROMs）的当前应用，重点关注接受全髋关节置换术（THA）的日本髋关节骨性关节炎（OA）患者，三评估反应能力和口译的方法。结果提供了一些指南，包括方法学质量检查表、研究方案和PROMs报告。36/12项目健康状况调查表用于多层面评估。EuroQol 5维度（EQ-5D）是最常用的基于偏好的实用程序。为了评估接受THA的髋关节骨性关节炎患者的疾病特异性生活质量，使用了西安大略大学和麦克马斯特大学骨关节炎指数、牛津髋关节评分、髋关节残疾和骨关节炎结果评分、遗忘关节评分-12和日本骨科协会髋关节疾病评估问卷。中枢敏感性调查表可用于评估中枢敏感性综合征。Ikigai-9用于评估Ikigai（赋予生命意义的综合概念），也在英语中得到了验证。最小可检测变化（SDC）可用于评估响应性。最小的重要变化、最小的临床重要差异和患者可接受的症状状态可用于帮助解释结果。结论建立了一些工具和技术来促进日本THA患者的共同决策，以支持他们的生活质量。这篇综述对PROM进行了广泛的概述，有利于未来的研究。

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