Knee Surgery and Related Research最新文献

Introduction: Chloroprocaine is a rapid, short-acting spinal anesthetic that may facilitate quicker postoperative recovery in total knee arthroplasty (TKA). However, limited literature exists regarding its use in patients undergoing same-day discharge (SDD) TKA. This study evaluated the clinical outcomes and safety of chloroprocaine compared with those of mepivacaine.

Methods: This retrospective study of 178 patients who underwent primary TKA at a single ambulatory surgery center from March 2022 to June 2023 compared chloroprocaine (n = 114) and mepivacaine (n = 64) spinal anesthesia. Surgical outcomes, including estimated blood loss (EBL), operative time, discharge time, 90-day emergency department visits, and 90-day readmissions, were evaluated. In addition, anesthesia-related complications such as hypotension, bradycardia, urinary retention, and postanesthesia care unit (PACU) outcomes were recorded. Continuous variables between the chloroprocaine and mepivacaine groups were compared via independent sample t-tests, whereas categorical variables were analyzed via chi-squared tests. A p-value of less than 0.05 was considered statistically significant.

Results: There were no differences in the baseline characteristics between the two groups. The chloroprocaine group had a significantly shorter operative time (73.1 versus 84.9 min, p < 0.001) and faster discharge (3.7 versus 4.2 h, p < 0.001), with no difference in EBL. Patients in the chloroprocaine group had a lower incidence of urinary retention (2.5 versus 15.6%, p = 0.004), a lower proportion of patients who needed a urinary catheter (2.6 versus 14.1%, p = 0.004), and fewer postoperative complaints of numbness (19.3 versus 39.1%, p = 0.004). There were no differences in surgical complications.

Conclusions: Compared with mepivacaine, chloroprocaine spinal anesthesia for SDD TKA was associated with lower rates of urinary retention, a reduced need for urinary catheterization, fewer neurological complaints in the PACU, and faster discharge times. No differences were observed in surgical outcomes between the groups, and there were no instances of unplanned direct admissions. These results suggest that chloroprocaine can be safely used as a reliable alternative to mepivacaine in outpatient TKA.

Purpose: The aim of this study was to compare total perioperative blood loss in patients undergoing total knee arthroplasty (TKA) in different ABO blood types.

Methods: This study was approved by the Institutional Review Board of our hospital (IRB No. 1510) on 2 February 2015. A total of 260 knees undergoing unilateral primary cemented cruciate-retaining TKA for knee osteoarthritis were retrospectively registered. Perioperative total blood loss was calculated for each blood types based on the change in hematocrit from pre- to postoperative day 7, preoperative height and weight. Differences in blood loss among the four ABO blood types were assessed. The association between blood type (O versus others) and total blood loss was further evaluated after adjusting for baseline characteristics through inverse probability of treatment weighting (IPTW).

Results: The study population was divided based on the ABO blood type: type O, 87; type A, 82; type B, 54; and type AB, 37. The mean total blood loss was 829 ± 370 ml for type O, 702 ± 384 ml for type A, 574 ± 361 ml for type B, and 528 ± 282 ml for type AB. Patients with blood Type O had significantly higher blood loss than all other blood types. After IPTW adjustment, mean total blood loss remained higher in type O (790 ± 370 ml) compared to other blood types (613 ± 364 ml).

Conclusion: These findings suggest that blood type O may be associated with increased perioperative blood loss in TKA.

Background: Mobile-bearing (MB) and medial-pivot (MP) prostheses are the two popular designs used in total knee arthroplasty (TKA), yet their long-term outcomes remain controversial. This meta-analysis was conducted to determine whether there are any differences in outcomes between patients who receive these two prostheses in TKA.

Method: We comprehensively searched electronic databases up to November 2024. Observational studies or randomized controlled trials reported postoperative outcomes, including radiographic results, functional score through the Knee Society Score (KSS), Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction. The results are presented in odd ratios (ORs) or mean differences with corresponding 95% confidence intervals (CIs).

Results: In total, four studies were included, with 1069 patients and 1251 operated knees (632 MB TKAs and 619 MP TKAs). The mean age was 68.21 years old and the mean follow-up duration was from 5 to 11 years. Regarding patient satisfaction, the MB prostheses brought greater comfort to patients in the last follow-up than the MP group (OR = 3.19; 95%CI 1.92-5.30; p < 0.001). Additionally, there were no differences in the outcomes of functional scores, including the KSS (p = 0.34), WOMAC score (p = 0.16), and range of motion (ROM) (p = 0.36) between patients receiving the MB and MP prostheses.

Conclusions: Our meta-analysis of four studies highlighted the long-term outcomes of TKA between MB and MP designs. While KSS, WOMAC scores, and knee ROM showed no significant differences, patients with MB designs reported higher satisfaction levels compared with those with MP designs.

Background: Tibial eminence fractures are common injuries that can cause significant functional limitations and require timely and effective treatment. Arthroscopic screw fixation and suture fixation are the primary methods used for managing displaced fractures. This study aimed to compare the functional and clinical outcomes between the two groups.

Methods: An associated systematic review was carried out with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines utilizing the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Sage Journals, Science Direct, and Core Journals databases. Any language publication that assessed the results following the fixation of tibial eminence fractures by screw and suture fixation from 2000 to 2024 was included. Clinical, functional outcomes, subsequent surgeries, complications, operation time, and union time were evaluated. All data were assessed using SPSS version 25 and RevMan version 5.4.

Results: A total of 9 studies involving 412 patients were analyzed out of 3365 papers. There were no significant differences (p > 0.05) between the two methods in the Lysholm score, Tegner Activity Scale, International Knee Documentation Committee (IKDC) score, range of motion, Lachman test, pivot-shift test, KT-1000, and union time. However, screw fixation had a significantly higher rate of subsequent surgeries (planned removal implant excluded) (29.75% versus 11.6%; p < 0.00001), complications (p = 0.0003), and shorter operation times (67 min versus 85 min; p = 0.0003).

Conclusions: The findings revealed that suture fixation carried a significantly lower risk of subsequent surgery and complications but required a longer operation time. Each technique presents advantages and challenges, making the decision a crucial aspect of patient care.

Introduction: Patella fractures account for about 1% of all bone fractures, predominantly affecting males at a 2:1 ratio and exhibiting distinctive age-related patterns. In younger individuals, these injuries typically result from high-velocity impacts, while in the elderly, they usually arise from lower-energy impacts. Consequently, the types of fractures differ; horizontal fractures are more common in younger individuals, whereas comminuted fractures are more prevalent in older adults. Owing to the knee's biomechanics, surgical intervention is often necessary. Preserving the articular surface is crucial to prevent retropatellar osteoarthritis, making thorough planning of surgical treatment essential. How can the osteosynthesis of this fracture entity be simulated as realistically as possible?

Materials and methods: This study focused on the feasibility of inducing realistic patella fractures with an intact soft tissue envelope on human cadaveric specimens for surgical training purposes. A total of seven fresh-frozen human cadaveric knee joints were used, and fractures were created using a custom-designed drop-test bench. The induced fractures were then classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) and Speck and Regazzoni classifications using radiographic and computed tomography (CT) evaluations. In addition, intra-rater and inter-rater reliability were further examined.

Results: All specimens were successfully fractured. The results demonstrated high intra-rater and inter-rater reliability in both fracture classification systems, indicating that the method can reliably replicate realistic fractures for training purposes.

Conclusions: The study highlights the significance of using specimens with realistically induced fracture patterns in surgical education. Given that patella fractures are relatively rare and limit direct clinical exposure, realistic fracture models are invaluable for understanding these conditions. These models enhance surgical training, enabling both novice and experienced surgeons to refine their skills and effectively adapt to new surgical techniques.

Background: A total of three techniques are used to guide tibial cuts in high tibial osteotomy (HTO): the conventional method, navigation systems, and patient-specific instrumentation (PSI). This network meta-analysis sought to assess whether any of these methods achieve better radiological outcomes, greater functional gains, or a reduced rate of complications.

Design: We included all controlled and noncontrolled trials comparing at least two of the surgical techniques. Primary outcomes were rates of medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) outliers. Secondary outcomes included the rate of hip-knee-ankle (HKA) angle outliers, joint range of motion, postoperative clinical scores, and complication rates.

Results: The analysis included 24 studies with 1817 patients and 1951 operated knees. PSI did not reduce the rate of MPTA outliers compared with conventional techniques (95% credible intervals, CI [0.09-56.84]) or navigation (95% CI [0.03-25.62]), and navigation did not reduce the rate compared with conventional methods (95% CI [0.84-9.17]). Navigation reduced the rate of PTS outliers compared with conventional techniques (95% CI [1.93-1.56.10⁴]). No study investigating PTS outliers with PSI was identified or included. Both navigation and PSI reduced the rate of HKA angle outliers (95% CI [1.33-3.16] and [1.15-42.61], respectively). Aside from the rate of HKA angle outliers and the Lysholm score between 1 and 2 years postoperatively, no differences were observed for other outcomes.

Conclusions: Navigation and PSI allow for more precise achievement of the PTS and HKA angle values set by the surgeons but do not affect long-term knee function or complication rates. However, the cost and limited availability of these techniques should be considered, especially in the absence of additional functional benefits.

Background: Tibial plateau fractures (TPFs) can be associated with development of significant joint degeneration, which can lead to functional impairment and pain severe enough to necessitate conversion to total knee arthroplasty (TKA). The factors influencing the progression to TKA after TPF, including preoperative fracture and patient characteristics, remain unclear. This study aimed to assess the national conversion rate to TKA following TPF depending on fracture type.

Patients and methods: The cohort consisted of all patients aged 18 years and older at time of injury with a TPF registered in the Swedish Fracture Register (SFR) between 2012 and 2023. The SFR holds information on baseline patient characteristics including fracture classification according to the AO/OTA system. Conversion to TKA was identified through linkage with the Swedish Arthroplasty Register (SAR). Kaplan-Meier survival analyses investigated conversion rate. Cox regression was performed to assess association between fracture type and TKA conversion adjusted for age, sex, and injury energy level. The follow-up period ranged from 0 to 12 years, with a mean of 4.2 years.

Results: A total of 12,012 patients with a mean age of 57 years were included; 63% were women. The observed conversion rate after 5 years was 2.8% in all patients and 4.1% in surgically treated patients. The conversion rate at 5 years was highest in the 65-74 years age group with 5.2%. Fractures with comminuted fracture patterns, particularly AO/OTA 41B3, 41C2, and 41C3, were associated with significantly increased risks of conversion, with adjusted hazard ratios (aHRs) of 2.1 (95% CI 1.3-3.3), 2.3 (1.2-4.5), and 3.2 (95% CI 2.0-4.5), respectively. High-energy trauma did not increase the risk of conversion, nor did sex. Increasing age was associated with an increased risk of conversion up to the age of 84, while age over 85 was not.

Conclusions: Fractures with complex fracture patterns, particularly AO/OTA 41B3, 41C2, and 41C3, were associated with an increased TKA conversion rate following TPF. The conversion rate increased with increasing age, but sex and high-energy injury mechanisms did not affect conversion rate. On a national level, 3% of patients were converted to TKA within 5 years of sustaining a TPF, and 4% of patients treated surgically. This may help surgeons when counseling patients with TPFs.

Purpose: The study's primary objective was to assess and quantify the ipsilateral (side A) and contralateral (side B) ankle joint line orientation (AJLO) changes after unilateral total knee arthroplasty (TKA) for primary knee osteoarthritis (OA) with varus deformity. The secondary objectives were to detect if there was a correlation between the knee deformity correction and AJLO changes and if the knee and ankle clinical outcomes on the TKA side correlate with joint alignment changes.

Methods: This retrospective cohort study included 70 patients with a mean age of 61.76 ± 5.96 years. The lower limb alignment was evaluated using the hip-knee-ankle (HKA) angle, while the AJLO was assessed using the tibial plafond to horizontal line angle (TPHA). The functional outcomes for side A were evaluated at a median follow-up of 18 (interquartile range (IQR): 12-46.2) months using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and The American Orthopaedic Foot and Ankle Society (AOFAS) score for the knee and ankle joints, respectively.

Results: In side A, the HKA significantly improved from 167.49 ± 6.25 to 177.08 ± 4.39 (p < 0.001). No difference in AJLO was found between both sides preoperatively (p = 0.329). At the last follow-up, in side A, the AJLO changed significantly into less varus from -7.11 ± 5.44° to -1.10 ± 4.91° (p < 0.001); in side B, the AJLO showed no significant changes (-6.38 ± 6.10° versus -6.65 ± 6.50°, p = 0.970). For side A, the KOOS and AOFAS showed significant improvement, 45.20 ± 14.94 versus 75.72 ± 13.28 (p < 0.001) and 70 (65-75) versus 90 (80-90; p < 0.001), respectively. The preoperative HKA and AJLO on side A and side B showed significant positive correlations (r = 0.591, p < 0.001 and r = 0.611, p < 0.001, respectively). On side A, the postoperative HKA and AJLO showed a significant positive correlation (r = 0.298, p = 0.012). The preoperative and postoperative AJLO and AOFAS on side A showed nonsignificant negative correlations (r = -0.202, p = 0.277 and r = -0.115, p = 0.537, respectively). The preoperative and postoperative HKA and AOFAS on side A showed nonsignificant positive correlations (r = 0.126, p = 0.499 and r = 0.331, p = 0.069, respectively). The linear regression analysis indicated that for every 1° correction in HKA, the AJLO changed by 0.5° (R² = 0.241, 95% confidence interval (CI) 0.298-0.747, p < 0.001).

Conclusions: The ipsilateral ankle joint realigned to a less varus position after ipsilateral TKA for managing knee OA with varus deformity, with an estimated half a degree of less varus AJLO after HKA correction by a degree. No changes occurred in the contralateral ankle joint. The ankle joint function improvement was not correlated to the HKA or AJLO changes.

Background: The implantation rate of knee arthroplasty and, in particular of unicondylar knee arthroplasty (UKA), is increasing, and revision is a feared complication. The aim of this study was to identify factors influencing aseptic and septic revision that are of high interest for establishing preventive measures.

Methods: Data were collected using the German Arthroplasty Registry (EPRD). Patients with UKA were analyzed using the multiple Log-rank test with Holm's method. Septic and aseptic revisions were calculated using Kaplan-Meier estimates. In total, 300,998 cases of knee arthroplasty were identified in the registry, and 36,861 patients with UKA were analyzed with a maximum follow-up of 7 years.

Results: The primary reason for UKA revision surgery was aseptic loosening (32.5%), particularly loosening of the tibial component (19.0%), followed by infection (11.0%) and the progression of arthritis (10.0%). Over 7 years, 8.7% of UKA procedures required revision, 7.8% for aseptic causes and 0.9% for infection. Risk factors for aseptic revision included uncemented implants [hazard ratio (HR) 1.38] and low annual surgical volume (fewer than 25 UKAs/year, HR 1.86; fewer than 50 UKAs/year, HR 1.43). Significant risks for septic revision were grade III obesity (HR 1.83), male sex (HR 1.69), and high comorbidity scores (Elixhauser > 5, HR 1.67). The surgical volume did not affect septic revision rates.

Conclusion: Aseptic loosening is the primary cause of UKA revision, influenced by implant type and low surgical volume, while septic revisions are associated with patient factors such as obesity, male sex, and comorbidities. Improvements in implant selection, surgical expertise, and patient risk management may reduce revision rates.

Level of evidence: III, retrospective case-control study.

Background: The mediolateral position and postoperative translation of the femoral and tibial components relative to the respective bones after total knee arthroplasty (TKA) have not yet been investigated. The purpose of the current study was to investigate the effect of the mediolateral position of the femoral and tibial components on clinical outcomes including muscle strength and ambulatory function.

Methods: A total of 86 consecutive knees were included. The mediolateral positions of the femoral and tibial components were measured on the postoperative long-leg radiographs. The mediolateral position of the femoral and tibial components was defined relative to the femoral distal anatomical axis and the tibial mechanical axis. The lateral position of the component was denoted as positive. The lateral translation of the femoral and tibial components was defined as the distance between the preoperative femoral and tibial centers and the postoperative center of the respective component. The Knee Society Score (KSS), New Knee Society Score (2011 KSS), and the Timed Up and Go (TUG) test results were evaluated 2 years postoperatively. Spearman's correlation coefficient was calculated.

Results: The lateral position of the femoral component was significantly positively correlated with KSS function score (ρ = 0.250, p = 0.020), 2011 KSS functional activities (ρ = 0.258, p = 0.017), and TUG values (ρ = - 0.241, p = 0.027). The lateral translation of the tibial component was significantly correlated with knee extension strength (ρ = 0.259, p = 0.017).

Conclusions: The lateralized position of the femoral and tibial components positively influenced postoperative knee function. When the width of the component does not fit the resected surface, a lateralized position of the femoral and tibial components with respect to the respective bones can be recommended for better functional outcomes.