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No Radiographic Evidence of Medial Collateral Ligament Elongation in Valgus Osteoarthritic Knees Enables Treatment with Kinematically Aligned Total Knee Arthroplasty. 膝关节外翻骨关节炎患者的内侧副韧带伸长在影像学上无明显证据,因此可采用运动对齐全膝关节置换术进行治疗。
IF 1.6 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-27 DOI: 10.1055/a-2395-6831
Alexander J Nedopil, Anand Singh Dhaliwal, Antonio Klasan, Stephen M Howell, Maury L Hull

When performing caliper-verified kinematically aligned total knee arthroplasty (KA TKA) in the osteoarthritic (OA) knee with valgus deformity, an elongated medial collateral ligament (MCL) could result in a valgus setting of the tibial component. The present study analyzed KA TKA in patients with valgus deformities (i.e., tibiofemoral angle > 10 degrees of valgus) and determined (1) the occurrence of radiographic MCL elongation, (2) the incidence of lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) release and the use of constrained components, and (3) whether the 1-year Forgotten Joint Score (FJS), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and Likert satisfaction score were comparable to KA TKAs for OA deformities ≤10 degrees of valgus. One hundred and two consecutive patients who underwent KA TKA by a single surgeon were analyzed radiographically and clinically at a minimum follow-up of 1 year. Radiographic MCL elongation was identified by a greater than 1 degree of valgus orientation of the tibial component relative to the OA tibial joint line. Twenty-six patients had a radiographic anatomic tibiofemoral angle greater than 10 degrees of valgus (range of OA deformity: 11-23 degrees of valgus). Seventy-six had an OA deformity ≤10 degrees of valgus (10-degree valgus to -14-degree varus). No patient had MCL elongation or a ligament release, or required constrained components. The median FJS of 78, OKS of 42, and KOOS JR of 76, and the 85% satisfaction rate of the patients with greater than 10 degrees of OA valgus deformity were not significantly different from those with ≤10 degrees of OA valgus deformity (p ≥ 0.17). Because MCL elongation was not detected in OA deformities up to 23 degrees of valgus, the risk of under-correcting the valgus deformity leading to instability and poor outcome scores is low when performing KA TKA using primary components without releasing the LCL and/or PCL. LEVEL OF EVIDENCE::  IV.

目的:在对伴有外翻畸形的骨关节炎(OA)膝关节进行卡尺验证的运动学配准全膝关节置换术(KA TKA)时,内侧副韧带(MCL)的拉长可能会导致胫骨组件的外翻设置。本研究分析了膝关节外翻畸形患者的 KA TKA(即、2)外侧副韧带(LCL)和后交叉韧带(PCL)松解的发生率以及受限组件的使用情况、3)对于髋关节外翻≤10°的OA畸形,一年的 "遗忘关节评分"(FJS)、"牛津膝关节评分"(OKS)、"膝关节损伤和骨关节炎关节置换术结果评分"(KOOS JR)和Likert满意度评分是否与KA TKAs相当。方法:对由一名外科医生实施 KA TKA 的 112 名连续患者进行了至少 1 年的放射学和临床随访分析。胫骨组件相对于OA胫骨关节线的外翻方向大于1°,即可确定MCL的影像学伸长:26名患者的胫股关节放射解剖角度大于10°外翻(OA畸形范围为11°至23°外翻)。76名患者的OA畸形≤10°外翻(10°外翻至-14°内翻)。没有患者出现 MCL 拉长、韧带松解或需要约束组件。OA外翻畸形大于10°的患者的FJS中位数为78,OKS中位数为42,KOOS JR中位数为76,满意率为85%,与OA外翻畸形小于10°的患者相比无显著差异(P≥0.17):由于在外翻23°以下的OA畸形中未检测到MCL伸长,因此在不释放LCL和/或PCL的情况下使用主组件进行KA TKA手术时,外翻畸形矫正不足导致不稳定和不良结果评分的风险很低。
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引用次数: 0
Boundaries in Kinematic Alignment: Why, When, and How. 运动校准的界限:为什么、何时以及如何。
IF 1.6 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-12 DOI: 10.1055/a-2395-6935
Pier Francesco Indelli, Giuseppe Petralia, Stefano Ghirardelli, Pieralberto Valpiana, Giuseppe Aloisi, Andrea Giordano Salvi, Salvatore Risitano

The use of alternative alignments in total knee arthroplasty (TKA) has recently been increasing in popularity: many of these alignments have been included in the broad spectrum of "kinematic alignment." This alternative approach was recommended to increase patients' satisfaction since many studies based on patient-reported outcome measures (PROMs) showed that every fifth patient is not satisfied with the surgical outcome. In fact, the original kinematic alignment technique was designed as a "pure resurfacing" technique, maintaining the preoperative axes (flexion-extension and axial rotation) of the knee. In adjunct, many new classifications of the preoperative limb deformity have been proposed to include a large range of knee anatomies, few of them very atypical. Following those classifications, many surgeons aimed for a reproduction of unusual anatomies putting in jeopardy the survivorship of the implant according to the classical "dogma" of a poor knee kinematics and TKA biomechanics if the final hip-knee-ankle (HKA) axis was not kept within 5 degrees from neutral. This article reviews the literature supporting the choice of setting alignment boundaries in TKA when surgeons are interested in reproducing the constitutional knee anatomy of the patient within a safe range.

近来,在全膝关节置换术(TKA)中使用替代对位的做法越来越流行:其中许多对位方法已被纳入 "运动学对位 "的广泛范畴。推荐采用这种替代方法是为了提高患者的满意度,因为许多基于患者报告结果衡量标准(PROMs)的研究显示,每五名患者中就有一人对手术结果不满意。事实上,最初的运动学对位技术被设计为一种 "纯粹的膝关节再植 "技术,保持术前的膝关节轴线(屈伸和轴向旋转)。与此同时,许多新的术前肢体畸形分类方法也被提出来,其中包括多种膝关节解剖结构,其中有一些非常不典型。根据这些分类,许多外科医生致力于再现不典型的解剖结构,如果最终的 HKA(髋-膝-踝)轴与中立位的距离不能保持在 5° 以内,那么根据膝关节运动学和 TKA 生物力学较差的经典 "教条",植入物的存活率就会受到威胁。本文回顾了支持在 TKA 中选择设置对齐边界的文献,当外科医生希望在安全范围内再现患者膝关节的解剖结构时。
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引用次数: 0
Patellar Tendon Ruptures after Total Knee Arthroplasty. 全膝关节置换术后髌骨肌腱断裂。
IF 1.7 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-11 DOI: 10.1055/a-2413-3962
Gabrielle Swartz,Sean Bonanni,Daniel Hameed,Jeremy Dubin,Sandeep S Bains,Deepak V Patel,Michael A Mont,Ronald E Delanois,Giles R Scuderi
Patellar tendon rupture following total knee arthroplasty (TKA) is a rare, but devastating complication. These injuries occur most frequently in the acute period following TKA due to trauma to the knee. Patellar tendon ruptures that disrupt the extensor mechanism create a marked functional deficit, impacting every facet of daily life. In complete ruptures of the patellar tendon, repair or reconstruction is typically indicated; however, complication rates following intervention remain high, between 25 to 63%. Operative intervention remains the mainstay of treatment, with only certain specific situations where nonoperative intervention is appropriate. Operative treatments include repair with or without augmentation or reconstruction. Augmentation does reduce the high risk of complications, bringing rates down from 63 to 25%. Augmentation options include autografts, allografts, synthetic grafts, or synthetic meshes. Despite advancements, outcomes are unpredictable, and complications are common, highlighting the need for further research to improve treatment protocols. Operative techniques are chosen based on the acuity, location of disruption, and status of the residual soft tissues. This article provides an overview of patellar tendon ruptures following TKA, the various treatment options, and the recommendations of the senior authors for each common type of patellar tendon injury encountered.
全膝关节置换术(TKA)后髌骨肌腱断裂是一种罕见但却具有破坏性的并发症。这种损伤最常发生在全膝关节置换术后的急性期,原因是膝关节受到创伤。髌腱断裂会破坏伸肌机制,造成明显的功能障碍,影响日常生活的方方面面。在髌腱完全断裂的情况下,通常需要进行修复或重建;然而,干预后的并发症发生率仍然很高,在 25% 到 63% 之间。手术干预仍是治疗的主流,只有在某些特殊情况下才适合采用非手术干预。手术治疗包括带或不带增强或重建的修复术。增强手术确实能降低并发症的高风险,使并发症发生率从 63% 降至 25%。植入物包括自体移植物、异体移植物、合成移植物或合成网。尽管技术不断进步,但结果仍难以预测,并发症也很常见,因此需要进一步研究以改进治疗方案。手术技术的选择基于损伤的敏锐度、破坏的位置和残余软组织的状态。本文概述了 TKA 术后髌腱断裂的情况、各种治疗方案以及资深作者对每种常见髌腱损伤类型的建议。
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引用次数: 0
Does Resurfacing the Patella Increase the Risk of Extensor Mechanism Injury Within the First Two Years After Total Knee Arthroplasty? 髌骨复位是否会增加全膝关节置换术后两年内伸肌机制损伤的风险?
IF 1.7 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-11 DOI: 10.1055/a-2413-3876
David E DeMik,Juan David Lizcano,Emily Jimenez,Kyle Mullen,Jess H Lonner,Chad A Krueger
Background Extensor mechanism injury (EMI) following total knee arthroplasty (TKA) is a potentially catastrophic complication and may lead to significant morbidity or need for revision reconstructive procedures. Patella resurfacing (PR), while commonly performed during TKA, reduces overall patella bone stock and may increase the risk of EMI after TKA. The purpose of this study was to assess if patellar resurfacing (PR) in elderly patients raises the risk for subsequent EMI. Methods The American Joint Replacement Registry (AJRR) was queried to identify Medicare patients ≥65 years old undergoing primary elective TKA for osteoarthritis between January 2012 and March 2020. Patient age, sex, and Charlson Comorbidity Index (CCI) were collected. Records were subsequently merged with Medicare claims records and evaluated for the occurrence of patella fracture, quadriceps tendon rupture, or patellar tendon rupture based on ICD-9/10 diagnosis codes within 2 years of TKA. Patients were stratified based on whether PR occurred or not (NR). Logistic regression was used to determine the association between PR and EMI. Results A total of 453,828 TKA were eligible for inclusion and 428,644 (94.45%) underwent PR. The incidence of PR decreased from 96.06% in 2012 to 92.35% in 2022 (p<0.001). Patients undergoing PR were more often female (60.93% vs 58.50%; p<0.001) and had a lower mean CCI (3.09 [1.10] vs. 3.16 [1.20]; p<0.001). Odds for EMI did not differ based on whether PR was performed (OR: 0.85 [0.65-1.11]; p=0.2246). Increasing age (OR: 1.06 [1.05-1.07], p<0.0001]) and CCI (OR: 1.06 [0.95-1.19], p=0.0009) were associated with EMI. Conclusions PR is commonly performed during TKA in the United States and was not found to increase odds for EMI within 2 years of TKA in patients ≥65 years old. Increased age and medical comorbidity were associated with higher odds for subsequent EMI.
背景 全膝关节置换术(TKA)后的伸肌机制损伤(EMI)是一种潜在的灾难性并发症,可能导致严重的发病率或需要进行翻修重建手术。髌骨复位(PR)虽然通常在 TKA 期间进行,但会减少整体髌骨骨量,并可能增加 TKA 后发生 EMI 的风险。本研究旨在评估老年患者的髌骨重置术(PR)是否会增加后续 EMI 的风险。方法 对美国关节置换登记处(AJRR)进行查询,以确定在 2012 年 1 月至 2020 年 3 月期间因骨关节炎接受初级选择性 TKA 的年龄≥65 岁的医疗保险患者。收集了患者的年龄、性别和查尔森合并症指数 (CCI)。随后将记录与医疗保险理赔记录合并,并根据 TKA 术后 2 年内的 ICD-9/10 诊断代码评估是否发生髌骨骨折、股四头肌腱断裂或髌腱断裂。根据是否发生 PR 对患者进行分层(NR)。采用 Logistic 回归确定 PR 与 EMI 之间的关系。结果 共有 453,828 例 TKA 符合纳入条件,其中 428,644 例(94.45%)接受了 PR。PR发生率从2012年的96.06%降至2022年的92.35%(P<0.001)。接受 PR 的患者多为女性(60.93% vs. 58.50%;p<0.001),平均 CCI 较低(3.09 [1.10] vs. 3.16 [1.20];p<0.001)。EMI的几率并不因是否进行PR而不同(OR:0.85 [0.65-1.11];P=0.2246)。年龄(OR:1.06 [1.05-1.07],p<0.0001])和 CCI(OR:1.06 [0.95-1.19],p=0.0009)的增加与 EMI 相关。结论 在美国,TKA 期间通常会进行 PR,在年龄≥65 岁的患者中,PR 并未发现会增加 TKA 术后 2 年内发生 EMI 的几率。年龄和并发症的增加与随后发生 EMI 的几率增加有关。
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引用次数: 0
Compartment Syndrome in Association with Tibial Plateau Fracture: Standardized Protocols Ensure Optimal Outcomes 胫骨平台骨折合并室间隔综合征:标准化方案确保最佳疗效
IF 1.7 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-09 DOI: 10.1055/s-0044-1790282
Luke Schwartz, Rown Parola, Abhishek Ganta, Sanjit Konda, Steven Rivero, Kenneth A. Egol

The purpose of this study was to report on the treatment, results, and longer-term outcomes of patients who sustained a tibial plateau fracture with an associated leg compartment syndrome (CS). A total of 766 patients who sustained 766 tibial plateau fractures met inclusion criteria. Fourteen patients (1.8%) were diagnosed with CS in association with a tibial plateau fracture during their initial hospitalization, 13 at the time of presentation and 1 delayed. The treatment protocol consisted of initial external fixation and fasciotomy, followed by irrigation and debridement, and eventual closure. Fasciotomy cases included 2/14 (14.3%) single incision approaches and 12/14 (85.7%) dual incision approaches. Operative treatment of the tibial plateau fracture was performed at the time of final closure or once soft tissues were permitted. One case of CS that developed following definitive fixation was treated with fasciotomy and delayed primary closure after initial stabilization. Ten (71.4%) were available at 1-year follow-up. We compared these 10 cases to the patients with operative tibial plateau fractures without CS to assess for surgical, radiographic, clinical, and functional outcomes. We used a propensity match based on age, body mass index, sex, Charleson comorbidity index, and fracture type to reduce the presence of confounding biases. Standard statistical methods were employed. Those in the CS cohort were younger males (p < 0.05). At latest follow-up, function did not differ between those in the CS group compared with the non-CS cohort (p > 0.05). Clinically, knee flexion (130.7 vs. 126; p = 0.548), residual depression (0.5 vs. 0.2; p = 0.365), knee alignment (87.7 vs. 88.3; p = 0.470), and visual analog scale pain scores (3.0 vs. 2.4; p = 0.763) did not differ between the cohorts. Although infection was higher in the CS cohort, the overall complication rates did not differ between the CS patients and non-CS cohort (p > 0.05). Early identification and standardized treatment protocols for the management of CS that develops in association with a tibial plateau fracture lead to outcome scores that were not significantly different from patients who did not develop CS.

本研究旨在报告胫骨平台骨折伴有腿部椎间隙综合征(CS)患者的治疗方法、结果和长期疗效。共有 766 名胫骨平台骨折患者符合纳入标准。14名患者(1.8%)在初次住院时被诊断为胫骨平台骨折伴有CS,13名患者在就诊时被诊断为CS,1名患者延迟诊断。治疗方案包括最初的外固定和筋膜切开术,然后进行冲洗和清创,最后缝合。筋膜切开术包括2/14(14.3%)例单切口手术和12/14(85.7%)例双切口手术。胫骨平台骨折的手术治疗在最终闭合时或软组织允许时进行。有一例在最终固定后发生的 CS,在初步稳定后进行了筋膜切开术和延迟初次闭合术。10例(71.4%)患者接受了为期1年的随访。我们将这 10 例患者与未发生 CS 的胫骨平台骨折手术患者进行了比较,以评估手术、影像学、临床和功能结果。我们根据年龄、体重指数、性别、查尔斯恩合并症指数和骨折类型进行倾向匹配,以减少混杂偏差的存在。我们采用了标准的统计方法。CS队列中的男性更年轻(P P > 0.05)。临床上,两组患者的膝关节屈曲度(130.7 vs. 126;p = 0.548)、残余凹陷(0.5 vs. 0.2;p = 0.365)、膝关节对齐度(87.7 vs. 88.3;p = 0.470)和视觉模拟量表疼痛评分(3.0 vs. 2.4;p = 0.763)均无差异。虽然CS组感染率较高,但CS患者与非CS组的总体并发症发生率并无差异(P > 0.05)。对于胫骨平台骨折伴发的CS,通过早期识别和标准化治疗方案的处理,其结果评分与未发生CS的患者无显著差异。
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引用次数: 0
Computer Patient-Specific 3D Modeling and Custom-Made Guides for Revision ACL Surgery. 用于前交叉韧带翻修手术的特定患者计算机三维建模和定制指南。
IF 1.6 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-04-27 DOI: 10.1055/a-2315-7873
Armando Del Prete, Piero Franco, Matteo Innocenti, Fabrizio Matassi, Filippo Leggieri, Rosario Jr Sagliocco, Roberto Civinini

Revision anterior cruciate ligament reconstruction (ACLR) is a challenging surgery occurring in 3 to 24% of primary reconstructions. A meticulous planning to study the precise size and location of both femoral and tibial bone tunnels is mandatory. The aim of the study was to evaluate the intra- and interoperator differences in the decision-making process between experienced surgeons after they were asked to make preoperative planning for ACL revision reconstruction with the use of both the computed tomography (CT) scan and a three-dimensional (3D)-printed model of the knee. Data collected from 23 consecutive patients undergoing revision of ACLR for graft failure at a single institute between September 2018 and February 2020 were prospectively reviewed. The double-blinded collected data were presented to three board-certificate attending surgeons. Surgeons were asked to decide whether to perform one-stage or two-stage revision ACLR based on the evaluation of the CT scan images and the 3D-printed custom-made models at two different rounds, T0 and T1, respectively, 7 days apart one from the other. Interoperator consensus following technical mistake was 52% at T0 and 56% at T1 using the CT scans, meanwhile concordance was 95% at T0 and 94% at T1 using the 3D models. Concordance between surgeons following new knee injury was 66% at T0 and 70% at T1 using CT scans, while concordance was 96% both at T0 and T1 using 3D models. Intraoperative variability using 3D models was extremely low: concordance at T0 and T1 was 98%. McNemar test showed a statistical significance in the use of 3D model for preoperative planning (p < 0.005). 3D-printed model reliability resulted to be higher compared with CT as intraoperator surgery technique selection was not modified throughout time from T0 to T1 (p < 0.005). The use of 3D-printed models had the most impact when evaluating femoral and tibial tunnels, resulting to be a useful instrument during preoperative planning of revision ACLR between attending surgeons with medium-high workflow.

简介:前交叉韧带重建(ACLR)翻修手术是一项具有挑战性的手术,占初次重建手术的 3-24%。必须对股骨和胫骨隧道的精确尺寸和位置进行细致的规划研究。该研究旨在评估经验丰富的外科医生在利用 CT 扫描和膝关节 3D 打印模型进行前交叉韧带翻修重建的术前规划后,其决策过程中的术内和术者间差异:前瞻性回顾了2018年9月至2020年2月期间在一家研究所因移植物失败而接受前交叉韧带翻修重建术的23名连续患者的数据。收集到的双盲数据提交给了三位获得委员会认证的主治外科医生。外科医生被要求根据 CT 扫描图像和 3D 打印定制模型的评估结果,分别在 T0 和 T1 两轮不同的时间段(相隔七天)决定进行一期或二期前交叉韧带翻修手术:结果:使用 CT 扫描时,技术失误后医生间的一致性在 T0 和 T1 分别为 52% 和 56%;而使用 3D 模型时,一致性在 T0 和 T1 分别为 95% 和 94%。外科医生在膝关节新伤后使用 CT 扫描时,T0 和 T1 的一致性分别为 66% 和 70%,而使用三维模型时,T0 和 T1 的一致性均为 96%。使用三维模型的术中变异性极低:T0 和 T1 的一致性为 98%。McNamar 检验显示,使用三维模型进行术前规划具有统计学意义(P < 0.005)。与 CT 相比,3D 打印模型的可靠性更高,因为从 T0 到 T1 的整个时间段内,术者的手术技术选择都没有改变(p < 0.005):结论:在评估股骨和胫骨隧道时,3D 打印模型的使用影响最大,因此是工作流程中等偏上的主治医生在翻修 ACLR 术前规划中的有用工具。
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引用次数: 0
Isolated, Proximal Tibiofibular Injuries in Athletic Patients: A Critical Analysis Review. 运动员胫腓骨近端孤立性损伤:批判性分析综述。
IF 1.6 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-04-27 DOI: 10.1055/a-2315-7691
Derrick M Knapik, Varun Gopinatth, Garrett R Jackson, Robert F LaPrade, Jorge Chahla, Robert H Brophy, Matthew J Matava, Matthew V Smith

While infrequently reported, isolated injuries to the proximal tibiofibular (TF) joint primarily occur in young, athletic patients participating in sporting activities requiring explosive, high-impact movements, increasing the risk for potential twisting injuries, especially across a hyperflexed knee. The proximal TF joint is stabilized by bony, muscular and ligamentous structures, including both the anterior and posterior proximal TF complexes, with the anterior complex providing more robust stability. Proximal TF injuries frequently involve anterior and lateral displacement of the proximal fibula relative to its native articulation with the tibia. Proper diagnosis is dependent on careful and meticulous history and physical examination, as missed injuries are common, leading to the potential for continued pain, weakness and disability, especially in athletic patients. While spontaneous joint reduction has been reported, injuries may require formal closed reduction, with irreducible and chronic injuries requiring open reduction and stabilization, with recent investigations reporting satisfactory outcomes following anatomic reconstruction of the proximal TF ligament.

胫腓骨近端(TF)关节的孤立损伤虽然鲜有报道,但主要发生在参与需要爆发力、高冲击力运动的体育活动的年轻运动员身上,这增加了潜在扭转损伤的风险,尤其是在膝关节过度屈曲的情况下。胫腓骨近端关节由骨、肌肉和韧带结构稳定,包括胫腓骨近端前复合体和后复合体,其中前复合体提供更强的稳定性。胫腓骨近端损伤经常涉及腓骨近端相对于其与胫骨的原生关节的前侧和外侧移位。正确的诊断有赖于认真细致的病史和体格检查,因为漏诊很常见,可能导致持续疼痛、虚弱和残疾,尤其是在运动员患者中。虽然有自发关节复位的报道,但损伤可能需要正式的闭合复位,不可复位的慢性损伤需要开放复位和稳定,最近的研究报告显示,近端 TF 韧带解剖重建后的疗效令人满意。
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引用次数: 0
Short-term Comparison of Survivorship and Functional Outcomes for Metaphyseal Cones with Short and Long Stems in Revision Total Knee Arthroplasty. 在翻修全膝关节置换术中使用带短柄和长柄的骺锥体的存活率和功能效果的短期比较。
IF 1.6 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-04-27 DOI: 10.1055/a-2315-7778
Nicolas S Piuzzi, Emily L Hampp, Sarah Shi, Manoshi Bhowmik-Stoker, Nickelas Huffman, Kevin M Denehy, David C Markel, Daniel D Li, Michael A Mont

Printed porous titanium metaphyseal cones have become a mainstay for managing bone loss in revision total knee arthroplasty (rTKA). A short or long stem is routinely used when implanting a cone to augment fixation and offload stresses. This retrospective analysis compared the short-term survivorships and functional outcomes for use of a short or long stem with a metaphyseal cone.A total of 179 cases using metaphyseal cones and stems with median follow-up of 1.95 years (interquartile range, 1.00-2.14) were compared based on stem type. There were 55 cases with long stem(s) and 124 cases with short stem(s). Cases with both long and short stems were excluded. Demographics, Kaplan-Meier survivorships, and preoperative and 1-year postoperative patient-reported outcome measures (PROMs; 2011 Knee Society Score [KSS] objective knee score, function, and satisfaction scores; EuroQol five-dimension scale; and Short Form Survey Physical Component Summary and Mental Component Summary scores) were compared using t-tests with a significance level of α = 0.05. There were no significant differences in body mass index (mean ± standard deviation) or sex (men [%]) between the short and long stem cohorts (32.3 ± 5.3, 36.3% and 31.5 ± 5.5, 38.2%, respectively; p > 0.05). Patients who had short stems were younger (65.9 ± 8.8 vs. 69.0 ± 9.4, p = 0.0323).Revision-free survivorship for the femoral or tibial component was 100% for long stems and 98.2% for short stems at 1 and 2 years, respectively (log-rank p = 0.6330). The two revisions in the short group were for infection, thus the survivorship for aseptic loosening was 100% at 2 years for both cohorts. There were no significant differences in preoperative or postoperative PROMs.This study demonstrated that highly porous printed metaphyseal cones provided rTKA with excellent early survivorship and similar PROMs whether a short or long stem was used. Additional studies will be needed to discern longer term differences.

简介:印刷多孔钛骺锥体已成为翻修全膝关节置换术(rTKA)中控制骨质流失的主要方法。在植入锥体时,通常会使用长短柄来增强固定和卸载应力。这项回顾性分析比较了使用骺锥体的短骨柄或长骨柄的短期存活率和功能结果:根据骨干类型比较了179个使用骺锥和骨干的病例,中位随访时间为1.95年(四分位间范围为1.00至2.14年)。其中 55 例使用长柄,124 例使用短柄。同时具有长茎和短茎的病例被排除在外。采用t检验比较了人口统计学、Kaplan-Meier存活率、术前和术后一年的患者报告结果指标(PROMs)[2011年膝关节协会评分(KSS)客观膝关节评分、功能和满意度评分;EuroQol五维量表(EQ5D);以及简表调查(SF12)身体成分汇总(PCS)和精神成分汇总(MCS)评分],显著性水平为α=0.05。在体重指数(BMI)(平均值±标度)或性别[男性(%)]方面,短茎组和长茎组之间没有明显差异(分别为32.3±5.3,36.3%和31.5±5.5,38.2%;P>0.05)。使用短茎的患者更年轻(65.9 ± 8.8 vs. 69.0 ± 9.4,P=0.0323):结果:一年和两年后,股骨或胫骨组件的无翻修存活率长柄组为100%,短柄组为98.2%(log-Rank P=0.6330)。短柄组的两次翻修都是因为感染,因此两组患者两年后的无菌性松动存活率均为100%。术前和术后PROMs无明显差异:这项研究表明,无论使用长茎还是短茎,高多孔印刷骺锥体都能为rTKA提供良好的早期存活率和相似的PROM。还需要进行更多研究,以确定长期差异。
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引用次数: 0
Patient Demographic Factors Impact KOOS JR Response Rates for Total Knee Arthroplasty Patients. 患者人口统计学因素对全膝关节置换术患者 KOOS JR 响应率的影响
IF 1.6 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-22 DOI: 10.1055/s-0044-1787055
Yixuan Tong, Vinaya Rajahraman, Rajan Gupta, Ran Schwarzkopf, Joshua C Rozell

The Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) is a validated patient-reported measure for assessing pain and function following total knee arthroplasty (TKA). This study investigates how patient demographic factors (i.e., age, sex, and race) correlate with KOOS JR response rates. This was a retrospective cohort study of adult, English-speaking patients who underwent primary TKA between 2017 and 2023 at an academic institution. KOOS JR completion status-complete or incomplete-was recorded within 90 days postoperatively. Standard statistical analyses were performed to assess KOOS JR completion against demographic factors. Among 2,883 total patients, 70.2% had complete and 29.8% had incomplete KOOS JR questionnaires. Complete status (all p < 0.01) was associated with patients aged 60 to 79 (71.8%), white race (77.6%), Medicare (81.7%), marriage (76.8%), and the highest income quartile (75.7%). Incomplete status (all p < 0.001) was associated with patients aged 18 to 59 (64.4%), Medicaid (82.4%), and lower income quartiles (41.6% first quartile, 36.8% third quartile). Multiple patient demographic factors may affect KOOS JR completion rates; patients who are older, white, and of higher socioeconomic status are more likely to participate. Addressing underrepresented groups is important to improve the utility and generalizability of the KOOS JR.

膝关节损伤和骨关节炎关节置换术结果评分(KOOS JR)是一项经过验证的患者报告测量方法,用于评估全膝关节置换术(TKA)后的疼痛和功能。本研究调查了患者人口统计学因素(即年龄、性别和种族)与 KOOS JR 响应率的相关性。这是一项回顾性队列研究,研究对象是 2017 年至 2023 年期间在一家学术机构接受初级 TKA 手术的讲英语的成年患者。术后 90 天内记录了 KOOS JR 的完成状态--完成或未完成。对KOOS JR完成情况与人口统计学因素进行了标准统计分析。在2883名患者中,70.2%的患者填写了完整的KOOS JR问卷,29.8%的患者填写了不完整的KOOS JR问卷。完成情况(所有 p
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引用次数: 0
Specific Preoperative Factors Increase Manipulations under Anesthesia Following Primary TKA. 特定的术前因素会增加初级 TKA 术后麻醉下的操作。
IF 1.6 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-04-27 DOI: 10.1055/a-2315-7955
Anson G Bautista, Nicholas L Kolodychuk, Jeremy S Frederick, Michael B Held, H John Cooper, Roshan P Shah, Jeffrey A Geller

Arthrofibrosis following primary total knee arthroplasty (TKA) can result in pain and limit postoperative range of motion (ROM), jeopardizing clinical outcomes and patient satisfaction. This study aims to identify preoperative risk factors associated with necessitating a manipulation under anesthesia (MUA) following primary TKA.We retrospectively reviewed 950 cases of consecutive primary TKAs performed at one institution by three arthroplasty surgeons between May 2017 and May 2019. Recorded preoperative variables included smoking status, race, preoperative ROM, presence of effusion or positive anterior drawer, and medical comorbidities. Demographic characteristics were compared with Student's t-tests or chi-square tests as appropriate. For each preoperative factor, we obtained an odds ratio (OR) for MUA risk using multivariate logistic regression.Twenty (2.3%) patients underwent MUA following their index primary TKA surgery. History of ipsilateral knee surgery (OR: 2.727, p = 0.047) and diagnosed hypertension (OR: 4.764, p = 0.016) were identified as risk factors associated with significantly increased risk of MUA. The greater the preoperative ROM, the higher likelihood needed of MUA (OR: 1.031, p = 0.034).Patients who had diagnosed hypertension or a history of prior ipsilateral knee surgery were associated with increased risk of necessitating an MUA following primary TKA. Additionally, a greater total arc of motion preoperatively increased the odds of needing MUA.Level III of evidence was present.

背景 原发性全膝关节置换术(TKA)后关节纤维化会导致疼痛并限制术后活动范围(ROM),从而影响临床效果和患者满意度。本研究旨在确定初级 TKA 术后需要麻醉下操作 (MUA) 的相关术前风险因素。方法 我们回顾性地审查了 2017 年 5 月至 2019 年 5 月期间由三位关节成形术外科医生在一家机构进行的 950 例连续原发性 TKA 病例。记录的术前变量包括吸烟状况、种族、术前 ROM、有无渗液或前抽屉阳性以及合并症。人口统计学特征酌情采用学生 t 检验或卡方检验进行比较。针对每个术前因素,我们使用多元逻辑回归法得出了MUA风险的几率比率。结果 20 名(2.3%)患者在接受了指数初级 TKA 手术后接受了 MUA。同侧膝关节手术史(几率比 [OR]:2.727,P=0.047)和确诊高血压(OR:4.764,P=0.016)被确定为与 MUA 风险显著增加相关的风险因素。术前活动范围越大,发生 MUA 的可能性越高(OR:1.031,P=0.034)。结论 诊断出患有高血压或之前有过同侧膝关节手术史的患者在初次 TKA 术后需要进行 MUA 的风险较高。此外,术前总运动弧度越大,需要 MUA 的几率越高。
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引用次数: 0
期刊
Journal of Knee Surgery
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