IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-30 DOI: 10.1016/j.knee.2024.10.008

Stephen A. Doxey , Torben H. Urdahl , Rafat H. Solaiman , Mariah N. Wegner , Harsh Parikh , Brian P. Cunningham , Patrick K. Horst

Background

The purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate prosthetic joint infection (PJI) within 90-days following primary total knee arthroplasty (TKA).

Methods

From October 2021-September 2022, a prospective quality control project was undertaken in which 10 high-volume arthroplasty surgeons alternated between using IVP and not using IVP each month. Patients who received IVP were compared to those who did not. The primary outcome was culture positive PJI within 90-days following primary total knee arthroplasty. Secondary outcomes included overall reoperation rate, wound complications, and readmission within 90-days post-operatively.

Results

A total of 1,317 primary TKA patients were identified for analysis. Fifty-six and seven tenths percent (n = 747) of patients were included in the IVP group and 43.3% (n = 570) patients were included in the non-IVP group. The overall PJI rate was 0.5%. There was no difference in 90-day culture positive PJI rates between the groups (0.7% vs. 0.2%, p = 0.24). The overall reoperation rate did not differ between the IVP and non-IVP group (6.4% vs. 4.6%, p = 0.15). Reoperation for suspected infection was not statistically different by IVP administration (1.2% vs. 0.5%, p = 0.25). Additionally, there were no differences in the incidence of wound complications (p = 0.80) or readmissions (p = 0.15).

Conclusions

The overall infection rate for this cohort was low. IVP was not associated with decreased culture positive PJI, wound complications, reoperation or readmission rates. Further analysis of IVP use in TKA should be undertaken to fully determine its efficacy and safety profile.

背景：这项前瞻性质量控制项目的回顾性分析旨在确定使用万古霉素粉（IVP）是否会降低初次全膝关节置换术（TKA）后 90 天内的假体关节感染（PJI）率：方法：2021年10月至2022年9月期间，开展了一项前瞻性质量控制项目，10名工作量大的关节置换外科医生每月交替使用或不使用IVP。接受 IVP 治疗的患者与未接受 IVP 治疗的患者进行比较。主要结果是初级全膝关节置换术后 90 天内 PJI 培养阳性。次要结果包括总体再手术率、伤口并发症和术后90天内的再入院率：共有 1,317 名初级全膝关节置换术患者接受了分析。56.7%的患者（n = 747）被纳入IVP组，43.3%的患者（n = 570）被纳入非IVP组。总的 PJI 发生率为 0.5%。两组患者的 90 天培养阳性 PJI 率没有差异（0.7% 对 0.2%，P = 0.24）。IVP 组和非 IVP 组的总再手术率没有差异（6.4% 对 4.6%，P = 0.15）。因疑似感染而再次手术的比例在统计学上没有因使用 IVP 而不同（1.2% 对 0.5%，P = 0.25）。此外，伤口并发症（p = 0.80）或再住院（p = 0.15）的发生率也没有差异：结论：该队列的总体感染率较低。IVP与培养阳性PJI、伤口并发症、再次手术或再次入院率的降低无关。应进一步分析 IVP 在 TKA 中的应用，以全面确定其疗效和安全性。

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引用次数: 0

Letter to the editor: Aseptic loosening of the option stemmed tibial tray in the Zimmer NexGen LPS total knee arthroplasty system. Knee. 2024 Mar;47:1-12. 致编辑的信：Zimmer NexGen LPS 全膝关节置换系统中的可选柄胫骨托无菌性松动。膝关节。2024年3月；47:1-12。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-26 DOI: 10.1016/j.knee.2024.10.004

引用次数: 0

Response to : Letter to the editor on "Aseptic loosening of the option stemmed tibial tray in the Zimmer NexGen LPS total knee arthroplasty system". 回应：致编辑的信，主题为 "Zimmer NexGen LPS 全膝关节置换系统中的可选柄胫骨托无菌性松动"。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-26 DOI: 10.1016/j.knee.2024.10.005

引用次数: 0

Long term outcomes following tibial plateau fracture fixation and risk factors for progression to total knee arthroplasty 胫骨平台骨折固定术后的长期疗效及发展为全膝关节置换术的风险因素。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-24 DOI: 10.1016/j.knee.2024.10.003

Matthew Howell , Alisa Khalid , Callum Nelson , James Doonan , Bryn Jones , Mark Blyth

Introduction

Tibial plateau fractures are complex, peri-articular fractures that can have poor outcomes resulting in conversion to total knee arthroplasty (TKA). This study evaluates the 10-year survival of tibial plateau fractures treated with open reduction and internal fixation and identifies risk factors associated with conversion to TKA.

Methods

This retrospective cohort study evaluates the outcomes of 126 patients undergoing tibial plateau ORIF from January 2011 to December 2012 at Glasgow Royal Infirmary. As well as patient factors, radiographic assessments were analysed including the degree of articular depression, medial proximal tibial angle, and femoral width ratio pre-operatively, peri-operatively and at the time of union. Patients requiring further surgical intervention, including TKA, were evaluated further.

Results

A bell-shaped distribution of patient age was observed. Schatzker II fractures were most prevalent (48%). Pre-operative articular depression averaged 6.9 mm ranging from 0.0 – 36.0 mm. Operative reduction was generally satisfactory (mean articular depression 1.3 mm, femoral width 0.96, mPTA 89.6⁰), with 82% achieving an anatomical reduction. 12 patients (9.3%) required TKA during follow-up with Kaplan-Meier calculated as 91.9% at 5 years and 87.4% at 10 years. Articular depression > 4 mm (HR = 16.2), femoral width ratio > 1.05 (HR = 14.7) and age > 50 years (HR = 4.2) at time for fracture union were independently associated with progression to TKA.

Conclusion

9.3% of patients required TKA within 10 years of tibial plateau ORIF, Kaplan Meier 10-year survivorship was 87.4%. Joint depression and increased tibial width at time of union and age were independent risk factors associated with need for TKA. Particular care must be taken during operative intervention to ensure adequate reduction to lower this risk.

导言：胫骨平台骨折是一种复杂的关节周围骨折，治疗效果不佳，可能导致患者转为全膝关节置换术（TKA）。本研究评估了采用切开复位内固定术治疗的胫骨平台骨折的 10 年存活率，并确定了转为全膝关节置换术的相关风险因素：这项回顾性队列研究评估了2011年1月至2012年12月在格拉斯哥皇家医院接受胫骨平台开放复位内固定术的126名患者的治疗效果。除患者因素外，研究还分析了放射学评估，包括术前、围手术期和骨结合时的关节凹陷程度、胫骨内侧近端角度和股骨宽度比。对需要进一步手术治疗（包括全膝关节置换术）的患者进行了进一步评估：患者年龄呈钟形分布。Schatzker II型骨折最为常见（48%）。术前关节凹陷平均为 6.9 毫米，范围在 0.0 - 36.0 毫米之间。手术复位效果普遍令人满意（平均关节凹陷1.3毫米，股骨宽度0.96，mPTA 89.6⁰），82%的患者实现了解剖复位。12名患者（9.3%）在随访期间需要进行全膝关节置换术，根据Kaplan-Meier计算，5年时91.9%的患者需要进行全膝关节置换术，10年时87.4%的患者需要进行全膝关节置换术。关节凹陷>4毫米（HR=16.2）、股骨宽度比>1.05（HR=14.7）和骨折结合时年龄>50岁（HR=4.2）与进展为TKA有独立关联。结论：9.3%的患者在胫骨平台ORIF术后10年内需要TKA，Kaplan-Meier 10年生存率为87.4%。关节凹陷、关节结合时胫骨宽度增加以及年龄是需要进行 TKA 的独立风险因素。在进行手术干预时必须特别小心，以确保充分缩小以降低这种风险。

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引用次数: 0

Influence of varus-producing distal femur osteotomy correction and hinge width in relation to hinge fractures: Biomechanical study on porcine femora 股骨远端变曲截骨矫正和铰链宽度对铰链骨折的影响：猪股骨生物力学研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-24 DOI: 10.1016/j.knee.2024.10.002

Michel Meisterhans , Anna-Katharina Calek , Christoph Zindel , Esteban Ongini , Mario Somm , Lazaros Vlachopoulos , Sandro F. Fucentese

Background

Hinge fractures in varus-producing distal femoral osteotomies (DFOs) lead to decreased axial and torsional stability. The purpose of this study was to assess (1) which hinge width has a high risk of hinge fracture in DFO for lateral opening wedge (LOW) and medial closing wedge (MCW) osteotomies, (2) which osteotomies allow for greater correction before risking a fracture, (3) whether patient-specific instrumentation (PSI) allows accurate hinge width planning.

Methods

Thirty porcine femoral bones were divided into two groups: LOW, MCW with hinge widths of 5 mm, 7.5 mm, and 10 mm as subgroups. Osteotomies were performed in a PSI-navigated fashion. A force parallel to the longitudinal bone axis was applied in a uniaxial testing machine until a fracture occurred.

Results

The maximum correction was 6.7 ± 1.1° for LOW and 13.4 ± 1.9° for MCW (β₀ < 0.001_, β₁ = 0.002, β₂ = 0.02_, β₃ = 0.005). The relative error of the planned hinge width compared with the actual hinge width was −3.7 ± 12.3% for LOW (P = 0.25) and 12.3 ± 13.1% for MCW (P = 0.003).

Conclusions

Increasing the hinge width allows for greater correction in MCW osteotomies. For LOW osteotomies, a smaller hinge width seems to be advantageous because it allows a greater correction without the risk of hinge fracture. With PSI-guided LOW osteotomies, the planned hinge width could be achieved intraoperatively with greater accuracy than with MCW osteotomies. However, the MCW osteotomy appears to be the preferred option when larger corrections are desired because a larger correction angle can be achieved without the risk of intraoperative hinge fracture.

背景：股骨远端截骨术（DFO）中产生的变位铰链骨折会导致轴向和扭转稳定性下降。本研究旨在评估：（1）在股骨远端截骨术（DFO）中，外侧开放楔形截骨术（LOW）和内侧闭合楔形截骨术（MCW）哪种铰链宽度发生铰链骨折的风险较高；（2）哪种截骨术可在发生骨折风险前进行较大程度的矫正；（3）患者特异性器械（PSI）是否可准确规划铰链宽度：将 30 块猪股骨分为两组：方法：将 30 块猪股骨分为两组：LOW 组、MCW 组（铰链宽度分别为 5 毫米、7.5 毫米和 10 毫米）。以 PSI 导航方式进行截骨。在单轴试验机中施加平行于纵向骨轴的力，直至发生骨折：LOW和MCW的最大矫正角度分别为6.7 ± 1.1°和13.4 ± 1.9°（β0 , β1 = 0.002, β2 = 0.02, β3 = 0.005）。计划铰链宽度与实际铰链宽度的相对误差，LOW 为 -3.7 ± 12.3% (P = 0.25)，MCW 为 12.3 ± 13.1% (P = 0.003)：结论：在MCW截骨术中，增加铰链宽度可获得更大的矫正效果。对于 LOW 截骨术，较小的铰链宽度似乎更有优势，因为它可以在不产生铰链断裂风险的情况下实现更大的矫正。与MCW截骨术相比，PSI引导下的LOW截骨术可以在术中更准确地达到计划的铰链宽度。然而，当需要较大的矫正时，MCW截骨术似乎是首选，因为它可以实现较大的矫正角度，而不会有术中铰链骨折的风险。

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引用次数: 0

Surgical treatment of progressive melorheostosis worsening over 19 years: A case report 对 19 年来不断恶化的进行性黑变病进行手术治疗：病例报告

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-24 DOI: 10.1016/j.knee.2024.10.001

Ziyang Dong , Yang Li , Feng Li , Hua Tian

Background

Melorheostosis is a relatively rare disease, which may cause chronic pain, soft tissue mass and restricted range of motion. Diagnosis and treatment of melorheostosis remains challenging.

Case report

We describe a patient with sclerotic bone involving the left acetabulum, femur, tibia, and talus. Over 19 years this patient showed slow progression of disease. The bone mass in the right popliteal region resulted in limitation of knee motion. Comprehensive management including physical therapy, medications and surgeries were adopted to obtain a full range of motion and no recurrence for 2 years.

Discussion

Accurate diagnosis and adequate treatments are critical to melorheostosis patients. Resection of redundant calcified mass is an effective method to treat severe limitation of range of motion associated with knee melorheostosis.

背景介绍骨化性骨质疏松症是一种相对罕见的疾病，可导致慢性疼痛、软组织肿块和活动范围受限。黑骨症的诊断和治疗仍具有挑战性：病例报告：我们描述了一名左侧髋臼、股骨、胫骨和距骨骨质硬化的患者。19 年来，该患者的病情发展缓慢。右侧腘窝部位的骨块导致膝关节活动受限。经过物理治疗、药物治疗和手术治疗等综合治疗后，患者的膝关节活动范围得以恢复，且两年来未再复发：讨论：准确的诊断和适当的治疗对骨质疏松症患者至关重要。讨论：准确诊断和适当治疗对膝关节骨质疏松症患者至关重要，切除多余的钙化块是治疗膝关节骨质疏松症活动范围严重受限的有效方法。

引用次数: 0

Validity of wearable sensors for total knee arthroplasty (TKA) rehabilitation: A study in younger and older healthy participants 用于全膝关节置换术（TKA）康复的可穿戴传感器的有效性：一项针对年轻和年长健康参与者的研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-24 DOI: 10.1016/j.knee.2024.10.006

L. Forsyth , A. Ligeti , M. Blyth , J.V. Clarke , P.E. Riches

Background

With 100,000 total knee arthroplasty (TKA) procedures taking place in the United Kingdom annually, the demand on rehabilitation services is high. Most regimes are home-based. Without clinician-patient interaction, detection of rehabilitation concerns can be delayed, reducing the chance of successful early intervention. Wearable technologies, such as MotionSense^TM (Stryker, US), may offer a solution to this problem by remotely supporting post-operative TKA rehabilitation through the provision of personalised rehabilitation and tracking of home exercises, enabling healthcare professionals to continuously monitor rehabilitation progress remotely. Validation of such devices against a known kinematic model in activities of daily living is important for confident interpretation of resulting clinical data. The aim of this study therefore was to validate the accuracy of MotionSense^TM against a clinical motion capture standard.

Methods

Twenty younger and 14 older healthy, able-bodied adults attended one testing session (Younger: 24 ± 4 years old; Older: 71 ± 5 years old). Movement was tracked using Vicon motion analysis and a Plug-In-Gait lower body model was applied to all participants. Three activities were performed – walking, stair ascent, stair descent. The knee flexion angle root mean square error (RMSE) between the technologies was determined.

Results

For both groups the knee flexion RMSE remained below 3° for all activities. The combined RMSE for all adults was 2.4° for walking, 2.7° for stair ascent, and 2.6° for stair descent. The signed error increased during the swing phase of gait.

Conclusion

MotionSense^TM was found to accurately estimate knee flexion angles during several common activities compared to Vicon motion capture.

背景：英国每年有 10 万例全膝关节置换术 (TKA) 手术，因此对康复服务的需求很高。大多数康复治疗都是在家中进行的。如果没有临床医生与患者之间的互动，康复问题就可能被延迟发现，从而降低早期干预的成功机会。MotionSenseTM（史赛克，美国）等可穿戴技术可为这一问题提供解决方案，通过提供个性化康复服务和跟踪家庭锻炼，远程支持TKA术后康复，使医护人员能够持续远程监控康复进展。根据日常生活活动中的已知运动学模型对此类设备进行验证，对于自信地解释由此产生的临床数据非常重要。因此，本研究旨在根据临床运动捕捉标准验证 MotionSenseTM 的准确性：方法：20 名年轻人和 14 名老年人参加了一次测试（年轻人：24 ± 4 岁；老年人：71 ± 5 岁）。使用 Vicon 运动分析对运动进行跟踪，并对所有参与者应用 Plug-In-Gait 下半身模型。进行了三种活动--行走、上楼梯和下楼梯。结果显示，两组参与者的膝关节屈曲角度均方根误差（RMSE）均为0：结果：两组人在所有活动中的膝关节屈曲均方根误差都低于 3°。所有成年人的综合均方根误差分别为：步行 2.4°、上楼梯 2.7°、下楼梯 2.6°。步态摆动阶段的签名误差有所增加：结论：与 Vicon 运动捕捉相比，MotionSenseTM 能够准确估计几种常见活动中的膝关节屈曲角度。

{"title":"Validity of wearable sensors for total knee arthroplasty (TKA) rehabilitation: A study in younger and older healthy participants","authors":"L. Forsyth , A. Ligeti , M. Blyth , J.V. Clarke , P.E. Riches","doi":"10.1016/j.knee.2024.10.006","DOIUrl":"10.1016/j.knee.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>With 100,000 total knee arthroplasty (TKA) procedures taking place in the United Kingdom annually, the demand on rehabilitation services is high. Most regimes are home-based. Without clinician-patient interaction, detection of rehabilitation concerns can be delayed, reducing the chance of successful early intervention. Wearable technologies, such as MotionSense<sup>TM</sup> (Stryker, US), may offer a solution to this problem by remotely supporting post-operative TKA rehabilitation through the provision of personalised rehabilitation and tracking of home exercises, enabling healthcare professionals to continuously monitor rehabilitation progress remotely. Validation of such devices against a known kinematic model in activities of daily living is important for confident interpretation of resulting clinical data. The aim of this study therefore was to validate the accuracy of MotionSense<sup>TM</sup> against a clinical motion capture standard.</div></div><div><h3>Methods</h3><div>Twenty younger and 14 older healthy, able-bodied adults attended one testing session (Younger: 24 ± 4 years old; Older: 71 ± 5 years old). Movement was tracked using Vicon motion analysis and a Plug-In-Gait lower body model was applied to all participants. Three activities were performed – walking, stair ascent, stair descent. The knee flexion angle root mean square error (RMSE) between the technologies was determined.</div></div><div><h3>Results</h3><div>For both groups the knee flexion RMSE remained below 3° for all activities. The combined RMSE for all adults was 2.4° for walking, 2.7° for stair ascent, and 2.6° for stair descent. The signed error increased during the swing phase of gait.</div></div><div><h3>Conclusion</h3><div>MotionSense<sup>TM</sup> was found to accurately estimate knee flexion angles during several common activities compared to Vicon motion capture.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"51 ","pages":"Pages 292-302"},"PeriodicalIF":1.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Establishment of anterior cruciate ligament injury thresholds for injured pediatric population with GNRB®, a prospective study on 141 children 通过对 141 名儿童进行前瞻性研究，为使用 GNRB® 的受伤儿童群体确定前十字韧带损伤阈值。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-19 DOI: 10.1016/j.knee.2024.09.011

Théo Cojean , Catherine Mulier , Laurence Cheze , Franck Chotel

Background

Treating an anterior cruciate ligament (ACL) injury in pediatric patients is challenging. The GNRB® is a diagnostic tool for laximetry and can provide valuable information for clinical decision. As few data exist on this subject, the first objective is to provide physiological laxity values of anterior tibial translation in healthy and pathological knees in pediatric population by age and gender groups. A second objective is to establish injury thresholds with the GNRB®.

Methods

This prospective study included 141 pediatric patients with a complete ACL tear. They all underwent GNRB® measurements before the surgery. Age and gender groups were created: child/adolescent girls and child/adolescent boys. Thresholds were established using ROC curves and 2-factors ANOVA tests were used for comparisons.

Results

A significant age effect was found for laxities measured on healthy knees. Significant age and gender effects were found for laxities measured on pathological knees and for side-to-side differences of laxity (SSD) between healthy and pathological knees. The optimal threshold to detect a complete ACL rupture with GNRB® is 1.5 mm at 134N with a sensitivity of 83.7% and a specificity of 92.7%.

Conclusion

GNRB® brought new information about ACL laxities for healthy and pathological knees in pediatric population. Children have a greater anterior tibial translation which decreases gradually with age, and girls have grater laxities than boys. Thresholds for complete ACL tears, presenting good predictive values, were established and can help surgeons in their decisions to improve clinical practice.

Level of evidence: Prospective cohort study, level of evidence III.

背景：治疗儿童患者的前十字韧带损伤具有挑战性。GNRB® 是一种松弛测量诊断工具，可为临床决策提供有价值的信息。由于这方面的数据很少，我们的第一个目标是按年龄组和性别组提供健康和病理膝关节的胫骨前平移生理松弛值。第二个目标是使用 GNRB® 确定损伤阈值：这项前瞻性研究包括 141 名前交叉韧带完全撕裂的儿科患者。他们都在手术前接受了 GNRB® 测量。年龄和性别分组为：儿童/青少年女孩组和儿童/青少年男孩组。使用 ROC 曲线确定阈值，并使用 2 因子方差分析进行比较：结果：在健康膝关节上测量的松弛程度存在明显的年龄效应。在病理膝关节上测量的松弛度以及健康膝关节和病理膝关节之间的侧向松弛度差异（SSD）均有明显的年龄和性别效应。使用 GNRB® 检测前交叉韧带完全断裂的最佳阈值是 134N 处的 1.5 毫米，灵敏度为 83.7%，特异度为 92.7%：结论：GNRB®为健康和病理膝关节的前交叉韧带松弛带来了新的信息。儿童的胫骨前移较大，随着年龄的增长而逐渐减小，女孩的松弛程度大于男孩。前交叉韧带完全撕裂的阈值已经确定，具有良好的预测价值，可以帮助外科医生做出决定，改善临床实践：前瞻性队列研究，证据等级 III。

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引用次数: 0

Radiographic factors affecting contralateral knee alignment in patients with dysplastic hip osteoarthritis 影响髋关节骨关节炎发育不良患者对侧膝关节排列的影像学因素

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-16 DOI: 10.1016/j.knee.2024.09.014

Shinya Tanaka, Yusuke Osawa, Yasuhiko Takegami, Yuto Ozawa, Shiro Imagama

Introduction

Patients with dysplastic hip arthritis (DHA) often present with abnormal knee alignment. We investigate the factors influencing varus and valgus knee alignment on the contralateral side in patients with unilateral DHA.

Methods

123 patients with unilateral DHA were enrolled between 2018 and 2022. Based on the hip-knee-ankle angle (HKAA), patients were divided into three groups: neutral group (HKAA <3° varus and valgus), varus group (>3° varus), and valgus group (>3° valgus). Demographics, radiographic parameters, and functional scores were compared between the groups.

Results

There were 58, 44, and 21 patients in the neutral, varus, and valgus group, respectively. The varus group had a varus HKAA and hip adduction angle in the affected hip and a large femoral offset in the healthy hip. The valgus group had a valgus HKAA and large hip adduction angle in the affected hip and a small femoral offset in the healthy hip. In addition, the valgus group presented with pelvic obliquity, expressed as an upper pelvic tilt on the affected side. Multivariate analysis identified a varus HKAA in the affected hip (odds ratio [OR], 0.64; 95% confidence interval [CI]: 0.51–0.79; p < 0.01) as a factor associated with the varus group, while pelvic obliquity (OR, 0.69; 95% CI: 0.53–0.89; p = 0.01) was associated with the valgus group. The varus and valgus groups had significantly worse functional scores than the neutral group.

Conclusions

This study demonstrated that varus and valgus alignments of the contralateral knee with unilateral DHA were associated with radiographic parameters and hip function.

导言发育不良性髋关节炎（DHA）患者通常表现为膝关节排列异常。我们研究了影响单侧DHA患者对侧膝关节屈曲和外翻的因素。方法在2018年至2022年期间，我们招募了123名单侧DHA患者。根据髋-膝-踝角度（HKAA），将患者分为三组：中性组（HKAA<3°变位和外翻）、变位组（>3°变位）和外翻组（>3°外翻）。结果中性组、曲张组和外翻组分别有 58、44 和 21 名患者。外翻组患侧髋关节的HKAA和髋关节内收角度为外翻，健侧髋关节的股骨偏移较大。瓣膜外翻组的受累髋关节 HKAA 和髋关节内收角度均为瓣膜外翻，而健康髋关节的股骨偏移量较小。此外，髋外翻组还伴有骨盆倾斜，表现为患侧骨盆上倾。多变量分析发现，患侧髋关节的香港开奖现场结果直墦曲度（几率比 [OR]，0.64；95% 置信区间 [CI]：0.51-0.79；P = 0.01）是与香港开奖现场结果直墦曲度相关的因素，而骨盆倾斜（OR，0.69；95% 置信区间 [CI]：0.53-0.89；P = 0.01）与外翻组相关。结论这项研究表明，单侧DHA对侧膝关节的屈曲和内翻排列与放射学参数和髋关节功能有关。

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引用次数: 0

Quadriceps strength can improve twelve months after opening wedge high tibial osteotomy and opening wedge distal tibial tubercle osteotomy, particularly after opening wedge high tibial osteotomy 开放式楔形高胫骨截骨术和开放式楔形胫骨远端结节截骨术后 12 个月，尤其是开放式楔形高胫骨截骨术后，股四头肌力量可得到改善

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-15 DOI: 10.1016/j.knee.2024.09.013

Ryo Goto , Takehiko Matsushita , Yuya Ueda , Yohei Shibata , Daisuke Miura , Kumiko Ono , Akihiro Kida , Kyohei Nishida , Kanto Nagai , Noriyuki Kanzaki , Yuichi Hoshino , Yoshitada Sakai , Ryosuke Kuroda

Background

Knee osteoarthritis (KOA) is a globally prevalent condition leading to joint pain and disabilities. Surgical interventions such as opening-wedge high tibial osteotomy (OWHTO) and opening-wedge distal tuberosity osteotomy (OWDTO) aim to alleviate symptoms and delay disease progression. Quadriceps strength, crucial for knee function, may decline postoperatively, affecting patient outcomes. However, little is known about quadriceps strength variation after OWHTO and OWDTO. This study investigated changes in quadriceps strength before and after OWHTO and OWDTO.

Methods

This retrospective study included patients who underwent OWHTO or OWDTO between 2016 and 2022. Quadriceps strength and demographic and surgical data were collected preoperatively and at 6 and 12 months postoperatively. Statistical analyses were performed to compare changes in quadriceps strength over time.

Results

Of 120 knees, 52 (OWHTO, 27; OWDTO, 25) were included in this study. Quadriceps strength increased over 12 months post-OWHTO, significantly improving at 12 months compared to the preoperative and 6-month values. In OWDTO, the strength improved but not significantly.

Conclusions

Quadriceps strength improved following OWHTO and OWDTO, with OWHTO showing significant enhancements. Future studies should investigate the relationship between quadriceps strength and functional outcomes and guide rehabilitation strategies for improved postoperative recovery.

背景膝关节骨关节炎（KOA）是一种导致关节疼痛和残疾的全球性疾病。开刃胫骨高位截骨术（OWHTO）和开刃远端结节截骨术（OWDTO）等手术干预措施旨在缓解症状并延缓疾病进展。股四头肌力量对膝关节功能至关重要，术后股四头肌力量可能会下降，从而影响患者的治疗效果。然而，人们对 OWHTO 和 OWDTO 术后股四头肌力量的变化知之甚少。本研究调查了OWHTO和OWDTO前后股四头肌力量的变化。方法这项回顾性研究纳入了2016年至2022年间接受OWHTO或OWDTO的患者。收集了术前以及术后6个月和12个月的股四头肌力量、人口统计学和手术数据。结果在120个膝关节中，52个（OWHTO，27个；OWDTO，25个）被纳入本研究。OWHTO术后12个月内，股四头肌力量有所增加，与术前和6个月的数值相比，12个月时的力量明显提高。结论 OWHTO 和 OWDTO 术后股四头肌力量均有改善，其中 OWHTO 术后改善明显。未来的研究应探讨股四头肌力量与功能结果之间的关系，并为改善术后恢复的康复策略提供指导。

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引用次数: 0