IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.011

Zhu Dai , Jian Li , Juan Tan , Zhijun Yang , Zhihao Gong

Background

The tibial tuberosity–trochlear groove (TT-TG) distance is an important reference for the evaluation of patellar instability. However, measurement of the TT-TG distance has disadvantages with relatively low reproducibility. This study aimed to investigate the reliability of patellar tendon lateral deviation angle (PTLD-A) measured on a single computed tomography (CT) slice and the clinical significance for predicting patellar instability.

Methods

Seventy-eight knees with recurrent patellar dislocation were included as the study group, and 76 normal knees in the control group. The PTLD-A and the TT-TG distance were measured on CT images, inter- and intra-observer reproducibility were assessed, and correlation was analyzed, and compared between the groups. The predictive value of both measurements for patellar instability was examined using the receiver operating characteristic curve, and the cut-off value was predicted using the Youden index.

Results

Inter- and intra-observer reproducibility of PTLD-A was better than TT-TG distance in both groups as well as across all extents of trochlear types. The correlation between the two measurements was strong (r = 0.756, P < 0.001). Notably, both measurements were significantly higher in the study group than in the control group (P < 0.05). PTLD-A showed high predictive value for patellar instability, whereas TT-TG distance showed medium predictive value. A PTLD-A value of ≥ 13.7° was the threshold for diagnosis of patellar instability.

Conclusion

PTLD-A measured on a single computed tomography slice of the distal femoral trochlear groove is more reliable than TT-TG distance for prediction of patellar instability. A PTLD-A ≥ 13.7° predicts patellar instability.

背景：胫骨结节-跗骨沟（TT-TG）距离是评估髌骨不稳定性的重要参考指标。然而，TT-TG 距离的测量存在可重复性相对较低的缺点。本研究旨在探讨单张计算机断层扫描（CT）片上测量的髌腱侧偏角（PTLD-A）的可靠性及其对预测髌骨不稳的临床意义：研究组包括78个复发性髌骨脱位的膝关节，对照组包括76个正常膝关节。在CT图像上测量PTLD-A和TT-TG距离，评估观察者之间和观察者内部的重复性，分析相关性，并进行组间比较。利用接收者操作特征曲线检验了这两项测量对髌骨不稳的预测价值，并利用尤登指数预测了临界值：结果：在两组中，PTLD-A的观察者间和观察者内再现性均优于TT-TG距离，也优于所有范围的髌骨类型。两种测量结果之间的相关性很强（r = 0.756，P 结论：PTLD-A 和 TT-TG 测量结果之间的相关性很强：在预测髌骨不稳方面，股骨远端套骨沟单片计算机断层扫描测量的PTLD-A比TT-TG距离更可靠。PTLD-A≥13.7°可预测髌骨不稳。

{"title":"Patellar tendon lateral deviation angle: a new computed tomography scan measurement for evaluation of patellar instability","authors":"Zhu Dai , Jian Li , Juan Tan , Zhijun Yang , Zhihao Gong","doi":"10.1016/j.knee.2024.11.011","DOIUrl":"10.1016/j.knee.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>The tibial tuberosity–trochlear groove (TT-TG) distance is an important reference for the evaluation of patellar instability. However, measurement of the TT-TG distance has disadvantages with relatively low reproducibility. This study aimed to investigate the reliability of patellar tendon lateral deviation angle (PTLD-A) measured on a single computed tomography (CT) slice and the clinical significance for predicting patellar instability.</div></div><div><h3>Methods</h3><div>Seventy-eight knees with recurrent patellar dislocation were included as the study group, and 76 normal knees in the control group. The PTLD-A and the TT-TG distance were measured on CT images, inter- and intra-observer reproducibility were assessed, and correlation was analyzed, and compared between the groups. The predictive value of both measurements for patellar instability was examined using the receiver operating characteristic curve, and the cut-off value was predicted using the Youden index.</div></div><div><h3>Results</h3><div>Inter- and intra-observer reproducibility of PTLD-A was better than TT-TG distance in both groups as well as across all extents of trochlear types. The correlation between the two measurements was strong (r = 0.756, <em>P</em> < 0.001). Notably, both measurements were significantly higher in the study group than in the control group (<em>P</em> < 0.05). PTLD-A showed high predictive value for patellar instability, whereas TT-TG distance showed medium predictive value. A PTLD-A value of ≥ 13.7° was the threshold for diagnosis of patellar instability.</div></div><div><h3>Conclusion</h3><div>PTLD-A measured on a single computed tomography slice of the distal femoral trochlear groove is more reliable than TT-TG distance for prediction of patellar instability. A PTLD-A ≥ 13.7° predicts patellar instability.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 35-41"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Total knee arthroplasty improves energy conversion efficiency during walking in patients with knee osteoarthritis 全膝关节置换术提高膝关节骨关节炎患者行走时的能量转换效率。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.020

Ruido Ida , Gen Kuroyanagi , Yoshino Ueki , Satona Murakami , Takayuki Shiraki , Daiki Shimotori , Hideki Okamoto , Kunio Yamada

Background

Energy conversion efficiency of human gait can be evaluated by calculating the ratio of conversion of mechanical energy from vertical motion to horizontal motion of the center of gravity through the movement of the joints. Osteoarthritis (OA) of the knee joint impairs this energy conversion efficiency. Total knee arthroplasty is the standard treatment for knee OA. However, its effect on energy conversion efficiency is unclear. In this study, we investigated how energy conversion efficiency changed in the gait of patients with knee OA before and after surgery.

Methods

Twelve patients with unilateral knee OA who underwent total knee arthroplasty were included. Ground walking was measured using a motion capture system (VICON®) before and 6 months after surgery. We calculated potential and kinetic energy from the coordinate change of the center of mass to obtain energy conversion efficiency. Other gait parameters such as gait speed, vertical movement distance of the body center, step length, hip joint angle, and trailing and leading limb angles were assessed.

Results

Energy conversion efficiency on the operated side significantly improved from 41.4 ± 12.2% to 57.5 ± 9.2% 6 months after surgery. Other gait parameters on the operated side were significantly improved after surgery compared with before surgery. Step length on the operated and the non-operated sides and trailing limb angles on the non-operated side before surgery correlated to energy conversion efficiency, while at 6 months after surgery, gait speed and step length on the non-operated side correlated to energy conversion efficiency.

Conclusion

Energy conversion efficiency was strongly improved postoperatively in patients with knee OA.

背景：通过计算关节运动将机械能量从垂直运动转化为重心水平运动的比率，可以评价人体步态的能量转换效率。膝关节骨关节炎（OA）损害了这种能量转换效率。全膝关节置换术是膝关节OA的标准治疗方法。然而，其对能量转换效率的影响尚不清楚。在这项研究中，我们研究了膝关节OA患者手术前后步态中能量转换效率的变化。方法：12例单侧膝关节炎患者行全膝关节置换术。在手术前和手术后6个月，使用运动捕捉系统（VICON®）测量地面行走。通过质心的坐标变化计算势能和动能，得到能量转换效率。评估其他步态参数，如步态速度、身体中心垂直运动距离、步长、髋关节角度、前后肢角度等。结果：术后6个月手术侧能量转换效率由41.4±12.2%显著提高至57.5±9.2%。手术侧其他步态参数术后较术前有明显改善。术前手术侧与非手术侧步长、非手术侧尾肢角度与能量转换效率相关，术后6个月时，非手术侧步长、步态速度与能量转换效率相关。结论：膝关节OA患者术后能量转换效率明显提高。

{"title":"Total knee arthroplasty improves energy conversion efficiency during walking in patients with knee osteoarthritis","authors":"Ruido Ida , Gen Kuroyanagi , Yoshino Ueki , Satona Murakami , Takayuki Shiraki , Daiki Shimotori , Hideki Okamoto , Kunio Yamada","doi":"10.1016/j.knee.2024.11.020","DOIUrl":"10.1016/j.knee.2024.11.020","url":null,"abstract":"<div><h3>Background</h3><div>Energy conversion efficiency of human gait can be evaluated by calculating the ratio of conversion of mechanical energy from vertical motion to horizontal motion of the center of gravity through the movement of the joints. Osteoarthritis (OA) of the knee joint impairs this energy conversion efficiency. Total knee arthroplasty is the standard treatment for knee OA. However, its effect on energy conversion efficiency is unclear. In this study, we investigated how energy conversion efficiency changed in the gait of patients with knee OA before and after surgery.</div></div><div><h3>Methods</h3><div>Twelve patients with unilateral knee OA who underwent total knee arthroplasty were included. Ground walking was measured using a motion capture system (VICON®) before and 6 months after surgery. We calculated potential and kinetic energy from the coordinate change of the center of mass to obtain energy conversion efficiency. Other gait parameters such as gait speed, vertical movement distance of the body center, step length, hip joint angle, and trailing and leading limb angles were assessed.</div></div><div><h3>Results</h3><div>Energy conversion efficiency on the operated side significantly improved from 41.4 ± 12.2% to 57.5 ± 9.2% 6 months after surgery. Other gait parameters on the operated side were significantly improved after surgery compared with before surgery. Step length on the operated and the non-operated sides and trailing limb angles on the non-operated side before surgery correlated to energy conversion efficiency, while at 6 months after surgery, gait speed and step length on the non-operated side correlated to energy conversion efficiency.</div></div><div><h3>Conclusion</h3><div>Energy conversion efficiency was strongly improved postoperatively in patients with knee OA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 42-48"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sartorius muscle transfer for chronic quadriceps tendon rupture: A prospective study 缝匠肌转移治疗慢性股四头肌肌腱断裂：一项前瞻性研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.023

Andrea Pintore , Ernesto Pintore , Giovanni Asparago , Emanuela Marsilio , Ernesto Torsiello , Olimpio Galasso

Background

Quadriceps tendon rupture (QTR) is an uncommon injury. In chronic QTR there may be a large defect and direct repair is not possible with sutures or transosseous anchors. There is no gold standard surgical procedure for the treatment of chronic QTR. We propose a novel technique in which the quadriceps tendon (QT) is reconstructed using a transfer of ipsilateral sartorius tendon.

Methods

Between January 2002 and April 2020, 19 patients undergoing sartorius muscle transfer for chronic QTR were prospectively recruited. The Knee Society Score (KSS), range of motion (ROM), and Medical Research Council (MRC) Scale for QT muscle strength were collected preoperatively and at a minimum of 2 years follow up.

Results

The mean age of our cohort was 53.4 ± 9.8 years with a female patient count of 12 (54%). The mean body mass index recorded was 28.5 ± 3.2 kg/m² (range 23–30). At the mean follow up of 53.4 ± 28.1 months the mean KSS was 90.9 ± 6.3 (range 80–100) (P < 0.05), the mean ROM was 119.5 ± 9.9° for flexion (range 100–130) (P < 0.05) and the mean extension lag was 3.8 ± 5.1° (range 0–15) (P < 0.05). The mean MRC scale was 4.5 ± 0.7 (range 3–5) (P < 0.05). The most frequent complication was QT hypotrophy; it was noted in 14 patients.

Conclusion

Satisfactory clinical outcomes of ipsilateral sartorius muscle transfer for chronic QTR can be expected a mean of 4.4 years after surgery.

背景：股四头肌腱断裂（QTR）是一种不常见的损伤。慢性股四头肌腱断裂可能存在较大的缺损，无法通过缝合或经骨锚直接修复。目前还没有治疗慢性 QTR 的金标准手术方法。我们提出了一种新技术，利用同侧萨尔图里肌腱的转移重建股四头肌腱（QT）：方法：2002 年 1 月至 2020 年 4 月间，我们前瞻性地招募了 19 名因慢性 QTR 而接受萨尔特里肌转移的患者。在术前和至少两年的随访中收集膝关节社会评分（KSS）、活动范围（ROM）和医学研究委员会（MRC）QT肌力量表：患者的平均年龄为 53.4 ± 9.8 岁，其中女性患者 12 人（占 54%）。平均体重指数为 28.5 ± 3.2 kg/m2（23-30）。平均随访时间为（53.4 ± 28.1）个月，平均 KSS 为（90.9 ± 6.3）（范围为 80-100）：同侧腓肠肌转移治疗慢性 QTR 的临床疗效令人满意，平均可在术后 4.4 年实现。

{"title":"Sartorius muscle transfer for chronic quadriceps tendon rupture: A prospective study","authors":"Andrea Pintore , Ernesto Pintore , Giovanni Asparago , Emanuela Marsilio , Ernesto Torsiello , Olimpio Galasso","doi":"10.1016/j.knee.2024.11.023","DOIUrl":"10.1016/j.knee.2024.11.023","url":null,"abstract":"<div><h3>Background</h3><div>Quadriceps tendon rupture (QTR) is an uncommon injury. In chronic QTR there may be a large defect and direct repair is not possible with sutures or transosseous anchors. There is no gold standard surgical procedure for the treatment of chronic QTR. We propose a novel technique in which the quadriceps tendon (QT) is reconstructed using a transfer of ipsilateral sartorius tendon.</div></div><div><h3>Methods</h3><div>Between January 2002 and April 2020, 19 patients undergoing sartorius muscle transfer for chronic QTR were prospectively recruited. The Knee Society Score (KSS), range of motion (ROM), and Medical Research Council (MRC) Scale for QT muscle strength were collected preoperatively and at a minimum of 2 years follow up.</div></div><div><h3>Results</h3><div>The mean age of our cohort was 53.4 ± 9.8 years with a female patient count of 12 (54%). The mean body mass index recorded was 28.5 ± 3.2 kg/m<sup>2</sup> (range 23–30). At the mean follow up of 53.4 ± 28.1 months the mean KSS was 90.9 ± 6.3 (range 80–100) (<em>P</em> < 0.05), the mean ROM was 119.5 ± 9.9° for flexion (range 100–130) (<em>P</em> < 0.05) and the mean extension lag was 3.8 ± 5.1° (range 0–15) (<em>P</em> < 0.05). The mean MRC scale was 4.5 ± 0.7 (range 3–5) (<em>P</em> < 0.05). The most frequent complication was QT hypotrophy; it was noted in 14 patients.</div></div><div><h3>Conclusion</h3><div>Satisfactory clinical outcomes of ipsilateral sartorius muscle transfer for chronic QTR can be expected a mean of 4.4 years after surgery.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 79-85"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823004","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

Optimal arithmetic hip–knee–ankle angle for performing prearthritic/kinematic alignment in unicompartmental knee arthroplasty 单室膝关节置换术中进行关节炎前/运动学对齐的最佳算法髋关节-膝关节-踝关节角度。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-06 DOI: 10.1016/j.knee.2024.11.013

Kyota Ishibashi , Eiji Sasaki , Shohei Yamauchi , Kento Ota , Ryo Tomita , Hikaru Kristi Ishibashi , Hironori Otsuka , Yasuyuki Ishibashi

Background

This study aimed to investigate whether arithmetic hip–knee–ankle angle (aHKA) can be a surrogate for valgus stress radiography (VSR). Furthermore, we investigated the optimal cutoff values for preoperative radiographic parameters, thereby validating the appropriate inclusion criteria for prearthritic/kinematic unicompartmental knee arthroplasty (prearthritic-UKA).

Methods

We retrospectively analyzed 123 patients who underwent medial UKA. We measured the HKA on VSR, termed sHKA. The aHKA was calculated by subtracting the lateral distal femoral angle from the medial proximal tibial angle. Prearthritic-UKA was defined as a postoperative HKA angle within 3° of the aHKA. We divided the patients into the prearthritic-UKA and non-prearthritic-UKA groups. To assess whether the aHKA serves as a surrogate for VSR, Spearman’s rank correlations were performed among the radiographic parameters. These radiographic parameters calculated the proper criteria for prearthritic-UKA using receiver operating characteristic (ROC) curve analysis and logistic regression analysis.

Results

Overall, 59 patients were classified into the prearthritic-UKA group. The aHKA was larger than the sHKA and exhibited no significant correlation with the sHKA. ROC analysis revealed that the cutoff values of aHKA for detecting overcorrected UKA (i.e., postoperative HKA – aHKA >3°) was −5.0°. Similarly, the cutoff values for detecting undercorrected UKA (i.e., postoperative HKA – aHKA <−3°) were −3°. Logistic regression analysis revealed that the aHKA was significantly associated with prearthritic-UKA.

Conclusion

The aHKA was not identified as a surrogate for the sHKA. Comprehensive preoperative radiographic assessment, including both aHKA and VSR, is crucial for optimizing UKA outcomes and minimizing risks of misalignment.

背景：本研究旨在探讨算术髋关节-膝关节-踝关节角（aHKA）是否可以作为外翻应力摄影（VSR）的替代指标。此外，我们研究了术前影像学参数的最佳截止值，从而验证了关节炎前/运动学单室膝关节置换术（prearthritis - uka）的合适纳入标准。方法：我们回顾性分析了123例内侧UKA患者。我们测量了VSR上的HKA，称为sHKA。aHKA通过从胫骨内侧近端角度减去股骨外侧远端角度计算。关节炎前uka定义为术后HKA角度在aHKA 3°以内。我们将患者分为关节炎前期uka组和非关节炎前期uka组。为了评估aHKA是否可以作为VSR的替代指标，在放射学参数之间进行Spearman秩相关。这些影像学参数通过受试者工作特征（ROC）曲线分析和logistic回归分析计算出关节炎前期uka的合适标准。结果：59例患者分为关节炎前期- uka组。aHKA大于sHKA，与sHKA无显著相关。ROC分析显示，检测过校正UKA（即术后HKA - aHKA >.3°）的aHKA截断值为-5.0°。同样，检测未校正的UKA的截止值（即术后HKA - aHKA）结论：aHKA不能作为sHKA的替代品。全面的术前x线评估，包括aHKA和VSR，对于优化UKA结果和最小化不对准风险至关重要。

{"title":"Optimal arithmetic hip–knee–ankle angle for performing prearthritic/kinematic alignment in unicompartmental knee arthroplasty","authors":"Kyota Ishibashi , Eiji Sasaki , Shohei Yamauchi , Kento Ota , Ryo Tomita , Hikaru Kristi Ishibashi , Hironori Otsuka , Yasuyuki Ishibashi","doi":"10.1016/j.knee.2024.11.013","DOIUrl":"10.1016/j.knee.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate whether arithmetic hip–knee–ankle angle (aHKA) can be a surrogate for valgus stress radiography (VSR). Furthermore, we investigated the optimal cutoff values for preoperative radiographic parameters, thereby validating the appropriate inclusion criteria for prearthritic/kinematic unicompartmental knee arthroplasty (prearthritic-UKA).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 123 patients who underwent medial UKA. We measured the HKA on VSR, termed sHKA. The aHKA was calculated by subtracting the lateral distal femoral angle from the medial proximal tibial angle. Prearthritic-UKA was defined as a postoperative HKA angle within 3° of the aHKA. We divided the patients into the prearthritic-UKA and non-prearthritic-UKA groups. To assess whether the aHKA serves as a surrogate for VSR, Spearman’s rank correlations were performed among the radiographic parameters. These radiographic parameters calculated the proper criteria for prearthritic-UKA using receiver operating characteristic (ROC) curve analysis and logistic regression analysis.</div></div><div><h3>Results</h3><div>Overall, 59 patients were classified into the prearthritic-UKA group. The aHKA was larger than the sHKA and exhibited no significant correlation with the sHKA. ROC analysis revealed that the cutoff values of aHKA for detecting overcorrected UKA (i.e., postoperative HKA – aHKA >3°) was −5.0°. Similarly, the cutoff values for detecting undercorrected UKA (i.e., postoperative HKA – aHKA <−3°) were −3°. Logistic regression analysis revealed that the aHKA was significantly associated with prearthritic-UKA.</div></div><div><h3>Conclusion</h3><div>The aHKA was not identified as a surrogate for the sHKA. Comprehensive preoperative radiographic assessment, including both aHKA and VSR, is crucial for optimizing UKA outcomes and minimizing risks of misalignment.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 1-9"},"PeriodicalIF":1.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does a medial congruent bearing in total knee arthroplasty compromise fixation? A randomized controlled trial 全膝关节置换术中内侧一致负重会影响固定吗？一项随机对照试验。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-06 DOI: 10.1016/j.knee.2024.11.015

Kristian R.L. Mortensen , Lina Holm Ingelsrud , Omar Muharemovic , Kirill Gromov , Anders Troelsen

Background

Medially congruent (MC) bearings aim at promoting medial pivoting after total knee arthroplasty (TKA), as the congruency provides further constraint for the medial femoral compartment. However, this design difference could alter intra-articular force distribution, potentially compromising fixation of the tibia implant. The aim of this study was to compare migration, measured with radiostereometric analysis (RSA), of an MC to a more traditional cruciate retaining (CR) TKA system. Secondary aims were to compare patient-perceived treatment outcome and number of complications between the treatment groups.

Methods

Sixty patients undergoing TKA were randomized to an MC or CR bearing and had follow up visits after 3 months, 1 and 2 years. Primary outcome was tibia implant migration, measured by maximal total point motion (MTPM) with model-based RSA, 2 years post-surgery. Secondary outcomes were tibia MTPM, change in patient-reported outcome measurements (PROMs) and number of complications registered at all follow up visits.

Results

Primary outcome was available for 52 patients (27 MC patients, 25 CR patients). We found no difference in tibia MTPM between the MC and CR groups 2 years post-surgery. Median (interquartile range) MTPM was 0.60 (0.39–0.97) mm and 0.48 (0.32–0.78) mm in the MC and CR group, respectively (P = 0.167). There were no between-group differences in improvement in PROMs and no between-group differences in number of complications.

Conclusion

We found no compromising of tibia implant fixation in TKA by choosing an MC bearing, when compared with a CR bearing. PROMs and complication rates suggest comparable treatment results with both types of bearings in TKA.

背景：内侧一致（MC）轴承旨在促进全膝关节置换术（TKA）后内侧旋转，因为一致性提供了进一步的股骨内侧室约束。然而，这种设计差异可能改变关节内的力分布，潜在地影响胫骨植入物的固定。本研究的目的是比较MC与更传统的交叉保留（CR） TKA系统的迁移，用放射立体分析（RSA）测量。次要目的是比较两组患者感知的治疗结果和并发症的数量。方法：60例TKA患者随机分为MC或CR组，分别于3个月、1年和2年后随访。术后2年，主要终点是胫骨植入物的移动，通过基于模型的RSA测量最大总点运动（MTPM）。次要结果是胫骨MTPM，患者报告的结果测量值（PROMs）的变化和所有随访中记录的并发症数量。结果：52例患者获得主要结局（27例MC患者，25例CR患者）。我们发现MC组和CR组术后2年胫骨MTPM无差异。MC组和CR组的MTPM中位数（四分位间距）分别为0.60 (0.39-0.97)mm和0.48 (0.32-0.78)mm （P = 0.167）。两组间PROMs改善无差异，并发症数量无差异。结论：我们发现选择MC轴承与CR轴承相比，在TKA中胫骨内固定没有妥协。prom和并发症发生率表明两种类型的TKA轴承的治疗结果相当。

{"title":"Does a medial congruent bearing in total knee arthroplasty compromise fixation? A randomized controlled trial","authors":"Kristian R.L. Mortensen , Lina Holm Ingelsrud , Omar Muharemovic , Kirill Gromov , Anders Troelsen","doi":"10.1016/j.knee.2024.11.015","DOIUrl":"10.1016/j.knee.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Medially congruent (MC) bearings aim at promoting medial pivoting after total knee arthroplasty (TKA), as the congruency provides further constraint for the medial femoral compartment. However, this design difference could alter intra-articular force distribution, potentially compromising fixation of the tibia implant. The aim of this study was to compare migration, measured with radiostereometric analysis (RSA), of an MC to a more traditional cruciate retaining (CR) TKA system. Secondary aims were to compare patient-perceived treatment outcome and number of complications between the treatment groups.</div></div><div><h3>Methods</h3><div>Sixty patients undergoing TKA were randomized to an MC or CR bearing and had follow up visits after 3 months, 1 and 2 years. Primary outcome was tibia implant migration, measured by maximal total point motion (MTPM) with model-based RSA, 2 years post-surgery. Secondary outcomes were tibia MTPM, change in patient-reported outcome measurements (PROMs) and number of complications registered at all follow up visits.</div></div><div><h3>Results</h3><div>Primary outcome was available for 52 patients (27 MC patients, 25 CR patients). We found no difference in tibia MTPM between the MC and CR groups 2 years post-surgery. Median (interquartile range) MTPM was 0.60 (0.39–0.97) mm and 0.48 (0.32–0.78) mm in the MC and CR group, respectively (<em>P</em> = 0.167). There were no between-group differences in improvement in PROMs and no between-group differences in number of complications.</div></div><div><h3>Conclusion</h3><div>We found no compromising of tibia implant fixation in TKA by choosing an MC bearing, when compared with a CR bearing. PROMs and complication rates suggest comparable treatment results with both types of bearings in TKA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 19-27"},"PeriodicalIF":1.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792296","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

Analysis of microvascular density and collagen structure of the medial meniscotibial ligament of the knee: Immunohistochemical study with CD31 and histology with Picrosirius red 膝关节内侧半月板韧带微血管密度及胶原结构分析：CD31免疫组化及小天狼星红组织学研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-06 DOI: 10.1016/j.knee.2024.11.016

Amanda Progenio dos Santos , Jonatas Brito de Alencar Neto , Pedro Henrique Marques Amorim , Paulo Goberlânio de Barros Silva , Maria Luzete Costa Cavalcante

Background

The aim of the present study was to describe the structure of the collagen matrix and the microvascularization of the medial meniscotibial ligament (MMTL), in order to contribute to the refinement of the surgical technique for repairing these structures and consequently lead to a reduction in the risk of anterior cruciate ligament re-rupture.

Methods

Twelve MMTLs were obtained from deceased organ donors. The ligaments were initially analyzed macroscopically and evaluated histologically using hematoxylin and eosin staining. The evaluation of the collagen matrix was carried out using the Picrosirius red staining method under a polarized light microscope. Immunohistochemical study using monoclonal antibodies against CD31 was used to evaluate microvascularization.

Results

The MMTL was identified in 100% of the dissections. The hematoxylin and eosin-stained histological sections exhibited oriented and parallel collagen fibers, with low cellularity in its intrasubstance portion and increase in cellularity close to the meniscal insertion. Quantitative analysis of the collagen matrix showed a ratio of type I to type III collagen of 3.86 (±3.07). The average microvascular density in the intrasubstance portion was 33.71 ± 8.7 vessels/mm² and in the meniscal insertion portion it was 74.14 ± 23.85 vessels/mm².

Conclusion

The MMTL is a structure with a predominance of Type I collagen in relation to Type III collagen and high microvascular density in the region of meniscal insertion. These findings suggest that the healing potential of MMTL, regarding ramp injuries, is high because these injuries occur in the meniscal insertion area.

背景：本研究的目的是描述胶原基质的结构和内侧半月板胫韧带（MMTL）的微血管化，以促进修复这些结构的手术技术的改进，从而降低前交叉韧带再破裂的风险。方法：从死者器官供者中获得12个mmtl。韧带最初进行宏观分析，并用苏木精和伊红染色进行组织学评估。在偏光显微镜下，采用Picrosirius红染色法对胶原基质进行评价。采用CD31单克隆抗体免疫组化方法评价微血管形成。结果：MMTL的鉴别率为100%。苏木精和伊红染色的组织学切片显示胶原纤维取向平行，其实质部分细胞密度低，靠近半月板插入处细胞密度增加。胶原基质定量分析显示，I型与III型胶原的比例为3.86（±3.07）。物质内部分微血管密度平均值为33.71±8.7支/mm2，半月板止点部分微血管密度平均值为74.14±23.85支/mm2。结论：MMTL是一种I型胶原相对于III型胶原占优势的结构，在半月板止点区域微血管密度高。这些发现表明，对于斜坡损伤，MMTL的愈合潜力很高，因为这些损伤发生在半月板插入区。

{"title":"Analysis of microvascular density and collagen structure of the medial meniscotibial ligament of the knee: Immunohistochemical study with CD31 and histology with Picrosirius red","authors":"Amanda Progenio dos Santos , Jonatas Brito de Alencar Neto , Pedro Henrique Marques Amorim , Paulo Goberlânio de Barros Silva , Maria Luzete Costa Cavalcante","doi":"10.1016/j.knee.2024.11.016","DOIUrl":"10.1016/j.knee.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>The aim of the present study was to describe the structure of the collagen matrix and the microvascularization of the medial meniscotibial ligament (MMTL), in order to contribute to the refinement of the surgical technique for repairing these structures and consequently lead to a reduction in the risk of anterior cruciate ligament re-rupture.</div></div><div><h3>Methods</h3><div>Twelve MMTLs were obtained from deceased organ donors. The ligaments were initially analyzed macroscopically and evaluated histologically using hematoxylin and eosin staining. The evaluation of the collagen matrix was carried out using the Picrosirius red staining method under a polarized light microscope. Immunohistochemical study using monoclonal antibodies against CD31 was used to evaluate microvascularization.</div></div><div><h3>Results</h3><div>The MMTL was identified in 100% of the dissections. The hematoxylin and eosin-stained histological sections exhibited oriented and parallel collagen fibers, with low cellularity in its intrasubstance portion and increase in cellularity close to the meniscal insertion. Quantitative analysis of the collagen matrix showed a ratio of type I to type III collagen of 3.86 (±3.07). The average microvascular density in the intrasubstance portion was 33.71 ± 8.7 vessels/mm<sup>2</sup> and in the meniscal insertion portion it was 74.14 ± 23.85 vessels/mm<sup>2</sup>.</div></div><div><h3>Conclusion</h3><div>The MMTL is a structure with a predominance of Type I collagen in relation to Type III collagen and high microvascular density in the region of meniscal insertion. These findings suggest that the healing potential of MMTL, regarding ramp injuries, is high because these injuries occur in the meniscal insertion area.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 10-18"},"PeriodicalIF":1.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical outcome and complications after simultaneous bilateral medial opening-wedge high tibial osteotomy 双侧内侧开楔式胫骨高位截骨术的临床疗效及并发症

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-03 DOI: 10.1016/j.knee.2024.11.012

Kyung Wook Nha , Hyung Suh Kim , Jong Min Kim , Tulyapruek Tawonsawatruk , Sang-Gyun Kim

Background

The literature provides limited evidence regarding postoperative outcomes and complications following simultaneous bilateral medial opening-wedge high tibial osteotomy (MOWHTO). This study aimed to investigate the clinical outcomes and complications associated with simultaneous bilateral MOWHTO.

Methods

We retrospectively evaluated 72 knees from 36 patients (mean age, 58.6 ± 8.2 years) who underwent simultaneous bilateral MOWHTOs between December 2011 and January 2021. Locking compression plates were used for simultaneous bilateral MOWHTOs. The Oxford Knee Score (OKS) was used to assess clinical outcomes at the last follow up. Complications (lateral hinge fracture (LHF), nonunion, and loss of correction) were evaluated using postoperative serial plain radiography and computed tomography (CT).

Results

At the last follow up (range, 2.0–11.1 years), the mean OKS for the 72 knees was 36.8 ± 10.4. According to the OKS, 42 knees (58.3%) scored ’excellent’, 16 (22.2%) scored ‘good’, eight (11.1%) scored ‘moderate’, and six (8.3%) scored ‘poor’. LHFs occurred in 11 of the 72 knees (15.3%). Among these, five LHFs were identified on postoperative plain radiographs and CT scans (acute LHFs), whereas six fractures were identified only on follow up plain radiographs (delayed LHFs). Loss of correction occurred in one patient with delayed LHFs. The patient required an additional surgical treatment to achieve bone healing at the osteotomy site.

Conclusion

Simultaneous bilateral MOWHTO is a viable treatment option for patients with bilateral medial osteoarthritis of the knee joint. Serial plain radiographs at short-term intervals are recommended to detect delayed LHFs and prevent complications such as fixation failure and loss of correction.

背景文献提供的关于双侧内侧开楔形高位胫骨截骨术（MOWHTO）的术后结果和并发症的证据有限。本研究旨在探讨同时双侧MOWHTO的临床结果和并发症。方法回顾性评估2011年12月至2021年1月期间同时行双侧MOWHTOs的36例患者（平均年龄58.6±8.2岁）的72个膝关节。同时双侧mowho采用锁定加压钢板。牛津膝关节评分（OKS）用于评估最后随访时的临床结果。术后系列x线平片和计算机断层扫描（CT）评估并发症（外侧铰链骨折（LHF）、骨不连和矫正缺失）。结果最后一次随访（2.0 ~ 11.1年），72例膝关节平均OKS为36.8±10.4。根据OKS的数据，42个膝盖（58.3%）被评为“优秀”，16个（22.2%）被评为“良好”，8个（11.1%）被评为“中等”，6个（8.3%）被评为“差”。72例膝关节中有11例发生LHFs（15.3%）。其中，术后x线平片和CT扫描发现了5例lhf（急性lhf），而6例仅在随访x线平片上发现（延迟性lhf）。1例迟发性LHFs患者矫正功能丧失。患者需要额外的手术治疗以实现截骨部位的骨愈合。结论双侧同时MOWHTO治疗双侧膝关节内侧骨性关节炎是一种可行的治疗方法。建议在短时间间隔内进行连续x线平片检查，以发现迟发性lhf，并预防固定失败和矫正丢失等并发症。

{"title":"Clinical outcome and complications after simultaneous bilateral medial opening-wedge high tibial osteotomy","authors":"Kyung Wook Nha , Hyung Suh Kim , Jong Min Kim , Tulyapruek Tawonsawatruk , Sang-Gyun Kim","doi":"10.1016/j.knee.2024.11.012","DOIUrl":"10.1016/j.knee.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>The literature provides limited evidence regarding postoperative outcomes and complications following simultaneous bilateral medial opening-wedge high tibial osteotomy (MOWHTO). This study aimed to investigate the clinical outcomes and complications associated with simultaneous bilateral MOWHTO.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated 72 knees from 36 patients (mean age, 58.6 ± 8.2 years) who underwent simultaneous bilateral MOWHTOs between December 2011 and January 2021. Locking compression plates were used for simultaneous bilateral MOWHTOs. The Oxford Knee Score (OKS) was used to assess clinical outcomes at the last follow up. Complications (lateral hinge fracture (LHF), nonunion, and loss of correction) were evaluated using postoperative serial plain radiography and computed tomography (CT).</div></div><div><h3>Results</h3><div>At the last follow up (range, 2.0–11.1 years), the mean OKS for the 72 knees was 36.8 ± 10.4. According to the OKS, 42 knees (58.3%) scored ’excellent’, 16 (22.2%) scored ‘good’, eight (11.1%) scored ‘moderate’, and six (8.3%) scored ‘poor’. LHFs occurred in 11 of the 72 knees (15.3%). Among these, five LHFs were identified on postoperative plain radiographs and CT scans (acute LHFs), whereas six fractures were identified only on follow up plain radiographs (delayed LHFs). Loss of correction occurred in one patient with delayed LHFs. The patient required an additional surgical treatment to achieve bone healing at the osteotomy site.</div></div><div><h3>Conclusion</h3><div>Simultaneous bilateral MOWHTO is a viable treatment option for patients with bilateral medial osteoarthritis of the knee joint. Serial plain radiographs at short-term intervals are recommended to detect delayed LHFs and prevent complications such as fixation failure and loss of correction.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 230-237"},"PeriodicalIF":1.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Budgets, costs and deprivation 预算、成本和匮乏。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-01 DOI: 10.1016/j.knee.2024.11.010

Caroline Hing (Editor-in-chief), Oday Al-Dadah (Editor-in-chief)

引用次数: 0

Machine learning is better than surgeons at assessing unicompartmental knee replacement radiographs 机器学习比外科医生更擅长评估单室膝关节置换术的x光片

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-30 DOI: 10.1016/j.knee.2024.11.007

S Jack Tu , Sara Kendrick , Karthik Saravanan , Christopher Dodd , David W Murray , Stephen J Mellon

Background:

Poor results occasionally occur after unicompartmental knee replacement (UKR). It is often difficult, even for experienced surgeons, to determine why patients have poor outcomes from radiographs. The aim was to compare the ability of experienced surgeons and machine learning to predict whether patients had poor or excellent outcomes from radiographs.

Methods:

924 one-year anterior-posterior radiographs post-UKR were used to train a machine learning model (ResNet50v2) with a transfer learning approach based on their one-year Oxford Knee Score categories. Two experienced surgeons and the model assessed and categorised 70 radiographs (14 Poor scores; 56 Excellent scores) not used for training according to their expected outcome.

Results:

The ResNet50v2 model correctly identified 71% (n = 10) of the patients with a poor score and 46 (82%) of those with an excellent score. In contrast, one surgeon could not identify patients with Poor scores (0%) and the other identified one (7%). Both misidentified 3 of those with Excellent scores. The model visualisation method suggested that estimated classifications were made from image features around the implants.

Conclusion:

The results suggest that there are radiographical features that relate to poor outcomes, which the surgeons are unaware of. Those the model did not identify may have an extra-articular cause for their poor outcome. Further analysis to identify the features associated with poor outcomes could potentially suggest ways that indications or techniques could be improved so as to decrease the incidence of poor results.

背景：单室膝关节置换术（UKR）后偶尔会出现不良结果。即使是经验丰富的外科医生，也很难从x光片中确定患者预后不良的原因。目的是比较经验丰富的外科医生和机器学习的能力，以预测患者的x光片结果是差还是好。方法：使用924张一年的ukr后前后位x线片，基于他们一年的牛津膝关节评分分类，使用迁移学习方法训练机器学习模型（ResNet50v2）。两名经验丰富的外科医生和模型对70张x线片进行了评估和分类(14张评分差；（56）优秀成绩)不用于培训，根据他们的预期结果。结果：ResNet50v2模型正确识别了71% （n = 10）评分差的患者和46（82%）评分优的患者。相比之下，一名外科医生无法识别评分较差的患者（0%），另一名外科医生识别出评分较差的患者（7%）。两家公司都错认了成绩优异的3名学生。模型可视化方法表明，根据植入物周围的图像特征进行估计分类。结论：结果提示存在与预后不良相关的影像学特征，而这些特征是外科医生所不知道的。那些模型没有识别的患者可能有关节外的原因导致他们的不良结果。进一步分析以确定与不良结果相关的特征，可能会提出改进指征或技术的方法，以减少不良结果的发生率。

{"title":"Machine learning is better than surgeons at assessing unicompartmental knee replacement radiographs","authors":"S Jack Tu , Sara Kendrick , Karthik Saravanan , Christopher Dodd , David W Murray , Stephen J Mellon","doi":"10.1016/j.knee.2024.11.007","DOIUrl":"10.1016/j.knee.2024.11.007","url":null,"abstract":"<div><h3><strong>Background:</strong></h3><div>Poor results occasionally occur after unicompartmental knee replacement (UKR). It is often difficult, even for experienced surgeons, to determine why patients have poor outcomes from radiographs. The aim was to compare the ability of experienced surgeons and machine learning to predict whether patients had poor or excellent outcomes from radiographs.</div></div><div><h3><strong>Methods:</strong></h3><div>924 one-year anterior-posterior radiographs post-UKR were used to train a machine learning model (ResNet50v2) with a transfer learning approach based on their one-year Oxford Knee Score categories. Two experienced surgeons and the model assessed and categorised 70 radiographs (14 Poor scores; 56 Excellent scores) not used for training according to their expected outcome.</div></div><div><h3><strong>Results:</strong></h3><div>The ResNet50v2 model correctly identified 71% (n = 10) of the patients with a poor score and 46 (82%) of those with an excellent score. In contrast, one surgeon could not identify patients with Poor scores (0%) and the other identified one (7%). Both misidentified 3 of those with Excellent scores. The model visualisation method suggested that estimated classifications were made from image features around the implants.</div></div><div><h3><strong>Conclusion:</strong></h3><div>The results suggest that there are radiographical features that relate to poor outcomes, which the surgeons are unaware of. Those the model did not identify may have an extra-articular cause for their poor outcome. Further analysis to identify the features associated with poor outcomes could potentially suggest ways that indications or techniques could be improved so as to decrease the incidence of poor results.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 212-219"},"PeriodicalIF":1.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748211","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

Inferior short-term survivorship and patient outcomes for cementless compared to hybrid fixation with a cemented femoral implant in a novel blade-anchored medial unicompartmental knee arthroplasty design: An analysis of 132 cases 在新型刀片锚定内侧单室膝关节置换术设计中，与混合固定与骨水泥股骨植入物相比，无骨水泥短期生存率和患者预后较差

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-30 DOI: 10.1016/j.knee.2024.11.008

Roderick J.M. Vossen , Lindsey V. Ruderman , Jonathan Spaan , Tarik Bayoumi , Edwin Su , Andrew D. Pearle

Purpose

For younger, more active patients, a cementless unicompartmental knee arthroplasty (UKA) might be more advantageous than cemented fixation. Therefore, this study aimed to compare implant survivorship and patient-reported outcome measures (PROMs) between cementless and hybrid fixation (cemented femur and cementless tibial fixation) in a novel tibial blade-anchored, medial UKA design.

Methods

Two surgeon’s registries were reviewed for patients who underwent primary cementless or hybrid medial UKA for medial osteoarthritis between 2019 and 2022. Patients were included if implant survivorship and one-year postoperative PROMs (UCLA-activity score, Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), pain (VAS) and satisfaction) were registered. Variables were compared using independent two-sample t-tests or the Chi-square test. Survival rates were determined using the Kaplan-Meier models and compared using the Log-rank test.

Results

A total of 132 knees were included (cementless 58.3%; cemented 41.7%; mean follow-up 3.1 ± 0.6 years). Three-year all-cause revision survival rate was significantly superior for the hybrid fixation (hybrid: 100%; cementless 88.5%[84.7%–92.3%], p = 0.026). However, the difference in three-year conversion rate to total knee arthroplasty (TKA) did not reach statistical significance. The one-year postoperative OKS (hybrid: 42.9 ± 4.8; cementless: 39.8 ± 6.4, p = 0.003) and KOOS-JR (hybrid:81.5 ± 13.7; cementless: 74.4 ± 12.1, p = 0.002) were significantly superior for the hybrid fixation. Three-year conversion rate to TKA and two-year postoperative PROMs did not significantly differ.

Conclusion

The cementless medial UKA demonstrated a significantly inferior short-term all-cause survival rate and inferior postoperative one-year OKS and KOOS-JR compared to the hybrid medial UKA design with a cemented femoral component.

目的：对于年轻、活跃的患者，无骨水泥单室膝关节置换术（UKA）可能比骨水泥固定更有利。因此，本研究旨在比较无骨水泥和混合固定（骨水泥股骨和无骨水泥胫骨固定）在新型胫骨叶片锚定内侧UKA设计中的种植体存活率和患者报告的结果测量（PROMs）。方法回顾了两名外科医生在2019年至2022年期间因内侧骨关节炎接受原发性无骨水泥或混合型内侧UKA的患者。如果患者的种植体存活和术后一年的PROMs （UCLA-activity评分、牛津膝关节评分（OKS）、膝关节损伤和骨关节炎关节置换术结局评分（KOOS-JR）、疼痛（VAS）和满意度）被纳入研究。变量比较采用独立双样本t检验或卡方检验。生存率使用Kaplan-Meier模型确定，并使用Log-rank检验进行比较。结果共纳入132个膝关节(无骨水泥58.3%；巩固了41.7%;平均随访时间（3.1±0.6年）。杂交固定的3年全因翻修生存率明显优于杂交固定(杂交：100%；无水泥88.5%[84.7% ~ 92.3%],p = 0.026)。然而，3年转换率到全膝关节置换术（TKA）的差异无统计学意义。术后1年OKS(混合型：42.9±4.8；cementless: 39.8±6.4,p = 0.003)和KOOS-JR(混合:81.5±13.7;无骨水泥：74.4±12.1,p = 0.002)明显优于混合固定。术后3年TKA转换率与术后2年PROMs转换率无显著差异。结论与带骨水泥股骨假体的混合型内侧UKA设计相比，无骨水泥内侧UKA的短期全因生存率和术后1年OKS和KOOS-JR明显较低。

{"title":"Inferior short-term survivorship and patient outcomes for cementless compared to hybrid fixation with a cemented femoral implant in a novel blade-anchored medial unicompartmental knee arthroplasty design: An analysis of 132 cases","authors":"Roderick J.M. Vossen , Lindsey V. Ruderman , Jonathan Spaan , Tarik Bayoumi , Edwin Su , Andrew D. Pearle","doi":"10.1016/j.knee.2024.11.008","DOIUrl":"10.1016/j.knee.2024.11.008","url":null,"abstract":"<div><h3>Purpose</h3><div>For younger, more active patients, a cementless unicompartmental knee arthroplasty (UKA) might be more advantageous than cemented fixation. Therefore, this study aimed to compare implant survivorship and patient-reported outcome measures (PROMs) between cementless and hybrid fixation (cemented femur and cementless tibial fixation) in a novel tibial blade-anchored, medial UKA design.</div></div><div><h3>Methods</h3><div>Two surgeon’s registries were reviewed for patients who underwent primary cementless or hybrid medial UKA for medial osteoarthritis between 2019 and 2022. Patients were included if implant survivorship and one-year postoperative PROMs (UCLA-activity score, Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), pain (VAS) and satisfaction) were registered. Variables were compared using independent two-sample t-tests or the Chi-square test. Survival rates were determined using the Kaplan-Meier models and compared using the Log-rank test.</div></div><div><h3>Results</h3><div>A total of 132 knees were included (cementless 58.3%; cemented 41.7%; mean follow-up 3.1 ± 0.6 years). Three-year all-cause revision survival rate was significantly superior for the hybrid fixation (hybrid: 100%; cementless 88.5%[84.7%–92.3%], p = 0.026). However, the difference in three-year conversion rate to total knee arthroplasty (TKA) did not reach statistical significance. The one-year postoperative OKS (hybrid: 42.9 ± 4.8; cementless: 39.8 ± 6.4, p = 0.003) and KOOS-JR (hybrid:81.5 ± 13.7; cementless: 74.4 ± 12.1, p = 0.002) were significantly superior for the hybrid fixation. Three-year conversion rate to TKA and two-year postoperative PROMs did not significantly differ.</div></div><div><h3>Conclusion</h3><div>The cementless medial UKA demonstrated a significantly inferior short-term all-cause survival rate and inferior postoperative one-year OKS and KOOS-JR compared to the hybrid medial UKA design with a cemented femoral component.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 220-229"},"PeriodicalIF":1.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Knee最新文献

Background

Methods

Results

Conclusion

Background

Methods

Results

Conclusion

Background

Methods

Results

Conclusion

Background

Methods

Results

Conclusion

Background

Methods

Results

Conclusion

Background

Methods

Results

Conclusion

Background

Methods

Results

Conclusion

Background:

Methods:

Results:

Conclusion:

Purpose

Methods

Results

Conclusion