BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar k...BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.展开更多
目的:比较直接前方入路与后外侧入路全髋关节置换术(THA)治疗股骨颈骨折患者的效果。方法:回顾性分析2022年1月至2025年1月该院收治的82例股骨颈骨折患者的临床资料,根据手术入路不同将其分为观察组和对照组各41例。观察组采用直接前方...目的:比较直接前方入路与后外侧入路全髋关节置换术(THA)治疗股骨颈骨折患者的效果。方法:回顾性分析2022年1月至2025年1月该院收治的82例股骨颈骨折患者的临床资料,根据手术入路不同将其分为观察组和对照组各41例。观察组采用直接前方入路THA治疗,对照组采用后外侧入路THA治疗,比较两组手术相关指标[切口长度、住院时间、术中出血量、术后72 h视觉模拟评分法(VAS)评分、术后引流量]水平,手术前后炎性指标[超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、淀粉样蛋白A(SAA)]水平、术后髋关节功能[Charnley髋关节疗效量表(CHS)、Harris髋关节功能量表(HSS)]评分,以及并发症发生率。结果:两组手术时间比较,差异无统计学意义(P>0.05);研究组切口长度、住院时间均短于对照组,术中出血量、术后引流量均少于对照组,术后72 h VAS评分低于对照组,差异有统计学意义(P<0.05);术后3 d,两组hs-CRP、IL-1β、SAA水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);术后1个月,观察组CHS、HHS评分均高于对照组,差异有统计学意义(P<0.05);术后3、6个月,两组CHS、HHS评分均高于术后1个月,但组间比较,差异均无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:直接前方入路THA治疗股骨颈骨折患者可缩短切口长度和住院时间,减少术中出血量和术后引流量,降低疼痛评分和炎性指标水平,以及提高髋关节功能评分的效果优于后外侧入路THA治疗。展开更多
BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affectin...BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affecting the alignment,such as ankle joint alignment,should be considered.AIM To determine CPAK distribution in the North African(Egyptian)population with knee osteoarthritis and to assess ankle joint line orientation(AJLO)adaptations across different CPAK types.METHODS A cross-sectional study was conducted on patients with primary knee osteoarthritis and normal ankle joints.Radiographic parameters included the mechanical lateral distal femoral angle,medial proximal tibial angle,and the derived calculations of joint line obliquity(JLO)and arithmetic hip-knee-ankle angle(aHKA).The tibial plafond horizontal angle(TPHA)was used for AJLO assessment,where 0°is neutral(type N),<0°is varus(type A),and>0°is valgus(type B).The nine CPAK types were further divided into 27 subtypes after incorporating the three AJLO types.RESULTS A total of 527 patients(1054 knees)were included for CPAK classification,and 435 patients(870 knees and ankles)for AJLO assessment.The mean age was 57.2±7.8 years,with 79.5%females.Most knees(76.4%)demonstrated varus alignment(mean aHKA was-5.51°±4.84°)and apex distal JLO(55.3%)(mean JLO was 176.43°±4.53°).CPAK types I(44.3%),IV(28.6%),and II(10%)were the most common.Regarding AJLO,70.2%of ankles exhibited varus orientation(mean TPHA was-5.21°±6.45°).The most frequent combined subtypes were CPAK type I-A(33.7%),IV-A(21.5%),and I-N(6.9%).A significant positive correlation was found between the TPHA and aHKA(r=0.40,P<0.001).CONCLUSION In this North African cohort,varus knee alignment with apex distal JLO and varus AJLO predominated.CPAK types I,IV,and II were the most common types,while subtypes I-A,IV-A,and I-N were commonly occurring after incorporating AJLO types;furthermore,the AJLO was significantly correlated to aHKA.展开更多
BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is ...BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.展开更多
文摘BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.
文摘目的:比较直接前方入路与后外侧入路全髋关节置换术(THA)治疗股骨颈骨折患者的效果。方法:回顾性分析2022年1月至2025年1月该院收治的82例股骨颈骨折患者的临床资料,根据手术入路不同将其分为观察组和对照组各41例。观察组采用直接前方入路THA治疗,对照组采用后外侧入路THA治疗,比较两组手术相关指标[切口长度、住院时间、术中出血量、术后72 h视觉模拟评分法(VAS)评分、术后引流量]水平,手术前后炎性指标[超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、淀粉样蛋白A(SAA)]水平、术后髋关节功能[Charnley髋关节疗效量表(CHS)、Harris髋关节功能量表(HSS)]评分,以及并发症发生率。结果:两组手术时间比较,差异无统计学意义(P>0.05);研究组切口长度、住院时间均短于对照组,术中出血量、术后引流量均少于对照组,术后72 h VAS评分低于对照组,差异有统计学意义(P<0.05);术后3 d,两组hs-CRP、IL-1β、SAA水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);术后1个月,观察组CHS、HHS评分均高于对照组,差异有统计学意义(P<0.05);术后3、6个月,两组CHS、HHS评分均高于术后1个月,但组间比较,差异均无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:直接前方入路THA治疗股骨颈骨折患者可缩短切口长度和住院时间,减少术中出血量和术后引流量,降低疼痛评分和炎性指标水平,以及提高髋关节功能评分的效果优于后外侧入路THA治疗。
基金approved by Institutional Review Board of Faculty of Medicine in Assiut University,No.04-2024-300470.
文摘BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affecting the alignment,such as ankle joint alignment,should be considered.AIM To determine CPAK distribution in the North African(Egyptian)population with knee osteoarthritis and to assess ankle joint line orientation(AJLO)adaptations across different CPAK types.METHODS A cross-sectional study was conducted on patients with primary knee osteoarthritis and normal ankle joints.Radiographic parameters included the mechanical lateral distal femoral angle,medial proximal tibial angle,and the derived calculations of joint line obliquity(JLO)and arithmetic hip-knee-ankle angle(aHKA).The tibial plafond horizontal angle(TPHA)was used for AJLO assessment,where 0°is neutral(type N),<0°is varus(type A),and>0°is valgus(type B).The nine CPAK types were further divided into 27 subtypes after incorporating the three AJLO types.RESULTS A total of 527 patients(1054 knees)were included for CPAK classification,and 435 patients(870 knees and ankles)for AJLO assessment.The mean age was 57.2±7.8 years,with 79.5%females.Most knees(76.4%)demonstrated varus alignment(mean aHKA was-5.51°±4.84°)and apex distal JLO(55.3%)(mean JLO was 176.43°±4.53°).CPAK types I(44.3%),IV(28.6%),and II(10%)were the most common.Regarding AJLO,70.2%of ankles exhibited varus orientation(mean TPHA was-5.21°±6.45°).The most frequent combined subtypes were CPAK type I-A(33.7%),IV-A(21.5%),and I-N(6.9%).A significant positive correlation was found between the TPHA and aHKA(r=0.40,P<0.001).CONCLUSION In this North African cohort,varus knee alignment with apex distal JLO and varus AJLO predominated.CPAK types I,IV,and II were the most common types,while subtypes I-A,IV-A,and I-N were commonly occurring after incorporating AJLO types;furthermore,the AJLO was significantly correlated to aHKA.
文摘BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.
