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Giaretta S, Magni A, Migliore A, Natoli S, Puntillo F, Ronconi G, Santoiemma L, Sconza C, Viapiana O, Zanoli G. A Review of Current Approaches to Pain Management in Knee Osteoarthritis with a Focus on Italian Clinical Landscape. J Clin Med 2024; 13:5176. [PMID: 39274389 PMCID: PMC11396710 DOI: 10.3390/jcm13175176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/24/2024] [Accepted: 08/11/2024] [Indexed: 09/16/2024] Open
Abstract
The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. Italian experts from the fields of rheumatology, physical medicine and rehabilitation, orthopedics, primary care, and pain therapy have identified several key issues. They emphasized the need for standardized care protocols to address inconsistencies in patient management across different specialties. Early diagnosis is crucial, as cartilage responds better to early protective and structural therapies. Faster access to physiatrist evaluation and reimbursement for physical, rehabilitative, and pharmacological treatments, including intra-articular (IA) therapy, could reduce access disparities. Concerns surround the adverse effects of oral pharmacological treatments, highlighting the need for safer alternatives. Patient satisfaction with corticosteroids and hyaluronic acid-based IA therapies reduces over time and there is no consensus on the optimal IA therapy protocol. Surgery should be reserved for severe symptoms and radiographic KOA evidence, as chronic pain post-surgery poses significant societal and economic burdens. The experts advocate for a multidisciplinary approach, promoting interaction and collaboration between specialists and general practitioners, to enhance KOA care and treatment consistency in Italy.
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Affiliation(s)
- Stefano Giaretta
- UOC Ortopedia e Traumatologia OC San Bortolo di Vicenza (AULSS 8 Berica), 36100 Vicenza, Italy
| | - Alberto Magni
- Local Health Department, Desenzano sul Garda, 25015 Brescia, Italy
| | - Alberto Migliore
- Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy
| | - Silvia Natoli
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pain Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Filomena Puntillo
- Anaesthesia, Intensive Care and Pain Unit, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianpaolo Ronconi
- Department of Rehabilitation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | | | | | - Ombretta Viapiana
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, 37126 Verona, Italy
| | - Gustavo Zanoli
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Occhiobello, 45030 Rovigo, Italy
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Yazdi H, Talebi S, Razi M, Sarzaeem MM, Moshirabadi A, Mohammadpour M, Seiri S, Ghaeini M, Alaeddini S, Abolghasemian M. Effect of Adding Stem Extension to a Short-Keeled Knee Implant on the Risk of Tibial Loosening: a Historical Cohort Study. J Am Acad Orthop Surg 2024:00124635-990000000-01070. [PMID: 39186613 DOI: 10.5435/jaaos-d-23-00833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 06/06/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Short-keeled tibial implants may be at higher risk of aseptic loosening. Stem augmentation has been suggested to improve its fixation. We aimed to assess whether this technique could decrease the loosening rate of such tibial implants. METHODS We retrospectively studied the knees receiving stemmed versus nonstemmed versions of a short-keeled prosthesis. A total of 932 patients undergoing total knee arthroplasty using a Persona prosthesis with >24-month follow-up (mean 53.7) were included, of whom 212 were at high risk of loosening due to osteoporosis or high body mass index (BMI). The rate of tibial aseptic loosening in high-risk patients and in the whole cohort was compared between those with and without stem extension. Multivariable analysis was conducted to identify the risk factors of loosening. RESULTS In the whole cohort, in 203 knees (21.8%), a cemented short stem was used, versus 729 knees (78.2%) without. The tibial implant revision rates for loosening were 2.06% and 0.99% for nonstemmed and stemmed cases, respectively (P = 0.551). When the cohort was categorized based on the loosening risk factors, the loosening risk was significantly higher in the high-risk than in the low-risk group, regardless of stem status (log-rank test = 8.1, hazard ratio = 2.17, 95% CI = 1.78, 2.57, P = 0.005). 212 patients were at high risk of loosening, due to high BMI or osteoporosis, among whom the risk of aseptic loosening was higher when a stem was not used (log-rank = 32.1, hazard ratio = 4.95, 95% CI = 4.05, 5.86, P < 0.001). In multivariate analysis, osteoporosis, BMI ≥35, and smoking were correlated with loosening. CONCLUSION The failure rate was markedly lower in the stemmed group of the patients at elevated risk of aseptic loosening due to osteoporosis and/or high BMI. In the entire cohort, the risk of loosening in stemmed tibial implants was similar to the nonstemmed group. The findings support a protective role for the stem in patients at high risk of failure of the cemented tibial implant. LEVEL OF EVIDENCE III therapeutic.
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Affiliation(s)
- Hamidreza Yazdi
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Sina Talebi
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Mohammad Razi
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Mohammad Mahdi Sarzaeem
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Ataollah Moshirabadi
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Mehdi Mohammadpour
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Sina Seiri
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Moein Ghaeini
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Soroush Alaeddini
- From the Department of Orthopedics, School of Medicine, Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran (Yazdi, Talebi, Razi, Mohammadpour, Seiri, Ghaeini, Alaeddini, and Abolghasemian), the Neuromusculoskeletal Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (Yazdi), Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Sarzaeem), and the Department of Orthopedic Surgery, Atieh Private Hospital, Tehran, Iran (Moshirabadi)
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
| | - Mansour Abolghasemian
- Division of Orthopedic Surgery, Department of Surgery, University of Alberta, Alberta, Canada
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Sanghvi PA, Burkhart RJ, Belt NG, Nedder VJ, Saleh A, Kaelber DC, Mistovich RJ. Epidemiological Trends and Outcomes of Unicompartmental Knee Arthroplasty Among 104 Million Patients in the United States. J Arthroplasty 2024:S0883-5403(24)00647-8. [PMID: 38914143 DOI: 10.1016/j.arth.2024.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) for localized osteoarthritis. Recent advancements in UKA implant design and expanding patient criteria may have increased its utilization. However, few studies have examined the use of UKA in the United States. Thus, this study assessed the current and projected future trends of UKA and robotic UKA in the United States through 2035, along with postoperative outcomes. METHODS A collaborative healthcare research network was queried to identify patients who had undergone UKA. Primary outcomes measured included prevalence (P), incidence proportion (IP), and incidence rate (IR) from 2012 to 2022. Chi-squared analyses were done to compare outcomes across categorical data. Regression modeling was performed to project UKA to the year 2035. Statistical significance was held at P < .05 for all analyses. RESULTS In 2022, 1,662 UKAs were performed within the network, a 590% increase from 2012 (241 performed). The IP increased on an average annual basis by 41.8%, the IR by 50%, and the P by 51.3%. A year following UKA, conversion to TKA was the most common orthopaedic complication (39.9%). As of 2022, there were 68 robotic UKAs performed, a 518% increase from the 11 performed in 2012. Regression analysis for UKA through 2035 showed that IP will be 0.04%, IR will be 1.75 × 10-6 cases/person-day, and P will be 0.3%. CONCLUSIONS These findings are consistent with prior studies indicating a higher utilization of UKA over the past decade. Reported complications were not uncommon, as nearly 40% of patients required a conversion to a TKA. Further research is needed to optimally identify criteria for appropriate patients and determine the benefits robotic UKA may provide, specifically reducing the risk of conversion to a TKA.
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Affiliation(s)
- Parshva A Sanghvi
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert J Burkhart
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nicholas G Belt
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Victoria J Nedder
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anas Saleh
- The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David C Kaelber
- The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio; The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - R Justin Mistovich
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio; The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Yin J, Lai P, Zhu L, Ma J. Angiopoietin 1 Relieves Osteolysis by Promoting Macrophage Mitophagy Through the TBK1-SQSTM1 Pathway to Inhibit AIM2 Inflammasome-Mediated Pyroptosis. Appl Biochem Biotechnol 2024:10.1007/s12010-024-04961-z. [PMID: 38662322 DOI: 10.1007/s12010-024-04961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
Osteolysis resulting from wear particles and subsequent aseptic loosening is a leading cause of revision surgery of artificial joints. The underlying pathogenesis of particle-induced osteolysis (PPO) has remained largely uncertain. Addressing how to mitigate osteolysis caused by wear particles presents a significant challenge for orthopedic surgeons. This study aimed to explore the molecular mechanism by which Angiopoietin (Ang-1) inhibits osteoclast activation to alleviate osteolysis. RAW264.7 mouse macrophages were stimulated with LPS or RANKL to induce osteoclast formation. Additionally, titanium (Ti) particles (50 mg) were subperiosteally implanted around the cranial suture of mice to establish a calvarial osteolysis model. Ang-1, a member of the pro-angiogenic factor protein family and an important inflammatory regulator molecule, was utilized in this model. TRAP staining was utilized to detect osteoclast activation, while a western blot was conducted to identify key proteins associated with mitophagy and pyroptosis. Scanning electron microscopy was employed to observe the morphology and dimensions of Ti particles. Additionally, a combination of micro-CT, H&E, Masson's trichrome, and immunohistochemical staining techniques were applied to analyze the calvarial samples. Results indicated that Ang-1 could inhibit LPS- or RANKL-induced osteoclastogenesis and alleviate Ti particle-induced calvarial osteolysis in mice. TBK-1, a key signaling molecule involved in initiating mitophagy, was found to be mechanistically enhanced by Ang-1 through promoting TBK-1 phosphorylation in macrophages. This process inhibited AIM2 inflammasome-mediated pyroptosis and impeded osteoclastogenesis. Overall, this research uncovers a novel mechanism by which Ang-1 can attenuate inflammatory osteolysis, potentially offering a new therapeutic approach for PPO.
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Affiliation(s)
- Jian Yin
- Department of Orthopedics, Shanghai General Hospital of Nanjing Medical University, Songjiang, Shanghai, 201600, China
- Department of Orthopedics, the Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, 211100, China
| | - Peng Lai
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Songjiang, Shanghai, 201600, China
| | - Libo Zhu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Songjiang, Shanghai, 201600, China
| | - Jinzhong Ma
- Department of Orthopedics, Shanghai General Hospital of Nanjing Medical University, Songjiang, Shanghai, 201600, China.
- Department of Orthopedics, the Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, 211100, China.
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Songjiang, Shanghai, 201600, China.
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Szapary HJ, Farid A, Desai V, Franco H, Ready JE, Chen AF, Lange JK. Predictors of reoperation and survival experience for primary total knee arthroplasty in young patients with degenerative and inflammatory arthritis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05299-1. [PMID: 38613613 DOI: 10.1007/s00402-024-05299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION While total knee arthroplasty (TKA) is typically implemented in patients > 65 years old, young patients may need to undergo TKA for pain relief and functional improvement. Current data are limited by older cohorts and short-term survival rates. This study aimed to examine a large sample size of patients with degenerative and inflammatory conditions who underwent primary TKA at a young (≤ 40) age to identify predictors of reoperation, as well 15-year survivorship. MATERIALS AND METHODS A retrospective study was performed on 77 patients (92 surgeries) who underwent primary TKA at ≤ 40 years old, between January 1990 and January 2020. Patient charts were reviewed and a multivariable logistic regression model identified independent predictors of reoperation. Kaplan-Meier analysis was employed to build survival curves and log-rank tests analyzed survival between groups. RESULTS Of the 77 patients, the median age at the time of surgery was 35.7 years (IQR: 31.2-38.7) and median follow-up time was 6.88 years. Twenty-one (22.8%) primary TKAs underwent 24 reoperations, most commonly due to stiffness (n = 9, 32.1%) and infection (n = 13, 46.4%) more significantly in the OA group (p = 0.049). There were no independent predictors of reoperation in multivariable analysis, and 15-year revision-free survivorship after TKA did not differ by indication (77.3% for OA/PTOA vs. 96.7% for autoimmune, p = 0.09) or between ≤ 30 and 31-40 year age groups (94.7% vs. 83.6%, p = 0.55). CONCLUSIONS In this cohort of patients ≤ 40 years old, revision-free survival was comparable to that reported in the literature for older TKA patients with osteoarthritis/autoimmune conditions (81-94% at 15-years). Though nearly a quarter of TKAs required reoperation and causes of secondary surgery differed between degenerative and inflammatory arthritis patients, there were no significant predictors of increased reoperation rate. Very young patients ≤ 30 years old did not have an increased risk of revision compared to those aged 31-40 years.
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Affiliation(s)
- Hannah J Szapary
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Alexander Farid
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Vineet Desai
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Helena Franco
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - John E Ready
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
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Bergstein VE, Weinblatt AI, Taylor WL, Long WJ. Total knee arthroplasty survivorship and outcomes in young patients: a review of the literature and 40-year update to a longitudinal study. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05198-5. [PMID: 38436715 DOI: 10.1007/s00402-024-05198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/31/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Growing numbers of younger patients are electing to undergo total knee arthroplasty (TKA) for end-stage osteoarthritis. The purpose of this study was to compare established literature regarding TKA outcomes in patients under age 55, to data from an ongoing longitudinal young patient cohort curated by our study group. Further, we aimed to provide a novel update on survivorship at 40 years post-TKA from our longitudinal cohort. METHODS A literature search was conducted using the electronic databases PubMed, Embase, and Cochrane Library, using terms related to TKA, patients under age 55, and osteoarthritis. Demographic and outcome data were extracted from all studies that met the inclusion criteria. Data were divided into the "longitudinal study (LS) group," and the "literature review (LR) group" based on the patient population of the study from which it came. RESULTS After screening, 10 studies met the inclusion criteria; 6 studies comprised the LR group, and 4 studies comprised the LS group. 2613 TKAs were performed among the LR group, and 114 TKAs were longitudinally followed in the LS group. The mean patient ages of the LR and LS groups were 46.1 and 51, respectively. Mean follow-up was 10.1 years for the LR group. Mean postoperative range of motion was 113.6° and 114.5° for the LR and LS groups, respectively. All-cause survivorship reported at 10 years or less ranged from 90.6% to 99.0%. The LS cohort studies reported survivorship ranges of 70.1-70.6% and 52.1-65.3% at 30 and 40 years, respectively. CONCLUSIONS Young TKA patients demonstrated improved functionality at each follow-up time point assessed. Survivorship decreased with increasing lengths of follow-up, ultimately ranging from 52.1-65.3% at 40 years post-TKA. The paucity of literature on long-term TKA outcomes in this patient population reinforces the necessity of further research on this topic.
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Affiliation(s)
- Victoria E Bergstein
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA.
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Aaron I Weinblatt
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Walter L Taylor
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - William J Long
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Wautier D, Thienpont E. Tibial implant design in primary TKA: retrospective comparison of two designs for the occurrence of radiolucent lines and aseptic loosening. Arch Orthop Trauma Surg 2024; 144:323-332. [PMID: 37733127 DOI: 10.1007/s00402-023-05030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION The purpose of this retrospective study was to study the effect of tibial implant design on the occurrence of radiolucent lines (RLLs) and aseptic loosening (AL) by comparing two different total knee arthroplasty (TKA) designs. MATERIALS AND METHODS Two types of total knee arthroplasty, different for tibial shape, size and keel design were compared, 255 for the first and 774 for the second. The occurrence of RLLs and radiological signs of micro- and macro-mobility and aseptic loosening was analyzed. Demographic data were compared, as well as the type and rate of RLLs, occurrence of aseptic loosening and the presence of potential risk factors. RESULTS The first implant design is morphometric and has a squarer keel than the second implant TKA. The overall rate of RLLs was similar (21% vs 23%), despite of a significantly lower rates of radiological signs of macro-mobility of the tibial component with the first implant (2% vs 17%). Survivorship of both designs was overall comparable (99.6% vs 98.8 %) the first implant group had more potential risk factors for poor bone quality than the second group (p < 0.05). CONCLUSION A morphometric design is more anatomic and offers better bone coverage of the epiphyseal tibial surface. RLLs, as a sign of implant micro-mobility, were equally present in both designs. Radiological signs of macro-mobility at the metaphysis were less frequently observed in squared keel design. The morphometric implant did not show improved survivorship compared with a symmetric implant. LEVEL OF EVIDENCE III.
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Affiliation(s)
- D Wautier
- Department of Orthopedic Surgery, CHU UCL Namur, Godinne, Avenue Docteur Gaston Therasse 1, 5530, Yvoir, Belgium.
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Braithwaite S, Qamhawi Z, Briggs J, Little MW. Transcatheter embolisation in chronic musculoskeletal disorders. Br J Radiol 2023; 96:20220728. [PMID: 37335189 PMCID: PMC10461266 DOI: 10.1259/bjr.20220728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 06/21/2023] Open
Abstract
Chronic musculoskeletal conditions affect millions of patients worldwide resulting in disability, reduced quality of life, and have a profound economic impact on the individual and society. Current treatment strategies fail patients who have not responded to conservative management but are not surgical candidates. Over the last decade, transcatheter embolisation has emerged as a potential treatment for these difficult to treat patients. By exploiting pathological neovascularisation within conditions such as knee osteoarthritis, adhesive capsulitis, and tendinopathy, embolisation has been used to improve patients' pain and function. This review explores the rationale for musculoskeletal transcatheter embolisation, illustrating the technique, and latest evidence for the most common procedures.
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Affiliation(s)
- Simon Braithwaite
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Zahi Qamhawi
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - James Briggs
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Mark W Little
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
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Brunken F, Senft T, Herbster M, Relja B, Bertrand J, Lohmann CH. CoNiCrMo Particles, but Not TiAlV Particles, Activate the NLRP3 Inflammasome in Periprosthetic Cells. Int J Mol Sci 2023; 24:ijms24065108. [PMID: 36982177 PMCID: PMC10048784 DOI: 10.3390/ijms24065108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
Aseptic loosening is the main reason for arthroplasty failure. The wear particles generated at the tribological bearings are thought to induce an inflammatory tissue response, leading to bone loss and the subsequent loosening of the implant. Different wear particles have been shown to activate the inflammasome, thereby contributing to an inflammatory milieu in the direct vicinity of the implant. The aim of this study was to investigate whether the NLRP3 inflammasome is activated by different metal particles in vitro and in vivo. Three different cell lines representing periprosthetic cell subsets (MM6, MG63 and Jurkat) were incubated with different amounts of TiAlV or CoNiCrMo particles. The activation of the NLRP3 inflammasome was determined through the detection of the caspase 1 cleavage product p20 in a Western blot. The formation of the inflammasome was also investigated in vivo using immunohistological staining for ASC in primary synovial tissues as well as tissues containing TiAlV and CoCrMo particles and in vitro after the stimulation of the cells. The results show that the CoCrMo particles induced ASC more markedly, as a readout for inflammasome formation in vivo, compared to TiAlV particular wear. The CoNiCrMo particles also induced ASC-speck formation in all the tested cell lines, which was not induced by the TiAlV particles. The Western blot shows that NRLP3 inflammasome activation, measured through caspase 1 cleavage, was increased only by the CoNiCrMo particles in the MG63 cells. We conclude from our data that the activation of the inflammasome is mainly driven by CoNiCrMo particles and less by TiAlV particles, indicating that different inflammatory pathways are activated by the different alloys.
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Affiliation(s)
- Fenna Brunken
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Tristan Senft
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Maria Herbster
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, 39120 Magdeburg, Germany
- Institute of Materials and Joining Technology, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Borna Relja
- Department of Experimental Radiology, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49-391-67-15804
| | - Christoph H. Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, 39120 Magdeburg, Germany
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Involvement of NF-κB/NLRP3 axis in the progression of aseptic loosening of total joint arthroplasties: a review of molecular mechanisms. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:757-767. [PMID: 35377011 DOI: 10.1007/s00210-022-02232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
Particulate wear debris can trigger pro-inflammatory bone resorption and result in aseptic loosening. This complication remains major postoperative discomforts and complications for patients who underwent total joint arthroplasty. Recent studies have indicated that wear debris-induced aseptic loosening is associated with the overproduction of pro-inflammatory cytokines. The activation of osteoclasts as a result of inflammatory responses is associated with osteolysis. Moreover, stimulation of inflammatory signaling pathways such as the NF-κB/NLRP3 axis results in the production of pro-inflammatory cytokines. In this review, we first summarized the potential inflammatory mechanisms of wear particle-induced peri-implant osteolysis. Then, the therapeutic approaches, e.g., biological inhibitors, herbal products, and stem cells or their derivatives, with the ability to suppress the inflammatory responses, mainly NF-κB/NLRP3 signaling pathways, were discussed. Based on the results, activation of macrophages following inflammatory stimuli, overproduction of pro-inflammatory cytokines, and subsequent differentiation of osteoclasts in the presence of wear particles lead to bone resorption. The activation of NF-κB/NLRP3 signaling pathways within the macrophages stimulates the production of pro-inflammatory cytokines, e.g., IL-1β, IL-6, and TNF-α. According to in vitro and in vivo studies, novel therapeutics significantly promoted osteogenesis, suppressed osteoclastogenesis, and diminished particle-mediated bone resorption. Conclusively, these findings offer that suppressing pro-inflammatory cytokines by regulating both NF-κB and NLRP3 inflammasome represents a novel approach to attenuate wear-particle-related osteolytic diseases.
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11
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Egloff C, Hirschmann MT, Moret C, Henle P, Ellenrieder M, Tischer T. [Total knee arthroplasty in the young patient-an update]. DER ORTHOPADE 2021; 50:395-401. [PMID: 33834286 PMCID: PMC8081686 DOI: 10.1007/s00132-021-04104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/01/2022]
Abstract
The absolute number of total knee arthroplasties (TKA) continues to rise every year. About 10% of the patients are less than 55 years of age, although it is known that functional results and patient satisfaction are lower combined with an increased likelihood of revision compared to older patients. Higher physical activity and patient expectations are a major challenge in this age group. At the same time, the incidence of posttraumatic/postoperative alterations is high, including ligamentous or bony deficiencies, which can make the surgical procedure challenging. In view of these facts conservative treatments and joint sparing procedures should always be considered first. The potential correction of lower-limb deformities and unicompartmental knee arthroplasties need to be carefully evaluated before considering total knee arthroplasty. Only in advanced cases of osteoarthritis in more than one compartment of the knee of with combined ligamentous instability, can a TKA provide satisfactory results in the young patient. However, the strongest predictor of satisfaction is a realistic expectation.
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Affiliation(s)
- Christian Egloff
- Department of Orthopaedic Surgery and Traumatology, University Hospital Basel, Spitalstrasse 21/Petersgraben 4, 4031, Basel, Schweiz.
- University of Basel, Basel, Schweiz.
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Schweiz
- University of Basel, Basel, Schweiz
| | - Céline Moret
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Schweiz
- University of Basel, Basel, Schweiz
| | | | - Martin Ellenrieder
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057, Rostock, Deutschland
| | - Thomas Tischer
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057, Rostock, Deutschland
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Erivan R, Jacquet C, Villatte G, Ollivier M, Paprosky W. Epidemiology of painful knee after total knee arthroplasty in a tertiary care center: Assessment by decision tree. Knee 2020; 27:1049-1056. [PMID: 32305235 DOI: 10.1016/j.knee.2020.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/18/2020] [Accepted: 03/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Painful knee after arthroplasty concerns up to 21% of patients at six months. We aimed to evaluate: the application of a decision tree to explain painful knee after total knee arthroplasty (TKA), the rate of unexplained pain after complete algorithmic screening. The aim of the study was to evaluate the causes of painful TKA. Our hypothesis was that it is possible to find the cause of the pain in more than 90% of cases. METHODS A single-center retrospective study analyzed all 1130 consultations between 1 April 2017 and 31 July 2018. We included all patients consulting for unexplained chronic painful knee arthroplasty. RESULTS We included 112 knees in 105 patients as unexplained painful knee arthroplasty. Final diagnostic status was no diagnosis in seven (6.3%) cases; infection in five (4.5%); instability without real dislocation in three (2.7%); placement error in two (1.8%), due to rotational problems; loosening in 25 (22.3%): 24 (21.4%) tibial and two (1.8%) femoral; polyethylene wear in nine (8.0%); periarticular pain in 37 (33.9%): 20 with quadriceps deficiency, four with iliotibial tendinitis, four with pes bursitis, six with stiffness, and three with prepatellar bursitis); zero material problems; projected pain in 21 (18.8%); and complex regional pain syndrome in three (2.7%) cases, improved by gentle physiotherapy. CONCLUSIONS The present study was original and presents the problem in the context of everyday practice, from the clinician's point of view, with an easy-to-use decision tree that can be implemented to assess painful knee in consultation.
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Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, Clermont-Ferrand, France.
| | - Christophe Jacquet
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille cedex 09, France; Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, Clermont-Ferrand, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille cedex 09, France; Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Wayne Paprosky
- Rush University, Chicago, IL, USA; Central DuPage Hospital, Northwestern University, Winfield, IL, USA
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13
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孙 茂, 杨 柳, 何 锐, 郝 朋, 孙 加. [Effect of three-dimensional printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:335-340. [PMID: 32174079 PMCID: PMC8171644 DOI: 10.7507/1002-1892.201907045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/17/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effect of three-dimensional (3D) printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty (TKA). METHODS Between January 2018 and October 2018, 60 patients (60 knees) with advanced knee osteoarthritis who received TKA and met the selection criteria were selected as the study subjects. Patients were randomly divided into two groups according to the random number table method, with 30 patients in each group. The TKA was done with the help of 3D printing guide plate in the guide group and following traditional procedure in the control group. There was no significant difference in gender, age, disease duration, side, and preoperative hip-knee-ankle angle (HKA), posterior condylar angle (PCA), patella transverse axis-femoral transepicondylar axis angle (PFA), Hospital for Special Surgery (HSS) score, and American Knee Society (AKS) score ( P>0.05). RESULTS All incisions healed by first intention and no complications related to the operation occurred. All patients were followed up 10-12 months, with an average of 11 months. HSS score and AKS score of the two groups at 6 months after operation were significantly higher than those before operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). Postoperative X-ray films showed that the prosthesis was in good position, and no prosthesis loosening or sinking occurred during follow-up. HKA, PCA, and PFA significantly improved in the two groups at 10 months after operation compared with those before operation ( P<0.05). There was no significant difference in HKA at 10 months between the two groups ( t=1.031, P=0.307). PCA and PFA in the guide group were smaller than those in the control group ( P<0.05). CONCLUSION Application of 3D printing guide plate in TKA can not only correct the deformity of the knee joint and alleviate the pain symptoms, but also achieve the goal of the accurate femoral rotation alignment and good patellar tracking.
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Affiliation(s)
- 茂淋 孙
- 陆军军医大学第一附属医院关节外科中心(重庆 400038)Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - 柳 杨
- 陆军军医大学第一附属医院关节外科中心(重庆 400038)Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - 锐 何
- 陆军军医大学第一附属医院关节外科中心(重庆 400038)Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - 朋 郝
- 陆军军医大学第一附属医院关节外科中心(重庆 400038)Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - 加伟 孙
- 陆军军医大学第一附属医院关节外科中心(重庆 400038)Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
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Sun ML, Zhang Y, Peng Y, Fu DJ, Fan HQ, He R. Accuracy of a Novel 3D-Printed Patient-Specific Intramedullary Guide to Control Femoral Component Rotation in Total Knee Arthroplasty. Orthop Surg 2020; 12:429-441. [PMID: 32087620 PMCID: PMC7189049 DOI: 10.1111/os.12619] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Total knee arthroplasty (TKA) is one of the most universal and effective means for treating terminal stage osteoarthritis (OA) of knee. Accurate intramedullary guide of femur is the basis for the distal femoral cuts. Determining the surgical transepicondylar axis (sTEA) is the key to reconstruction of the femoral rotational alignment, because the correct rotational alignment can place the femoral component in the right position, balance the flexion gap so that the inner and outer tension is equal, get stability during the flexion process of the knee, and enhance the quality of life of patients. With the development of three‐dimensional printing (3DP) technology in the medical domain, the application of patient‐specific instrumentation (PSI) in arthroplasty has become more common. The aim of this study was to evaluate the accuracy of a novel 3D‐printed patient‐specific intramedullary guide to control femoral component rotation in TKA. Methods Eighty patients (65 females and 15 males) with knee OA were included in this prospective randomized study. The patients were divided into two groups by random number table method, 40 in each group. TKA assisted by PSI (PSI group) and conventional TKA (conventional group) was performed respectively. Clinical outcomes [operation time, postoperative drainage volume, duration of drainage, Hospital for Special Surgery knee score (HSS), American Knee Society knee score (AKS)] and radiological outcomes [hip‐knee‐ankle angle (HKA), posterior condylar angle (PCA), patella transverse axis‐femoral transepicondylar axis angle (PFA), depth of intramedullary guide] were compared between and within the two groups. Results PSI group had less postoperative drainage volume but longer operation time than the conventional group (P < 0.05). The AKS and HSS scores after surgery were improved compared with those before surgery in each group (P < 0.05). However, there was no significant difference in the duration of drainage and range of motion (ROM) after surgery between the two groups. For the radiological results, the HKA and PFA were improved after surgery in both groups (P < 0.05).The postoperative PFA and PCA of the PSI group were closer to 0°, which was better than that of the conventional group (P < 0.05). The depth of intramedullary guide in the PSI group was less than the conventional group (P < 0.05). But there was no significant difference in HKA before and after surgery between the two groups as well as the preoperative PFA. Conclusion The short‐term clinical efficacy of TKA assisted by PSI was similar to the conventional TKA. Although TKA assisted by PSI spent more time during operation, it could assist in intramedullary guide and align femoral rotation more accurately.
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Affiliation(s)
- Mao-Lin Sun
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Peng
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - De-Jie Fu
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua-Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Rui He
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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