【Abstract】 Objective To study the influence of close-box and open-box knee prosthesis on postoperative bloodloss in patients undergoing total knee replacement(TKR). Methods From June 2005 to December 2006, 108 atients with primaryknee osteoarthritis were treated with TKR. Closed-box knee prosthesis was used in 54 patients (Group A), including unilateral(Group A1, n =27)and bilateral (Group A2, n =27). There were 7 males and 47 females, aged 41-76 years; and the diseasecourse was 4-16 years. Open-box knee prosthesis was used in 54 patients(Group B), including unilateral (Group B1, n =27)andbilateral(Group B2, n =27). There were 8 males and 46 females, aged from 59-81 years; and the disease course was 8-26 years. Thepostoperative blood loss and perioperative blood loss were compared between groups. Results The postoperative blood losswas (890±352), (1 694±528), (1 068±386) and(2 065±622) mL in groups A1, A2, B1 and B2, respectively. There was no significantdifference between groups A1 and B1(P gt; 0.05). There was significant difference between groups A2 and B2(P lt; 0.05). The totalblood loss was (1 095±329), (2 082±594), (1 274±415) and (2 459±734) mL in groups A1, A2, B1 and B2, respectively. Therewas no significant difference between groups A1 and B1(P gt; 0.05). There was significant difference between groups A2 and B2(P lt; 0.05). Conclusion Closed-box knee prosthesis may play roles on reducing postoperative blood loss. The main influentialfactor for postoperative blood loss is operation techniques which includes reducing operation time and stanching thoroughlyduring operation.
Objective To analyze the outcomes and complications after total knee replacement(TKR) with posterior stabilized prosthesis(PS) and to investigate the influencing factors relating to outcomes. Methods From January 1998 to August2004, 60 cases (74 knees) of osteoarthritis underwent TKR with PS. The outcomeswere evaluated according to the HSS(hospital for special surgery) scoring. The difference in outcomes between patients with post-operative complications and without complications were compared. Pearson correlation was used to analyze post-operative outcomes and the pre-operative factors relating to patients. Results All 74 knees werefollowed up 42.5months(24 to 94 months). The scores for HSS, pain, function, ROM muscle strength, flexion deformity and stability of knees after operation were 84.2±14.2, 25.7±6.9, 17.9±4.3,13.1±2.0，9.2±0.8，8.1±0.4 and 9.3±0.1 respectively. They were improved to some extents, especially pain alleviation was remarkable. The excellent and good rate for outcome assessment was 90.5%. Among 74 knees, 10 cases suffered from postoperative complications, including 1 case of common peroneal nerve paralysis, two cases of wound faulty union, one case of wound infection, one case of joint infection, one case of stiff knee, two cases of deep vein thrombosis and 2 cases of patellofemoral joint complications. The excellent and good rate of outcome in patients with complications(60%) was much lower than that in patients without complication(95.3％),and there was significant difference betweenthem (P＜0.05). Analysis for correlation showed that postoperative HSS score was positively correlative with the postoperative HSS score, pain and function score of knees. The correlation value was 0.523，0.431 and 0.418 respectively(Plt;0.01). Whereas, postoperative HSS score was not correlative with ROM, muscle strength, flexion deformity, stability of knee, age, weight andbody mass index(P＞0.05). Conclusion TKR with PS is an effective method for severe osteoarthritis. The outcomes after TKR have a positive correlation with the HSS score, pain and function score of knees before surgery. Complicationsassociating with surgery have a negative influence on outcomes.
Objective To overview the systematic reviews/meta-analyses of efficacy of FNB used as a postoperative analgesic technique among patients undergoing TKR. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP from inception to July, 2016. Two reviewers independently screened literature and extracted data. AMSTAR tool was used to assess the methodological quality of included studies. The primary outcome was pain scores and the consumption of opoid medicine to evaluate the effectiveness of FNB. Results A total of 16 systematic reviews/meta-analyses were included, involving the FNBvs. LIA, PMDI, EA, PCA and ACB, respectively. The results of quality assessment indicated medium scores with 3 to 9 scores. The overviews’ results showed that: at rest, FNB was not superior to LIA at 6h after TKR; it was superior to PMDI at 12h after TKR; it was also superior to PCA and LIA, but not superior to ACB at 24h after TKR. On movement, FNB was superior to PCA and LIA at 24h after TKR; it was also superior to PCA at 48h after TKR. As to the consumption of opoid medicine, the consumption in FNB group was more than LIA group at 12h after TKR. In addition, the consumption in FNB group was less than PCA and LIA at 24h after TKR, and it was also less than PCA and ACB at 48h. The satisfaction of patients who received FNB was better than ACB, EA and PCA. Conclusion The current overview shows that FNB is more effective than PCA and LIA, the patients’ satisfaction is better. Due to the limitations of the quantity and quality of included studies, the above conclusions are needed to be verified by more studies.
Objective To systematically review the efficacy of preoperative rehabilitation for patients with total knee replacement. Methods Electronic databases including The Cochrane Library, EMbase, PubMed, CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) about preoperative rehabilitation for total knee replacement from inception to January 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. Results A total of 13 RCTs involving 745 patients were included. The results of meta-analysis showed that, the TUG scores (6 weeks: MD=–1.31, 95%CI –2.29 to –0.32, P=0.009; 3 months: MD=–1.59, 95%CI –2.03 to –1.15, P<0.000 01), 3 months knee flexion ROM scores (MD=4.75, 95%CI 0.63 to 8.86, P=0.02) in the preoperative rehabilitation group were higher than those in the control group. The 3 months VAS scores (MD=–0.95, 95%CI –1.70 to –0.20, P=0.01) in the preoperative rehabilitation group was lower than that in the control group. There were no statistical differences between two groups in WOMAC scores (MD=–5.61, 95%CI –12.84 to 1.62, P=0.13), SF-36 scores (MD=13.15, 95%CI –10.51 to 36.81, P=0.28), knee extension ROM scores (6 weeks: MD=0.60, 95%CI –1.02 to 2.21, P=0.47; 3 months: MD=–2.76, 95%CI –8.45 to 2.92, P=0.34), HSS scores (MD=0.54, 95%CI –0.46 to 1.54, P=0.29), and 6 minutes test scores (MD=–8.75, 95%CI –51.53 to 34.03, P=0.69). Conclusion Current evidence shows that preoperative rehabilitation can improve the postoperative knee function after operation and significantly reduce the pain. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
In unicompartmental replacement surgery, there are a wide variety of commercially available unicompartmental prostheses, and the consistency of the contact surface between the common liner and the femoral prosthesis could impact the stress distribution in the knee after replacement in different ways. Medial tibial plateau fracture and liner dislocation are two common forms of failure after unicompartmental replacement. One of the reasons is the mismatch in the mounting position of the unicompartmental prosthesis in the knee joint, which may lead to failure. Therefore, this paper focuses on the influence of the shape of the contact surface between the liner and the femoral prosthesis and the mounting position of the unicompartmental prosthesis on the stress distribution in the knee joint after replacement. Firstly, a finite element model of the normal human knee joint was established, and the validity of the model was verified by both stress and displacement. Secondly, two different shapes of padded knee prosthesis models (type A and type B) were developed to simulate and analyze the stress distribution in the knee joint under single-leg stance with five internal or external rotation mounting positions of the two pads. The results showed that under a 1 kN axial load, the peak contact pressure of the liner, the peak ACL equivalent force, and the peak contact pressure of the lateral meniscus were smaller for type A than for type B. The liner displacement, peak contact pressure of the liner, peak tibial equivalent force, and peak ACL equivalent force were the smallest for type A at 3° of internal rotation in all five internal or external rotation mounting positions. For unicompartmental replacement, it is recommended that the choice of type A or type B liner for prosthetic internal rotation up to 6° should be combined with other factors of the patient for comprehensive analysis. In conclusion, the results of this paper may reduce the risk of liner dislocation and medial tibial plateau fracture after unicompartmental replacement, providing a biomechanical reference for unicompartmental prosthesis design.
Objective To systematically review the incidence and risk factors of postoperative urinary retention (POUR) in patients undergoing hip or knee arthroplasty, and provide a theoretical basis for medical staff to assess and identify high-risk groups in advance. Methods PubMed, Embase, the Cochrane Library, Medline, China National Knowledge Infrastructure, Wanfang Data, VIP database, and SinoMed were electronically searched from the establishment of the databases to January 2023, for literature on the incidence and risk factors of POUR in patients undergoing hip or knee arthroplasty. Two researchers independently screened studies, extracted data, and assessed study quality. Meta-analysis was performed using Stata 14.0 software. Results A total of 21 articles were included, including 9041 patients undergoing hip or knee arthroplasty. The results of meta-analysis showed that the incidence of POUR in patients undergoing hip or knee arthroplasty was 26% [95% confidence interval (CI) (19%, 32%)]. Age [odds ratio (OR)=1.03, 95%CI (1.00, 1.05), P=0.03], male [OR=2.68, 95%CI (1.72, 4.18), P<0.001], infusion volume [OR=2.17, 95%CI (1.08, 4.35), P=0.030], spinal anesthesia [OR=1.72, 95%CI (1.29, 2.30), P<0.001], history of urinary retention/urethral stricture [OR=1.84, 95%CI (1.35, 2.49), P<0.001], use of analgesic pump [OR=4.73, 95%CI (2.29, 9.78), P<0.001], use of glycopyrronium bromide [OR=2.79, 95%CI (1.53, 5.11), P=0.001] were risk factors for POUR in patients undergoing hip or knee arthroplasty. Conclusions The incidence of POUR in patients undergoing hip or knee arthroplasty is relatively high. Age, male, infusion volume, spinal anesthesia, history of urinary retention/urethral stenosis, use of analgesia pump, and use of glycopyrronium bromide are causes of POUR. It is suggested that medical staff should identify the risk of related factors and take early intervention to reduce the occurrence of POUR.