Unicompartmental knee arthroplasty is associated with lower proportions of surgical site infection compared with total knee arthroplasty: A retrospective nationwide database study

BackgroundThis study aimed to clarify the association between types of knee arthroplasty (KA) (total knee arthroplasty (TKA) or unicompatmental knee arthroplasty (UKA)) and surgical site infection (SSI) with adjustment for various factors, using a Japanese national database.MethodsData on 181,608 patients who underwent unilateral primary KA for osteoarthritis from 2010 to 2017 were obtained from the Japanese Diagnosis Procedure Combination database. SSI was identified based on International Classification of Diseases 10th Revision codes. Deep SSI (i.e. periprosthetic joint infection (PJI)) was identified as SSI treated with surgical procedures. Multivariable logistic regression analyses for SSI and PJI were performed, in which dependent variables included types of KA, patient backgrounds (sex, age, body mass index (BMI), smoking status, comorbidities), and seasonality.ResultsEight percent of analyzed patients underwent UKA, while 92% underwent TKA. The proportions of SSI and PJI after UKA were 0.9% and 0.3%, respectively, both of which were lower than those after TKA (1.9% and 0.6%) (P < 0.001). Multivariable analyses showed lower proportions of SSI for UKA (adjusted odds ratio, 0.47; 95% confidence interval, 0.37–0.60; P < 0.001) and PJI (adjusted odds ratio, 0.47; 95% confidence interval, 0.34–0.65; P < 0.001) than TKA. Other factors associated with both SSI and PJI included male sex, BMI >30 kg/m², renal dysfunction and summer season.ConclusionUKA was associated with lower proportions of SSI and PJI than TKA. Surgeons should carefully consider the indication of UKA before performing TKA, especially in patients with knee unicompartmental osteoarthritis who are at a high risk for SSI or PJI.     

Efficacy of antifungal-impregnated cement spacer against chronic fungal periprosthetic joint infections after total knee arthroplasty

Background

Although two-stage exchange arthroplasty is considered a treatment of choice for chronic features of fungal PJI (periprosthetic joint infection), there is no consensus for local use of antifungal agent. The purpose of this study was to evaluate the efficacy of antifungal-impregnated cement spacer (AICS).

旋转平台全膝置换术治疗治疗重症膝关节炎34例的临床观察

目的探讨旋转平台全膝置换治疗重症膝关节骨性关节炎的临床疗效。方法对2007年1月～2009年10月我院34例（41膝）人工旋转平台全膝置换术进行临床分析和总结,行HSS[5,6]膝关节评分系统进行分析。结果术后平均随访17个月（5～31个月）,手术前HSS（thehospitalforspecialsurgery）评分平均51分,手术后评分平均92分,手术优良率为91%。病人术后在膝关节疼痛,功能和活动度方面有明显改善。结论旋转平台全膝置换术对治疗重症膝关节炎有良好的疗效。     

单髁置换术与全膝关节置换术在治疗膝内侧单间室骨性关节炎术后早期关节遗忘度中的比较

目的 比较膝关节单髁置换术（unicompartmental knee arthroplasty, UKA）与全膝人工关节置换术（total knee arthroplasty, TKA）治疗膝内侧单间室骨性关节炎的早期膝关节功能评分与关节遗忘度评分,评价并分析两类术式在早期关节遗忘度评分方面的差异。方法 回顾性分析上海中医药大学附属光华医院关节外科2016年10月至2020年10月期间行全膝关节置换术及膝关节单髁置换术患者共296例,根据不同手术方式进行分组,其中TKA组共144例,UKA组共152例。出院后对患者术后1、3、6、12、24个月进行门诊复查,进行关节遗忘度评分、膝关节功能HSS评分、目测类比评分（VAS评分）。结果 (1)296例患者获得24～37个月的随访,平均随访（30.41±6.93）个月;(2)术后24个月TKA组与UKA组的HSS评分与VAS评分均明显好于术前,组内比较差异具有统计学意义（P<0.05）;(3)两组患者术后24个月膝关节VAS评分的改善程度差异无统计学意义（P>0.05）,UKA组的HSS评分改善程度好于TKA组,且差异有统计学意...     

Total knee arthroplasty with computer-assisted navigation more closely replicates normal knee biomechanics than conventional surgery

Background

Computer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated.

关节置换术后假体周围感染临床诊断与治疗的研究现状

目的:总结髋、膝关节置换术后假体周围感染(PJI)的临床诊断,以及保留假体清创术和翻修手术治疗PJI的研究现状。方法:在中国知网、万方数据、PubMed等中、英文数据库,以"假体周围感染""诊断""清创""再手术"以及"periprosthetic joint infection""diagnosi""debridem...     

Reduced postoperative morbidity in computer-navigated total knee arthroplasty: A retrospective comparison of 225,123 cases

BackgroundTotal knee arthroplasty (TKA) is one of the most common elective surgical procedures in the United States, with more than 650,000 performed annually. Computer navigation technology has recently been introduced to assist surgeons with planning, performing, and assessing TKA bone cuts. The aim of this study is to assess postoperative complication rates after TKA performed using computer navigation assistance versus conventional methods.MethodsThe American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for unilateral TKA cases from 2008 to 2016. The presence of the CPT modifier for use of computer navigation was used to separate cases of computer-navigated TKA from conventional TKA. Multivariate and propensity-matched logistic regression analyses were performed to control for demographics and comorbidities.ResultsThere were 225,123 TKA cases included; 219,880 were conventional TKA (97.7%) and 5,243 were navigated (2.3%). Propensity matching identified 4,811 case pairs. Analysis demonstrated no significant differences in operative time, length of stay, reoperation, or readmission, and no differences in rates of post-op mortality at 30 days postoperatively. Compared to conventional cases, navigated cases were at lower risk of serious medical morbidity (18% lower, p = 0.009) within the first 30 days postoperatively.ConclusionAfter controlling for multiple known risk factors, navigated TKA patients demonstrated lower risk for medical morbidity, predominantly driven by lower risk for blood transfusion. Given these findings, computer-navigation is a safe surgical technique in TKA.     

Mini-incision versus mini-incision and computer-assisted surgery in total knee replacement: a radiological prospective randomised study

The aim of this trial was to compare the radiological results of 74 patients undergoing a mini-invasive total knee replacement (TKR) using either a traditional alignment guide (MIS group) or a computer assisted alignment system (MICA group). All the patients were prospectively randomised to either group and the same implant was used for both groups. At 8 months post-operatively, the frontal femoral component angle (FFC), the frontal tibial component angle (FTC), the hip–knee–ankle angle (HKA) and the sagittal orientation of components (slopes) were evaluated respectively. The slopes of the femoral component and the FTC angle were statistically better aligned in the MICA group (p < 0.001). The MICA group showed both a significant fewer number of outliners and a significant higher number of implants with all five radiological parameters ideally aligned. The operative time was statistically longer in the computer assisted group.     

新型国产膝关节假体用于全膝关节置换术的临床研究

目的 通过随机对照临床试验,验证新型国产膝关节假体临床应用的安全性和有效性.方法 本研究采用多中心、随机、单盲、阳性平行对照设计,自2017年3月至2019年3月在全国6家医院共招募72例受试者,试验组和对照组各36例.试验组使用新型国产膝关节假体,对照组使用成熟的膝关节假体.所有受试者在术前和术后3个月、6个月、1年...     

Success rates,characteristics, and costs of articulating antibiotic spacers for total knee periprosthetic joint infection

Background

The optimal type, characteristics, and success rates of articulating antibiotic spacers used during total knee arthroplasty (TKA) periprosthetic joint infection (PJI) have not been well defined in a single series. We sought to (1) determine the success rate for three unique spacer constructs and (2) evaluate any microbiological, surgical, or patient characteristics that would influence the success rate.

Experience of total knee arthroplasty using a novel navigation system within the surgical field

Background

With the aim of improving component alignment and outcome in total knee arthroplasty (TKA), several computer-assisted devices (CAD) have been developed.

Patellofemoral arthroplasty conversion to total knee arthroplasty: Retrieval analysis and clinical correlation

Background

Patellofemoral arthroplasty (PFA) can be a successful, bone-sparing treatment for isolated patellofemoral arthritis. However, progression of tibio-femoral arthritis or incorrect indications may predispose patients to early conversion to total knee arthroplasty (TKA). The purpose of this study was to review the clinical cases and perform retrieval analysis of PFA conversions to TKA at our institution.

The incidence and impact of arthroscopy in the year prior to total knee arthroplasty

Background

Prior knee surgery and arthroscopy is known to increase complications and re-operations in subsequent total knee arthroplasty (TKA). We set out to examine the time dependant effect of arthroscopy on Patient Reported Outcome Measures following subsequent TKA.

Diagnosis of knee prosthetic joint infection; aspiration and biopsy

BackgroundProsthetic joint infection (PJI) is a significant cause of morbidity and mortality following knee replacement surgery. The diagnosis can be challenging and is based on a combination of clinical suspicion, radiographic findings and also biochemical/ microbiological investigations. Our Aim was to review the role of aspiration and biopsy in the diagnosis of PJI in Total Knee Arthroplasty (TKA).Method/resultsAspirated synovial fluid should be analysed by direct culture, via blood culture bottles, EDTA bottles for cell count and ‘point of care’ testing such as leucocyte esterase or alpha defensin. Synovial WCC and PMN cell percentage are important steps in diagnosis of both acute and chronic PJI. A minimum of 5 deep samples using a 5 clean instrument technique should be obtained and sent for tissue culture done either blind or arthroscopic. Formal fluoroscopic guided interface biopsy has also been described with excellent results. In a recent series of 86 TKRs preoperative arthroscopic biopsy group had a sensitivity of 100%, specificity of 94.7%, positive predictive value of 87.4% and a negative predictive value of 100%.ConclusionIn the presence of clinical suspicion with raised biomarkers, it is recommended that aspiration +/- biopsy with synovial fluid testing is performed. Direct culture and cell count are recommended. ‘Point of care tests’ such as Leucocyte Esterase testing should be considered. Duration of culture, including pathogen and host factors, should be discussed with a local microbiology/ID department in the context of a formal multi-disciplinary team.     

Navigation-based analysis of associations between intraoperative joint gap and mediolateral laxity in total knee arthroplasty

BackgroundNo data have demonstrated how joint gap measured under a distraction force is actually associated with mediolateral laxity evaluated under a varus–valgus force during total knee arthroplasty (TKA). This study aimed to investigate the correlations between them using a navigation system.MethodsA total of 113 primary navigated TKAs were included. After bone resection and soft-tissue balancing, the component gap was measured with a distraction force of 60 N and 80 N for both the medial and lateral compartment (i.e. a total of 120 N and 160 N) at 0°, 10°, 30°, 60°, 90°, and 120° knee flexion. After the final prosthetic implantation and capsule closure, mediolateral laxity under a maximum varus–valgus stress was recorded with image-free navigation at each knee flexion angle. The correlation between joint gap laxity (total differences between component gap and insert thickness in the medial and lateral compartment) and mediolateral laxity was analyzed using Spearman’s rank correlation coefficient.ResultsThe joint gap laxity under both distraction forces showed significant positive correlations with mediolateral laxity at 10°, 30°, 60°, and 90° flexion, whereas no correlation was observed at extension and 120° flexion. The correlations were stronger in gap measurement under 80 N than 60 N at all examined ranges. In patients with body mass indexes (BMIs) ≥ 30 kg/m², the correlation became non-significant.ConclusionIntraoperative joint gap laxity was associated with mediolateral laxity after TKA, especially at mid-flexion angles. The factors weakening the correlations were a lower applied distraction force for gap measurement and a larger BMI.     

Deluxe-ps膝关节假体在一期双膝关节置换过程中的应用

背景：Deluxe-PS型人工膝关节假体是根据中国人膝关节解剖特点尤其是股骨髁的形态特征而设计的,其膝关节假体股骨髁内外侧距(M-L)较进口假体少3.5 mm。 目的：探讨Deluxe-ps膝关节假体行一期双膝关节置换中的近期疗效。 方法：纳入使用Deluxe-ps型膝关节假体行一期双侧膝关节置换的膝关节炎患者15例(30膝)设为实验组,对照组为同期采用P.F.C.Sigma膝关节假体行一期双侧膝关节置换的20例患者(40膝)。采用KSS评分和关节功能HSS评分、膝关节关节活动度评估两组手术前、后膝关节功能,对比两组手术时间、及术中输血量。 结果与结论：两组患者置换后均得到12-24个月随访,平均16个月。置换后患者膝关节疼痛均缓解,关节功能恢复满意。两组膝关节置换后与置换前KSS评分、HSS评分及膝关节关节活动度比较,差异均有显著性意义(P < 0.05)。置换后,两组间KSS评分和HSS评分及膝关节关节活动度,差异均无显著性意义(P > 0.05),两组间置换过程中出血量比较,差异均无显著性意义(P > 0.05),手术时间比较,差异有显著性意义(P < 0.05)。说明采用Deluxe-ps膝关节假体行一期双膝关节置换近期疗效满意。     

Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis

Background

Utilization of unicompartmental knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) as alternatives to total knee arthroplasty (TKA) for unicompartmental knee osteoarthritis (OA) has increased. However, no single resource consolidates survivorship data between TKA and partial resurfacing options for each variant of unicompartmental OA. This meta-analysis compared survivorship between TKA and medial UKA (MUKA), lateral UKA (LUKA) and PFA using annual revision rate as a standardized metric.

关节局部注射罗哌卡因结合静脉PCA泵对全膝关节置换术后的镇痛研究

目的研究全膝关节置换术后关节周围注射罗哌卡因结合PCA泵的镇痛效果。方法选取择期行全膝关节置换手术患者90例,随机分为3组,每组30例（n=30）,第一组（A组）术后包括膝关节后关节囊和前侧切口周围组织浸润注射罗哌卡因,结合静脉PCA泵镇痛;第二组（B组）术后仅在前侧切口周围组织浸润注射罗哌卡因,而不注射后关节囊,结合静脉PCA泵镇痛。第三组（C组）术后仅采用静脉PCA泵镇痛。分别在术后2、12、24、48、72小时,以视觉模拟量表（visual analogue scale,VAS）评估患者术后的疼痛水平。结果术后2、12、24、48、72小时A、B、C组评分分别为2．0,2．1,4．9;2．7,2．6,5．5;3．5,3．4,4．6;2．4,2．5,3．8;1．4,1．4,2．8。A组和B组评分差异无统计学意义（P〉0．05）,A组和B组评分较C组差异有统计学意义（P〈0．05）。结论全膝关节置换术后应用罗哌卡因和静脉PCA泵能够有效缓解疼痛,后关节囊可不注射,镇痛效果优于单用PCA泵。     

Outcomes of cementless unicompartmental and total knee arthroplasty: A systematic review

Background

Aseptic loosening is a common failure mode in cemented unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This led to the development of cementless designs but the historical outcomes were poor. Recent developments in cementless designs have improved outcomes, but the current status is unknown. Therefore, a systematic review was performed to assess recent outcomes of cementless knee arthroplasty.

Fixed-bearing versus mobile-bearing total knee arthroplasty: a prospective randomised, clinical and radiological study with mid-term results at 7 years

Mobile-bearing (MB) total knee arthroplasty (TKA) was developed as an alternative to the established fixed-bearing (FB) design because of theoretical advantages. Short-term studies comparing these designs have not shown any differences in clinical and radiographic results. We compared the results at 7 years of a randomised study of patients undergoing TKA using either a FB or a MB variant of the same prosthesis. Fifty-two patients (52 knees) with an average age of 70 years received a FB posterior-stabilized prosthesis, and 50 patients (52 knees) with an average age of 72 years, a MB prosthesis. All implants were cemented and the patella was routinely resurfaced. Preoperatively, there were no differences between the two groups, and surgical procedure and postoperative protocol were the same for both. At an average follow-up of 7.1 years, no significant differences of FB over MB design could be demonstrated with respect to the American Knee Society score (AKSS), pain score, a questionnaire of general health (SF-12 score), range of motion (ROM), or complication rates. Radiographs showed no significant difference in prosthetic alignment or evidence of loosening. Two knees with a MB design required reoperation, one for persistent joint stiffness and another to treat septic loosening. One patient with a MB prosthesis with signs of tibial component loosening was asymptomatic. We conclude that at mid-term follow-up there is no evidence to prove the superiority of MB over FB TKA with regard to the clinical and radiographic results.