Background Treating developmental dysplasia of the hip is often challenging. The difficulties include not only the hip surgery itself but also the treatment of the associated lower-limb valgus deformity. However, ther...Background Treating developmental dysplasia of the hip is often challenging. The difficulties include not only the hip surgery itself but also the treatment of the associated lower-limb valgus deformity. However, there have been very few studies on such deformity in patients with developmental hip dysplasia. In this study, we investigated the prevalence and severity of lower-limb valgus deformity, along with the relationship between the severity of valgus deformity and mechanical alterations of the hip or the ipsilateral knee. Methods Two hundred and six affected lower limbs of 116 adult patients with untreated developmental dysplasia of the hip were included in the study, grouped according to the severity of hip dysplasia. Each study participant＇s radiographs were measured to quantitatively evaluate the mechanical axis deviation of the lower limb, and further to evaluate the prevalence and severity of the lower-limb valgus deformity. Some mechanical alterations of the hip and the ipsilateral knee were also measured on the radiographs. Results Of the affected lower limbs, 14.1% had valgus deformities. Study participants with Crowe type III hip dysplasia had the most severe deformity and the highest prevalence of deformity. Severity of valgus deformity had a strong positive correlation with the lateral migration of the femoral head but not with the superior migration. A decreased lateral distal femoral angle contributed to the lower-limb valgus deformity, and the lateral distal femoral angle had a strong negative correlation with the severity of valgus deformity. Conclusions Hip dysplasia is commonly associated with lower-limb valgus deformity, and the severity of the lower-limb valgus deformity is mostly affected by lateral migration but not superior migration of the femoral head. The valgus deformity may originate mainly in the distal femur, in addition to the hip joint itself. These findings can be taken into account when planning to treat the patients with hip dysplasia.展开更多
Total Knee Arthroplasty (TKA) is a procedure to replace the diseased or damaged knee joint with artificial prosthesis for the relief of disabling pain and restoring the function of knee. Total Knee Arthroplasty (TKA) ...Total Knee Arthroplasty (TKA) is a procedure to replace the diseased or damaged knee joint with artificial prosthesis for the relief of disabling pain and restoring the function of knee. Total Knee Arthroplasty (TKA) is one of the most common and successful procedures in modern orthopedics and is spreading through the world. Many surgeons are developing their skill but it needs experience and patience for successful outcomes. There are different factors which affect the outcome after total knee arthroplasty, among them;the coronal alignment of lower limb plays a major role. Many studies have supported that neutral mechanical alignment after total knee arthroplasty leads to better function. The aim of this review is to evaluate clinical outcome with reference to the coronal alignment of the limb and safety based on Western Ontario and McMaster Universities (WOMAC), Knee Society Score (KSS) score.展开更多
Introduction: Accurate postoperative alignment and implant positioning are determinant factors for successful total knee arthroplasty (TKA). Patient-specific template (PST) is a technique that uses computer technology...Introduction: Accurate postoperative alignment and implant positioning are determinant factors for successful total knee arthroplasty (TKA). Patient-specific template (PST) is a technique that uses computer technology for the planning, deigning and production of cutting guides. This study aims to compare PST to conventional technique in terms of mechanical axis alignment and component positioning. Patients and method: 109 TKA were performed for 78 patients in 2 groups. Group A included 69 conventional TKA in 55 patients and Group B included 40 patient-specific TKA in 23 patient. Postoperative long-film X-rays were done for all patients to observe the mechanical axis, anatomical axis, lateral distal femoral mechanical angle and medial proximal tibial angle. Results: No statistically significant difference was found between the two groups regarding alignment or component positioning. Conclusion: Both techniques have shown similar results in restoring the mechanical axis and alignment after TKA. However, PST had the advantages of reduced blood loss and shorter operative time.展开更多
<b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:""><span style="font-family:Verdana;"> To evaluate intraobserv...<b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:""><span style="font-family:Verdana;"> To evaluate intraobserver and interobserver reliability of the measurement of the mechanical axis of the lower limb by means of the panoramic radiograph of lower limbs by physicians with different levels of medical practice. </span><b><span style="font-family:Verdana;">Method:</span></b> </span><span style="font-family:Verdana;">A</span><span style="font-family:""><span style="font-family:Verdana;"> retrospective cross-sectional study with preoperative and postoperative radiographic analysis of a group of 100 patients submitted to total knee arthroplasty.</span><b><span style="font-family:Verdana;"> Results: </span></b></span><span style="font-family:Verdana;">I</span><span style="font-family:""><span style="font-family:Verdana;">t was observed that there is a highly significant intraobserver and interobserver agreement (p < 0.0001), both preoperatively and postoperatively, among four observers with different training levels. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The panoramic radiograph of the lower limbs is a reliable method for measuring the mechanical axis of the lower limb in patients submitted to total knee arthroplasty, regardless of the level of medical practice of the evaluator.展开更多
BACKGROUND Nearly 10%of patients undergoing primary total knee arthroplasty(TKA)have valgus deformity(VD)of the knee.For severe VD of the knee,a more lateral structural release is needed to achieve balance between med...BACKGROUND Nearly 10%of patients undergoing primary total knee arthroplasty(TKA)have valgus deformity(VD)of the knee.For severe VD of the knee,a more lateral structural release is needed to achieve balance between medial and lateral space and neutral femorotibial mechanical axis(FTMA),which is challenging and technical.AIM To introduce a new surgical technique of resection,soft tissue release,and FTMA for Ranawat type-Ⅱ VD with a 5-year follow-up.METHODS A retrospective study was conducted on patients who underwent TKA from December 2011 to December 2014.Hip-knee-ankle(HKA),range of motion(ROM),Oxford knee score(OKS),and knee society score(KSS)were used to assess the joint activity of patients in the new theory TKA group(NT-TKA)and were compared with those of the conventional TKA group(C-TKA).RESULTS A total of 103 people(103 knees)were included in this study,including 42 patients with an average follow-up period of 83 mo in the C-TKA group and 61 patients with an average follow-up period of 76 mo in the NT-TKA group.Six patients had constrained prosthesis,one had common peroneal nerve injury,and two had joint instability in the C-TKA group,but none of these occurred in the NT-TKA group.There were significant statistical differences in constrained prosthesis usage and complications between the groups(P=0.002 and P=0.034,respectively).The KSS at 1 mo post-operation for the C-TKA and NT-TKA groups were 11.2±3.8 and 13.3±2.9,respectively,with a significant difference(P=0.007).However,the data of HKA,ROM,OKS KSS,and prosthesis survival rate were insignificant(P>0.05)in both the preoperative and follow-up periods.CONCLUSION Adopting 5°-7°valgus cut angle for VD and sacrificing 2°neutral FTMA for severe VD which cannot be completely corrected during TKA can reduce the need for soft tissue release,maintain early joint stability,reduce the use of constrained prostheses,and minimize postoperative complications.展开更多
文摘Background Treating developmental dysplasia of the hip is often challenging. The difficulties include not only the hip surgery itself but also the treatment of the associated lower-limb valgus deformity. However, there have been very few studies on such deformity in patients with developmental hip dysplasia. In this study, we investigated the prevalence and severity of lower-limb valgus deformity, along with the relationship between the severity of valgus deformity and mechanical alterations of the hip or the ipsilateral knee. Methods Two hundred and six affected lower limbs of 116 adult patients with untreated developmental dysplasia of the hip were included in the study, grouped according to the severity of hip dysplasia. Each study participant＇s radiographs were measured to quantitatively evaluate the mechanical axis deviation of the lower limb, and further to evaluate the prevalence and severity of the lower-limb valgus deformity. Some mechanical alterations of the hip and the ipsilateral knee were also measured on the radiographs. Results Of the affected lower limbs, 14.1% had valgus deformities. Study participants with Crowe type III hip dysplasia had the most severe deformity and the highest prevalence of deformity. Severity of valgus deformity had a strong positive correlation with the lateral migration of the femoral head but not with the superior migration. A decreased lateral distal femoral angle contributed to the lower-limb valgus deformity, and the lateral distal femoral angle had a strong negative correlation with the severity of valgus deformity. Conclusions Hip dysplasia is commonly associated with lower-limb valgus deformity, and the severity of the lower-limb valgus deformity is mostly affected by lateral migration but not superior migration of the femoral head. The valgus deformity may originate mainly in the distal femur, in addition to the hip joint itself. These findings can be taken into account when planning to treat the patients with hip dysplasia.
文摘Total Knee Arthroplasty (TKA) is a procedure to replace the diseased or damaged knee joint with artificial prosthesis for the relief of disabling pain and restoring the function of knee. Total Knee Arthroplasty (TKA) is one of the most common and successful procedures in modern orthopedics and is spreading through the world. Many surgeons are developing their skill but it needs experience and patience for successful outcomes. There are different factors which affect the outcome after total knee arthroplasty, among them;the coronal alignment of lower limb plays a major role. Many studies have supported that neutral mechanical alignment after total knee arthroplasty leads to better function. The aim of this review is to evaluate clinical outcome with reference to the coronal alignment of the limb and safety based on Western Ontario and McMaster Universities (WOMAC), Knee Society Score (KSS) score.
文摘Introduction: Accurate postoperative alignment and implant positioning are determinant factors for successful total knee arthroplasty (TKA). Patient-specific template (PST) is a technique that uses computer technology for the planning, deigning and production of cutting guides. This study aims to compare PST to conventional technique in terms of mechanical axis alignment and component positioning. Patients and method: 109 TKA were performed for 78 patients in 2 groups. Group A included 69 conventional TKA in 55 patients and Group B included 40 patient-specific TKA in 23 patient. Postoperative long-film X-rays were done for all patients to observe the mechanical axis, anatomical axis, lateral distal femoral mechanical angle and medial proximal tibial angle. Results: No statistically significant difference was found between the two groups regarding alignment or component positioning. Conclusion: Both techniques have shown similar results in restoring the mechanical axis and alignment after TKA. However, PST had the advantages of reduced blood loss and shorter operative time.
文摘<b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:""><span style="font-family:Verdana;"> To evaluate intraobserver and interobserver reliability of the measurement of the mechanical axis of the lower limb by means of the panoramic radiograph of lower limbs by physicians with different levels of medical practice. </span><b><span style="font-family:Verdana;">Method:</span></b> </span><span style="font-family:Verdana;">A</span><span style="font-family:""><span style="font-family:Verdana;"> retrospective cross-sectional study with preoperative and postoperative radiographic analysis of a group of 100 patients submitted to total knee arthroplasty.</span><b><span style="font-family:Verdana;"> Results: </span></b></span><span style="font-family:Verdana;">I</span><span style="font-family:""><span style="font-family:Verdana;">t was observed that there is a highly significant intraobserver and interobserver agreement (p < 0.0001), both preoperatively and postoperatively, among four observers with different training levels. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The panoramic radiograph of the lower limbs is a reliable method for measuring the mechanical axis of the lower limb in patients submitted to total knee arthroplasty, regardless of the level of medical practice of the evaluator.
基金the Project of Excellent Young Talents of Traditional Chinese Medicine of Zhejiang Province,No.2019ZQ016the Zhejiang Medical and Health Science and Technology Young Talents Program,No.2019RC059.
文摘BACKGROUND Nearly 10%of patients undergoing primary total knee arthroplasty(TKA)have valgus deformity(VD)of the knee.For severe VD of the knee,a more lateral structural release is needed to achieve balance between medial and lateral space and neutral femorotibial mechanical axis(FTMA),which is challenging and technical.AIM To introduce a new surgical technique of resection,soft tissue release,and FTMA for Ranawat type-Ⅱ VD with a 5-year follow-up.METHODS A retrospective study was conducted on patients who underwent TKA from December 2011 to December 2014.Hip-knee-ankle(HKA),range of motion(ROM),Oxford knee score(OKS),and knee society score(KSS)were used to assess the joint activity of patients in the new theory TKA group(NT-TKA)and were compared with those of the conventional TKA group(C-TKA).RESULTS A total of 103 people(103 knees)were included in this study,including 42 patients with an average follow-up period of 83 mo in the C-TKA group and 61 patients with an average follow-up period of 76 mo in the NT-TKA group.Six patients had constrained prosthesis,one had common peroneal nerve injury,and two had joint instability in the C-TKA group,but none of these occurred in the NT-TKA group.There were significant statistical differences in constrained prosthesis usage and complications between the groups(P=0.002 and P=0.034,respectively).The KSS at 1 mo post-operation for the C-TKA and NT-TKA groups were 11.2±3.8 and 13.3±2.9,respectively,with a significant difference(P=0.007).However,the data of HKA,ROM,OKS KSS,and prosthesis survival rate were insignificant(P>0.05)in both the preoperative and follow-up periods.CONCLUSION Adopting 5°-7°valgus cut angle for VD and sacrificing 2°neutral FTMA for severe VD which cannot be completely corrected during TKA can reduce the need for soft tissue release,maintain early joint stability,reduce the use of constrained prostheses,and minimize postoperative complications.
