Hospital For Special Surgery Score Research Articles

Comparative study between isolated medial meniscus root repair versus open-wedge high tibial osteotomy versus combined approach in patients with root tears, 2-year follow-up

Background Medial meniscus root tears usually lead to loss of hoop tension of the meniscus and result in high-contact pressure in the medial compartment of the knee. Surgical management of those types of tears is mandatory to restore hope tension and to save medial compartment. This study was done to evaluate the necessity of medial root repair with high tibial osteotomy (HTO) for treatment of medial meniscus root tears. Patients and methods This is a prospective comparative study over 60 patients with medial meniscal root tears. The patients were classified randomly into three groups. The first group (group A) was treated with isolated medial meniscus posterior root tear repair (n=20). The second group (group B) was treated with isolated open-wedge high HTO (n=20). The third group (group C) was treated using combined medial meniscal root repair with high tibial open-wedge osteotomy (n=20). A clinical evaluation was made using range of motion (ROM) and pain assessment. Functional evaluation was done using Lysholm score and Hospital for Special Surgery score. Radiological evaluation was done using follow-up standing Lyon–Schuss films. Results Regarding the patients’ reported outcome measures, one-way analysis of variance was calculated to compare means between the three groups. The results of isolated root repair were the worst and there was no statistically significant difference between groups B and C. Conclusion Results recommend isolated HTO as a solo fast-attack procedure with reliable durable clinical and radiological outcomes for the treatment of root tears of the posterior horn of the medial meniscus.

The effect of platelet rich plasma combined with celecoxib on knee function and pain in patients with knee osteoarthritis.

Objectives:To analyze the immediate effect of platelet rich plasma, combined with celecoxib, on knee function and pain in patients with knee osteoarthritis.Methods:The clinical data of 86 patients with knee osteoarthritis, treated in our hospital from January 2019 to January 2021, were analyzed retrospectively. According to the treatment records, patients were divided into a control group (n = 43, celecoxib) and a treatment group (n = 43, platelet rich plasma + celecoxib). The knee function, pain and clinical effect in the two groups were compared and analyzed using the Hospital for Special Surgery (HSS) knee score and the visual analog scale (VAS).Results:The treatment group had a higher HSS score, and a lower VAS score compared to the control group (P<0.05). The clinical efficacy in the treatment group was higher than that in the control group (95.35% and 72.09% respectively, P<0.05).Conclusions:Platelet rich plasma combined with celecoxib can promote the recovery of knee function and reduce pain in patients with knee osteoarthritis. This treatment combination also has a high immediate clinical effectiveness but needs further evaluation to find out the long term effects.

A Comparison Between Unstemmed and Stemmed Constrained Condylar Knee Prostheses in Primary Total Knee Arthroplasty: A Propensity Score-Matched Analysis.

ObjectiveTo compare and analyze the clinical outcomes between unstemmed and stemmed constrained condylar knees (CCK) in complex primary total knee arthroplasty (TKA) in terms of implant survivorship, change in outcome evaluations, and complications.MethodsWe reviewed 156 consecutive patients who received primary TKA using PFC®SIGMA®TC3 (TC3) of constrained condylar design between January 2009 and January 2017 at our institution. After removing patients who met exclusion criteria, 25 patients were identified as unstemmed TC3 cases and 81 as stemmed TC3 cases. Propensity score matching was used to select 25 stemmed cases as a control group for the unstemmed group with comparable preoperative conditions including preoperative demographics, preoperative diagnosis, preoperative range of motion, main reason to use TC3, ASA score (American Society of Anesthesiologists), and follow‐up duration. Preoperative and postoperative clinical evaluations including Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, the 12‐Item Short‐Form Health Survey (SF‐12), and the range of motion (ROM) were obtained and compared. The instability, periprosthetic fracture, radiolucent lines, polyethylene wear, and heterotrophic ossification were assessed according to the anteroposterior and lateral radiographs of the knee. The complications and implant survivorship between the two groups were also recorded and compared.Results3After the index surgery, both groups showed substantial improvement in KSS (knee and function), HSS score, SF‐12, and ROM compared with baseline. There was no significant difference in the mean KSS scores (knee and function), HSS score, SF‐12, and ROM between the unstemmed and stemmed group postoperatively. No statistically significant difference was found in the overall complication rate between the two groups. The overall Kaplan–Meier survivorship was 98.0% (95% confidence interval 94.1%–100.0%) at 7 years. No significant difference was found in the survival rate between the unstemmed group (100.0%) and the stemmed group (96.0%) at 7 years (log rank, P = 0.317). The mean duration of follow‐up was 7.0 years for unstemmed group and 7.7 years for stemmed group.ConclusionsIn patients with adequate bone stock receiving complex primary TKA, unstemmed CCK could achieve similar clinical outcomes at mid‐term follow‐up as stemmed CCK.

Functional outcome of judet’s quadriceptoplasty in posttraumatic stiff knees.

Objective: To evaluate functional outcomes of Judet’s Quadriceptoplasty in posttraumatic stiff knees according to Judet’s criteria and Hospital for special surgery score of knee. Study Design: Retrospective Cohort Study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan. Period: January 2015 to June 2017. Material &amp; Methods: 74 patients 61 males and 13 femal with stiff knees underwent Judet’s Quadriceptoplasty and followed by 12 weeks of aggressive rehabilitation and followed by aggressive rehabilitation for 12 weeks. Range of motion was measured with goniometer at last follow up. Outcomes were measured in terms of Judet’s criteria and Hospital for special surgery score of the knee. Results: Mean age at time of operation was 33.70±10.66 years. According to Judet’s criteria 68.9% (51) patients have excellent range of motion, 21.6% (16) have Good, 6.8% (5) patients have fair, 2.7% (2) have poor outcome. According to Hospital for special surgery score of the knee (HSS) mean score was 86.68±5.92 (60-96). There were 83.8% (62), 13.5% (10) and 2.7% (2) cases in excellent, good and fair group respectively. Blood loss was minimum 250ml max 650ml mean 443ml. Conclusion: Judet’s quadriceptoplasty for knee extension contracture is a useful procedure to increase the range of motion of stiff knees.

Use of a suspended and straightened knee joint position when fixing steel plates can prevent the increase in postoperative posterior tibial slope after open\u2011wedge high tibial osteotomy

BackgroundPosterior tibial slope (PTS) increases after medial open-wedge high tibial osteotomy (OWHTO) is challenging for patients. This study aims to determine whether use of a suspended and straightened knee joint position during the fixing of steel plates can prevent an increase in the PTS after OWHTO.MethodsThis study retrospectively analyzed 112 subjects (122 knees) [34 males, 78 females; mean age 59.1 ± 6.6 (range 48–76) years; mean body mass index 28.06 ± 3.61 kg/m2] who underwent OWHTO. A total of 78 knees that were suspended and extended by placing a sterile cloth ball under the ipsilateral ankle during the fixing of steel plates comprised the suspended and straightened knee joint position (SSP) group, and 44 knees that were kept naturally straightened without placing a sterile cloth ball under the ipsilateral ankle during the fixing of steel plates comprised the naturally straightened knee joint position (NSP) group. Patients were clinically assessed according to the visual analog pain scale (VAS), the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, the Knee Society Scores (KSS) knee and function scores, the Hospital for Special Surgery (HSS) knee scores and the Lysholm knee scores. Radiological assessment was performed according to the changes in the PTS between preoperation, 1-day postoperation, and the final follow-up periods. Ultimately, the difference in postoperative PTS changes between the two groups was statistically analyzed. The median follow-up period was 2.2 years (range 1.6–3.7 years).ResultsIn the final follow-up period, significant improvements were observed in the clinical VAS scores, WOMAC scores, KSS knee and function scores, HSS scores and the Lysholm knee scores in both groups (P < 0.001), and no difference was found between the two groups. Radiological assessment showed that there was no statistical difference in the preoperative PTS between the two groups. The 1-day postoperative PTS and the most recent follow-up PTS were significantly greater than the preoperative PTS in the NSP group (t = − 3.213, − 6.406, all P < 0.001), but no significant increase was seen in the SSP group (P > 0.05). The increase in PTS in the NSP group was significantly greater than that in the SSP group at the 1-day postoperative (t = 2.243, P = 0.030) and final follow-up periods (t = 6.501, P < 0.001).ConclusionsFor OWHTO, the use of a suspended and straightened knee joint position rather than a naturally straightened knee joint position during the fixing of steel plates could effectively prevent the increase in postoperative PTS.Level of Evidence: Retrospective Study Level III.

Comparison of two osteotomies in the treatment of medial compartment osteoarthritis

To compare the effectiveness of modified distal tibial tubercle-high tibial osteotomy (DTT-HTO) and open-wedge HTO (OWHTO) in the treatment of medial compartment osteoarthritis. A clinical data of 80 patients with medial compartment osteoarthritis treated with HTO between January 2016 and January 2019 was retrospectively analyzed, including 40 patients treated with DTT-HTO (DTT-HTO group) and 40 patients treated with OWHTO (OWHTO group). There was no significant difference in gender, age, body mass index, affected side, disease duration, Kellgren-Lawrence grading of osteoarthritis, and preoperative knee society score (KSS), Hospital for Special Surgery (HSS) score, knee joint visual analogue scale (VAS) score, hip-knee-ankle angle (HKA), posterior tibial slope (PTS), weight-bearing line ratio (WBL), Blackburne-Peel index (BPI), Caton-Deschamps index (CDI), and Insall-Salvati index (ISI) between the two groups ( P>0.05). The operation time, incision length, bleeding volume, hospital stay, and complications in both groups were recorded. The KSS, HSS, and VAS scores were used to evaluated the effectiveness. A self-made questionnaire was used to evaluate the recovery of low-impact sports ability of the knee. X-ray films were used to observe the osteotomy healing and measure the HKA, PTS, WBL, and the patellar height indexes (BPI, CDI, ISI). All operations successfully completed in both groups. The OWHTO group operated longer than the DTT-HTO group ( P<0.05). There was no significant difference in the incision length, bleeding volume, and hospital stay between the two groups ( P>0.05). All incisions healed by first intention in both groups. There were 2 cases of lateral hinge fractures in the OWHTO group, and 1 case of lateral hinge fracture and 2 cases of tibial plateau fractures in the DTT-HTO group. No other complications occurred. The patients in both groups were followed up 2-4 years with an average of 2.8 years. The HSS, KSS, and VAS scores in both groups significantly improved after operation when compared with preoperative scores ( P<0.05). All scores gradually improved with the time and there were significant differences between different time points ( P<0.05). The HSS, KSS, and VAS scores were significantly better in the DTT-HTO group than in the OWHTO group at 3 months after operation ( P<0.05). There was no significant difference between the two groups at 6 months, 1 year, and 2 years ( P>0.05). At 1 year, the low-impact sports ability of the OWHTO group was rated as excellent in 8 cases, general in 25 cases, and poor in 7 cases, and as excellent in 7 cases, general in 26 cases, and poor in 7 cases of the DTT-HTO group. There was no significant difference between the two groups ( Z=-0.715, P=0.475). X-ray film reexamination showed that the osteotomies healed in both groups. The healing time was (4.52±1.23) months in the OWHTO group, and (4.23±1.56) months in the DTT-HTO group, showing no significant difference ( t=0.923, P=0.359). At immediate after operation, the HKA and WBL of the two groups significantly improved when compared with the preoperative values ( P<0.05). However, the pre- and post-operational difference was not significant between the two groups ( P>0.05). The PTS of the OWHTO group was significantly higher than preoperative value ( P<0.05), while the PTS of the DTT-HTO group was lower than preoperative value ( P>0.05). The pre- and post-operational difference between the two groups was significant ( P<0.05). BPI and CDI in the OWHTO group were significantly lower than preoperative values ( P<0.05), but there was no significant difference in ISI when compared with preoperative value ( P>0.05). There was no significant difference in the BPI, CDI, and ISI of the DTT-HTO group between pre- and post-operation ( P>0.05). The pre- and post-operational differences of BPI and CDI between the two groups were significant ( P<0.05), and there was no significant difference in the pre- and post-operational difference of ISI ( P>0.05). The two osteotomies in the treatment of medial compartment osteoarthritis can significantly change the varus deformity and achieve satisfactory effectiveness. The early functional recovery of DTT-HTO is faster, which can avoid the increased PTS and patellar baja of traditional OWHTO. However, neither of the two surgical procedures can restore the patient's ideal low-impact sports ability of the knee.

Degree of coronal alignment correction can\u2019t predict knee function in total knee replacement

BackgroundWhether neutral alignment brings better clinical outcomes is controversial. Consideration of the preoperative knee condition of patients and some limitations of previous studies, we suggested that other index may be more important than a generic target of 0° ± 3° of a neutral axis to reflect changes in coronal alignment after total knee replacement (TKR). The purpose of this study was to explore the relationship between alignment and functional outcome with a new grouping method and the concept of correction rate.MethodsThe study included 358 knees, the mean follow-up period was 3.62 years. A new grouping method was adopted to divide patients into three groups based on the degree of correction of mechanical femoral—tibial angle (MFTA): under-correction (n = 128), neutral (n = 209) and over-correction (n = 21). Hospital for Special Surgery (HSS) score were compared among the 3 groups (ANOVA with or without LSD t-test). In addition, we also attempt to further explore whether the concept of correction rate can predict postoperative functional score (Simple linear correlation analysis).ResultsHSS score showed significant improvement in all groups. There was no difference in HSS score (88.27 vs 88 vs 85.62) (p = 0.88) or incremental scores (26.23 vs 25.22 vs 22.88) (p = 0.25) based on the postoperative alignment category for the degree of correction of MFTA at the last follow-up. The correlational analyses also didn’t show any positive results (r = -0.01 p = 0.95, r = -0.01 p = 0.97, r = 0.11 p = 0.15, r = 0.01 p = 0.90).ConclusionCategorization of optimal coronal alignment after TKR may be impractical. But we still believe that the concept of correction rate and new grouping method are worthy of research which can reflects the preoperative knee condition and the change of coronal alignment. Perhaps it can be better used in TKR in the future.Level of evidence: III.

Three-dimensional surgical planning and clinical evaluation of the efficacy of distal tibial tuberosity high tibial osteotomy in obese patients with varus knee osteoarthritis

PurposeHigh tibial osteotomy (HTO) is an effective surgical treatment for varus knee osteoarthritis. However, obese patients require reinforced internal fixation materials to prevent internal fixation fractures and hardware failure after osteotomy. Therefore, the purpose of our study is to evaluate the clinical efficacy of distal tibial tuberosity high tibial osteotomy (DTT-HTO) using the new patented π-shaped plate in obese patients with varus knee osteoarthritis. MethodThirty-four obese patients (39 knees) with varus knee osteoarthritis who underwent DTT-HTO with the π-shaped plate and second-look arthroscopy when implant removal occurred from September 2017 to June 2020 were retrospectively reviewed. Three-dimensional surgical planning using DTT-HTO on the knees is performed. There were 9 males and 25 females, with body mass index (BMI) values ranging from 30.3 to 38.5 kg/m2 and ages ranging from 50 to 75 years old. The radiological assessment was performed with the femora tibial angle (FTA) and the weight-bearing line ratio (WBLR). The clinical outcomes were evaluated by the Hospital for Special Surgery (HSS) knee score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The status of the cartilage was evaluated by the International Cartilage Repair Society (ICRS) grading system. ResultsAll patients were followed up for 18-30 months. The FTA significantly changed from 181.68±1.68.preoperatively to171.29±1.51.at the last follow-up (P<0.001). The WBLR significantly increased from 16.85±2.20 to 55.41±2.46% from before surgery to the last follow-up after surgery (P<0.001). The HSS score significantly improved from 56.65±5.27 preoperatively to 68.79±2.61, 77.82±2.15, and 86.12±2.78 at the 6-month, 12-month, and last follow-up after surgery (P<0.001). The WOMAC score significantly decreased from 105.47±3.89 preoperatively to 80.50±4.20, 71.44±4.65, and 52.44±3.14 at the 6-month, 12-month, and last follow-up after surgery (P<0.001). During implant removal, no internal fixation fractures occurred in any patient. The articular cartilage grade in the medial compartment of the knee were significantly higher in the second arthroscopy than in the first arthroscopy, according to the ICRS grading system (P<0.001). The articular cartilage grade in the lateral compartment of the knee showed no statistical differences from the first- to the second-look arthroscopy (P>0.05). ConclusionThere are no correlation between BMI and postoperative outcomes. DTT-HTO shows yield excellent clinical results in obese patients with varus knee osteoarthritis. It can be recommended to be used for the heavy patients.

Early effectiveness of computer navigation-assisted total knee arthroplasty

To estimate the early effectivenss of computer navigation-assisted total knee arthroplasty (TKA) by comparing with traditional TKA. The clinical data of 89 patients (100 knees) underwent primary TKA between October 2017 and July 2018 were analyzed retrospectively, including 44 patients (50 knees) who completed the TKA under the computer-assisted navigation system as the navigation group and 45 patients (50 knees) treated with traditional TKA as the control group. There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, diagnosis, side, disease duration, Kellgren-Lawrence classification of osteoarthritis, and preoperative American Hospital for Special Surgery (HSS) score, range of motion (ROM), hip-knee-ankle angle (HKA) deviation. The operation time, incision length, difference in hemoglobin before and after operation, postoperative hospital stay, and the complications were recorded and compared between the two groups. The HSS score, ROM, and joint forgetting score (FJS-12) were used to evaluate knee joint function in all patients. Unilateral patients also underwent postoperative time of up and go test and short physical performance battery (SPPB) test. At 1 day after operation, the HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), and sagittal tibial component angle (sTCA) were measured and calculated the difference between the above index and the target value (deviation); and the joint line convergence angle (JLCA) was also measured. The operations of the two groups were successfully completed, and the incisions healed by first intention. The operation time and incision length of the navigation group were longer than those of the control group ( P<0.05); the difference in difference of hemoglobin before and after the operation and the postoperative hospital stay between groups was not significant ( P>0.05). Patients in the two groups were followed up 27-40 months, with an average of 33.6 months. Posterior tibial vein thrombosis occurred in 1 case in each of the two groups, and 1 case in the control group experienced repeated knee joint swelling. The HSS scores of the two groups gradually increased after operation ( P<0.05); HSS scores in the navigation group at 1 and 2 years after operation, and knee ROM and FJS-12 scores at 2 years were significantly higher than those in the control group ( P<0.05). There was no significant difference in the postoperative time of up and go test and SPPB results between the two groups at 7 days after operation ( P>0.05); the postoperative time of up and go test of the navigation group was shorter than that of the control group at 2 years ( t=-2.226, P=0.029), but there was no significant difference in SPPB ( t=0.429, P=0.669). X-ray film measurement at 1 day after operation showed that the deviation of HKA after TKA in the navigation group was smaller than that of the control group ( t=-7.392, P=0.000); among them, the HKA deviations of 50 knees (100%) in the navigation group and 36 knees (72%) in the control group were less than 3°, showing significant difference between the two groups ( χ 2=16.279, P=0.000). The JLCA and the deviations of mLDFA, mMPTA, sFCA, and sTCA in the navigation group were smaller than those in the control group ( P<0.05). Compared with traditional TKA, computer navigation-assisted TKA can obtain more accurate prosthesis implantation position and lower limb force line and better early effectiveness. But there is a certain learning curve, and the operation time and incision length would be extended in the early stage of technology application.

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

BackgroundEnhanced recovery after surgery (ERAS) protocols were rapidly adopted in many surgeries such as fast-track arthroplasty. The study aimed to investigate the impact of ERAS protocols on the clinical effect of total knee arthroplasty (TKA) via the midvastus approach.MethodsA total of 69 patients who underwent primary unilateral TKA via the midvastus approach from October 2018 to June 2019 were enrolled and randomly divided into two groups: ERAS group and Control group. The ERAS protocols were adopted for the ERAS group and consisted of pure juice drinking 2 h before the surgery, optimization of the preoperative anesthesia plan, phased use of tourniquets, and the use of tranexamic acid as well as a drug cocktail. The operative time, first postoperative walking time, first straight leg elevation time, postoperative hospitalization time, visual analogue scale score (VAS score), Hospital for Special Surgery score (HSS score), conventional Knee Society score (KSS), and knee range of motion (ROM) were used to assess the clinical effects in the two groups. All the included patients were followed up for 12 months.ResultsThere were no significant differences in the basic demographic information and operation time between the ERAS and Control groups (P > 0.05). The first postoperative walking time (2.11 ± 0.11 h) and first postoperative straight leg elevation time (6.14 ± 1.73 h) in the ERAS group were significantly earlier than those in the Control group (P < 0.001) and the postoperative hospitalization time was significantly shorter (3.11 ± 0.32 days). The postoperative mean VAS scores in both groups were significantly reduced compared with those before surgery (P < 0.001). The VAS scores for the ERAS group were significantly lower than those for the Control group at 1, 2, and 7 days after surgery (P < 0.001). The mean HSS scores, KSS, and knee ROM were significantly increased in both the ERAS and Control groups at 1, 3, 6, and 12 months after surgery (P < 0.001). In addition, the HSS scores, KSS, and knee ROM in the ERAS group were significantly higher than those in the Control group at 1 month after surgery (P < 0.001).ConclusionsERAS protocols improved the clinical effects of TKA via the midvastus approach, facilitating early out-of-bed activity and comfortable postoperative rehabilitation exercise, and further increasing patient satisfaction.Trial registrationClinicalTrials.gov Identifier: NCT04873544.

Excellent outcomes with Oxford Uni-compartmental knee arthroplasty in anteromedial osteoarthritis patients (\u226460 years) at mid-term follow-up

BackgroundThe use of Oxford uni-compartmental knee arthroplasty (UKA) has rapidly increased worldwide,however,the relevance of younger patients for postoperative function after Oxford UKA remains unclear. The main purpose of our study is to clarify the effectivemess of Oxford UKA in the younger Chinese patients with anteromedial osteoarthritis (AMOA).MethodsWe retrospectively enrolled 252 consecutive patients who underwent Oxford UKA for AMOA with a minimum follow-up of 5 years between March 2013 and December 2016. The patients were divided into the younger (≤60 years) and elderly (> 60 years) age groups. The demographic data and surgery variables were recorded and compared. Patient satisfaction grade, range of motion (ROM), Oxford knee score (OKS), Hospital for Special Surgery (HSS) score, Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index score and postoperative complications were recorded. The 5-year survival of the implants were also compared with TKA revision as the endpoint.ResultsA total of 252 consecutive patients were recruited, including 96 aged 60 years or less and 156 aged over 60 years. The mean follow-up duration in the younger and elderly groups were 73.6 months (SD,standard deviation, 4.1) and 74.7 months (SD 6.2) respectively. Patient satisfaction rate was high in both groups (P = 0.805). Furthermore, no significant differences were observed in postoperative ROM(P = 0.299), OKS(P = 0.117), HSS(P = 0.357) and WOMAC scores(P = 0.151) between the younger and elderly groups (P>0.05). However, the incidence of joint stiffness (P = 0.033) and delayed wound dehiscence (P = 0.026) were significantly different between both groups. Five-year implant survival without revision were also similar in both groups (96.9% vs 97.4%, P = 0.871), and that for the entire cohort was 97.2% (95% CI 95.4–99.6).ConclusionOxford UKA for AMOA demonstrated favorable results in younger patients aged ≤60 years at a minimum 5-year follow-up in terms of patient satisfaction, functional outcomes, implant survival and postoperative complications. Therefore, younger patients might not be considered as an absolute contraindication to Oxford UKA.

Insufficient Correction and Preoperative Medial Tightness Increases the Risk of Varus Recurrence in Open-Wedge High Tibial Osteotomy

To assess serial changes of limb alignment after open wedge high tibial osteotomy (HTO) using the weightbearing line (WBL) ratio in the midterm, with a focus on varus recurrence. Patients undergoing open wedge HTO from January 2010 to December 2016 were retrospectively reviewed. Those without serial postoperative weightbearing long-leg alignment films, those who showed remained varus alignment after osteotomy, and those who had <2 years of follow-up were excluded. In terms of immediate postoperative limb alignment (≤3 months) measured using WBL ratio, cases were categorized into 4 groups: <50%, undercorrection; 50% to 57%, insufficient correction; 57% to 67%, planned correction; and >67%, overcorrection. To determine risk factors for varus recurrence (WBL ratio <50%), immediate postoperative WBL ratio category and preoperative valgus and varus stress angles (which represent medial and lateral tightness of the joint, respectively) were investigated using logistic regression analysis, taking other related factors into account. Clinical outcomes according to varus recurrence were measured using Hospital for Special Surgery (HSS) scores. A total of 148 cases were included. Varus recurrence was noted in 40 cases (27.0%), with a mean follow-up of 49.7 ± 21.8 months (range 24 to 102 months). The incidence of varus recurrence was different according to WBL ratio category: 10/10 (100.0%) in undercorrection; 16/33 (48.5%) in insufficient correction; 13/58 (22.4%) in planned correction; and 1/47 (2.1%) in overcorrection. Based on logistic regression analysis, insufficient correction and preoperative valgus stress angle were found to be significant risk factors (P= .038, and .008, respectively). With valgus stress angle <2°, 7 of 10 insufficient correction cases showed varus recurrence (P= .005). However, HSS scores did not differ according to varus recurrence (P= .363). Insufficient correction and preoperative medial tightness increased the risk of varus recurrence. Especially in cases where preoperative valgus stress angle was <2°, insufficient correction was strongly associated with varus recurrence. However, no significant differences in clinical outcomes were observed according to varus recurrence in the midterm. III, retrospective cohort study.

Comparison of Postoperative Pain and Application Effect of High Tibial Osteotomy and Total Knee Replacement in Patients with Knee Arthritis

Objective: To investigate the effects of high tibial osteotomy (HTO) and total knee replacement (TKR) on postoperative pain of patients with knee arthritis. Methods: From February 2017 to March 2019, 72 patients with knee arthritis in our unit were collected for the experiment. Patients in the control group (CG, 35 cases) were treated with HTO, and research group (RG, 37 cases) were treated with TKR. Clinical efficacy. Visual Analogue Scale (VAS) score. Knee Society Score (KSS), and Hospital for Special Surgery (HSS) knee rating score of the two groups of patients were observed. Intraoperative blood loss, operative time and hospitalization expenses were observed, as well as the effect of knee joint recovery after operation. Results: In terms of overall effective rate, RG was superior to CG (p &lt; 0.05). VAS score of RG was notably lower at 1 week and 2 weeks after operation than that in CG (p &lt; 0.05). KSS of RG was evidently higher than that of CG (p &lt; 0.05). HSS score of RG was notably higher than that of CG after operation (p &lt; 0.05). The intraoperative blood loss and operative time in RG were notably better than those in CG (p &lt; 0.05). The effects of knee joint recovery in RG was considerably better than that in CG (p &lt; 0.05). Conclusion: TKR has a better clinical effect on elderly patients, which can reduce postoperative pain, intraoperative blood loss and operative time, and improve the recovery effect of knee joint.

Open reduction and internal fixation using multiple nonabsorbable suture materials in acute patella fracture: comparison of clinical and radiological outcome with tension band wiring

BackgroundFor treating displaced patella fractures, tension band wiring is the most widely used technique. However, implant removal surgery is often necessary to alleviate discomfort caused by fixation materials. On the contrary, fixation using nonabsorbable suture materials is anticipated to result in comparable outcomes without need for further implant removal surgery. However, there is a lack of clinical studies comparing the two fixation techniques (wire and nonabsorbable suture materials) for acute patella fractures.MethodsFrom 2014 to 2018, we retrospectively reviewed 60 patients who underwent open reduction with internal fixation for acute patella fracture. Thirty patients (group 1) who received surgery using tension band wiring and 30 patients (group 2) who received surgery using nonabsorbable suture materials were enrolled. The average follow-up period was more than 1 year after operation. Operation time, postoperative bone union time, range of motion (ROM) of the knee joint, postoperative clinical results, and complications were compared between the two groups.ResultOperation time, clinical bone union, and radiologic bone union were not statistically different between groups 1 and 2. At 3 months postoperatively, flexion was 120.3 ± 9.4° in group 1 and 110.5 ± 7.7° in group 2, showing statistically significant difference (p = 0.037). At 6 and 12 months postoperatively, the ROM was similar in both groups. Hospital for special surgery score at 3 months postoperatively was 78.4 ± 8.2 in group 1 and 83.7 ± 8.7 in group 2, showing statistically significant differences (p = 0.032). However, at 6 and 12 months postoperatively, there were no statistical differences. Lysholm score at 3 months postoperatively was 73.5 ± 8.1 in group 1 and 80.4 ± 8.2 in group 2, showing statistically significant difference (p = 0.016), but at 6 and 12 months postoperatively, there were no statistical differences.ConclusionFixation using multiple nonabsorbable suture materials can be an alternative surgical method in managing patella fractures, along with tension band wiring.

The treatment of posterolateral tibial plateau fracture with a newly designed anatomical plate via the trans-supra-fibular head approach: preliminary outcomes

BackgroundThere are no ideal plates or approaches for anatomical restoration and rigid fixation of posterolateral tibial plateau fractures. This study aimed to evaluate the short-term preliminary outcomes of our novel anatomical plate placed via the trans-supra-fibular approach to treat posterolateral tibial plateau fractures.MethodsFrom May 2016 to May 2018, 23 consecutive patients with posterolateral tibial quadrant fractures underwent open reduction with internal fixation via the trans-supra-fibular-head approach with our newly developed plate. The tibial plateau-tibial shaft angle (TPTSA), lateral posterior tibial slope angle (LPSTA), step-off, and condylar widening were measured on radiological images pre-operatively, 3 days post-operatively, 3 months post-operatively, and at the final follow-up examination. The radiological Rasmussen score was calculated, and the Hospital for Special Surgery (HSS) knee score was assessed to evaluate the functional outcomes.ResultsThe LTPSA, TPTSA, step-off, and condylar widening at 3 days post-operatively, 3 months post-operatively, and at the final follow-up were significantly different (p = 0.001) compared with those pre-operatively, as was the radiological Rasmussen score (p = 0.001). The HSS score at the final follow-up was 89.10 ± 5.94 (range, 78–98), which was significantly higher than that at the 3-month follow-up 84.36 ± 6.76 (range, 74–96); p = 0.001).ConclusionsOur newly designed anatomical plate placed via the trans-supra-fibular approach can effectively treat posterolateral tibial plateau fractures. We noted minor trauma, stable fixation, and satisfactory clinical results.

Clinical application of split three-dimensional printing patient-specific instrumentation in medial open-wedge high tibial osteotomy

To investigate the accuracy of split three-dimensional (3D) printing patient-specific instrumentation (PSI) in medial open-wedge high tibial osteotomy (MOWHTO) and its effectiveness in treating medial knee osteoarthritis. Clinical data of 14 patients with medial knee osteoarthritis and treated with split 3D printing PSI-assisted MOWHTO between August 2019 and August 2020 were retrospectively analyzed. There were 5 males and 9 females with an average age of 61 years (range, 43-68 years). The disease duration ranged from 1 to 16 years, with an average of 4.7 years. Preoperative Kellgren-Lawrence grading of knee osteoarthritis included grade Ⅰ in 2 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 6 cases. The Hospital for Special Surgery (HSS) score was 59.1±4.9. The weight bearing line ratio (WBL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), and actual correction angle of the lower limbs were measured on postoperative imaging data, and compared with the preoperative measurements and the designed target values to evaluate the accuracy of the PSI-assisted surgery. The patients' knee function were evaluated with the HSS score at 3 and 6 months postoperatively, and at last follow-up. One patient suffered from an incision exudation at 2 weeks postoperatively, and the incision healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 7-19 months (mean, 14.8 months). There was no neural injuries, hinge fracture, plate or screw fractures, loosening, or other complications. The WBL was maintained at the postoperative level according to the X-ray examination during the follow-up period. The WBL, HKA, MPTA, and PTSA were all within a satisfactory range after operation. The WBL, HKA, and MPTA were significantly improved when compared with the preoperative measurements ( P<0.05). There was no significant difference between preoperative and postoperative PTSA ( P>0.05). The differences in postoperative WBL, HKA, MPTA, and correction angle compared with the preoperative designed target values were not significant ( P>0.05). The HSS scores were 69.2±4.7, 77.7±4.3, and 88.1±5.4 at 3 and 6 months postoperatively, and last follow-up, respectively. The differences between time points were significant ( P<0.05). For patients with medial knee osteoarthritis, the split 3D printing PSI can assist the surgeon in MOWHTO with accurate osteotomy orthopedics and achieve favorable effectiveness.

Comparison of unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of severe medial compartment osteoarthritis

To compare the effectiveness of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in the treatment of severe medial compartment osteoarthritis (OA). A clinical data of 69 patients (69 knees), who underwent joint replacement due to severe medial compartment OA between February 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. Among them, 38 cases were treated with UKA (UKA group) and 31 cases with TKA (TKA group). There was no significant difference in gender, age, body mass index, course of disease, lesion side, and preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Feller score, range of motion of knee, physiological and psychological scores of short-form 12 health survey scale (SF-12) between the two groups ( P>0.05). The femorotibial angle (FTA) of TKA group was bigger than that of UKA group, and hip-knee-ankle angle (HKA) was smaller, showing significant differences ( P<0.05). The operative time, incision length, blood loss, time for flexion 90°, ambulation time, hospital stay, and incidence of deep venous thrombosis of lower extremity were recorded and compared between the two groups. The VAS score, HSS score, WOMAC score, Feller score, range of motion, and physiological and psychological scores of SF-12 were used to evaluate patients' quality of life. FTA, HKA, and prosthesis looseness were observed by X-ray films. Kaplan-Merier survival analysis was used to evaluate the survival rate of prosthesis. All operations were successfully completed in both groups. Compared with TKA group, UKA group had shorter incision length, longer operative time, and less blood loss ( P<0.05). There was no significant difference in time for flexion 90°, ambulation time, hospital stay, and the incidence of deep venous thrombosis of lower extremity between the two groups ( P>0.05). The incisions in both groups healed by first intention. During follow-up, 3 patients in the UKA group and 1 patient in the TKA group developed mild anterior knee pain. Patients were followed up (30.7±9.6) months in the UKA group and (34.9±8.7) months in the TKA group, and the difference was not significant ( t=-1.832, P=0.071). At last follow-up, there were significant differences in the HSS score, Feller score, WOMAC score, range of motion, VAS score, and physiological and psychological scores of SF-12 between pre- and post-operation ( P<0.05). The range of motion in the UKA group was bigger than that in the TKA group ( Z=-2.666, P=0.008), and there was no significant difference in the other indexes between the two groups ( P>0.05). X-ray films showed that the alignment of the two groups recovered well, and the FTA and HKA of the two groups were improved at 1 week after operation ( P<0.05). No radiolucency was found around the prosthesis during follow-up, no prosthesis loosening and meniscal bearing dislocation occurred. The survival rates of the prostheses in the two groups were 100%. For severe medial compartment OA, the early survival rates of the two prostheses are similar, but UKA has less traumatic, can preserve the normal structure of the knee, and the range of motion of the knee after operation is significantly better than TKA.

Preoperative characteristics and intraoperative factors do not correlate with accomplishments of active straight-leg raising, standing up, and walking after primary total knee arthroplasty

BackgroundThe correlations between patient characteristics and early postoperative functional performances after total knee arthroplasty have not been adequately studied. The purpose of this study was to clarify the effects of preoperative characteristics (sex, age, body mass index, American Society of Anesthesiologists grade, hospital for special surgery score) and intraoperative factors (duration of surgery and tourniquet use) on the time required to accomplish active straight-leg-raising, standing up, and walking as the objective performances for the initiation of early postoperative rehabilitation.MethodsThis cross-sectional retrospective study included 307 patients (384 primary total knee arthroplasties). Postoperative times required until each activity was accomplished were measured. Various preoperative characteristics and intraoperative factors that might affect three objective performances were evaluated.ResultsThe postoperative times required before each activity was accomplished were 1.5 ± 0.5 days for active straight-leg-raising, 1.2 ± 0.5 days for standing up, and 1.4 ± 0.7 days for walking. There were no significant correlations between any factor (age, body mass index, hospital for special surgery score, duration of surgery, and tourniquet use) and the three objective performances using Spearman’s correlation coefficient. There were no differences in sex or American Society of Anesthesiologists grade for three objective functional assessments by Wilcoxon rank sum test.ConclusionsDifferences in patient preoperative characteristics and intraoperative factors are unlikely to affect three objective functional performances in the early postoperative period. Therefore, there is no need to consider differences between patients when initiating early postoperative rehabilitation.

Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy

IntroductionTo compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results.Materials and methodsSixty-three knees with medial-compartment osteoarthritis were retrospectively studied. Thirty-four knees with subluxated lateral joint and depression of the medial tibial plateau underwent TCVO and the rest underwent OWHTO. Among the 63 knees included, 27 knees with a pre-operative femorotibial angle (FTA) ≥ 185° were defined as severe varus (subgroup S, 15 in STCVO group and 12 in SHTO group). Lower limb alignment, intra-, and extra-articular congruency were evaluated according to the radiograph obtained before and 24 months after surgery. The visual analog scale (VAS) score and Hospital for Special Surgery (HSS) score were obtained to assess the clinical results. Opening angle and distance of the opening gap in each group were measured by intra-operative fluoroscopy.ResultsDuring the 2-year follow-up period, the mean HSS score increased from 70.3 to 81.4 in HTO group and 65.9 to 87.3 in TCVO group (p < 0.05). The mean VAS score decreased from 5.9 to 2.6 and 6.0 to 2.1, respectively (p < 0.01). Pre-operative FTA was restored to 172.9° in HTO group and 171.3° in TCVO group, and percentage of mechanical axis (%MA) was improved to 59.7% and 61.2%, respectively. Joint line convergence angle (JLCA) was slightly restored and medial tibial plateau depression (MTPD) was relatively the same before and after OWHTO, while these parameters improved greatly (from 6.4° to 1.2° and − 8.0° to 5.9°, p < 0.01) in TCVO group. More undercorrected knees were observed in SHTO group than STCVO group (58.3% and 13.3%, p < 0.05). Opening angle and distance of the opening gap were larger in TCVO group (19.1° and 14.0 mm) than those in OWHTO group (9.3° and 10.1 mm, p < 0.05).ConclusionCompared to OWHTO, TCVO had priority in treating advanced knee OA with intra-articular deformity. However, TCVO had a limited capacity to correct the varus angle. Besides, TCVO might be suitable for medial-compartment OA with a pre-operative FTA ≥ 185°.

Treatment of posterolateral tibial plateau fractures with a rotational support plate and special pressurizer: technical note and retrospective case series

BackgroundIn tibial plateau fractures, the posterolateral segment of the tibia plateau is frequently affected and challenging to treat. Although there are many surgical approaches and fixation methods for the treatment of these fractures, all of these methods have limitations. We designed a new rotational support plate (RSP) and a special pressurizer that can fix the fracture directly via the anterolateral approach. This method is advantageous because it leads to little trauma, involves a simple operation, and has a reliable fixation effect. This study details the technique of treating these fractures with the RSP and special pressurizer and provides the outcomes.MethodsFrom May 2016 to January 2019, the data of 12 patients with posterolateral tibial plateau fractures treated with the RSP and special pressurizer in our hospital were retrospectively analyzed. Postoperative rehabilitation was advised, knee X-rays were taken at follow-ups, and fracture healing, complications, and knee range of motion were assessed. The Hospital for Special Surgery (HSS) knee score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate knee function at the last follow-up.ResultsThe average follow-up time of all patients was 16.5 months (range, 12–25 months). The average bony union time was 3.2 months (range, 3–4.5 months). At the last follow-up, the average knee range of motion was 138° (range, 107–145°). The average HSS score was 91 (range, 64–98). The average KOOS Symptoms score was 90 (range, 75–96). The average KOOS Pain score was 91 (range, 72–97). The average KOOS ADL score was 91 (range, 74–97). The average KOOS sport/recreation score was 83 (range, 70–90). The average KOOS QOL score was 88 (range, 69–93). Skin necrosis, incision infections, and fixation failure did not occur during the follow-up period.ConclusionsWith our newly designed RSP and special pressurizer, posterolateral tibial plateau fractures can be easily and effectively reduced and fixed through the anterolateral approach, which serves as a novel treatment for posterolateral tibial plateau fractures.