Postoperative Flexion Contracture Research Articles

Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective cohort study

BackgroundReverse homodigital artery island flap (RHDI) has reported some postoperative complications. Cross-finger reverse digital artery island flap (CRDI), which is harvested from an adjacent intact finger, has been performed to decrease these complications. This study aimed to provide a review of the CRDI procedure and to compare the clinical outcomes of CRDI with RHDI. MethodsRHDI has been performed for fingertip amputations with the deficit of 1.5–2.5cm before 2018, and CRDI has been performed since 2018. We assessed functional and aesthetic outcomes, including finger length, nail deformity, finger motion, and Hand20 scores at the final follow-up. ResultsWe identified 22 patients who underwent RHDI and ten patients who underwent CRDI. The mean follow-up period was 10.3 ± 5.3 months. The median time required for wound healing in RHDI was 47.0 days (IQR: 34.3–55.8), and that in CRDI was 34.5 days (IQR: 29.3–44.3). The hook nail deformity occurred significantly more frequently in RHDI compared to in CRDI (40.9% vs. 0.0%, p = 0.03). Flexion contracture of the proximal interphalangeal joint greater than 15º was found significantly more in RHDI than in CRDI (36.4% vs. 0,0%, p = 0.04). The median postoperative total active motion of the donor site in CRDI was 278º (IQR: 260º–280º). The median postoperative Hand20 scores were similar between the two groups. ConclusionCRDI was associated with superior clinical outcomes in terms of lower rate of postoperative flexion contracture and hook nail deformity, potentially making it a better option compared to RHDI.

Use of Botulinum Toxin A to Manage Hamstring-Induced Flexion Contracture Following Total Knee Arthroplasty: A Case Series.

Introduction Flexion contractures following total knee arthroplasty (TKA) greatly affect patient function and satisfaction. Botulinum toxin A (BTX) has been described in the literature as a means of addressing post-operative flexion contractures due to hamstring muscle rigidity. Methods We retrospectively report a case series of eight patients with range of motion (ROM) who developed a flexion contracture status post-TKA and were managed with the use of physical therapy, diagnostic hamstring lidocaine injections, and therapeutic hamstring BTX injections. Results All patients had an improvement in extension ROM following diagnostic lidocaine hamstring injections and were therefore considered candidates for therapeutic hamstring BTX injections. Prior to therapeutic hamstring BTX injections, patients had an average flexion contracture of 19° (range: 15°-22°). All patients had an improvement in extension ROM two to four weeks following the therapeutic hamstring BTX injection, with an average improvement in ROM of 7° (range: 2°-19°). At the final follow-up, all patients continued to sustain an improvement in extension ROM with an average deficit of 9° (range: 0°-17°). Conclusion Our case series highlights the use of diagnostic hamstring lidocaine injections to confirm hamstring rigidity as an etiology for flexion contracture following TKA. In addition, we showed a persistent improvement in flexion contracture for all patients after hamstring BTX injections. Therefore, when the appropriate patient is selected, BTX may provide an additional treatment option for a flexion contracture following TKA.

Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review.

This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture. Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded. Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model. This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture. IV.

The clinical results of bi-cruciate vs posterior stabilized total knee arthroplasty for flexion contracture in osteoarthritic knee.

The improvement of flexion contracture is important in knee arthroplasty since residual flexion contracture postoperatively is associated with decreased quality of life and patient satisfaction. In this study, we investigated the effect of bi-cruciate stabilized (BCS)-type total knee arthroplasty (TKA) as compared to posterior stabilized (PS)-type TKA on osteoarthritic primary knees with flexion contractures. 59 TKAs from January 2014 to December 2020, of which 30 were PS-type TKAs (NexGen LPS-flexⓇ; 76.3years, BMI 27.5) and 29 BCS-type TKAs (Journey IIⓇ; 72.5years, BMI 28.6), were performed for knee osteoarthritis with preoperative flexion contracture of 15° or greater. Full extension was obtained intraoperatively during all TKAs. Clinical outcomes, radiological evaluations, and the amount of additional distal femoral osteotomy during TKA were evaluated in a retrospective study design. The range of motion improved in the both groups. Postoperative flexion contracture was significantly improved in the BCS group. Knee Society Score improved significantly in both groups, with no difference between the two groups. The amount of additional distal femoral osteotomy was 2.5 ± 1.3mm for the PS group, and 1.8 ± 1.5mm for the BCS group, showing a significant difference (p = 0.04). The BCS-type TKA significantly improved preoperative flexion contracture and reduced the amount of additional distal femoral osteotomy compared to PS-type TKA. This is attributed to the anterior cam in the BCS-type TKA, which leads to a smaller amount of protrusion of the posterior femoral condyle from the posterior margin of the tibial component in the BCS-type in knee extension, as compared to the PS-type.

PATELLA RESURFACING DOES NOT IMPROVE OUTCOMES IN PATIENTS WITH POSTOPERATIVE FLEXION CONTRACTURE AFTER PRIMARY TOTAL KNEE ARTHROPLASTY

Objective: Biomechanical studies have shown that flexion contracture leads to higher patellofemoral compressive forces with potentially poorer outcomes. We studied the outcome of primary knee arthroplasty with or without patella resurfacing in patients presenting with postoperative flexion contracture to determine if patella resurfacing improves the outcome. Materials and Methods: We retrospectively reviewed the registry data at the Singapore General Hospital from 1998-2014. Of 18074 primary knee replacements carried out, 665 knees were identified with postoperative flexion contracture greater than 10 degrees at 2 years follow-ups, out of which 562 knees were included in the study. One hundred and three patients were lost to follow-ups. All the infected cases were excluded from the study. Knees with patella resurfaced (227) were compared with knees with patella non-resurfaced (335) using Oxford Knee Score, Knee Society Clinical Scoring System, and SF-36. A handheld goniometer was used for measurements by an independent assessor and a physiotherapist. Analysis of factors for prognostic importance was performed using the R statistics. Results: At two years follow-ups, the non-resurfaced patella group had significantly higher median knee flexion compared to the resurfaced group. Age, male gender, preoperative flexion, and patella resurfacing were found to be significant predictors for knee flexion at two years. Outcome scores did not differ significantly between the two groups. Conclusion: No significant difference in outcome scores was observed in resurfaced versus non-resurfaced patella groups in patients with more than 10 degrees’ postoperative flexion contracture after primary knee arthroplasty. Keywords: Patella Resurfacing, Flexion contracture

Treatment of early post-operative flexion contracture after total knee arthroplasty with osteopathic manipulations

Treatment of early post-operative flexion contracture after total knee arthroplasty with osteopathic manipulations

Treatment of camptodactyly with a new progressive correction device

The aim of this study was to introduce a new progressive correction device and present treatment results in camptodactyly patients. Eight patients (11 fingers) were treated for camptodactyly by an external fixator between February 2019 and April 2020. Mean follow-up was 28.7 ± 3.3 months (range, 24–35 months). Operative times and treatment complications were recorded. Pre- and post-operative flexion contracture, total active range of motion (TAM) and esthetic satisfaction were evaluated at final follow-up. Esthetic satisfaction was rated by the patient on a 1–5 point scale. Seven patients were male, and 1 female. Mean age was 21.6 ± 8.5 years (range, 15–42 years). Mean surgery time was 14.9 ± 2.4 min (range, 10−18 min). Mean preoperative flexion contracture was 85.9 ± 7° (range, 75−95°), and mean postoperative flexion contracture was 4 ± 3° (range, 0−10°). Transient proximal interphalangeal joint swelling was seen in 1 case and pin tract infection in 1. TAM was perfect in 5 fingers and good in 6. Patients were either very satisfied (n = 5) or satisfied (n = 3) with the esthetic appearance of each operated finger. Camptodactyly could be managed with a hinged external fixator simply and effectively with gratifying results in selected patients. Level of evidenceLevel IV, case series.

Postoperative bleeding adversely affects total knee arthroplasty outcomes in hemophilia

BackgroundHemophilic arthropathy can result in severe degenerative arthritis and functional limitations in the knees of relatively young patients. Total knee arthroplasty (TKA) provides pain relief and gain of function in advanced-stage hemophilic arthropathy cases. However, little is known about the long-term effects of early major postoperative bleeding (MPOB) in people with hemophilia (PWH). The aim of this study was to evaluate the effects of early MPOB on the final functional outcome, complications, and implant survival of TKA in a single-center hemophilia cohort. MethodPWH who underwent TKA between 1998 and 2019 in a single center were reviewed. Demographic data, clinical data, and radiographic images were evaluated. Hospital for Special Surgery (HSS), Knee Society Score (KSS), and Knee Society Function Score (KSS-F) scores were used to determine function. Patients with early bleeding complications (wound dehiscence, ecchymosis, hemarthrosis, hematoma formation, prolonged or recurrent bleeding attacks) were defined as the bleeding group. Patients who did not experience these complications were assigned to the control group. The bleeding group was compared with controls. Survival of the primary arthroplasty was analyzed by Kaplan–Meier curves. ResultsForty-five TKAs in 29 patients were included in the study. TKA led to an increase in the mean range of motion from 46.08° to 84.59° (P < 0.01). HSS scores increased from 48.33 preoperatively to 82.67 postoperatively (P < 0.01). There were improvements in both KSS and KSS-F scores from 34.22 and 53.3 preoperatively to 82.00 and 84.63 (P < 0.01), respectively. Ten patients (10 TKAs) (34%) experienced major bleeding during the postoperative period. Six of these patients had moderate hemophilia, and four had severe hemophilia. Three of these patients had hemarthroses (10.2%), one patient had a hematoma (3.4%), one patient had hemorrhagic bullae formation (3.4%), and five had excessive/prolonged bleeding from the wound (17%). The bleeding group (34%) had significantly worse HSS (63.78 vs 92.75, P < 0.001), KSS (61.78 vs 93.25, P < 0.001), and KSS-F (60.71 vs 96.25, P = 0.005) scores compared with controls. Preoperative and postoperative flexion contractures were positively correlated (+0.33, P = 0.003). One of the patients with postoperative hemarthrosis also had an accompanying transient common peroneal nerve palsy, and one patient (3.4%) had a periprosthetic fracture. Three knees (6.6%), two of whom were in the bleeding group, developed periprosthetic infections. Four knees (8.8%) in three patients underwent revision surgery, and two knees (4.4%) ended up in arthrodeses. Kaplan–Meier analysis revealed a mean survival duration of 17.04 years for the bleeding group and 22.15 years for the control group (P = 0.83). Survival rates were 80.0% for the bleeding group and 96.4% for the control group (P = 0.83). ConclusionsIn this study, MPOB after TKA in PWH was common and led to significantly worse function. MPOB after TKA in PWH was associated with a higher rate of complications and lower survival rates, although the differences were not statistically significant. Efforts must be made to avoid MPOB after TKA in PWH.

Optimal intraoperative medial joint gap in extension to prevent flexion contracture following total knee arthroplasty using modified gap balancing technique

BackgroundPrimary aim to identify the ideal medial joint gap in extension needed to prevent post-operative flexion contracture following total knee arthroplasty (TKA) in varus osteoarthritic knees by the modified gap balancing technique. A secondary aim was to analyze multiple factors that influence knee extension in TKA by modified gap balancing. MethodsThis is a prospective cohort study of 150 patients diagnosed with osteoarthritic varus knee who underwent TKA using the modified gap balancing technique. Operative and clinical records were assessed to determine factors including age, BMI (Body mass index), pre-operative extension angle and the medial extension laxity. Patients were followed for 6-months post-operatively and reviewed for knee extension angle. ResultsSix months final follow-up information was available for 148 patients with an average age of 75.5 years. Pre-operative knee extension and BMI were significantly associated with post-operative knee extension. Post-operative flexion contracture of ≧ 100 was not seen in any of 34 patients with a medial extension laxity ≧ 0 mm who had no pre-existing flexion contracture, and in 1/9 (11.1%) patients with a medial extension laxity ≧ 1 mm who had pre-existing flexion contracture. ConclusionsPre-operative extension angle and BMI significantly influence the post-operative knee extension angle in TKA using the modified gap balancing technique. A medial extension laxity of at least 1 mm is ideally needed to prevent post-operative flexion contracture in patients with a pre-existing contracture ≧ 100. Level of evidenceLevel II; Prospective cohort study.

How much preoperative flexion contracture is a predictor for residual flexion contracture after total knee arthroplasty in hemophilic arthropathy and rheumatoid arthritis?

BackgroundAlthough total knee arthroplasty (TKA) in hemophilic arthropathy (HA) or rheumatoid arthritis (RA) can improve functional ability, the postoperative range of motion (ROM) and prosthesis durability are reduced compared with those in osteoarthritic patients.AimWe aimed to compare (1) the pre- and postoperative flexion contracture after TKA in HA and RA, (2) the threshold of preoperative flexion contracture as a predictor of residual contracture > 15° after TKA, and (3) the survival rate.MethodsData from a consecutive cohort comprising 48 TKAs in HA and 92 TKAs in RA were retrospectively reviewed. The degree of flexion contracture was analyzed. Through receiver operating characteristics analysis, we aimed to determine the cutoff value of preoperative flexion contracture that increases the risk of residual contracture > 15° after TKA and compare the cutoff value in HA and RA. The survival rate was evaluated based on life table analysis and the Kaplan–Meier method.ResultsThe degree of preoperative flexion contracture was not significantly different. The degree of postoperative residual flexion contracture was 5.6° in the HA group and 1.4° in the RA group, respectively (p < 0.001). The cutoff value of preoperative flexion contracture for residual contracture of > 15° at last-follow up was 25.0° in the HA group and 32.5° in the RA group. The 5- and 12-year survival rates were 96% and 87% in the HA and 99% and 95% in the RA group, respectively (n.s.).ConclusionsThe postoperative residual flexion contracture was greater and the cutoff value of preoperative flexion contracture for residual contracture was smaller in the HA group than the RA group. Appropriate intra- and postoperative care to avoid postoperative residual contracture is required in HA patients.Level of evidenceIII.

Robotic arm-assisted posterior-stabilised total knee arthroplasty reduces the amount of tibial bone resection thickness without increasing the rate of postoperative flexion contracture in varus knees in the short term: Comparison with image-free navigated total knee arthroplasty.

This study aimed to compare the bone resection thickness, rate of minimal thickness insert usage, and postoperative range of motion (ROM) between robotic and navigated total knee arthroplasty (TKA). Fifty consecutive posterior-stabilised (PS) robotic TKA and 50 case-controlled PS navigated TKA were enroled. Bone resection thickness, rate of minimal thickness insert usage, and postoperative flexion contracture over 5° were statistically compared. The tibial bone resection thickness was significantly thinner in robotic TKA. The insert thickness was significantly lower, and the rate of minimal thickness insert usage was significantly higher in robotic TKA. The ROM at 3months postoperatively and the rate of postoperative flexion contracture were comparable between the two groups. Robotic TKA can reduce the tibial bone resection thickness and increase the rate of minimal thickness insert usage without increasing postoperative flexion contracture as compared with navigated TKA.

Severity and location of lumbar spine stenosis affects the outcome of total knee arthroplasty

BackgroundRecent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility before and after TKA.MethodsThis retrospective case series assessed all TKAs performed at our institution for primary osteoarthritis from 2017–2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery was necessary for inclusion. Stenosis severity was demonstrated by (1) anterior–posterior (AP) diameter of the thecal sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia.ResultsPatients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1–2, L2–3, L3–4, and L4–5, there was a significant reduction in preoperative-AOM (p < 0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p < 0.001). The same was noted with respect to increased morphological grade (p < 0.001), with a 5 degree decrease for patients’ most stenotic level (p < 0.001).ConclusionSevere LSS, which is readily demonstrated by a reduction in the AP diameter of the thecal sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery.Level of evidence: Level 4

A dynamic knee extension device improves flexion contracture before total knee arthroplasty: a randomized controlled trial

Background: Postoperative flexion contracture (FC) after total knee arthroplasty (TKA) affects gait and causes pain and fatigue, which can result in poor patient outcomes and decreased satisfaction. This study evaluates a dynamic extension brace that may help improve extension and decrease the rate of postoperative FC. Methods: This study was a prospective randomized controlled trial of 101 patients with a FC of ≥10 degrees scheduled to undergo TKA. Primary outcome was change in maximal active extension during the perioperative period; secondary outcomes were patient-reported outcomes. Data were collected at enrollment, preoperative appointments, and 2-week postoperative appointments. Chi-squared, t tests and repeated measures analysis of variance (ANOVA) were used to evaluate the results between and within groups. Results: Fifty-five patients were in the control group and 46 in the experimental group. The mean FC in the experimental group was significantly worse at enrollment (14.22 degrees vs. 15.76 degrees, P=0.049), but improved by the preoperative appointment (15.76 degrees to 12.52 degrees, P&lt;0.001), while the control group FC remained stable. The experimental group experienced a greater improvement in Knee Society Knee Scores and a smaller decline in Knee Society Function Scores compared with the control group. The experimental group experienced a significant improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) score through all time points (29.47 degrees to 35.84 degrees to 51.33 degrees, P&lt;0.001), while the control group only had significant improvement from enrollment to postoperative appointment (35.06 degrees to 49.15 degrees, P&lt;0.001). Conclusions: Patients with FC that used a dynamic knee extension brace preoperatively had improved extension before surgery and more rapid improvement in outcome measures when compared to patients treated with a standard program alone. Level of Evidence: Level I.

Lateral and patellofemoral compartment osteoarthritis progression after medial unicompartmental knee arthroplasty: A five- to 10-year follow-up study

BackgroundThe purpose of the study was to evaluate lateral and patellofemoral osteoarthritis (OA) progression after medial unicompartmental knee arthroplasty (UKA) and identify factors affecting the progression that were not identified previously. MethodsWe evaluated 146 patients who underwent medial UKA between 2009 and 2014. Kellgren–Lawrence grading of lateral and patellofemoral OA was performed on preoperative and final follow-up knee radiographs. Radiographic and clinical characteristics, SF-36, and Oxford knee scores were compared between the OA progressed and non-progressed groups. Risk factors for lateral and patellofemoral OA progression were evaluated. ResultsThe lateral OA progressed and non-progressed groups significantly differed in side, preoperative flexion contracture, preoperative joint line convergence angle, postoperative tibiofemoral angle, insert size, revision status (P < 0.05), and the patellofemoral OA progressed and non-progressed groups significantly differed in age, pre- and postoperative flexion contracture, postoperative tibiofemoral angle and pre- and postoperative patellofemoral OA grade (P < 0.05). At the final follow-up, Visual Analogue Scale, Oxford Knee Scores, and SF-36 sub-scores were significantly better in the lateral OA non-progressed group (P < 0.001).Dominant leg (odds ratio (OR): 2.759), insert size (>4, OR: 2.219), revision status (+, OR: 6.692), and postoperative tibiofemoral angle (>5.5°, OR: 1.177) were independent risk factors for lateral OA progression, whereas age (>60 years, OR: 3.222), preoperative patellofemoral OA grade (>1, OR: 2.085), and postoperative flexion contracture (>10°, OR: 1.919) were those for patellofemoral OA progression. ConclusionsMild radiographic progression of 1 KL grade is frequently seen five to 10 years after medial UKA. Postoperative outcomes are significantly affected by lateral compartment OA progression but not by patellofemoral OA progression.

Effects of bilateral knee arthroplasty on sagittal spinopelvic balance in patients with primer degenerative osteoarthritis

Aim: We aimed to evaluate the change in sagittal spinopelvic parameters in knee osteoarthritis patients without prior degenerative spinal disease following bilateral knee arthroplasty. Knee osteoarthritis often causes knee flexion contracture and the flexion contracture may affect posture and lumbar lordosis.Material and Methods: We performed a retrospective study by evaluating the records of patients who have undergone bilateral knee arthroplasty in our clinic between 2012 and 2016 in patients due to degenerative bilateral knee osteoarthritis and minimum 12 months follow up. Patients with prior hip surgery, prior spine surgery, rheumatic disease and postoperative flexion contracture were excluded. Lumber lordosis, sacral slope, pelvic tilt and pelvic incidence were measured on lateral lumbosacral view in supine position pre-postoperatively and compared with paired T test. Extension deficit was also measured preoperatively.Results: This study includes 83 patients (77 females and 6 males) who underwent bilateral knee arthroplasty and matched the inclusion and exclusion criteria. The average age at the time of first total knee arthroplasty was 64.4 years. Mean follow up was 37.3(12-66) months. The mean lumber lordosis was 43.9° preoperatively and 49.6° postoperatively. The increase in lumbar lordosis angle was statistically significant (p: 0,001). These changes were only related to the degree of extension deficit but not to age and postoperative follow-up time. Sacral slope, pelvic incidence and pelvic tilt did not change significantly. Conclusion: Bilateral knee arthroplasty increased lumbar lordosis patients with primer degenerative osteoarthritis especially who had high extension deficit. Sacral slope and pelvic tilt were decreased postoperatively but not significantly changed.

Abnormally high dislocation rate following constrained condylar knee arthroplasty for valgus knee: a case-control study

BackgroundWith the use of constrained condylar knee (CCK) prostheses, dislocation of the knee following total knee arthroplasty (TKA) with valgus deformity is rare. In our practice with such patients, however, an abnormally high dislocation rate was noted. It appeared to be associated with the extent of soft-tissue release which varied among surgeons following different sequences of release. We asked in CCK TKA with valgus deformity is releasing both the lateral collateral ligament (LCL) and popliteus tendon (PT) associated with the occurrence of dislocation.MethodsThis is a case-control study of consecutive patients with valgus deformity who underwent primary CCK TKA between July 2008 and October 2015. The cases and controls were patients with and without postoperative dislocation of the knee, respectively. The extent of the release of lateral soft-tissue structures was compared between the two groups. Other patient characteristics including age, body mass index, pre- and post-operative valgus deformity, preoperative flexion-contracture, and height of the polyethylene insert were compared as well to reduce confounding.ResultsForty-three consecutive patients with a minimum 2-year follow-up were enrolled. 9.3% (4/43) of the patients had postoperative dislocation of the knee. While the dislocated patients did not significantly differ from the controls on most characteristics, they were more likely to have both the LCL and PT released together during the surgery [100% (4/4) vs. 2.6% (1/39), P < 0.001].ConclusionReleasing both LCL and PT in CCK TKA with valgus deformity may increase the risk of dislocation, and need to be performed with some caution.

Electroacupuncture treatment could exert better anti-apoptosis function than SP600125 by modulating hoppocampal JNK signaling pathway in APP/PS1 mice

Both rotating-platform (RP) mobile-bearing and medial-pivot (MP) fixed-bearing prostheses allow axial femorotibial rotation using a highly conforming polyethylene insert. However, limited comparative data are available between the 2 designs. This study was performed to compare the midterm clinical outcomes and patient-reported outcome measures (PROMs) of RP and MP prostheses.We retrospectively reviewed the records of 52 total knee arthroplasties using RP mobile-bearing prosthesis and 49 total knee arthroplasties using MP fixed prosthesis with a minimum follow-up period of 5 years. Clinical and radiological outcomes, failure rates, and PROMs, including the Western Ontario and McMaster Universities Osteoarthritis Index score and satisfaction, were compared.There was no difference in clinical or radiographic outcomes (P > .1 for all comparisons), with the exception of the larger flexion contracture (FC) in the MP group (0.3° in RP vs 2.3° in MP, P < .01). No failure in either group was recorded during the study period. PROMs were comparable (P > .1 in all comparisons), with the exception of higher satisfactions in the RP group while performing light household duties (P < .01) and leisure or recreational activities (P = .014) in patients without FC.The midterm clinical results with both the RP mobile-bearing and MP fixed-bearing prostheses were satisfactory. Although both prostheses provided comparable PROMs, patients with an RP prosthesis were more satisfied than those with an MP prosthesis for highly demanding activities that are strongly associated with the presence of postoperative FC.

Intraoperative manipulation for flexion contracture during total knee arthroplasty.

Joint gap unbalancing during total knee arthroplasty (TKA) induces flexion contracture. Flexion contracture is one of the most serious complications of TKA. When flexion contracture is found during surgery, intraoperative manipulation is often empirically performed. We evaluated the effects of intraoperative manipulation on joint gap and postoperative flexion contracture. TKA was performed for 136 knees. Intraoperative manipulation was performed for flexion contracture in 61 knees. Joint gap changes before and after manipulation were measured at six positions from extension to 120° of flexion. Manipulation was not performed for 75 knees. The extension angle was measured radiographically immediately after surgery, at 3 months, and 6 months postoperatively. Extension angles with manipulation and without manipulation were compared. Joint gap changes (mm) before and after manipulation were 0.1, 0.0, -0.2, -0.3, -0.1, and -0.3 at 0°, 30°, 45°, 60°, 90°, and 120° of flexion, respectively, indicating that manipulation could not change joint gaps significantly. Extension angles (°) with and without manipulation were -4.0 ± 4.6 and -3.8 ± 3.9 immediately after surgery, -5.3 ± 6.7 and -5.5 ± 6.2 at 3 months postoperatively, and -2.7 ± 6.0 and -3.8 ± 5.8 at 6 months postoperatively. No statistically significant difference existed between the values with or without manipulation during all periods. Intraoperative manipulation does not enlarge the gap or resolve postoperative flexion contracture. Developing the new surgical technique is required to achieve perfect balance at TKA.

Pie-crusting technique is effective and safe to release superficial medial collateral ligament for total knee arthroplasty

BackgroundPie-crusting technique is a damage-control soft tissue balance skill of total knee arthroplasty (TKA). The outcome of this technique to release lateral soft tissue is reasonable. A limited number of studies have focused on medial collateral ligament release with pie-crusting technique in the past years because of concerns about its efficacy and safety. MethodAll cases underwent superficial medial collateral ligament (SMCL) release with either pie-crusting technique or traditional technique (39 knees in each group) between January 1, 2014 and August 31, 2015. A comparison study between two techniques was performed; meanwhile, 23 patients (26 knees) in pie-crusting group were followed up. Data including knee function, radiographic result and complications were analysed. ResultsComparison study demonstrates that pie-crusting technique can achieve a comparable or even better effect of alignment correction. Data of follow-up patients are reasonable. The mean postoperative flexion contracture is 1.2 ± 3.6°. The mean postoperative motion arrange is 104.0 ± 14.4°. The mean postoperative hospital for special surgery knee score point is 82.0 ± 7.4 points. The mean postoperative femoral tibial angle is 172.4 ± 2.0°. The level of joint line elevates around 2.1 ± 1.9 mm. There are four knees that use brace after operation, and none of them present unstable knee. No severe complication has been reported, and most patients were satisfied with life quality. ConclusionsUsing pie-crusting technique to release SMCL for TKA is effective and safe. The translational potential of this articleAlthough pie-crusting technique has been used in TKA for years, it is seldom chosen to release medial collateral ligament, especially to release SMCL, which is a vital step of malalignment correction. This study aims to evaluate the efficacy and safety of this technique in total knee arthroplasty patients.

The medial tibial joint line elevation over 5mm restrained the improvement of knee extension angle in unicompartmental knee arthroplasty.

The purpose of this study was to examine the relationship between medial tibial joint line elevation and the improvement of range of motion (ROM) in unicompartmental knee arthroplasty (UKA). The hypothesis was that limited elevation of tibial joint line will improve knee range of motion in UKA. Forty-six consecutive medial UKAs were enrolled in this study. Medial tibial joint line elevation was defined as the polyethylene insert and tibial tray thickness minus the tibial osteotomy and sawblade thickness. Positive values indicated an elevation of the tibial joint line. A component gap between the femoral trial prosthesis and the medial tibial osteotomy surface was also examined. Joint loosening was also calculated based on the joint component gap minus insert and tibial tray thickness. The correlation of the medial tibial joint line elevation with joint looseness and postoperative range of motion were analyzed. The mean medial tibial joint line elevation was 4.9 ± 1.1mm. The medial tibial joint line elevation reduced the improvement of knee extension (R = - 0.43, p < 0.01). The medial tibial joint line elevation was also correlated with reduced loosening of the joint knee extension (R = - 0.42, p < 0.01). This, in turn, resulted in limited improvement of the knee extension angle. Moreover, joint line elevation under 5mm significantly improved knee extension angle compared to joint line elevation over 5mm. The medial joint line elevation of the tibia in UKA reduced the improvement of knee extension angle, due to a reduced joint looseness at knee extension. A tibial joint line elevation greater than 5mm in UKA should be avoided to prevent postoperative flexion contracture. For the clinical relevance, this study clarified that the medial joint line of the tibia is an important factor to prevent postoperative flexion contracture in UKA. II.