【Abstract】 Objective To investigate the surgical technique and the cl inical results of total knee arthroplasty (TKA)in treating end-stage gonarthrosis combined with valgus knee deformity. Methods Between November 1998 and October2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medialparapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years),including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilicarthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. Theflexion and extension range of motion (ROM) of the knee joint was (82.2 ± 28.7)°; the femur-tibia angle (FTA) was (18.0 ± 5.8)°;according to Knee Society Score (KSS) criterion, the preoperative cl inical score was 31.2 ± 10.1 and functional score was37.3 ± 9.0. According to Krackow’s classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellarapproach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posteriorcruciate l igament were used in 7 cases (7 knees), posterior stabil ize prosthesis in 54 cases (60 knees), constrained prosthesisin 4 cases (5 knees). Results Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient withhaemophilic arthritis, severe valgus deformity (FTA was 41°), and flexion contracture (20°), which was cured after 1 year ofconservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients werefollowed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 ± 2.5)°, showing significant differencewhen compared with preoperative value (t=15.502, P=0.000). The KSS cl inical score was 83.0 ± 6.6 and functional score was85.1 ± 10.5, the flexion and extension ROM of the knee joint was (106.1 ± 17.0)°, all showing significant differences whencompared with preoperative values (P lt; 0.05). Five patients had 12-15° valgus knee deformity, but the function of the affectknees were good. Conclusion TKA is an effective way for the patients with end-stage gonarthrosis combined with valgusknee deformity by medial parapatellar approach combined with conventional osteotomy and Ranawat soft tissue release. Thecorrection of deformity and improvement of joint function can be achieved significantly. The cl inical result is satisfactory.
【Abstract】 Objective To explore the effectiveness of multiple joint arthroplasty in treating lower limb joint disease. Methods Between January 2000 and December 2007, 5 patients with lower limb joint disease (three or more joints were involved) were treated with total hip and knee arthroplasty. There were 3 males and 2 females, aged from 27 to 59 years (mean, 41.8 years). Two patients had ankylosing spondylitis and 3 had rheumatoid arthritis, whose hip and knee joints were involved. Four patients lost the ability of walking preoperatively, 1 patient could only walk with crutch. The Harris score was 24 ± 24 and the Hospital for Special Surgery (HSS) score was 28 ± 15. All patients underwent multiple joint arthroplasty simultaneously (2 cases) or multiple-stage (3 cases). Results Wounds healed by first intention in all patients. In 1 patient who had dislocation of the hip after operation, manipulative reduction and immobilization with skin traction were given for 3 weeks, and no dislocation occurred; in 2 patients who had early sign of anemia, blood transfusion was given. All patients were followed up 46-140 months with an average of 75 months. The patients could walk normally, and had no difficulty in upstairs and downstairs. The stability of the hip and knee was good, and no joint infection or loosening occurred. The Harris score was 88 ± 6 at last follow-up, showing significant difference when compared with the preoperative score (t=8.16, P=0.00); the HSS score was 86 ± 6, showing significant difference when compared with the preoperative score (t=13.96, P=0.00). Conclusion Multiple joint arthroplasty is an effective treatment method in patients with lower limb joint disease, which can significantly improve life quality of patients.
Objective To investigate the clinical outcomes of total knee arthroplasty (TKA) by using the condylar constrained knee prosthesis in the treatment of destructive hemophilic arthritis. Methods Between September 2007 and July 2015, 8 cases (8 knees) of destructive hemophilic arthritis accepted TKA by using condylar constrained knee prosthesis. All patients were male, aged 22 to 56 years, with an average age of 35 years. The disease course of hemophilia A was 3-30 years (mean, 17.3 years). Preoperative range of motion (ROM) was (68.1±32.6)°; the flexion deformity was (14.38±16.13)°. Six patients had valgus of 7-35° (mean, 17.3°), of whom, one had fixed dislocation of patella; and one had varus of 15°. Hospital for Special Surgery (HSS) knee score was 52.5±12.9. Pre-operative X-ray film examination demonstrated narrowing of the knee gap and cystic degeneration of articular cartilage and subchondral bone. Results All patients achieved primary wound healing, and were followed up 1-9 years (mean, 5 years). Tense blister with common peroneal nerve damage and extension penetrating into distal tibial cortex occurred in 1 case respectively, which were cured corresponding treatment. At last follow-up, the knee ROM and the flexion deformity were significantly improved to (98.1±8.9)° and (0.63±1.77)° (t=–2.527,P=0.036;t=2.396,P=0.047). At 2 weeks after operation and last follow-up, the HSS scores were significantly increased to 77.3±11.0 and 85.0±9.0 (P<0.05). X-ray film showed that lower extremity alignment returned to normal in patients with varus and valgus. Conclusion Good curative effect can be get by using condylar constrained knee prosthesis in TKA for the treatment of destructive hemophilic arthritis.