Objective To summarize the research progress of anterior cutaneous nerve injury and repair in knee arthroplasty. Methods The relevant literature at home and abroad in recent years was reviewed and summarized from the anatomy of anterior cutaneous nerve, nerve injury grade, clinical manifestations, prevention and treatment of anterior cutaneous nerve. Results The anterior cutaneous nerve injury is a common complication of knee arthroplasty. Because the anterior cutaneous nerve branches are many and thin, and mainly run between the first and second layers of fascia, this level is often ignored during surgical exposure. In addition, the knee arthroplasty does not routinely perform the exploration and repair of the cutaneous nerve. So the anterior cutaneous nerve injury is difficult to avoid, and can lead to postoperative skin numbness and knee pain. At present, studies have explored the feasibility of preventing its occurrence from the aspects of improved incision and intraoperative separation of protective nerve. There is no effective prevention and treatment measures for this complication. For patients with skin numbness after knee arthroplasty, the effectiveness of drug treatment is not clear. Local nerve block or nerve excision can be used to treat patients with painful symptoms after knee arthroplasty considering cutaneous pseudoneuroma. ConclusionKnee arthroplasty is widely used and anterior cutaneous nerve injury is common in clinic. In the future, more high-quality clinical studies are needed to further explore the prevention and treatment measures of this complication and evaluate the clinical benefits obtained.
ObjectiveTo investigate the effect of body mass index (BMI) on the short- and medium-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of anterior medial compartmental osteoarthritis of knee joint.MethodsThe clinical data of 55 patients (61 knees) with anterior medial compartmental osteoarthritis of knee joint treated with minimally invasive UKA between May 2014 and May 2019 were retrospectively analyzed. According to BMI, the patients were divided into 3 groups: normal body mass group [group A, BMI 18.50-24.99 kg/m2, 23 cases (25 knees)], overweight group [group B, BMI 25.00-29.99 kg/m2, 23 cases (25 knees)], obesity group [group C, BMI 30.00-39.99 kg/m2, 9 cases (11 knees)]. There was no significant difference in gender, age, sides, disease duration, and preoperative American Special Surgery Hospital (HSS) score, pain visual analogue scale (VAS) score, and knee range of motion (ROM) among 3 groups (P>0.05). The operation time, intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week were recorded and compared among 3 groups. The HSS score, VAS score, and ROM were used to evaluate the knee function and pain improvement.ResultsThere was no significant difference in the operation time, the intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week among 3 groups (P>0.05). All the 55 patients were followed up 5-60 months, with an average of 24 months. No complication such as infection, fat embolism, or deep venous thrombosis of lower extremity occurred after operation. The anteroposterior and lateral X-ray films of the knee joint showed that no dislocation or loosening of the prosthesis occurred and the position of the prosthesis was good. At last follow-up, the HSS score, VAS score, and ROM of the 3 groups were significantly improved when compared with preoperative ones (P<0.05); but there was no significant difference among 3 groups (P>0.05).ConclusionFor obese and overweight patients with anterior medial compartmental osteoarthritis of the knee joint, the use of minimally invasive UKA can achieve satisfactory short- and medium-term effectiveness, and the long-term effectiveness needs further follow-up.
Objective To investigate the influence of tibial component posterior slope angle (TCPSA) on the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA). MethodsThe clinical data of the patients with anterior medial knee osteoarthritis (KOA) treated by UKA between May 2014 and May 2019 were retrospectively analysed. There were 10 males and 45 females with a median age of 68 years (range, 49-83 years). The body mass index (BMI) was 27.63-52.26 kg/m2, with an average of 40.04 kg/m2. There were 28 cases of left knee, 21 cases of right knee, and 6 cases of double knees. The disease duration was from 7 months to 12 years, with an average of 4.33 years. Measurements of posterior tibial slope (PTS) and TCPSA were performed on the knee joint X-ray films of patients before operation and at last follow-up, respectively. According to the postoperative TCPSA, patients were divided into TCPSA<4° group (group A), 4°≤TCPSA<9° group (group B), and TCPSA>9° group (group C) with the quartile method. Baseline data such as age, gender, BMI, and affected side were compared among the 3 groups, as well as the Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) before and after operation. ResultsAll 55 patients were followed up 17-72 months, with an average of 36 months. No complication such as prosthesis loosening, infection, tibial plateau collapse, and dislocation of the meniscus pad occurred. The preoperative PTS was (7.38±3.37)°, and the postoperative TCPSA was (6.25±3.22)°, showing no significant difference (t=1.815, P=0.074). According to postoperative TCPSA, there were 12 knees in group A, 32 in group B, and 17 in group C. There was no significant difference in age, gender, BMI, affected side, and preoperative HSS scores, ROM, and VAS scores among the 3 groups (P>0.05). At last follow-up, the HSS scores, ROM, and VAS scores of the 3 groups significantly improved when compared with preoperative ones (P<0.05). There was no significant difference in the difference of the above indicators before and after operation among 3 groups (P>0.05). ConclusionThe patients with anterior medial KOA may have good short- and mid-term effectiveness after UKA. Among the recommended range of TCPSA, there is no significant influence on the postoperative short- and mid-term effectiveness. Long-term effectiveness need to extend the follow-up time and expand the sample size for research verification.
Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups (P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results There was no significant difference in the operation time between the two groups (P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant (P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group (P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points (P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups (P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups (P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation (P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points (P>0.05). Conclusion In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.