Humans ; Knee Joint ; physiopathology ; Osteoarthritis, Knee ; physiopathology ; therapy

Patellofemoral crepitus and clunk syndrome are infrequent, yet troublesome complications of total knee arthroplasty with a reported incidence of 0%-18%. They are primarily associated with implantation of posterior cruciate substituting designs. These entities are the result of peripatellar fibrosynovial hyperplasia at the junction of the superior pole of the patella and the distal quadriceps tendon which becomes entrapped within the superior aspect of the intercondylar box of the femoral component during knee flexion. When the knee extends, a crepitant sensation occurs as the fibrosynovial tissue exits the intercondylar box. Numerous etiologies have been proposed such as femoral component designs with a high intercondylar box ratio, previous knee surgery, reduced patellar tendon length, thinner patellar components, reduced patella-patellar component composite thickness, and smaller femoral components. Preventative measures include choice of femoral components with a reduced intercondylar box ratio, use of thicker patellar components, avoidance of over-resection of the patella, and debridement of the fibrosynovial tissue at the time of knee arthroplasty. Most patients with crepitus are unaware of the problem or have minimal symptoms so that no treatment is required. If significant disability is incurred, symptoms can be eliminated in a high percentage of patients with arthroscopic debridement of the fibrosynovial hyperplasia.
Arthralgia/etiology ; Arthroplasty, Replacement, Knee/*adverse effects ; Humans ; Knee Joint/*physiopathology ; Patellofemoral Joint/*physiopathology ; Postoperative Complications/etiology/physiopathology/prevention & control

Knee osteoarthritis (KOA) is the most common knee joint disease. Although KOA belongs to a disease of degeneration of knee joint cartilage, its pathology involves cartilage, subchondral bone, meniscus, synovial membrane, articular capsule and other joint tissue. The infrapatellar fat pad (IPFP), an intracapsular but extrasynovial structure, has some special characteristics of endocrine metabolism, then it has double roles in the development of KOA, but its protective effect is much more than harmful effect. Considering protective roles of IPFP in KOA and some serious complications after IPFP resection, the surgeon shall protect IPFP as far as possible if total knee arthroplasty surgical field is good. If it is necessary to improve the surgical field, its fibrotic tissue even all part can be removed.
Adipose Tissue ; physiology ; Arthroplasty, Replacement, Knee ; Humans ; Knee Joint ; physiopathology ; surgery ; Osteoarthritis, Knee ; surgery

The capacity to perform certain activities is frequently compromised after total knee arthroplasty (TKA) due to a functional decline resulting from decreased range of motion and a diminished ability to kneel. In this manuscript, the current biomechanical understanding of hyperflexion and kneeling before and after TKA will be discussed. Patellofemoral and tibiofemoral joint contact area, contact pressure, and kinematics were evaluated in cadaveric studies using a Tekscan pressure measuring system and Microscribe. Testing was performed on intact knees and following cruciate retaining and posterior stabilized TKA at knee flexion angles of 90degrees, 105degrees, 120degrees, and 135degrees. Three loading conditions were used to simulate squatting, double stance kneeling, and single stance kneeling. Following TKA with double stance kneeling, patellofemoral contact areas did not increase significantly at high knee flexion angle (135degrees). Kneeling resulted in tibial posterior translation and external rotation at all flexion angles. Moving from double to single stance kneeling tended to increase pressures in the cruciate retaining group, but decreased pressures in the posterior stabilized group. The cruciate retaining group had significantly larger contact areas than the posterior stabilized group, although no significant differences in pressures were observed comparing the two TKA designs (p < 0.05). If greater than 120degrees of postoperative knee range of motion can be achieved following TKA, then kneeling may be performed with less risk in the patellofemoral joint than was previously believed to be the case. However, kneeling may increase the likelihood of damage to cartilage and menisci in intact knees and after TKA increases in tibiofemoral contact area and pressures may lead to polyethyelene wear if performed on a chronic, repetitive basis.
*Arthroplasty, Replacement, Knee ; Biomechanical Phenomena ; Cadaver ; Humans ; Knee Joint/*physiopathology/surgery ; Osteoarthritis, Knee/*physiopathology/surgery ; Patellofemoral Joint/physiopathology/surgery ; Posture/physiology ; Range of Motion, Articular

OBJECTIVETo investigate results of total knee arthroplasty using the long-stem tibial component combined with metallic wedge of knee prosthesis for the treatment of proximal defects.

METHODSFrom January 2011 to May 2013, 10 patients (11 knees) were treated with total knee arthroplasties using the long-stem tibial component with metallic tibial wedge of knee prosthesis. All the patients were female and the average age was 67 years old (ranged, 60 to 77 years old). All the patients were osteoarthritis. All the patients were classified as T2A style. The patients were evaluated according to knee score system (KSS).

RESULTSAll the patients were followed up for 12 months on average (ranged 3 to 29 months). The clinical outcome was assessed using KSS score, including knee pain score, knee stability score, knee range of motion score and knee walking score, knee stairs score. There were significantly differences at 6 weeks, 3 months, 6 months and 12 months between pre-and postoperative KSS score.

CONCLUSIONThe mechanical stability of tibial fixation in primary TKA is significantly increased by using the long-stem tibial component with metallic wedge of knee prosthesis, even in the presence of poor proximal bone.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Knee Joint ; physiopathology ; surgery ; Knee Prosthesis ; Male ; Osteoarthritis, Knee ; physiopathology ; surgery ; Range of Motion, Articular ; Tibia ; abnormalities ; physiopathology ; surgery

OBJECTIVETo observe the change of clearance and range of joint improved situation during total knee arthroplasty (TKA) by operating extended release manipulation of the posterior knee clearance.

METHODSA total of 120 patients with knee osteoarthritis undergoing unilateral TKA from March 2010 to March 2012 were equally randomized prospectively assigned to the experimental group and control group, each 60 cases. There were 46 male and 74 female patients, the mean age was 63.6 years (range from 49 to 75 years). After the osteotomy of the tibia and the femoral condyle and before the release of soft tissue intraoperation, patients in experimental group were taken the extended release manipulation of the posterior knee clearence while the control group were cleaned the osteophyte of the posterior condyle only, 2-sided paired t test was used to compare the clearence intraoperation and the time to flexion angle of 90° and 120° and the maximum angle after 3 months' follow-up.

RESULTSThere was no significant difference of the index between the experimental group and control group (P > 0.05). Between experimental group and control group, the difference was significant in extention clearance ((18.9 ± 1.5) mm vs. (17.9 ± 1.6) mm, t = 3.53, P < 0.01) intraoperation, and no significant difference in flexion clearance ((20.7 ± 1.8) mm vs. (20.2 ± 1.9) mm, t = 1.48, P > 0.05). It took longer time for the knee flexion range of motion to 90°(t = 10.2399, P < 0.01) or 120°(t = 11.142, P < 0.01) of the control group than that of the experimental group, and the difference of the maximum range of motion between experimental group and control group was significant statistically at the 3-months follow-up (t = 4.4255, P < 0.01). All the patients were followed up for 3 - 24 months, average of 14.6 months, no femoral component loosening happened.

CONCLUSIONSExtended release of the posterior knee clearance benefits the knee extension clearence intraoperation and functional exercise of range of motion postoperation, while it is no meaning to the flexion clearence.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Joint Capsule Release ; methods ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Osteoarthritis, Knee ; physiopathology ; surgery ; Osteotomy ; Range of Motion, Articular ; Treatment Outcome

Professor -'s academic idea of "pain in joint and disorder in tendon region of meridian" was explored in this paper. According to the particular characteristics of the occurrence and development of the disease, knee arthralgia is divided into 4 stages, named tendon spasm, tendon blockage, tendon contraction and tendon atrophy. It is proposed that "tendon disorder results in bone disorder", implying the relationship between the disorders of tendon and bone. It is pointed that insufficiency occurs throughout knee arthralgia. "The tendon disorder should be treated at the first-line procedure for the bone disorder, and the tendon softening benefits the recovery of knee joints". The treatment principle includes "removing obstruction from meridian, eliminating pathogen, warming up and softening tendon". In clinical application, the heat-sensitive moxibustion is predominated. The various regimens are developed align with the pathogenesis characteristics of the disease at different stages.
Acupuncture Therapy ; Arthralgia ; therapy ; Humans ; Knee Joint ; physiopathology ; Meridians ; Moxibustion ; Pain ; Tendons ; physiopathology

OBJECTIVE: To study the application of isokinetic muscle testing in identification of the faked paralysis to provide scientific data for establishing a standard system of muscle strength in forensic medicine identification. METHODS: Fifty-seven patients with bone fracture or nerve damage as damaged group and 128 normal subjects pretended paralysis as faked paralyzed group were included in this study. Isokinetic muscle testing was performed on bilateral knees of all subjects in the two groups. The peak torque (PT) and peak torque angle (PTA) were compared between both sides in each group. The features of torque-time graph of two groups were classified. RESULTS: In the damaged group, the differences of PT between two sides of flexors and extensors were statistically significant (P<0.05), while the dif- ferences of PTA were not statistically significant (P>0.05). In faked paralyzed group, the differences of PT and PTA between two sides of flexors and extensors were both statistically significant (P<0.05). The torque-time graph of damaged knee presented mostly as single lead peak, while torque-time graph of the faked paralyzed knee presented mostly as multiple peaks. CONCLUSION The feature of torque-time graph could be useful to identify the faked paralyzed extremities in forensic authentication.
Case-Control Studies ; Humans ; Knee Joint/physiopathology* ; Male ; Muscle Strength ; Muscle, Skeletal/physiopathology* ; Muscles ; Torque

OBJECTIVETo study the effect of rotational alignment of the femoral components on the patellofemoral biomechanics in total knee arthroplasty (TKA) demonstrated on autopsy specimens, as the guide for surgeons to choose the correct reference axis for rotational alignment of the femoral components and to reduce the patellofemoral joint complications.

METHODSSelect 9 frozen fresh human cadaver knees without gross deformities or instabilities and mount specimens on a patellofemoral joint testing jig connected to a Model 8501 Instron machine (Instron Corporation, Canton, MA). The study simulated the action of squatting from the standing position with the foot firmly planted. Standard TKA was performed in each specimen by the same senior surgeon using Nexgen LPS total knee system (Zimmer Corporation, Warsaw Indiana). Alter rotational alignment of the femoral components referenced to the transepicondylar axis and the Whiteside's line respectively. Measure biomechanics of the patellofemoral joints using Fuji prescale film at 30 degrees , 60 degrees , 90 degrees , 120 degrees of knee flexion respectively. The digital values were obtained by the handheld pressure measurement systems (FPD-305E, FPD-306E) and Autocad software.

RESULTSThe rotational alignment of the femoral components paralleled to the transepicondylar axis had the best results of the peak value of the patellofemoral contact pressure (P < 0.05). There were no statistically significant differences in patellofemoral contact area (P > 0.05). But the patellofemoral contact area had the close correlations to the angles of the knee flexion and the specimens.

CONCLUSIONSRotational alignment of the femoral components has a great influence on the patellofemoral contact pressure in total knee arthroplasty. It is reliable for surgeons to choose the transepicondylar axis as the reference axis to rotate femoral components.

Adult ; Arthroplasty, Replacement, Knee ; methods ; Biomechanical Phenomena ; Cadaver ; Humans ; Knee Joint ; physiopathology ; surgery ; Knee Prosthesis ; Middle Aged ; Rotation

OBJECTIVETo study the therapeutic effects of electroacupuncture for the treatment of osteoarthritis of knee joint.

METHODSForty patients with knee osteoarthritis were randomly divided into two groups: the electroacupuncture group (20 patients)and the control group (20 patients). The patients in electroacupuncture group (8 male and 12 female, with an average age of 62.50 +/- 9.23 years and mean course of disease 9.85 +/- 8.17 years)were treated with electroacupuncture for one month. At the same time, the patients in control group (7 male and 13 female, with an average age of 61.15 +/- 6.75 years and mean course of disease 8.60 +/- 6.89 years) were given Diclofenac sodium orally for one month. The motor function of knee joints were evaluated before and after treatment according to Lysholm knee scoring scale.

RESULTSMost scores in the electroacupuncture group improved significantly compared with those of before treatment (P < 0.01 or P < 0.05) except for the item demands for support. While in the control group, compared with those of before treatment, there were significant difference on the item of pain, inter locking and instability (P < 0.01 or P < 0.05), but there were no significant differences on other five items (P > 0.05). Between the two groups after treatment, differences on item of inter locking, instability, swelling, stair activity and squat were significant (P < 0.05), but no differences on limp, demands for support and pain (P > 0.05).

CONCLUSIONAcupuncture can effectively improve the clinical symptoms and knee joint's motor function of patients with knee osteoarthritis, and more superior than Diclofenac sodium oral. It is a proved effective method for osteoarthritis.

Aged ; Electroacupuncture ; Female ; Humans ; Knee Joint ; physiopathology ; Male ; Middle Aged ; Osteoarthritis, Knee ; physiopathology ; therapy ; Pain Measurement ; Treatment Outcome