Endoscopic surgery was carried out at various hospitals to treat successfully diverse injuries of knee joint as meniscal cutting, meniscal suture and crucial ligament reconstruction. Endoscopic surgery had minimized the duration of treatment and assured high esthetic success. But this operation had needed modern equipments, high skill of professional staff and a synchronizing practice. In the near future, endoscopic surgery will get larger development.
Knee Joint ; Surgery ; Endoscopy

In this special issue, several papers related to clinical application of arthroscopic surgery are published, which present the current situation of arthroscopic techniques in our country. As a technique of minimally invasive orthopedics, arthroscopy is used in examination, diagnosis and treatment of joint diseases, which is the trend of modern surgery. Arthroscopy has been widely used in surgical procedures in knee diseases, and now it expands the scope of application to other joints, such as shoulder, elbow, wrist, hip, ankle and even smaller joints. The application scope of arthroscopy has spread from arthroscopic debridement to reparative and reconstructive surgery. Some innovation has been made in extra-articular surgeries. Researchers conduct in depth study and exploration in the basic and clinical application of arthroscopy. Arthroscopic surgery has become an indispensable branch of modern orthopedics.
Ankle Joint ; surgery ; Arthroscopes ; Arthroscopy ; methods ; Elbow Joint ; surgery ; Humans ; Joint Diseases ; diagnosis ; surgery ; Knee Joint ; surgery ; Wrist Joint ; surgery

BACKGROUNDControversy still exists regarding whether medial parapatellar approach (MP) or midvastus approach (MV) is preferable in total knee arthroplasty (TKA) up to now. The aim of this meta-analysis was to compare the clinical and radiological outcomes following the MV or MP for TKA.

METHODSA comprehensive search of unrestricted-language literature of all studies comparing MP with MV was conducted through the electronic literature databases of PubMed, EMBASE, Cochrane Library, CNKI, VIP, and WANFANG. Retrieval time was from the time when databases were built to October 2013. Manual search of relevant trials, reviews, and related articles was also performed. Outcomes of interest included postoperative knee extensor and flexor function, postoperative pain, patella tilt, and complications. Relative risk (RR) and weighted mean differences (WMD) from each trial were pooled using random-effects or fixed-effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.

RESULTSTwenty-one randomized controlled trials (RCTs) comprising 1 188 patients (1 450 knees) were eligible. Our results showed that MV was associated with better early postoperative extension (WMD = -1.26, 95% CI -2.36 to -0.16, P = 0.02) and flexion (WMD = 10.13, 95% CI 5.36 to 14.90, P < 0.01), less postoperative pain (WMD = -0.21, 95% CI -0.34 to -0.07, P = 0.002) , and no greater risk for complications than MP. The patella tilt did not differ significantly between the two groups (WMD = -0.70, 95% CI -1.94 to 0.54, P = 0.27).

CONCLUSIONSMV may be a better approach than MP, as it improves postoperative early joint function and decreases pain. Future multi-center randomized controlled studies with large sample sizes are required to verify the current findings.

Arthroplasty, Replacement, Knee ; methods ; Humans ; Knee Joint ; surgery

Humans ; Osteoarthritis, Knee/surgery* ; Knee Joint/surgery* ; Arthroplasty, Replacement, Knee ; Minimally Invasive Surgical Procedures ; Tibia/surgery*

The angle between the lower extremity force line and the position of the unicondylar prosthesis is an important factor affecting the long-term survival and rate clinical outcome of the unicondylar replacement prostheses. Insufficient lower limb alignment will accelerate the wear of prosthesis and reduce the survival rate of prosthesis. Excessive lower limb alignment will accelerate the progress of contralateral interventricular arthritis. It is generally believed that the lower limb force line should be corrected in mild varus after unicompartmental knee arthroplasty. However, some scholars believe that the lower limb alignment has no effect on the functional score and prosthesis survival rate after unicompartmental knee arthroplasty. The poor position of femoral and tibial prosthesis will cause unexplained pain and even prosthesis wear, but the optimal position of femoral and tibial prosthesis is controversial. It is generally believed that the posterior tibial slope should be corrected in the range of 3° to 7° in unicompartmental knee arthroplasty, but some scholars believe that excessive change of posterior tibial slope will also affect the balance of knee joint space and knee joint range of motion. This study shows that the correction of lower limb alignment to mild varus is still the best lower limb alignment for unicompartmental knee arthroplasty. The best position of femoral and tibial prosthesis needs to be confirmed by further biomechanical research. The correction of tposterior tibial slope should be changed according to the specific original dissection angle of patients before operation.
Humans ; Arthroplasty, Replacement, Knee ; Knee Prosthesis ; Knee Joint/surgery* ; Tibia/surgery* ; Osteoarthritis, Knee/surgery* ; Lower Extremity/surgery* ; Retrospective Studies

Component malrotation is one of the major causes of failure in total knee arthroplasty.Based on previous researches,Insall line has excessive external rotation tendency.Although Akagi line is the most recognized anatomical axis at present,it still has a certain tendency of internal rotation.The tibial posterior condylar axis is not suitable for symmetrical component and yet the Curve-on-Curve technique is not suitable for anatomic component.In addition,reference to any fixed anatomical markers cannot ensure the rotation consistency of tibiofemoral component in extension position.Although range of motion technique is beneficial to tibiofemoral rotation synchronization,its clinical effect seems to be unstable.Nevertheless,Patients can obtain good postoperative results with all major techniques.Before the recognized "gold standard" is defined,orthopedic surgeons can determine the rotation alignment of tibial component according to their most accustomed surgical method.With a deeper understanding of knee anatomy,biomechanics and kinematics,digital assistive technology may be expected to become a breakthrough in the tibial rotational alignment.
Arthroplasty, Replacement, Knee/methods* ; Femur/surgery* ; Humans ; Knee Joint/surgery* ; Knee Prosthesis ; Osteoarthritis, Knee/surgery* ; Range of Motion, Articular ; Tibia/surgery*

BACKGROUNDPrimary total knee arthroplasty (TKA) in severe valgus knees may prove challenging, and choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release. The purpose of this study was to review 8 to 11 years (mean, 10 years) follow-up results of primary TKA for varient-III valgus knee deformity with use of different type implants.

METHODSBetween January 2002 and January 2005, 20 women and 12 men, aged 47 to 63 (mean, 57.19 ± 6.08) years old, with varient-III valgus knees underwent primary TKA. Of the 32 patients, 37 knees had varient-III deformities. Pie crusting was carefully performed with small, multiple inside-out incisions, bone resection balanced the knee in lieu of soft tissue releases that were not used in the series. Cruciate-retaining knees (Gemini MKII, Link Company, Germany) were used in 13 knees, Genesis II (Simth & Nephew Company, USA) in 14 knees, and hinged knee (Endo-Model Company, Germany) in 10 knees. In five patients with bilateral variant-III TKAs, three patients underwent 1-stage bilateral procedures, and two underwent 2-stage procedures. All implants were cemented and the patella was not resurfaced. The Hospital for Special Surgery (HSS) knee score was assessed. Patients were followed up from 8 to 11 years.

RESULTSThe mean HSS knee score were improved from 50.33 ± 11.60 to 90.06 ± 3.07 (P < 0.001). The mean tibiofemoral alignment were improved from valgus 32.72° ± 9.68° pre-operation to 4.89° ± 0.90° post-operation (P < 0.001). The mean range of motion were improved from 93.72° ± 23.69° pre-operation to 116.61 ± 16.29° post-operation (P < 0.001). No patients underwent revision. One patient underwent open reduction and internal fixation using femoral condylar plates for supracondylar femoral fractures secondary to a fall at three years. Three patients developed transient peroneal nerve palsies, which resolved within nine months. Two patients developed symptomatic deep vein thrombosis that was managed with rivaroxaban and thrombo-embolic deterrent stockings. There was no incidence of pulmonary embolism. Post-operative patient satisfaction was 80.7 ± 10.4 points in the groups. Prosthetic survival rate was 100% at mean 10 years postoperative.

CONCLUSIONSNot only hinged implants can be successfully used in variant-III valgus knees. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components. Our results also present alternative implant choices for severe knee deformities.

Arthroplasty, Replacement, Knee ; methods ; Female ; Humans ; Joint Deformities, Acquired ; surgery ; Knee Joint ; surgery ; Male ; Middle Aged

The correct alignment of the knee joint is considered to be one of the most influential factors in determining the long-term prognosis after total knee arthroplasty(TKA). In order to achieve the correct alignment goal, many different alignment concepts and surgical techniques have been established. For example, mechanical alignment(MA), kinematic alignment(KA) and functional alignment(FA) have their own characteristics. MA focuses on achieving neutral alignment of the limbs, parallel and equal bone gaps during stretching and flexion. KA aims to restore the patient 's natural joint line, make the joint level and angle normal and improve the physiological soft tissue balance, and strive to reproduce the normal knee function;among them, functional alignment(FA) developed with robot-assisted surgery technology is a relatively new alignment concept. It not only considers the alignment of the body, but also aims to achieve flexion and extension balance, while respecting the native soft tissue capsule. It not only restores the plane and slope of the in situ joint line accurately during the operation, but also takes into account the balance of soft tissue, which is a better alignment method. Therefore, it is of great significance to correctly construct the lower limb force line of patients, which is helpful to restore knee joint function, relieve pain symptoms and prolong the service life of prosthesi. However, compared with traditional TKA, the operation time of robot-assisted FA-TKA is prolonged, which means that the probability of postoperative infection will be greater. At present, most studies of FA technology report short-term results, and the long-term efficacy of patients is not clear. Therefore, long-term research results are needed to support the application of this technology. Therefore, the author makes a review on the research status of functional alignment.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Robotics ; Knee Joint/surgery* ; Osteoarthritis, Knee/surgery* ; Knee ; Knee Prosthesis ; Biomechanical Phenomena

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

OBJECTIVE: To investigate the expectations of patients for total knee arthroplasty (TKA), and to analyze its influencing factors. METHODS: Experimental design: Single center, retrospective, multiple regression analysis. The data including the age, height, and weight of 108 patients undergoing unilateral TKA due to end-stage osteoarthritis were obtained. The patients' preoperative Hospital for Special Surgery (HSS) knee arthroplasty expectation score, the Western Ontario and McMaster Universities (WOMAC) score, Knee Society score (KSS), the MOS 36-item short-from health survey (SF-36) score, and visual analogue scale (VAS) were evaluated, and the 30-second chair-stand test (30-CST), 40-meter fast-paced walk test (40-FPWT), 12-level stair-climb test (12-SCT), 3-meter timed up-and-go test (TUG), 6-minute walk test (6-MWT), and recorded daily steps for 7 consecutive days were performed. The SPSS 22.0 software was used for statistical analysis. The observed values of various data were described. Pearson correlation analysis was used to evaluate the correlation between various parameters, and the multi-factor linear regression analysis was used to investigate the influencing factors of the patients preoperative expectation scores. RESULTS: The average expectation score of this group of patients was 58.98±5.44. In the Pearson correlation analysis, the patient's preoperative expectation had a weak correlation to the result of the patient's 12-SCT, TUG, 6-MWT, KSS function score, and SF-36 mental component score (correlation coefficient 0.1-0.3). The patient's preoperative expectation had a moderate correlation to the patient's daily average steps, 30-CST, 40-FPWT, KSS, WOMAC and its pain, stiffness, function scores, SF-36 physical functioning, role-physical, bodily pain, vitality, and physical component score (correlation coefficient 0.3-0.6). In the multivariate linear regression analysis, only the results of 30-CST and the role-physical, bodily pain and vitality in the SF-36 scale were related to the patient's expectation score (P < 0.05). CONCLUSION The estimated expectation score of patients before TKA is not high. Patients with more severe preoperative pain, worse physical function, and lower overall health are more eager to improve after surgery. Thus surgeons must communicate fully with patients with unrealistic expectations before surgery in order to obtain more satisfactory results postoperatively.
Arthroplasty, Replacement, Knee ; Humans ; Knee Joint/surgery* ; Motivation ; Osteoarthritis, Knee/surgery* ; Retrospective Studies ; Treatment Outcome