OBJECTIVE: To review the application progress of customized steel plates in osteotomy and orthopedic treatment for knee osteoarthritis (KOA), and provide reference for orthopedic surgeons and researchers. METHODS: Extensive review of the literature on customized steel plates for osteotomies and knee-preserving surgeries for KOA, 2015-2025, with an overview of the principles of customized steel plate design, clinical applications, and future directions, describing their advantages and shortcomings. RESULTS: Customized steel plates have demonstrated many advantages in osteotomy and orthopedic treatment of KOA, which not only enhance surgical outcomes and optimize mechanical properties, but also reduce the incidence of postoperative complications. However, high cost, long manufacturing period, and selection of patient indications are still important factors restricting their use. CONCLUSION Customized steel plates show promising potential in treating KOA. Not only do they reduce surgical duration and enhance postoperative healing outcomes, but they also effectively lower the incidence of postoperative complications, thereby improving patients' quality of life.
Humans ; Osteoarthritis, Knee/surgery* ; Osteotomy/methods* ; Bone Plates ; Postoperative Complications/epidemiology* ; Steel ; Quality of Life ; Treatment Outcome ; Knee Joint/surgery*

OBJECTIVE: To investigate the risk factors associated with the development of knee osteoarthritis (OA) following arthroscopic surgery for degenerative lesions of the posterior horn of the medial meniscus. METHODS: Between January 2012 and January 2014, a retrospective analysis was conducted on 506 patients who underwent arthroscopic surgery for degenerative disease of the posterior horn of the medial meniscus. The cohort included 230 males and 276 females, aged from 32 to 58 years old with an average of (46.77±9.02) years old. According to the results of postoperative follow-up, patients were categorized into a knee osteoarthritis(OA) group and a non-OA group. The following parameters were recorded for each subject:gender, medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKA), presence of bone edema on MRI, physical characteristics (including McMurray test results, locking symptoms, and medial knee tenderness points), meniscus protrusion, type of meniscus injury, and free body condition as observed via arthroscopy. Multivariate unconditional Logistic regression analysis was employed to investigate the associated factors influencing the 10-year postoperative incidence of knee osteoarthritis following surgery for degenerative injury of the posterior horn of the medial meniscus. Independent risk factors potentially influencing the development of postoperative OA were identified, and a nomogram-based predictive model for postoperative OA was established. The discriminatory ability and calibration accuracy of the model were assessed using the C-index and Hosmer-Lemeshow goodness-of-fit test, respectively. Furthermore, internal validation was performed using the bootstrap resampling method. RESULTS: Within a 10-year period following arthroscopic surgery, there were 123 patients in the OA group and 383 patients in the non-OA group. Significant differences were observed between two groups with respect to gender (χ²=5.156, P=0.023), MPTA<86.6° (χ²=21.671, P<0.001), varus lower limb alignment( χ²= 80.086, P<0.001). Additionally, meniscus extrusion (χ²=6.371, P=0.012), meniscus transverse tear (χ²=14.573, P<0.001), and bone edema detected on MRI(χ²=9.881, P=0.002) were identified as factors associated with the development of postoperative knee OA. The multifactorial Logistic regression analysis revealed that the lower limb line of force inversion OR=4.324, 95%CI (1.391, 13.443), P=0.011;MPTA <86.6°, OR=2.519, 95%CI (1.150, 5.519), P=0.021;transverse meniscus tear, OR=4.546, 95%CI (1.827, 11.310), P=0.001;meniscus ectropion, OR=5.401, 95%CI (1.992, 14.646), P=0.001;and bone edema manifestation on MRI OR=2.692, 95%CI (1.169, 6.200), P=0.020. They were independent risk factors associated with the development of postoperative OA. The area under the ROC curve predicted by the model was 0.927, 95%CI (0.903, 0.950). The Hosmer-Lemeshow goodness-of-fit test, used to evaluate the accuracy of the model, yielded P=0.689. Additionally, the internally sampled calibration curve demonstrated good consistency with the actual postoperative OA outcomes. CONCLUSION Varus alignment of the lower extremity, MPTA <86.6°, transverse meniscus tear, lateral meniscus injury, and bone marrow edema observed on MRI were independent risk factors for the development of knee osteoarthritis following arthroscopic surgery. Additionally, the prognostic model demonstrated excellent predictive performance.
Humans ; Male ; Female ; Middle Aged ; Arthroscopy/adverse effects* ; Adult ; Retrospective Studies ; Tibial Meniscus Injuries/surgery* ; Osteoarthritis, Knee/epidemiology* ; Risk Factors ; Menisci, Tibial/surgery* ; Incidence ; Postoperative Complications/epidemiology*

INTRODUCTIONPatients suffering from bilateral knee osteoarthritis often require bilateral total knee arthroplasty (TKA) to alleviate symptoms. There is controversy surrounding the approach to the surgical treatment of such patients. We asked if Asian patients undergoing staged-bilateral TKA had any difference in their short-term functional outcomes, comparing the first TKA to the second one and if the interval between the 2 surgeries had any impact of functional outcomes.

MATERIALS AND METHODSWe identified 100 patients from a single surgeon from 2006 to 2010 who had staged-bilateral TKA and had at least 2 years of follow-up for each TKA. The time interval between the first and second TKA ranged from 6 months to 1 year. Range of motion, Oxford knee questionnaire scores, knee scores and function scores at 6 months and 2 years of follow-up were then compared between the first and second TKA using the Student's T-test.

RESULTSAlthough length of stay was reduced and time to ambulation was shorter for the second TKA, there were no significant differences in functional outcomes at 2 years. There was also no difference in outcome when patients were stratified according to time interval between TKAs.

CONCLUSIONStaged-bilateral TKA continues to be a good option for patients presenting with severe bilateral knee osteoarthritis. The second arthroplasty has similar functional outcomes as the first arthroplasty. Our results can be used in preoperative counselling of patients undergoing staged-bilateral TKA.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; methods ; Asian Continental Ancestry Group ; Female ; Humans ; Length of Stay ; statistics & numerical data ; Male ; Middle Aged ; Operative Time ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; epidemiology ; Range of Motion, Articular ; Retrospective Studies ; Singapore ; Time Factors ; Treatment Outcome ; Walking

Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intraoperative Care ; instrumentation ; methods ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; diagnosis ; epidemiology ; etiology ; prevention & control ; Recovery of Function ; Risk Assessment ; Singapore ; epidemiology ; Tourniquets ; adverse effects ; Treatment Outcome

This study sought to demonstrate bone mineral density (BMD) conditions in elderly female patients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). In addition, we sought to determine whether their BMD conditions differ from those of community-based females without knee OA. Finally we sought to determine whether clinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 female patients undergoing TKA and 273 community-based females were evaluated. Additionally, comparative analyses of BMD between age and body mass index-matched knee OA groups (n=212) and the control groups (n=212) were performed. In the pre-matched knee OA group, regression analyses were performed to determine whether preoperative clinical statuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%) was found in the pre-matched knee OA patients undergoing TKA. We found no significant differences of the BMD T-scores and the prevalence of osteoporosis between the age and body mass index-matched knee OA and control groups. In the pre-matched knee OA patients, poorer preoperative clinical scores were related to poorer BMD T-scores in the proximal femur and/or lumbar spine. Our study suggests that more attention should be paid to identify and treat osteoporosis in elderly female patients with advanced knee OA undergoing TKA.
Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Knee ; Body Mass Index ; Bone Density ; Female ; Humans ; Knee Joint/pathology/surgery ; Osteoarthritis, Knee/*epidemiology/*surgery ; Osteoporosis/*epidemiology

BACKGROUND/AIMS: Chronic arthritis of familial Mediterranean fever (FMF) involves weight-bearing joints and can occur in patients without a history of acute attack. Our aim was to investigate a possible causal relationship between FMF and osteoarthritis in a population in which FMF is quite common. METHODS: Patients with late stage primary osteoarthritis were enrolled, and five MEFV gene mutations were investigated. The frequency of MEFV gene mutations was compared among patients with osteoarthritis and a previous healthy group from our center. RESULTS: One hundred patients with primary osteoarthritis and 100 healthy controls were studied. The frequency of MEFV gene mutations was significantly lower in the osteoarthritis group (9% vs. 19%). M694V was the most frequent mutation (5%) in the osteoarthritis group, whereas in the control group, E148Q was the most common (16%). In subgroup analyses, the mutation frequency of patients with hip osteoarthritis was not different from that of patients with knee osteoarthritis and controls (7.1%, 9.7%, and 19%, respectively). There were no differences among the three groups with respect to MEFV gene mutations other than E148Q (8.1% vs. 3.6%). E148Q was significantly lower in the osteoarthritis group than in the controls (16% vs. 1%), although the mutations did not differ between patients with knee osteoarthritis and controls. CONCLUSIONS: In a population with a high prevalence of MEFV gene mutations, we did not find an increased mutation rate in patients with primary osteoarthritis. Furthermore, we found that some mutations were significantly less frequent in patients with osteoarthritis. Although the number of patients studied was insufficient to claim that E148Q gene mutation protects against osteoarthritis, the potential of this gene merits further investigation.
Adolescent ; Adult ; Case-Control Studies ; Chi-Square Distribution ; *Cytoskeletal Proteins ; DNA Mutational Analysis ; Familial Mediterranean Fever/diagnosis/epidemiology/*genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; *Mutation ; Osteoarthritis, Hip/diagnosis/epidemiology/*genetics/surgery ; Osteoarthritis, Knee/diagnosis/epidemiology/*genetics/surgery ; Phenotype ; Risk Factors ; Turkey/epidemiology ; Young Adult

INTRODUCTIONThere is considerable controversy regarding the best method to prevent venous thromboembolism. In 2008, the American College of Chest Physicians (ACCP) published specific guidelines recommending the use of ow-molecular-weight heparin or warfarin, and a target international normalised ratio of 2.0-3.0 for a duration of at least 7-10 days, after elective knee arthroplasties. Many orthopaedic surgeons believe that these recommendations are biased toward reducing deep venous thrombosis (DVT), but neglect the implicated possibility of a higher incidence of wound complications. In order to enable an objective evaluation of the fit of the ACCP recommendations to the needs of our local cohort of patients, we aimed to look at the incidence of DVT in our local population.

METHODSThis study was a prospective observational study involving existing local patients in Singapore General Hospital, Singapore, who underwent total knee arthroplasty (TKA) and were on a short course of chemothromboprophylaxis (< 7 days) after the operation. The incidence of DVT in patients was evaluated using DVT imaging 4-6 days after the operation and at one month after the operation.

RESULTSIn our study cohort, the prevalence of DVT during the period between postoperative Days 4 and 6 was 12% (11% were distal DVT and 1% was proximal DVT). Only 9% of the patients had DVT one month after the operation. Using chi-square analysis, we found that there was no significant increase in the number of DVT and pulmonary embolism cases 4-6 days and 1 month after the operation (p > 0.05).

CONCLUSIONContrary to the ACCP guidelines, a short course of chemothromboprophylaxis post TKA, lasting no more than 7 days, is safe and adequate in the low-risk Asian population.

Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; therapeutic use ; Arthroplasty, Replacement, Knee ; adverse effects ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Incidence ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; Prognosis ; Prospective Studies ; Singapore ; epidemiology ; Treatment Outcome ; Venous Thrombosis ; epidemiology ; etiology ; prevention & control ; Warfarin ; therapeutic use

INTRODUCTIONLocal data on revision total knee arthroplasty (TKA) are limited. This study aims to assess the causes and outcomes of revision TKA in a single institution, with a 2-year follow-up.

MATERIALS AND METHODSA retrospective review of case records of patients who underwent revision TKA in 2008 and 2009 in the authors' institution was performed. Outcome was assessed using SF-36, Oxford knee score and Knee Society Clinical Rating System preoperatively, at 6 months and at 2 years' follow-up.

RESULTSForty-one patients (41 knees) were included in the study. Indications for revision were aseptic loosening in 13 (31.7%), mechanical wear/component failure in 10 (24.4%), infection in 9 (22.0%), malalignment in 4 (9.8%), instability in 3 (7.3%), periprosthetic fracture in 1 (2.4%) and persistent stiffness in 1 (2.4%). Significant improvements were seen postoperatively in all 3 instruments used to evaluate clinical outcome. These improvements were seen at 6 months after surgery, and were maintained through the 2-year follow-up period. There were no significant changes in all scores between 6 months and 2 years follow-up. There was 100% survivorship of the implants with no postoperative complications requiring surgical intervention.

CONCLUSIONIndications for revision TKA locally are similar to those in other large centres. Revision total knee arthroplasty results in significantly improved function and quality of life for patients, which is maintained over a 2-year follow-up period. In our series, we obtained 100% implant survivorship.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Incidence ; Knee Prosthesis ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Complications ; epidemiology ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Singapore ; epidemiology ; Time Factors

OBJECTIVETo investigate the incidence rate of anterior knee pain after total knee arthroplasty (TKA) and identify the related factors.

METHODSThis prospective, double-blind clinical trial involved a total of 128 patients scheduled for primary ipsilateral cemented three-component TKA for osteoarthrosis. The patients were randomized into two groups to receive operations for TKA with patellar resurfacing (experimental group) or not (control). The incidence of anterior knee pain was observed in these patients and the factor affecting the occurrence of anterior knee pain and knee was analyzed.

RESULTSThe patients were followed up for a mean of 16.5 months (range 6~24 months). The incidence rate of anterior knee pain was 10.9% (7/64) in the experimental group, showing no significant difference from the rate of 14.1% (9/64) in the control group. But the 52 patients with varus or valgus knee showed a significantly higher incidence rate of anterior knee pain (21.2%, 11/52).

CONCLUSIONTKA with patellar resurfacing can not decrease the incidence of anterior knee pain, and varus or valgus before the operation is associated with a higher risk of anterior knee pain.

Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; China ; epidemiology ; Denervation ; methods ; Double-Blind Method ; Female ; Humans ; Knee Joint ; blood supply ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Patella ; surgery ; Patellofemoral Pain Syndrome ; epidemiology ; etiology ; physiopathology ; Risk Factors