OBJECTIVE: To investigate the effectiveness and safety of simultaneous bilateral total knee athroplasty (SB-TKA) for the treatment of patients aged 65 years and younger with bilateral knee osteoarthritis (KOA) by comparing with patients undergoing unilateral total knee arthroplasty (U-TKA). METHODS: A clinical data of patients, who underwent primary TKA for KOA and met the selection criteria between June 2019 and July 2023, was retrospectively analyzed, including 181 patients in the U-TKA group and 52 patients in the SB-TKA group. The baseline data of age, gender, disease duration, body mass index, and preoperative hemoglobin (Hb), knee range of motion (ROM), Oxford knee score (OKS), and visual analogue scale (VAS) score for pain were compared between the two groups, with no significant difference ( P>0.05). The operation time, postoperative hospital stay, and all complications related to knee arthroplasty were recorded. Hb was measured at 2 days after operation and the difference between pre- and post-operation was calculated. The knee function and pain were evaluated by using ROM, OKS score, and VAS score and compared between the two groups. RESULTS: The operation time and postoperative hospital stay duration were significantly shorter in the U-TKA group than in the SB-TKA group ( P<0.05). The difference of Hb was significantly lower in the U-TKA group ( P<0.05). All patients were followed up 12-61 months (mean, 37.2 months). There was no significant difference in follow-up time between the two groups ( P>0.05). At last follow-up, the ROM, OKS score, and VAS score of both groups were better than the preoperative ones, and the differences were significant ( P<0.05); there were significant differences between the two groups in the ROM and OKS score ( P<0.05), while no significant difference was found in the VAS score ( P>0.05). Mild complications were observed in 31 cases (17.13%) and severe complications in 3 cases (1.66%) in the U-TKA group, while mild complications were observed in 14 cases (26.92%) in the SB-TKA group, and no severe complication occurred. There was no significant difference in the incidences of mild and severe complications between the two groups ( P>0.05). CONCLUSION In patients aged 65 years and younger with bilateral KOA, knee function and mobility can significantly improved when treated by SB-TKA. While patients had lower postoperative knee mobility and function scores compared with U-TKA, there was no significant difference in pain scores or overall incidence of complication. Strict patient selection and scientific perioperative management are important to achieve good effectiveness after operation in patients with SB-TKA.
Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Male ; Female ; Retrospective Studies ; Osteoarthritis, Knee/physiopathology* ; Range of Motion, Articular ; Treatment Outcome ; Middle Aged ; Operative Time ; Length of Stay ; Knee Joint/physiopathology* ; Pain Measurement ; Postoperative Complications/epidemiology* ; Aged

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*

To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis.The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion.Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (=0.47, 95%:-4.35-5.28,=0.85), incidence of ANV (=0.56, 95%:0.25-1.24,=0.15), incidence of osteoarthritis (=0.56, 95%:0.19-1.68,=0.30), incidence of nonunion (=0.43, 95%:0.13-1.43,=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (=1.01, 95%:0.12-1.19,=0.03) and had statistically significant higher reoperative rate (=3.97, 95%:1.45-10.92,=0.007).No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient.
Aged ; Comparative Effectiveness Research ; Fracture Healing ; Fractures, Multiple ; complications ; therapy ; Fractures, Ununited ; epidemiology ; Humans ; Humerus ; injuries ; surgery ; Orthopedic Procedures ; adverse effects ; methods ; statistics & numerical data ; Osteoarthritis ; epidemiology ; Osteonecrosis ; epidemiology ; Randomized Controlled Trials as Topic ; Reoperation ; statistics & numerical data ; Shoulder Fractures ; complications ; therapy ; Treatment Outcome

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 investigated the epidemiology (prevalence, risk factors, and impact on quality of life) of knee pain and its severity in elderly Koreans. The subjects (n=3,054) were participants aged > or =50 yr from the fifth Korea National Health and Nutrition Examination Survey, conducted in 2010. Knee pain was defined as pain in the knee lasting > or =30 days during the most recent 3 months; severity was categorized as mild, moderate, or severe. EQ-5D was used to measure quality of life. The prevalence of knee pain was 23.1% (11.7% in men, 31.9% in women). The prevalences of mild, moderate, and severe knee pain were 4.3%, 9.1%, and 9.7%, respectively (2.8%, 5.4%, and 3.5% in men and 5.4%, 12.0%, and 14.4% in women). Old age, female gender, a low level of education, a manual occupation, obesity, and radiographic osteoarthritis were risk factors for knee pain, and were associated with increased severity of knee pain. Excluding men with mild knee pain, people with knee pain had significantly lower quality of life than those without knee pain. Early interventional approaches are needed to reduce the medical, social, and economic burden of knee pain in elderly Koreans.
Age Factors ; Aged ; Asian Continental Ancestry Group ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Obesity/complications ; Odds Ratio ; Osteoarthritis, Knee/complications/epidemiology/radiography ; Pain/*epidemiology/etiology ; Prevalence ; *Quality of Life ; Questionnaires ; Republic of Korea ; Risk Factors ; Severity of Illness Index ; Sex Factors

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

OBJECTIVES: People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. METHODS: We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. RESULTS: The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). CONCLUSIONS: One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.
Accidental Falls/*statistics & numerical data ; Adolescent ; Adult ; Age Factors ; Aged ; Arthritis, Rheumatoid/complications/epidemiology ; Back Pain/complications/epidemiology ; Female ; Health Surveys ; Humans ; Incidence ; Male ; Middle Aged ; Musculoskeletal Diseases/*complications ; Osteoarthritis/complications/epidemiology ; Osteoporosis/complications/epidemiology ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Socioeconomic Factors ; Young Adult