OBJECTIVE: To compare the mid- and long-term effectiveness of patellar resurfacing versus non-resurfacing in primary total knee arthroplasty (TKA). METHODS: Twenty-six patients who underwent bilateral TKA between March 2013 and September 2015 were selected as the study subjects. One side was randomly chosen for patellar resurfacing (resurfacing group), and the other side was not (control group). There were 4 males and 22 females, the age ranged from 51 to 65 years, with an average of 59 years. According to Kellgren-Lawrence classification, there were 21 cases of grade Ⅳ and 5 cases of grade Ⅲ in both knees. There was no significant difference in the surgical side, and preoperative clinical and functional scores of the Knee Society Score (KSS), visual analogue scale (VAS) score, and the composition ratio of anterior knee pain localization points between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, and the occurrence of complications were recorded and compared. Patient subjective evaluations included Forgotten Joint Score (FJS) and the degree of difficulty in high-level knee activities (including flexion with load bearing, going upstairs, going downstairs, squatting and standing up, kneeling, knee extension, and crossing legs for 7 items); KSS clinical/functional scores and VAS scores were used to evaluate the recovery of knee joint function, and the location of anterior knee pain was determined by a localization diagram. RESULTS: The operation time of the resurfacing group was significantly longer than that of the control group ( P<0.05), and there was no significant difference in intraoperative blood loss between the two groups ( P>0.05). All patients' incisions healed by first intention; the hospital stay ranged from 8 to 23 days, with an average of 12.6 days. All patients were followed up 9-11 years, with an average of 9.7 years. Except for 1 case who died of multiple organ failure due to internal diseases at 9 years after operation and 5 cases with incomplete radiological data, the rest 20 patients were assessed radiologically and found that 1 side of the knee joint in the control group had patellar dislocation; the remaining patients had no prosthetic failure (fracture, loosening, displacement, etc.), patellar fracture, patellar necrosis, patellar instability, patellar tendon rupture, prosthetic revision, etc. No patients had reoperations due to patellar-related complications or anterior knee pain in both knee joints. At 2 years postoperatively and at last follow-up, there was no significant difference in the incidence of abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, the incidence of high-level knee activity difficulty, and the composition ratio of anterior knee pain localization between the two groups ( P>0.05). The KSS clinical scores, functional scores, and VAS scores of both groups significantly improved compared to preoperative ones ( P<0.05); there was no significant difference in the comparison between the two groups at the two time points postoperatively ( P>0.05). At 2 years postoperatively and at last follow-up, there was no significant difference in FJS scores between the two groups ( P>0.05). CONCLUSION Patellar resurfacing or not has similar mid- and long-term effectiveness in primary TKA.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Male ; Middle Aged ; Female ; Patella/surgery* ; Aged ; Treatment Outcome ; Range of Motion, Articular ; Knee Joint/surgery* ; Knee Prosthesis ; Pain Measurement ; Osteoarthritis, Knee/surgery* ; Pain, Postoperative/etiology* ; Follow-Up Studies ; Postoperative Complications ; Recovery of Function

Humans ; Liposarcoma/surgery* ; Retroperitoneal Neoplasms/surgery* ; Neoplasm Recurrence, Local/surgery*

Objective:To evaluate the feasibility and efficacy of remote follow-up based on knee scoring system after total knee arthroplasty (TKA).Methods:A total of 71 patients with knee osteoarthritis who underwent TKA from July 2021 to September 2022 at Department of Orthopaedic Surgery, First Medical Center, Chinese PLA General Hospital were retrospectively analyzed. There were 12 patients included in the study, including 6 males and 6 females, aged 72.83±4.22 years (range, 68-78 years), who were followed up using an online approach (remote follow-up group). According to the sample size of 1:2, patients who received outpatient follow-up during the same period were selected as controls (outpatient follow-up group), including 12 males and 12 females, aged 72.16±4.50 years (range, 65-80 years). Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), and 2011 New Knee Society Score (KSS) were used to assess outcomes after TKA.Results:The follow-up completion rate in the remote follow-up group was 17% (12/71). There were statistically significant differences in WOMAC scores between the two groups before and after operation ( F=106.18, P<0.001; F=34.33, P<0.001). The WOMAC score of remote follow-up group at the last follow-up was 11.21±5.64, which was lower than 43.83±8.52 before operation and 33.96±9.19 at 2-4 weeks after operation, and the difference was statistically significant ( P<0.001, P<0.001). The WOMAC scores of the outpatient follow-up group at the last follow-up was 13.33±5.36, which was lower than 42.00±7.21 before operation and 32.83±11.00 at 2-4 weeks after operation, and the difference was statistically significant ( P<0.001, P<0.001). There were statistically significant differences in OKS between the two groups before and after operation ( F=168.65, P<0.001; F=66.18, P<0.001). The OKS of remote follow-up group at the last follow-up was 15.13±4.92, which was lower than 44.50±5.84 before operation and 36.83±6.31 at 2-4 weeks after operation, and the difference was statistically significant ( P< 0.001, P<0.001). The OKS of the outpatient follow-up group at the last follow-up was 16.58±3.63, which was lower than 41.42±5.05 before operation and 33.33±6.60 at 2-4 weeks after operation, and the difference was statistically significant ( P<0.001, P<0.001). There were statistically significant differences in the 2011 new KSS between the two groups before and after operation ( F=164.21, P<0.001; F=51.78, P<0.001). The 2011 new KSS of remote follow-up group at the last follow-up was 83.67±6.27, which was higher than 41.33±10.33 before operation and 50.42±11.07 at 2-4 weeks after operation, and the difference was statistically significant ( P<0.001, P<0.001). The 2011 new KSS of the outpatient follow-up group at the last follow-up was 83.17±6.28, which was higher than 40.08±8.91 before operation and 44.37±9.04 at 2-4 weeks after operation, and the difference was statistically significant ( P<0.001, P<0.001). There was no significant difference in the three scores between the two groups before operation, 2-4 weeks, 6 weeks, 2-3 months or 4 months after operation ( P>0.05). Conclusion:The effect of remote follow-up based on knee scoring scale after TKA is similar to that of outpatient follow-up, but the rate of loss to follow-up in both groups is high. The scoring scale should be continuously optimized to improve patient compliance.

ObjectiveTo explore the etiology and biochemical markers of acute liver failure (ALF) in children.Methods The cause and the biochemical markers of ALF in children who were treated in December 2014 to January 2011 were ana-lyzed retrospectively.ResultsA total of 67 children were enrolled, including 31 females and 36 males. According to the cause of the disease, the children were divided into non-genetic metabolic group, genetic metabolic group, and cryptogenic group. In the non-genetic metabolic group (29 cases, 43.28%) there were 12 cases of drug-induced ALF, 5 cases of Reye syndrome, 3 cases of hemophagocytic syndrome, 3 cases of herpes simplex virus infection, 2 cases of autoimmune hepatitis, one of case mushroom poisoning one case of hepatitis A virus infection, one case of cytomegalovirus infection and one case of sepsis respectively. In the genetic metabolic group (14 cases, 20.90%) there were 6 cases of Wilson’s disease, 2 case of glycogen storage disease, 2 of cas-es progressive familial intrahepatic cholestasis, 2 cases of neonatal intrahepatic cholestasis caused by citrin deifciency, one case of very long-chain acyl coenzyme A dehydrogenase deifciency and one case of primary carnitine deifciency. In the cryptogenic group there were 24 cases (35.82%). The serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, blood glucose level and AST/ALT were statistically signiifcantly different in genetic metabolic group from in non-genetic me-tabolism disease group and cryptogenic group, (P<0.05). The genetic metabolic group had the lowest levels of serum ALT, AST, albumin and glucose while the genetic metabolic group had the highest ratio of AST/ALT.ConclusionsThe etiology of ALF in children are complex. Genetic metabolic disease should be considered when the child with ALF has no signiifcantly elevated ALT, extremely high ratio of AST/ALT, combined with hypoproteinemia and hypoglycemia.