Objective:To investigate the safety and effectiveness of ambulatory joint arthroplasty and to establish a standardized procedure for outpatient joint replacement surgery.Methods:The clinical data from patients who underwent joint replacement surgery at the Orthopaedics Department of the General Hospital of PLA Fourth Medical Center between April 2023 and January 2024 were retrospectively analyzed. After screening and evaluation, fifty-nine patients who met specific criteria were enrolled for elective ambulatory surgery, including unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and total hip arthroplasty (THA). For comparison, a 1∶1 matched control group was created from patients who underwent primary joint arthroplasty with routine hospitalization during the same period, matched by gender and surgical procedure. Functional outcomes were assessed pre- and post-operatively using the visual analogue scale (VAS), Harris hip score (HHS), and American Knee Society score (KSS). Postoperative complications, post-discharge complications, unplanned 90-day readmissions, and reoperations were analyzed.Results:The ambulatory surgery group had an average age of 62.0±6.5 years (range 53-76 years), which was significantly younger than the inpatient group at 66.2±8.3 years (range 46-81 years; t=3.707, P=0.002). No significant differences were observed in demographics such as body mass index (BMI) and American Society of Anesthesiologists (ASA) classification ( P>0.05). The incidence of complications, including nausea, vomiting, and severe pain, was similar between groups, with no statistically significant difference (χ 2=0.083, P=0.752). One case of unplanned emergency treatment occurred in the day-surgery group, but post-discharge complication rates did not significantly differ between the groups (3 cases vs. 1 case, P=0.473). The rate of delayed discharge in the ambulatory surgery group was 9%, primarily due to acute complications such as nausea, vomiting, severe pain, and poor patient compliance. VAS scores were lower in the ambulatory group compared to the conventional group within two weeks post-surgery, showing a statistically significant difference ( P<0.05). At one week post-surgery, the Harris hip score of ambulatory patients was significantly improved compared to the inpatient group ( t=7.362, P=0.027). The KSS knee score and KSS function score also showed significant improvement at two weeks post-surgery in the ambulatory group ( P<0.05). Cost-benefit analysis indicated that the hospitalization cost for ambulatory UKA (19.5±0.42 k CNY, excluding prosthesis costs) was approximately 3,000 CNY less than that for conventional surgery (22.5±0.41 k CNY), a statistically significant difference ( t=3.699, P=0.001). Conclusion:Ambulatory joint arthroplasty is a safe and effective option for selected patients, with manageable short-term postoperative complications. This outpatient surgery model promotes early recovery of joint function and provides effective pain management. Ambulatory UKA, in particular, offers enhanced cost-effectiveness, reduced length of stay, and faster bed turnover, making it a valuable approach for wider adoption.

OBJECTIVE: To analyze the accuracy of prosthesis size selection in Naton robot-assisted medial unicondyle knee arthroplasty by comparing the actual prosthesis size used during operation and the preoperative planning. METHODS: The clinical data of 100 patients (110 knees) who underwent Naton robot-assisted medial unicondylar knee arthroplasty between June 2023 and July 2024 was retrospectively analyzed, including 47 knees on left side and 63 knees on right side. There were 37 males (40 knees) and 63 females (70 knees) with a mean age of 65.4 years (range, 59-71 years). Body mass index was 22.2-28.6 kg/m ² (mean, 25.4 kg/m ²). The disease duration ranged from 1 to 8 years (mean, 3.4 years). Preoperative planning was performed by Naton robotic surgical system based on lower limb CT data. The final prosthesis size after osteotomy was recorded and compared with the preoperative plan to analyse whether it was consistent with the preoperative plan, as well as the situation of knee flexion and extension gaps (<0.5 mm, >2.0 mm) corresponding to the different models of prostheses. RESULTS: During operation, 5 patients (5 knees) were treated with traditional UKA due to mechanical arm failure, software obstacles, significant bone amputation bias, or loose reference frame, and were excluded from the final analysis. The remaining 95 patients (105 knees) successfully received Naton robot-assisted surgery, and no related complications occurred. The prosthesis size was consistent with the preoperative plan in 101 knees (96.2%) on the femur side, 100 knees (95.2%) on the tibia side, and 97 knees (92.4%) on both femur and tibia sides. The prosthesis size was inconsistent in 3 cases (2.86%) on the femur side alone, 4 cases (3.81%) on the tibial side alone, and 1 case (0.95%) on both femur and tibial sides. Among the prostheses with different models, the flexion and extension gaps were less than 0.5 mm in 3 knees, the flexion gap was less than 0.5 mm and the extension gap was more than 2.0 mm in 3 knees, and the flexion gap was more than 2.0 mm and the extension gap was less than 0.5 mm in 2 knees. CONCLUSION The accuracy of prosthesis size selection for Naton robot-assisted medial unicondylar knee arthroplasty is relatively high.
Humans ; Arthroplasty, Replacement, Knee/instrumentation* ; Female ; Male ; Middle Aged ; Aged ; Knee Prosthesis ; Retrospective Studies ; Robotic Surgical Procedures/methods* ; Prosthesis Design ; Knee Joint/surgery* ; Osteoarthritis, Knee/surgery* ; Range of Motion, Articular

Objective To investigate the relationship between the expressions of VEGF,ENS, MVD and arteriosclerosis (AS) plaque in atherosclerosis obliterans (ASO) patients. Methods Immunohistochemical staining was used to determine the expression of VEGF, ENS and MVD value in the atherosclerosis plaque of ASO patients hospitalized from October 2007 to August 2010 in our hospital (n =30),and the femoral arterials of control were collected from 22 amputation after traumatic injury. Results The expressions of VEGF (2. 24 ±0.31 vs. 1.87 ±0.27,t =3.58),ENS (1.84 ±0.41 vs. 1. 56 ±0. 38, t =2.09) and MVD value (8.79 ±2.46 slip/HP vs. 6. 05 ±1.68 slip/HP, t =3.64) were significantly higher in the AS plaque of ASO patient than control (P <0.01 or P < 0. 05). We found positive correlations between the expression of VEGF, VEGF/ENS with MVD (r = 0. 391, P < 0. 01; r =0. 583, P < 0. 05) , while negative correlation between the expression of ENS with MVD (r=-0. 328,P <0. 05). Conclusion VEGF promotes the angiogenesis in atherosclerosis plaque,while ENS shows opposite effect The comprehensive performance of them is promoting angiogenesis.