Objective:To analyze the clinical efficacy of internal fixation and prosthesis revision in the treatment of periprosthesis fracture after total knee arthroplasty.Methods:A total of 35 patients (35 knees) with periprosthetic fractures after total knee arthroplasty were retrospectively analyzed from January 2008 to January 2022 in the Department of Orthopaedics, West China Hospital, Sichuan University, including 13 males and 22 females, aged 71.4±4.1 years (range, 62-81 years). Left knee 19 cases, right knee 16 cases. There were 20 cases of Rorabeck type II and 15 cases of Rorabeck type III. The initial replacement was performed using a fixed platform post-stabilized knee prosthesis, which was fixed with bone cement. Patients with Rorabeck type II were treated with internal fixation alone (internal fixation group) and patients with Rorabeck type III underwent revision with replacement prosthesis (revision group). The Hospital for Special Surgery (HSS) score, range of motion (ROM) of knee joint, alignment of lower extremity and incidence of postoperative complications were compared between the two groups.Results:All patients successfully completed the operation and were followed up for 5.2±3.6 years (range, 1-12 years). Intraoperative blood loss was 680±102 ml (range, 420-1100 ml). The operative time in the internal fixation group was 105±17 min, which was less than 140±21 min in the revision group, and the difference was statistically significant ( t=-5.450, P<0.001). There was no complication of nerve or blood vessel injury during the operation. Five cases in the internal fixation group had unsatisfactory lower extremity force lines (>3° deviation from normal) after surgery, and all lower extremity force lines in the revision group were satisfied, and the difference in the satisfaction rate of lower extremity force lines between the two groups was not statistically significant ( P=0.057). The fracture healing time, knee ROM and HSS scores at the last follow-up were 5.1±1.3 months, 86°±5° and 84±5 in the internal fixation group and 4.8±1.5 months, 83°±6° and 82±4 in the revision group. One case in the revision group was diagnosed postoperatively with periprosthetic infection with pathogen culture suggestive of Candida albicans, recurrent anterior knee sinus tracts and patellar ectasia, which progressed to osteomyelitis, and mid-thigh amputation was performed 1 year after revision. Conclusion:The stability of prosthesis is an important reference for the treatment of periprosthetic fractures after total knee arthroplasty. Strong internal fixation in patients with unloosened prosthesis and revision with replacement of prosthesis in patients with loose prosthesis can achieve good knee joint function.

With the increasing prevalence of total knee arthroplasty (TKA), there is a corresponding rise in the number of patients requiring revision of total knee arthroplasty (R-TKA) for various reasons. R-TKA presents several complex challenges, with severe bone defect reconstruction being a critical obstacle to securing favorable long-term outcomes. Recently, the approach to managing bone defects has seen significant advancements, with a range of techniques proposed contingent on the defect's size and location. Severe bone defects require reconstruction with autologous or allogeneic bone grafts or metal fillers. However, bone grafts have their usage constrained by limited availability, risks of resorption and collapse, and the potential for disease transmission. Consequently, metal fillers have received widespread attention in practical applications due to their advantages, such as comprehensive source, customizability, and safety. The advantages of metal augment are that they provide immediate support without reinforcement and are not subject to necrosis and resorptive collapse. However, the difference in elastic modulus between metal and bone may lead to stress shielding and increase the risk of potential bone loss. Both Cone and Sleeve can achieve biological fixation of metaphyseal bone; however, in cases of periprosthetic infections, it is generally difficult to remove them easily due to the prosthetic bone in-growth and osseointegration. This study aims to provide a comprehensive review of the use of metal fillers to reconstruct bone defects during R-TKA. It is intended to aid orthopedic surgeons in understanding the spectrum of reconstructive possibilities and provide high-performance revision strategies for their patients.

Objective:To analyze the medium- and long-term outcomes of V-Y quadricepsplasty in primary total knee arthroplasty (TKA) to expose an ankylosed or stiff knee joint.Methods:From May 2010 to February 2019, a total of 12 patients with TKA revealed by V-Y quadricepsplasty in West China Hospital of Sichuan University due to knee ankylosis or stiffness were retrospectively analyzed, including 7 males and 5 females, aged (53.9±14.9) years (range, 24 to 72 years), 6 patients on the left side and 6 patients on the right side. Preoperative diagnosis: 7 cases of osteoarthritis, 2 cases of rheumatoid arthritis, 1 case of traumatic arthritis, and 2 cases of haemophilic arthritis. Visual analogue scale (VAS), range of motion, quadriceps muscle strength, Knee Society score (KSS) and postoperative complications were recorded before and after operation.Results:All patients successfully completed the operation and were followed up for 102.2±31.1 months (range, 51-141 months). The operation time was 87.0±15.7 min (range, 73 to 123 min), the intraoperative blood loss was 823.6±237.7 ml (range, 555 to 1 471 ml), and the hospital stay was 13.3±6.3 d (range, 6 to 28 d). Postoperative VAS scores were decreased in all patients, and the difference before and after operation was statistically significant ( F=132.000, P<0.001). The VAS scores at 3 months and the last follow-up were 2.2±0.7 points and 1.2±0.4 points, respectively, lower than those before operation (5.2±0.7 points), and the difference was statistically significant ( P<0.05). KSS knee scores were higher in all patients after operation, and the difference was statistically significant before and after operation ( F=40.960, P<0.001). KSS knee scores at 3 months and the last follow-up were 56.0±14.1 points and 74.3±16.1 points, respectively, higher than those before operation (26.1±7.8 points), and the difference was statistically significant ( P<0.05). Postoperative KSS functional scores were increased in all patients, and the difference before and after operation was statistically significant ( F=24.332, P<0.001). The KSS functional scores at 3 months and the last follow-up were 52.9±19.4 points and 79.2±19.6 points, respectively, higher than those before operation (27.1±15.6 points), and the difference was statistically significant ( P<0.05). Postoperative knee joint motion was increased in all patients, and the difference was statistically significant before and after operation ( F=24.145, P<0.001). The range of motion of the knee joint at 3 months and the last follow-up was 57.5°±22.2° and 70.0°±25.9°, respectively, which was higher than the preoperative 12.5°±14.1°, and the difference was statistically significant ( P<0.05). Preoperative quadriceps muscle strength was grade 3 in 2 cases and grade 4 in 10 cases; at the last follow-up, grade 4 in 1 case and grade 5 in 11 cases, and the muscle strength was improved compared with that before operation, the difference was statistically significant ( Z=11.000, P<0.001). At the last follow-up, there were no complications such as wound seepage, delayed healing, superficial or deep soft tissue infection, periprosthesis infection and loosening, deep vein thrombosis and pulmonary embolism. Conclusion:In patients with ankylosed or stiff knee receiving TKA, the use of V-Y quadricepsplasty can increase the exposure, thereby improving the range of knee motion and quadriceps muscle strength.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

BACKGROUND: Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up. METHODS: This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery. RESULTS: At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t  = 0.221, P  = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U  = 789.500, P  = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively ( P  > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups ( P  > 0.05). CONCLUSIONS: Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj=13334 .
Humans ; Arthroplasty, Replacement, Knee/methods* ; Synovectomy/methods* ; Osteoarthritis, Knee/surgery* ; Prospective Studies ; Pain, Postoperative ; Inflammation/etiology* ; Range of Motion, Articular ; Knee Joint/surgery* ; Treatment Outcome ; Knee Prosthesis/adverse effects*

  Objective  To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China.  Methods  Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis.  Results  A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems.  Conclusions  Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.

Objective:To retrieve and summarize the best evidence on non-pharmacological interventions for pain management in knee osteoarthritis.Methods:The literatures related to non-pharmacological intervention in pain management for knee osteoarthritis were searched on UpToDate, BMJ Best Practice, Australia Joanna Briggs Institute evidence-based healthcare center database, Cochrane Library, National Institute for Health and Clinical Excellence, Guidelines International Network, Medlive, Medline, PubMed, Wanfang database and China National Knowledge Infrasructure. The evidences were extracted after quality evaluation of the included literature.Results:A total of 11 references were included, including 6 guidelines, 2 expert consensuses, 2 systematic evaluations and 1 randomized controlled trial. Finally, 22 pieces of best evidences were summarized from 6 aspects, including health education, pain assessment, referral, psychological intervention, exercise intervention and physical therapy.Conclusions:Summary of the best evidence for non-pharmacological intervention in pain management for patients with knee osteoarthritis can provide evidence-based evidence for clinical healthcare professionals and knee osteoarthritis patients to undergo non-pharmacological pain intervention.

Objective:To summarize the evidence of cold therapy for patients after knee joint replacement, so as to provide theoretical support for the practical implementation of cold therapy in patients after knee joint replacement in clinical practice.Methods:The literature on cold therapy for patients after knee joint replacement was systematically searched in relevant databases and websites at home and abroad. The search period was from database establishment to September 2022. The evaluation of literature quality and evidence extraction were independently completed by two researchers.Results:A total of 17 articles were included, including two clinical practice guidelines, five systematic reviews, six randomized controlled trials, and four expert consensuses. After independent evaluation and evidence extraction by two researchers, a total of 19 pieces of evidence were collected from 5 aspects: evaluation and education, observation of cold therapy, cold therapy tools, cold therapy parameters, and cold therapy effects. Among them, 8 pieces of A-level recommended evidence and 11 pieces of B-level recommended evidence.Conclusions:Cold therapy for patients after knee joint replacement is widely accepted and applied. Medical and nursing personnel should prioritize patient safety and formulate scientific cold therapy plans based on various factors such as individual differences, patient preferences, actual clinical scenarios, differences in medical equipment, medical and nursing personnel technical level, and cost-effectiveness, in order to maximize patient benefits.

BACKGROUND: The screening of periprosthetic joint infection (PJI) in patients with inflammatory diseases before revision arthroplasty remains uncertain. Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), plasma fibrinogen (FIB), monocyte/lymphocyte ratio, and neutrophil/lymphocyte ratio (NLR) can help screening PJI, but their values in patients with inflammatory diseases have not been determined. METHODS: Patients with inflammatory diseases who underwent revision hip or knee arthroplasty at West China Hospital, Sichuan University, from January 2008 to September 2020 were divided into infected and non-infected groups based on the 2013 International Consensus Meeting criteria. Sensitivity and specificity of the tested biomarkers for diagnosing infection were determined based on receiver operating characteristic (ROC) curves, and optimal cutoffs were determined based on the Youden index. The diagnostic ability of these biomarkers was re-assessed after combining them with each other. RESULTS: A total of 62 patients with inflammatory diseases were studied; of them 30 were infected. The area under the ROC curve was 0.813 for CRP, 0.638 for ESR, 0.795 for FIB, and 0.656 for NLR. The optimal predictive cutoff of CRP was 14.04 mg/L with a sensitivity of 86.2% and a specificity of 68.7%, while FIB had a sensitivity of 72.4% and a specificity of 81.2% with the optimal predictive cutoff of 4.04 g/L. The combinations of CRP with FIB produced a sensitivity of 86.2% and specificity of 78.1%. CONCLUSION: CRP with a slightly higher predictive cutoff and FIB are useful for screening PJI in patients with inflammatory diseases, and the combination of CRP and FIB may further improve the diagnostic values. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR2000039989.
Humans ; C-Reactive Protein/analysis* ; Prosthesis-Related Infections/diagnosis* ; Fibrinogen ; Arthroplasty, Replacement, Hip ; Arthritis, Infectious/surgery* ; Blood Sedimentation ; Sensitivity and Specificity ; Biomarkers ; Retrospective Studies

Humans ; Tranexamic Acid ; Atrial Fibrillation ; Antifibrinolytic Agents ; Arthroplasty ; Blood Loss, Surgical ; Arthroplasty, Replacement, Hip