Background:Theoretical advantages of bicompartmental knee arthroplasty (BKA) over total knee arthroplasty (TKA) for bicompartmental (medial combined with patellofemoral) osteoarthritis (OA) are still unclear. This study aimed to compare patient-reported outcome measures (PROMs) and return-to-sport (RTS) rate between modular BKA and TKA in early follow-up.Methods:Twenty-five consecutive modular BKA cases with a minimum 2-year follow-up were matched with 50 TKA cases at 1:2 ratio. Demographic data and preoperative functional scores, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Scores (KSSs), were analyzed to ensure comparability. Postoperative WOMAC score, KSS, range of motion (ROM), Forgotten Joint Score-12 (FJS-12), and RTS rates were compared. Operative time and blood loss were also analyzed.Results:Significant differences in the WOMAC-function (median 97.1 vs. 89.7, p < 0.001) and KSS-function (median 90.0 vs. 80.0, p = 0.003) scores were identified between the BKA and TKA groups. ROM was significantly greater in the BKA group than in the TKA group (median 125.0° vs. 120.0°, p = 0.004), in addition to the FJS-12 (median 89.6 vs. 53.1, p < 0.001). The overall RTS rate was significantly higher in the BKA group than in the TKA group (71.6% vs. 56.5%, p = 0.039). Operative time was significantly longer in the BKA group than in the TKA group (median 105.0 vs. 67.5 min, p < 0.001), but blood loss was similar (median 557.6 vs. 450.7 ml, p = 0.334).Conclusion:Modular BKA demonstrated better functional recovery, better joint perception, and higher RTS rate than TKA; thus, modular BKA can be a good alternative for bicompartmental OA.

BackgroundThe optimal method to treat tibial bone defects during primary total knee arthroplasty (TKA) is still unclear. A novel technique of porous metal pillar augmentation has been applied recently. This study aimed to assess the short-term outcomes of primary TKA with the use of novel porous metal pillars for tibial bone defects.MethodsA total of 24 cases (22 patients) of primary TKA between January 2019 and December 2020 using porous metal pillars for tibial bone defects were reviewed. Clinical results were evaluated using the Knee Society knee score (KSKS) and function score (KSFS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM). Hip-knee-ankle angle (HKAA), femorotibial angle (FTA), and radiolucent lines were assessed radiologically.ResultsThe median follow-up period was 36.0 months (interquartile range: 31-37 months). The KSKS, KSFS, WOMAC score, and ROM improved significantly at the final follow-up assessment compared with the preoperative evaluation. Both of the HKAA and FTA were corrected after surgery. Only one knee had a nonprogressive radiolucent line at the bone-cement interface. No radiolucent lines were detected around the pillar in any of the cases. There were no cases of prosthesis loosening and revision.ConclusionsThe use of novel porous metal pillars yielded satisfactory clinical outcomes and reliable radiological evidence of fixation in this study with a minimum 2-year follow-up. Porous metal pillar augmentation can be considered as a valuable and easy-to-use method for the management of tibial bone defects in primary TKA.

PURPOSE:In clinical practice, many patients complained that their knees became larger after total knee arthroplasty (TKA), yet no studies have described this phenomenon. We named this as "patient-perceived enlargement of knee" (PPEK). This study aimed to investigate the prevalence of PPEK after TKA; assess the association between PPEK and demographics, surgical options, or component size; assess the influence of PPEK on patient satisfaction and functional outcomes; and determine whether there was radiological difference between patients with or without PPEK.METHODS:We reviewed patients that underwent unilateral primary TKA between May 2018 and April 2019. We investigated the prevalence of PPEK and acquired functional scores and satisfaction. Patients were divided into two groups according to whether they complained of PPEK. In radiological evaluation, we measured anterior and posterior condyle offset (ACO and PCO) of the femur, tibial coverage lines, tibial overhanging lines, and femoral overhanging lines.RESULTS:A total of 389 patients were enrolled and 101 patients felt their knee became "larger" after TKA. Patients with PPEK had significantly shorter height and lower weight, yet component size distribution showed no statistical difference. Patients with PPEK had significantly lower functional scores and satisfaction. Patients with PPEK had significantly larger ACO, shorter postoperative PCO, more ACO increase, and less anterior underhang of the tibia.CONCLUSION:PPEK is common in TKA patients, especially in individuals with smaller height and weight. PPEK is associated with poor satisfaction and lower functional scores. In radiology, post-operative ACO, PCO, and anterior underhang of the tibial component were correlated with PPEK.

[目的]探讨肥胖对膝骨关节炎内侧单髁置换术(unicompartmental knee arthroplasty,UKA)临床效果的影响.[方法]回顾性分析2016年7月—2018年6月因内侧室膝骨关节炎行初次单侧UKA 196例患者的临床资料.根据术前体重指数(body mass index,BMI)将患者分为 3 组:正常组 41 例(BMI 18.50-24.99 kg/m2),超重组 113 例(BMI 25.00～29.99 kg/m2),肥胖组42例(BMI≥30.00kg/m2).比较三组患者的围手术期、随访与影像资料.[结果]三组患者均顺利完成手术,无严重并发症.围手术期不良事件,正常组为2/41(4.88％),超重组为6/113(5.31％),肥胖组为2/42(4.76％);经相应处理,均未引发严重不良后果,三组间围手术期不良事件的发生率差异无统计学意义(P＞0.05).三组患者切口均一期愈合,术后均无伤口感染.所有患者均获随访2年以上,平均(35.12±6.53)个月.随访期间三组患者均无假体失败翻修.与术前相比,末次随访时三组患者WOMAC评分均显著改善(P＜0.05);相应时间点,三组间WOMAC评分的差异均无统计学意义(P＞0.05).末次随访时三组患者均对手术满意,三组间患者主观满意评分的差异无统计学意义(P＞0.05).影像方面,末次随访时HKAA,正常组为(175.86±2.50)°,超重组为(177.30±2.66)°,肥胖组为(176.23±2.52)°,三组之间整体差异有统计学意义(P=0.010);两两比较,肥胖组与正常组之间差异无统计学意义(P=0.563).[结论]肥胖对内侧UKA的疗效影响不显著,肥胖患者UKA术后可以获得治疗内侧室膝骨关节炎的满意疗效.

Objective:To compare the short-term effectiveness of medial unicompartmental knee arthroplasty (UKA) between patients younger or older than 60 years of age, and to investigate the impact of age on the effectiveness. Methods:The clinical data of 182 patients (182 knees) who underwent medial UKA between July 2016 and June 2018 were retrospectively analyzed, of which 72 patients were less than 60 years old (group A) and 110 patients were more than 60 years old (group B). There was a significant difference in age between groups (t=-20.198, P<0.001). No significant difference was found in gender, body mass index, surgical sides, Kellgren-Lawrence grading, disease duration, and preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between groups (P>0.05). The postoperative hospital stay and complications were recorded, and the WOMAC score, satisfaction score, and prosthesis revision were compared between groups. Results:The length of postoperative hospital stay was (4.50±1.09) days in group A, and (4.46±1.29) days in group B, with no significant difference between groups (t=0.198, P=0.844). All incisions healed by first intention. The incidences of early postoperative complications in groups A and B were 5.6% and 3.6%, respectively, and the difference was not significant (χ2=0.061, P=0.804). All patients were followed up. The follow-up time were 28-50 months (mean, 36 months) in group A and 28-50 months (mean, 35 months) in group B. At last follow-up, the WOMAC scores of both groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between groups (P>0.05) in the difference before and after operation. The satisfaction scores were 6.6±1.7 in group A and 6.9±1.6 in group B, with no significant difference between groups (t=-1.326, P=0.186). There was no revision surgery in both groups during follow-up period. Conclusion:Age has no significant effect on the prognosis of medial UKA, and patients younger than 60 years of age can also obtain good short-term effectiveness.

Objective To investigate the short-term effectiveness of novel computer navigation system (Knee 3 software; Brainlab, Germany) assisted total knee arthroplasty (TKA). Methods Between July 2020 and December 2020, 19 patients underwent unilateral TKA assisted with Knee 3 software. There were 4 males and 15 females. The mean age was 66.3 years (range, 52-79 years). Eighteen patients were diagnosed with osteoarthritis and 1 patient with rheumatoid arthritis. Sixteen patients had varus knees and 3 patients had valgus knees. Preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain, stiffness, function, and total scores were 12.4±3.4, 2 (1, 4), 22 (18, 29), and 37 (29, 43), respectively. Intraoperatively, the medial and lateral gaps in knee extension and in 90° of knee flexion were recorded. The operation time, intraoperative blood loss, blood transfusion, and complications were recorded. The hip-knee-ankle angle (HKA), lateral distal femoral angle, and medial proximal tibial angle were measured to evaluate lower limb alignment and prostheses's alignment using X-ray films at 6 weeks after operation. Patient's satisfaction rate and WOMAC pain, stiffness, function, and total scores were investigated. Results Eighteen patients (94.7%) had medial- lateral gap balancing in knee extension, 18 patients (94.7%) had medial-lateral gap balancing in 90° of knee flexion, 19 patients (100%) had medial gap balancing between knee extension and 90° of knee flexion, and 18 patients (94.7%) had lateral gap balancing between knee extension and 90° of knee flexion. The mean operation time was 126 minutes (range, 100-200 minutes). The mean intraoperative blood loss was 205 mL (range, 100-400 mL). Patients were followed up 4-8 months, with an average of 6.2 months. Postoperative complications included 1 deep vein thrombosis of lower extremities and 1 cerebral infarction. X-ray films showed that the mean HKA, lateral distal femoral angle, and medial proximal tibial angle were 179.8° (range, 178°-182°), 83.5° (range, 80°-87°), and 89.5° (range, 87°-93°), respectively. At last follow-up, WOMAC pain, stiffness, function, and total scores were 3.6±1.9, 0 (0, 2), 4 (2, 6), and 9 (5, 10), respectively, which improved when compared with preoperative scores ( P<0.05). Twelve patients were very satisfied with the operation results and 7 patients were satisfied with the operation results. The overall satisfaction rate was 100%. Conclusion Knee 3 software can help to obtain good gap balancing and optimal lower limb alignment, with high patient's satisfaction and good short-term effecectiveness.

目的 探讨膝关节置换术后翻修手术的主要原因.方法 回顾2010年1月至2017年6月在北京积水潭医院接受膝关节置换术后翻修手术的158例病历资料.通过分析病历记录、实验室检查、影像学检查和手术记录,确定膝关节翻修原因.初次膝关节置换术后2年内进行的翻修为早期翻修,2年后进行的翻修为晚期翻修.结果 膝关节置换术后翻修的常见原因有:假体周围感染(41.6％)、假体松动(24.8％)和不稳定(9.9％).聚乙烯磨损(3.1％)不是膝关节翻修的主要原因.早期翻修的常见原因是假体周围感染(61.1％)、僵直(12.5％)和不稳定(8.3％),晚期翻修的常见原因是假体松动(41.6％)、假体周围感染(25.8％)和不稳定(11.2％).结论 膝关节翻修的主要原因是假体周围感染.最常见的早期翻修原因是假体周围感染,而最常见的晚期翻修原因是假体松动.应该重视围手术期感染的预防和假体周围感染的防治.

Background: This study aimed to compare the biomechanical strength and permeability of barbed vs traditional suture for closure of the porcine knee joint. Methods: This study used Duroc pig knee joints. For each specimen, a 5-cm medial parapatellar arthrotomy was performed with the knee at 30 degrees of flexion. We closed the arthrotomy wound using barbed suture (size 1/0 V-Loc 180) or traditional suture (size 1/0 PDS II). Specimens were divided into a PDS II (n = 9) and a V-Loc group (n = 9) for biomechanical testing, and a PDS II (n = 9) and a V-Loc group (n = 9) for permeability testing. In biomechanical testing, a continuous load was applied and the wound was pulled apart at 50 mm/min. We compared the maximum load under which each suture type could maintain wound closure. In permeability testing, the knee joints were flexed and extended for 200 cycles at 0.5 Hz from 0 degrees to 120 degrees of flexion. A tube was fixed in the articular cavity of the specimen and connected to a 1.5-m high water capsule. The time taken to wound effusion was compared. Results: There was no significant difference between the mean load at initial failure for PDS II (424 +/- 192 N) vs V-Loc (471 +/- 100 N, P = .529), or between the mean time until effusion for PDS II (6.8 +/- 3.4 seconds) vs V-Loc (5.5 +/- 2.5 seconds, P = .390). Conclusion: Standard and barbed suture had similar wound holding strength and permeability. The barbed suture was as stable as traditional suture. (C) 2017 Elsevier Inc. All rights reserved.

目的 了解原发性膝关节炎患者住院费用水平,探讨其影响因素.方法 收集2011-2015年原发性膝关节炎患者的病案首页信息,分析住院费用及构成的年度变化趋势,并采用单因素和多因素分析方法进行统计推断,探讨住院费用的影响因素.结果 4497例原发性膝关节炎患者的住院费用呈逐年上升趋势(P<0.001),费用中位数由2011年的55995.56元上升至2015年的62984.07元.住院费用的构成中材料费所占比例最高,约占79.33％.材料费的变化趋势与总费用的变化基本一致.患者年龄在18～45岁之间、治疗方式为人工关节置换术和其他手术、医保类型为城镇居民基本医疗保险、新农合、全自费和其他医保的患者住院费较高,材料费、住院天数和出院年份与住院费用正相关,而年龄在45～60岁之间的患者住院费用较低(β=-0.010,P=0.024).结论 原发性膝关节炎患者的住院费用较高,住院费用结构不合理.合理选择治疗方式、控制材料费和缩短住院天数是控制原发性膝关节炎住院费用的重要措施.

Objective:Periacetabular spherical osteotomy for the treatment of dysplastic hip is effective but technically demanding. To help surgeons perform this difficult procedure reliably and safely, a computer assisted navigation technique has been developed and evaluated.Methods:Computed tomographic scans of 5 cadaveric pelvises were obtained and three-dimensional models were generated. The osteotomy was planned preoperatively. The pelvises were registered using an optimized algorithm. Periacetabular spherical osteotomy was performed at one side of each pelvis with navigation and at another side without navigation. The deviation of the real osteotomized surface from the planned surface was measured.Results:The computer assisted navigation system supported preoperative planning and provided real time display of the surgical procedure. The deviation of the real osteotomized surface from the planned surface was 1.59 ± 0.18 mm in the group with navigation, while 4.81 ± 1.67 mm in the group without navigation. The d...

Background: Total hip arthroplasty (THA) is a well-accepted surgical treatment for terminal hip diseases. Objective: To evaluate the effect of preemptive analgesia with parecoxib in patients undergoing primary unilateral THA. Study Design: A randomized, double-blind, placebo-controlled study. Setting: This study was conducted at Peking Union Medical College Hospital and Beijing Jishuitan Hospital in Beijing, China. Methods: A total of 94 patients scheduled for primary unilateral THA in 2 centers (Peking Union Medical College Hospital and Beijing Jishuitan Hospital) were randomly assigned to receive 40 mg parecoxib (n = 48) or 0.9% normal saline solution (n = 46) 30 minutes before incision. All patients received standardized intravenous patient-controlled analgesia (PCA) postoperatively. Preoperative baseline data, surgery-related conditions, postoperative Visual Analog Scale (VAS) pain score, cumulative narcotic consumption of PCA, and complications were compared between the parecoxib group and the placebo group. Results: There were no significant differences in postoperative VAS pain score, cumulative narcotic consumption of PCA, proportion of analgesic remedy, and complications between the 2 groups. Limitations: Only a single dose of parecoxib was used without including a dose-dependent control group. Conclusion: A single dose of parecoxib 30 minutes before incision did not provide effective preemptive analgesia for the management of postoperative pain after primary unilateral THA. The possible effect of preemptive analgesia with parecoxib needs further investigation. Key words: Total hip arthroplasty, pain, parecoxib, COX-2 selective inhibitor, preemptive analgesia, clinical trial, patient-controlled analgesia, analgesics

目的 通过对人工髋关节不良事件的报告进行分析,发现不良事件监测存在的问题,探讨解决问题的对策.方法 采用前瞻性研究方法,跟踪随访2014年1月至2015年6月北京市药品不良反应监测中心收集的行人工髋关节置换术的878例患者的基本信息,并将其中的127例可疑不良事件报告情况进行综合分析.结果 此次调查前瞻性入组878例行人工髋关节置换术的患者,127例发生可疑不良事件,总可疑不良事件发生率为14.46%,平均随访时间为5.28个月.在不良事件信息收集过程中有5例患者未填写随访表(即在前瞻库中不良事件有信息,但未填写随访表),共发现不良事件122例,其中疼痛发生率最高,为112例,下肢肌力弱、纠正步态、弹响、假体周围骨折、伤口脂肪液化、血栓各发生1例,红肿及下肢不等长各发生2例.112例疼痛患者中,轻微疼痛所占比例最高,为73.8%.重度疼痛最低,为0.8%.结论 对人工髋关节置换术后相关不良事件发生的原因进行简单分析,痛感是一种较为复杂的问题,因此要做好术前准备工作,术中要谨慎操作,严格遵循无菌操作的原则,有效预防疼痛,术后做好康复训练及健康指导,有效减少术后不良事件的发生.另外,应加强临床医师的培训,提高其对医疗器械不良事件的认知,及时发现医疗器械的使用风险,提高医疗产品的安全性.

BACKGROUND:Both modular and nonmodular tapered fluted titanium stems are used in revision total hip arthroplasty (THA), with follow-up showing good results for both stems. We aimed to determine whether there were any differences in clinical outcomes, survivorship, or frequency of complications. METHODS:A retrospective review of 160 consecutive THAs (153 patients) revised with a tapered fluted modular titanium stem from 2002 to 2014 and 129 consecutive THAs (128 patients) revised with a tapered fluted nonmodular titanium stem between 2008 and 2014 was conducted. The patient's level of satisfaction, clinical assessment, and complications were examined. A Kaplan-Meier survivorship analysis was performed with the endpoint defined as any reoperation due to septic/aseptic complications. RESULTS:Mean duration of follow-up was longer in the modular group (6.3 years) than the nonmodular group (5.0 years; P = .003). No significant group differences were found in the postoperative Harris Hip Score, the level of overall satisfaction, the 8-year cumulative survival, the rate of infection, dislocation, or postoperative periprosthetic fractures. However, intraoperative fractures occurred significantly more frequently in the modular group (16.9%) than in the nonmodular group (7.0%; P = .011), and stem subsidence was significantly less in the modular group (0.95 mm) than in the nonmodular group (1.93 mm; P = .001). Two mechanical failures associated with the modular design occurred in the modular group. CONCLUSION:Both modular and nonmodular tapered fluted titanium stems provide satisfactory midterm results in revision THA. Although tapered fluted modular stems are gaining in popularity in revision THA, tapered fluted nonmodular stems should not be disregarded as a viable alternative, especially for relatively straightforward cases.

Background Rigid and safe transacetabular screw fixation in total hip arthroplasty (THA) is achieved by pursuing deeper bone stock and avoiding injuries to the neurovascular structures, but these efforts can be restricted by the distribution of screw-holes on cups by the manufacturer. We therefore tried to determine: (i) optimal screw-hole positions on cups to allow anatomical placement of screws; (ii) rationality of the basic 3-screw-hole cluster on commercial cups; and (iii) the optimum method for placing commercial cups in accordance with acetabular anatomy. Methods Periacetabular osseous structure of 64 hips and arterial structures of 50 hips were three-dimensionally reconstructed. Simulated transacetabular screw fixation during THA was performed in these hips with 3 different screw lengths (15, 25, and 35 mm) to define deeper and safer screw trajectories. Screw-hole locations of 7 commercially available cups were measured and matched with the periacetabular anatomy. Results When the cup was placed into the acetabulum at 45° of abduction and 20° of anteversion, the optimal locations of 2 screw-holes on the cups were at 30° and 64° of latitude, with a 35° separation angle. The inversetriangle distribution pattern was safer than the triangle pattern in basic 3-screw-hole-cluster cups. When placing the commercial cups, 5°-10° of anterior rotation can be added to allow better screw trajectories. Conclusions Our study determined optimal screw-hole positions and their distribution pattern on cups. We describe methods to place the commercial cups that are not designed according to acetabular anatomy.

[目的]分析人工髋、膝关节置换术后症状性静脉血栓栓塞性疾病(venous thromboembolism,VTE)发生的危险因素.[方法] 2013年5月～2013年12月行人工髋、膝关节置换术患者602例,这些患者在术后出现下肢疼痛、肿胀、周径发生改变、Homans征阳性时行双下肢深静脉彩超(ultrasonography,USG)检查是否发生下肢深静脉血栓(deep vein thrombosis,DVT),同时记录入组患者肺栓塞(pulmonary embolism,PE)事件的发生,分析患者年龄、性别、BMI、手术类型、单双侧、糖尿病史、术前血糖、术前胆固醇、术前甘油三酯、术前D-dimer等与症状性VTE发生风险的相关性.[结果]人工髋、膝关节置换术后共发生症状性VTE 19例(3.16％),其中远端DVT 18例(3.oo％),近端DVT 4例(0.66％),PE 2例(0.33％).症状性VTE患者的平均年龄为(66.74±9.04)岁,显著高于其余患者人群(OR=1.065;95％ CI=1.001～1.133;P=0.047).[结论]症状性VTE是人工髋、膝关节置换术后不容忽视的问题,尽管进行常规的预防,其发生率仍不低.年龄是人工髋、膝关节置换术后发生症状性VTE的危险因素.对于年龄大的患者,应进行及时有效的VTE预防措施.

目的 观察同期双侧髋膝关节置换术(SB-TJA)与单侧髋膝关节置换术(U-TJA)术后住院期间并发症发生情况并分析术后严重并发症的危险因素.方法 接受初次人工髋膝关节置换术的1675例患者,接受SB-TJA者246例(SB-TJA组)、接受U-TJA者1429例(U-TJA组),比较两组术后住院期间各系统并发症发生情况,采用二分类多因素Logistic回归分析术后住院期间严重并发症危险因素.结果 SB-TJA组术后住院期间发生心血管疾病7例、神经系统疾病2例、消化系统疾病8例、呼吸系统疾病2例、伤口并发症5例、下肢深静脉血栓4例,U-TJA组分别为47、17、54、9、17、12例,两组各系统并发症发生情况比较,P均＞0.05.多因素分析结果 显示,年龄＞68岁(OR=1.986,P=0.01)和ASA分级Ⅲ级(OR=4.136,P=0.031)是术后住院期间严重并发症的危险因素.结论 接受SB-TJA与U-TJA患者住院期间并发症发生率比较无统计学差异,年龄＞68岁和ASA分级Ⅲ级是SB-TJA与U-TJA术后发生住院期间严重并发症的危险因素.

Objective To investigate the characteristics and risk factors for allogeneic transfusion after unilateral total knee arthroplasty (TKA).Methods 852 patients (663 female and 189 male) underwent primary unilateral TKA from January 2014 to December 2014 were included.Average age of included patients were 64.9±7.9 years old (22-87).829 patients were osteoarthritis,others rheumatoid arthritis.The ASA score,BMI,doctor groups,diabetes,hypertension,thrombus (duplex color Doppler ultrasonography),pre-HGB,pre-HCT,pre-TP,pre-Cr,pre-BUN,pre-PT,operation time,starting MABP of the operation,anesthesia and TXA were collected.Potential risk factors for allogeneic transfusion were analyzed statistically via univariate and multivariate regression analysis.Results The preoperative hemoglobin level in 71 (8.3％) patients were lower than that in normal (male ＜120 g/L,female ＜110 g/L).The hematokrit in 27 (3.2％) patients were lower than that in normal (male ＜40％,female ＜37％).TXA was used in 740 (86.9％) patients during the operation.Allogeneic transfusion was performed in 202 (23.7％) the patients after TKA.The differences in the following items within two groups were statistically significant via univariate analysis (P＜0.05),female and male,≥70 and ＜ 70 years,pre-HGB normal and low,pre-HCT normal and low and with and without TXA.Female [OR=2.283,95％CI (1.405,3.711)],patient age of 70 years or older [OR=2.048,95％CI (2.064,4.292)],preoperative hemoglobin level low [male ＜ 120 g/L,female ＜ 110 g/L,OR=1.506,95％CI (1.376,4.427)] and preoperative hematokrit below normal [male ＜ 40％,female ＜ 37％,OR=3.412,95％CI (1.086,6.591)] were independent predictors for postoperative allogeneic transfusion in multivariate regression analysis.Conclusion The allogeneic transfusion rate after unilateral TKA was 23.7％.Female,older than 70 years and preoperative anemia were independent predictors for postoperative allogeneic transfusion after TKA.TXA can effectively decrease the postoperative allogeneic transfusion rate and the amount of transfusion.

Objective To evaluate the additional efficacy of local anesthetic injection (LAI) as a part of multimodal anal?gesia in patients undergoing total knee arthroplasty (TKA) with respect to pain, narcotic use, knee function and complications. Methods A multicenter randomized, controlled, double blind study was performed. A total of 101 patients undergoing unilateral TKA in two centers were randomly divided into injection group and control group. Injection group (50 cases) received local anes?thetic injection of ropivacaine (200 mg), fentanyl (1μg) and epinephrine (1∶1 000, 0.25 mg) in operation and control group (51 cas?es) did not. All patients received standardized general anesthesia and postoperative intravenous patient controlled analgesia (PCA). Preoperative baseline data, surgery?related conditions, postoperative pain (on a 0 to 10 scale), knee function, time of open?ing PCA, narcotic dosage in PCA and complications were compared respectively. Results The time of opening PCA in injection group (4-10 h, M=8 h) was longer than that in control group (2-5 h, M=4 h) (P<0.05). The 12 h, 24 h and total narcotic use of PCA in injection group (8.62±3.601 ml, 21.22±9.220 ml, 38.52±7.764 ml) was less than that in control group (18.43±9.671 ml, 35.30± 11.414 ml, 55.52±12.405 ml) (P<0.05). At post anesthesia care unit the mean VAS in injection group (2.40±1.927) was lower than that in control group (3.06 ± 2.073) (P<0.05). There was no difference in mean VAS at other time points, knee function, length of stay between two groups (P>0.05). Conclusion LIA in TKA can relieve pain early after TKA, prolong the time of opening PCA and reduce narcotic use compared with patients without it. It is simple and safe to use.

Objective To investigate the outcomes of total knee arthroplasty( TKA) for post-traumatic osteoarthritis secondary to inter-nal fracture fixation of the tibial plateau treated with open reduction and internal fixation(ORIF). Methods From January 2003 to January 2015,12 consecutive patients underwent TKA at a mean of 7. 6 years(1 to 25)after tibial plateau fracture. All of these cases had undergone ORIF. Patients were assessed pre-operatively and post-operatively using Knee Society Score ( KSS ) and function score. The KSS score was(62. 7 ± 11. 1),function score was(61. 7 ± 10. 7),and the flexion and extension ROM of the knee joint was (80. 0° ± 34. 9°) pre-operatively. TKA was performed in all cases. Posterior stabilize prosthesis were used in 9 cases,condylar con-strained prosthesis in 2 cases,and rotational hinged prosthesis in one case. Results Complications included wound complication and superficial infection in one case,and partial avulsion of medial collateral ligament in one case. Patients were followed up for 4. 3 years on average(1-13 years),and no late complication was found. At last follow-up,the KSS score was(80. 5 ± 10. 4)and function score was (82. 5 ± 16. 6),the flexion and extension ROM of the knee joint was(101. 7° ± 16. 0°),and all showing significant differences when compared with preoperative values(P<0. 05). Conclusion TKA is technically demanded for post-traumatic osteoarthritis secondary to tibial plateau treated fracture with ORIF. Improvement of joint function can be achieved significantly with caution of infection and wound complication.

Objective To investigate the short-term clinical results of reconstruction of severe acetabular bone defect by using tantalum trabecular metal cup combining tantalum augment.Methods From April 2014 to April 2015, a group of 19 patients (20 hips) underwent total hip arthroplasty ( THA) with the use of tantalum trabecular metal cups combining tantalum augments.There were eight males (nine hips) and 11 females (11 hips).All the patients were followed up for an average period of 8.4 months (range, 4-17 months), the mean age was 52.7 years (range, 28 -62 years).Preoperative and most recent harris hip scores were compared by using paired student t test.The vertical position of the rotation center from the interteardrop line and the horizontal position of the rotation center from the teardrop were measured and analysed.Radiographic examination was performed on immediate postoperative X-ray and the most recent X-ray photos to search for radiolucent lines at the cup-bone or augment-bone interface as well as the implant migration.Any postoperative complications were recorded.Results The mean Harris hip score was 34.0 (range, 12-57) preoperatively and 78.3 postoperatively (t =-17.01, P <0.01).The average vertical location of the center of rotation was 34.4 mm preoperatively and 21.4 mm postoperatively (t=-3.11,P<0.01).All the tantalum cups and augments were stable.There was no infection, dislocation, nerve injury or perioprosthetic fracture complications.Conclusion Reconstruction of severe acetabular bone defect by using tantalum trabecular metal cup combining tantalum augment can increase the contact of host bone and obtain good primary fixation, restore relatively normal center of rotation and lay the basis for normal hip biomechanics.