Objective To review the research progress of intelligent remote follow-up modes in the application after hip and knee arthroplasty. Methods Extensive literature on this topic published in recent years both domestically and internationally was reviewed, and the application of intelligent remote follow-up modes after hip and knee arthroplasty was summarized and analyzed. Results The intelligent remote follow-up mode is a novel follow-up method based on network information technology. Patients who undergo hip and knee arthroplasty require long-term follow-up and rehabilitation guidance after operation. Traditional outpatient follow-up is relatively time-consuming and inconvenient for some patients in terms of travel and transportation, which makes the application of intelligent remote follow-up modes increasingly widespread worldwide. The inherent attributes of remote interaction and instant feedback of this mode make it particularly valued in the field of hip and knee arthroplasty. Artificial intelligence (AI)-based voice follow-up systems and virtual clinics have significant advantages in improving follow-up efficiency, reducing human resource costs, and enhancing patient satisfaction. Conclusion The existing intelligent follow-up system has formed a standardized protocol in remote follow-up and rehabilitation guidance. However, there are still shortcomings in the formulation of personalized rehabilitation plans and the gerontechnological adaptation of human-computer interaction. In the future, it is necessary to construct a multimodal data fusion platform and establish technical application guidelines for different rehabilitation stages.
Objective To compare the short-term effectiveness of “SkyWalker” robot-assisted total knee arthroplasty (TKA) and traditional TKA. Methods A clinical data of 54 patients (54 knees) with TKA who met the selection criteria between January 2022 and March 2022 was retrospectively analyzed. Among them, 27 cases underwent traditional TKA (traditional operation group) and 27 cases underwent “SkyWalker” robot-assisted TKA (robot-assisted operation group). There was no significant difference between the two groups (P>0.05) in terms of gender, age, body mass index, osteoarthritis side, disease duration, and preoperative Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), visual analogue scale (VAS) score, hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and posterior proximal tibial angle (PPTA). The operative time, intraoperative bleeding volume, surgery-related complications, the KSS, WOMAC, and VAS scores before operation and at 6 months after operation, and Forgotten Joint Score (FJS) at 6 months after operation were recorded. X-ray films were taken to review the prosthesis position and measure HKA, LDFA, MPTA, and PPTA. The differences of the clinical and imaging indicators between before and after operation were calculated and statistically analyzed. ResultsThe operations were completed successfully in both groups. There was no significant difference in the operative time and intraoperative bleeding volume between the two groups (P>0.05). After operation, 1 case of incision nonunion and 1 case of heart failure occurred in the traditional operation group, while no surgery-related complications occurred in the robotic-assisted operation group. The incidences of surgical complications were 7.4% (2/27) in the traditional operation group and 0 (0/27) in the robotic-assisted operation group, with no significant difference (P=0.491). Patients in both groups were followed up 6 months. KSS score, WOMAC score, VAS score, and ROM significantly improved in both groups at 6 months after operation when compared with preoperative ones (P<0.05). There was no significant difference between the two groups (P>0.05) in the differences between the pre- and post-operative values of the clinical indicators and FJS scores at 6 months after operation. X-ray films showed that the lower extremity force lines of the patients improved and the knee prostheses were in good position. Except for LDFA in the robot-assisted operation group, HKA, LDFA, MPTA, and PPTA significantly improved in both groups at 6 months after operation when compared with the preoperative ones (P<0.05). There was no significant difference between the two groups in the differences between the pre- and post-operative values of the radiological indicators (P>0.05). Conclusion The “SkyWalker” robot-assisted TKA is one of the effective methods for the treatment of knee osteoarthritis and had good short-term effectiveness. But the long-term effectiveness needs to be further studied.
In 2020, the American Association of Hip and Knee Surgeons (AAHKS), the American Society of Regional Anesthesia and Pain Medicine (ASRA), the American Academy of Orthopaedic Surgeons (AAOS), the American Hip Society (THS), the American Knee Society (TKS) have worked together to develop clinical practice guidelines on the use of Opioids in primary total joint arthroplasty (TJA). This clinical practice guideline formulates recommendations for common and important questions related to the efficacy and safety of Opioids in primary TJA. This article interprets the guideline to help doctors make clinical decisions.
ObjectiveTo explore the safety and effectiveness of quadriceps snip in complex total knee arthroplasty (TKA).MethodsA clinical data of 19 cases (29 knees) with complex TKA assisted with quadriceps snip between January 2016 and May 2017 were retrospectively analyzed. There were 9 males (13 knees) and 10 females (16 knees). The age of patients ranged from 34 to 66 years (mean, 50.2 years). Four patients (8 knees) were ankylosing spondylitis, 5 patients (7 knees) were rheumatoid arthritis, and 10 patients (14 knees) were knee osteoarthritis. The average disease duration was 10.9 years (range, 8-15 years). There were 12 knees of Kellgren-Lawrence grade Ⅲ and 17 knees of Kellgren-Lawrence grade Ⅳ. The range of motion (ROM) of knee was (19.86±7.23)°. The clinical and function scores of knee society score (KSS) were 47.86±11.26 and 15.52±11.21, respectively. Postoperative complications, ROM, KSS scores, extensor lag, and prosthesis loosening were observed to evaluate the effectiveness.ResultsAll incisions healed by first intention, and no infection or cardiovascular and cerebrovascular accidents occurred. All patients were followed up 25-39 months (mean, 30.3 months). At last follow-up, the ROM of knee was (91.03±7.30) °, the KSS clinical score was 83.62±9.99 and functional score was 66.38±7.89, showing significant differences when compared with preoperative ones (P<0.05). Postoperative extensor lag (10°, 10°, 15°) occurred in 3 cases. There was no evidence of prosthesis loosening or osteolysis on X-ray films during follow-up.ConclusionThe application of quadriceps snip in complex TKA can effectively improve the operative field exposure and reduce incidence of complications such as patella tendon tearing, patella fracture, and quadriceps tendon injury. The surgical technique of Krackow tendon suture can effectively guarantee early rehabilitation without occurrence of other complications.
Objective To investigate the changes of low back pain (LBP) and spinal sagittal parameters in patients with unilateral Crowe type Ⅳ developmental dysplasia of the hip (DDH) after total hip arthroplasty (THA). Methods The clinical data of 30 patients who met the selection criteria between October 2018 and March 2020 were retrospectively analyzed. Patients were divided into LBP group (16 cases) and control group (14 cases) according to whether there was LBP before operation. There was no significant difference between the two groups of patients in gender, age, body mass index, affected sides, preoperative Harris score (P>0.05). Full-length lateral X-ray films of the spine were taken within 1 week before operation and at 1 year after operation, and the following imaging indicators were measured: sacral slope (SS), lumbar lordosis (LL ), spinal tilt (ST), spine-sacral angle (SSA), sagittal vertebral axis (SVA). The visual analogue scale (VAS) score, lumbar Oswestry disability index (ODI), the Harris score of the hip joint before operation and at 1 year after operation, and the occurrence of postoperative complications were collected and analysed. Results In the LBP group, LBP was relieved to varying degrees at 1 year after operation, of which 13 patients (81.3%) had complete LBP remission; VAS score decreased from 4.9±2.3 preoperatively to 0.3±0.8, ODI decreased from 33.5±22.6 preoperatively to 1.3±2.9, the differences were all significant (t=7.372, P=0.000; t=5.499, P=0.000). There was no new chronic LBP in the control group during follow-up. The Harris scores of the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between the two groups at 1 year after operation (t=0.421, P=0.677). There was no significant difference in imaging indexes between the two groups before operation and the difference between pre- and post-operation (P>0.05). At 1 year after operation, ST and SVA in the LBP group, SSA in the control group, and SS in the two groups significantly improved when compared with those before operation (P<0.05); there was no significant difference in the other indexes between the two groups before and after operation (P>0.05). Conclusion Unilateral Crowe type Ⅳ DDH patients with LBP before operation were all relieved of LBP after THA. The relief of LBP may be related to the improvement of spinal balance, but not to lumbar lordosis and its changes.
ObjectiveTo summarize the clinical application and research progress in unicompartmental knee arthroplasty (UKA).MethodsThe literature related to UKA in recent years was reviewed and the emerging indications, implant options, comparisons between other surgical techniques, and recent advances were summarized.ResultsClinical studies show that UKA has many advantages, such as less trauma, faster recovery, and fewer postoperative complications. At present, the operative indication has been expanded. The body mass index more than 25 kg/m2, less than 60 years old, patellofemoral arthritis, and anterior cruciate ligament dysfunction are no longer considered as contraindications. The prosthesis type in UKA should be selected according to the patient’s condition. In recent years, the robot-assisted UKA can effectively improve the effectiveness, improve patient satisfaction, and reduce postoperative complications.ConclusionWith the development of surgical techniques, designs of prosthesis, and the robotic technology, UKA would be further applicated. As more long-term data on UKA become available, it will further guide clinicians in counseling patients on whether UKA should be performed.
ObjectiveTo compare the effectiveness of three different fixation methods after subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 63 patients (78 hips) with Crowe type Ⅳ DDH, who underwent THA with SSO between November 2014 and May 2019, was retrospectively analyzed. Among them, 18 patients (20 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses (group A); 22 patients (30 hips) underwent prophylactic binding by stainless steel wire after osteotomy and before stem implantation (group B); 23 patients (28 hips) were fixed with autogenous cortical strut grafts and stainless steel wire or cables (group C). There was no significant difference in gender, age, body mass index, affected limb side, and preoperative Harris score between groups (P>0.05). The operation time, complications, imaging results, hip functional score of the three groups were recorded and compared. Results There was no significant difference in the operation time between groups (P>0.05). All incisions healed by first intention. All patients were followed up, and the follow-up time was 2.5-4.0 years (mean, 3.1 years) in group A, 1.5-5.5 years (mean, 3.2 years) in group B, and 1.0-5.0 years (mean, 1.6 years) in group C. There was no significant difference in Harris score or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between groups at 4 and 12 months after operation (P>0.05). X-ray films showed that there was no significant difference in osteotomy healing rate at 4, 8, and 12 months after operation and the osteotomy healing time between groups (P>0.05). There was no complications such as joint dislocation, prosthesis loosening, prosthetic joint infection, or heterotopic ossification during follow-up, except for the distal femoral fracture of 1 hip during operation in group B. Conclusion In THA for patients with Crowe type Ⅳ DDH, the stainless steel wire binding alone and autogenous cortical strut grafts combined with stainless steel wire or cable binding can not significantly promote the osteotomy healing compared with femoral prosthesis intramedullary compression fixation. For patients with nonmatched medullary cavity after SSO, it is recommended to apply autogenous cortical strut grafts with wire or cables for additional fixation.
ObjectiveTo develop an artificial intelligence based three-dimensional (3D) preoperative planning system (AIHIP) for total hip arthroplasty (THA) and verify its accuracy by preliminary clinical application.MethodsThe CT image database consisting of manually segmented CT image series was built up to train the independently developed deep learning neural network. The deep learning neural network and preoperative planning module were assembled within a visual interactive interface—AIHIP. After that, 60 patients (60 hips) with unilateral primary THA between March 2017 and May 2020 were enrolled and divided into two groups. The AIHIP system was applied in the trial group (n=30) and the traditional acetate templating was applied in the control group (n=30). There was no significant difference in age, gender, operative side, and Association Research Circulation Osseous (ARCO) grading between the two groups (P>0.05). The coincidence rate, preoperative and postoperative leg length discrepancy, the difference of bilateral femoral offsets, the difference of bilateral combined offsets of two groups were compared to evaluate the accuracy and efficiency of the AIHIP system.ResultsThe preoperative plan by the AIHIP system was completely realized in 27 patients (90.0%) of the trial group and the acetate templating was completely realized in 17 patients (56.7%) of the control group for the cup, showing significant difference (P<0.05). The preoperative plan by the AIHIP system was completely realized in 25 patients (83.3%) of the trial group and the acetate templating was completely realized in 16 patients (53.3%) of the control group for the stem, showing significant difference (P<0.05). There was no significant difference in the difference of bilateral femoral offsets, the difference of bilateral combined offsets, and the leg length discrepancy between the two groups before operation (P>0.05). The difference of bilateral combined offsets at immediate after operation was significantly less in the trial group than in the control group (t=−2.070, P=0.044); but there was no significant difference in the difference of bilateral femoral offsets and the leg length discrepancy between the two groups (P>0.05).ConclusionCompared with the traditional 2D preoperative plan, the 3D preoperative plan by the AIHIP system is more accurate and detailed, especially in demonstrating the actual anatomical structures. In this study, the working flow of this artificial intelligent preoperative system was illustrated for the first time and preliminarily applied in THA. However, its potential clinical value needs to be discovered by advanced research.
【Abstract】 Objective To explore the midterm efficacy of superelastic cage implantation for the treatment of osteonecrosisof femoral head (ONFH). Methods From July 1996 to January 1998, 54 patients (75 hips) of ONFH were treatedwith superelastic cage and followed up. Among 54 patients, 5 patients were lost to follow up and 3 patients were dead of myocardialinfarction, renal failure and gastric cancer, respectively. Forty-six patients completed follow up including 32 males and14 females, aged from 21 to 61 with an average of 39 years old. Twenty-nine hips were classified as Ficat Stage Ⅱ and 36 as StageⅢ . Harris score was 58.20 ± 13.82. All patients were evaluated both cl inically and radiographically. Results Postoperatively,forty-six patients (65 hips) were followed up for 86 to 125 months with an average of 8 years and 8 months. Harris score was 80.78 ± 18.77. Twenty-nine hips were rated excellent, 21 good, 2 fair and 13 poor．A total of 76.9% of overall cl inical results were rated as good or excellent. Eight hips (12.3%) with the cage broken were turned to total hip replacement. Radiographicevaluation: 16 hips (24.6%) rated as grade Ⅰ , 34 (52.3%) grade Ⅱ and 15 (23.1%) grade Ⅲ . Conclusion Superelastic cage implantation is one of alternative treatments for ONFH at early and midterm stages. However, long-term follow-up is needed to know whether it is able to cure ONFH and whether cages will be broken as time passes by.
ObjectiveTo evaluate the performance, safety, and precision of the Yuanhua robotic-assisted total knee arthroplasty system (YUANHUA-TKA) through animal experiments, which will provide reference data for human clinical trials.MethodsSix 18-month-old goats, weighing 30-35 kg, were used in this study. The experimental study was divided into two parts: the preoperative planning and intraoperative bone resection. CT scans of the goats’ lower extremities were firstly performed before the experiments. Then the CT scans were segmented to generate the femoral and tibial three-dimensional (3D) models in the YUANHUA-TKA system. The volumes and angles of each resection plane on the femur and tibia were planned. The bone resection was finally implemented under the assistance of the YUANHUA-TKA system. After completing all bone resections, the lower extremities of each goat were taken to have CT scans. By comparing the femoral and tibial 3D models before and after the experiments, the actual bone resection volumes and angles were calculated and compared with the preoperative values.ResultsDuring the experiments, no abnormal bleeding was found; the YUANHUA-TKA system ran smoothly and stably and was able to stop moving and keep the osteotomy in the safe zone all the time. After the experiment, the resection planes were observed immediately and found to be quite flat. There was no significant difference between the planned and actual osteotomy thickness and osteotomy angle (P>0.05); the error of the osteotomy thickness was less than 1 mm, and the error of the osteotomy angle was less than 2°.ConclusionThe YUANHUA-TKA system can assist the surgeons to perform osteotomy following the planned thickness and angle values. It is expected to assist surgeons to implement more accurate and efficient osteotomy in the future clinical applications.