Objective To investigate the relief of low back pain after hip arthroplasty in patients with hip joint and spinal degenerative diseases, and to discuss the effects of unilateral and bilateral hip surgery on the relief of low back pain. Methods In this retrospective study, we followed 153 patients (69 males and 84 females, age: 43–88 years) who had undergone total hip arthroplasty (THA) via a posterolateral approach and also suffered from lumbar degenerative diseases in the period of 2009 to 2019. The inclusion criteria were: (i) patients who had been diagnosed with severe hip degenerative disease and also been diagnosed with lumbar degenerative disease; (ii) patients who had undergone THA surgery; and (iii) patients who were retrospectively recruited. The exclusion criteria were: (i) patients who had undergone lumbar fusion or internal fixation surgery; or (ii) patients who had vascular claudication, history of major trauma, diabetic polyneuropathy, lumbar and pelvic infections, tumor diseases; (iii) or patients who had undergone THA because of femoral neck fracture or ankylosing spondylitis. The improvement of hip joint function and the relief of low back pain (LBP) were studied, and the effect of unilateral and bilateral THA on the relief of LBP were discussed. Hip pain and function were evaluated by the Harris Hip Score (HHS), LBP was evaluated by Visual Analog Scale (VAS), and lumbar function was evaluated by the Japanese Orthopaedic Association (JOA) scoring system. Results The average follow‐up time was 44.3 months (24–108 months). All patients recovered smoothly without complications. The LBP VAS of 153 patients decreased from 4.13 ± 1.37 preoperatively to 1.90 ± 1.44 postoperatively. The average HHS increased from 45.33 ± 13.23 preoperatively to 86.44 ± 7.59 postoperatively at the latest follow‐up. According to Japanese Orthopaedic Association scoring system, the proportion of patients with good response to treatment in these 153 patients reached 93.46%. LBP VAS decreased from 4.18 ± 1.38 preoperatively to 1.95 ± 1.49 postoperatively in unilateral group and from 3.94 ± 1.32 preoperatively to 1.73 ± 1.23 postoperatively in bilateral group, respectively. There were only nine patients with persistent or aggravated LBP after operation. Among them, six patients underwent subsequent lumbar surgery (five patients had pain relieved after reoperation and one patient had not) and the other three patients chose conservative treatment for pain. Conclusion THA can relieve LBP while relieving hip pain and restoring hip function in patients with both hip and lumbar degenerative disease, thus possibly avoiding further spinal surgery.
Objective This study aimed to observe the relationship between education level and outcomes after total knee arthroplasty (TKA). Methods One thousand two hundred sixty four patients after TKA in our hospital from April 2016 to April 2020 were reviewed. These patients were divided into 4 groups (A who were illiterate, B who had elementary school degree, C who had junior high school degree, D who had senior high school degree or higher) by the educational level, which was blinded to the observers. The postoperative outcomes of KSS score, pain, joint extension and flexion function were observed 1 year after discharged from hospital. Results Among 1253 patients met the inclusion criteria, the average age was 68.63 years, the average body mass was 57.73 kg. There are no distinctions among 4 groups one day after the surgery. However, the outcomes of the follow up were that, the KSS score was: 77.84 ± 10.635; 80.70 ± 8.956; 87.92 ± 8.123;91.27 ± 8.262, with significant differences (P < 0.05). The mean VAS scores were: 1.97 ± 1.60; 2.07 ± 1.66; 1.197 ± 1.5265, 1.044 ± 1.4662. Patients in Group C and D had significantly less pain than that in Group A and B (P < 0.05). The knee flexion range of motion (ROM) was: 91.21 ± 11.69°; 91.77 ± 11.95°; 102.12 ± 11.38°; 109.96 ± 10.64°, Group D performed best, with significant differences (P < 0.05). The knee extension ROM were: – 2.41 ± 4.49°; – 0.91 ± 2.82°; – 0.83 ± 2.87°; – 0.35 ± 1.60°, with significant difference between Group D and the others (P < 0.05). Conclusion Education level affects the outcomes such as VAS score, KSS score, the extension and flexion ROM of the knee after TKA. The patients with higher education level have better outcomes.
Objective: Mismatch between the femoral component and the resected surface is related to the postoperative clinical outcome. This study aimed to measure the morphometric features of the distal femoral resected surfaces in patients with osteoarthritis in southwestern China and to compare the measured morphometric data with six commonly used total knee arthroplasty (TKA) femoral components in China. Method:The computer tomography (CT) images of a total of 406 knees from 203 osteoarthritis patients who underwent TKA from January 2018 to December 2021 were imported into Mimics 21.0 software to reconstruct the threedimensional (3D) model of the femur. Morphometric data of the distal femoral resected surfaces were measured after the completion of simulated bone resection in the software. The data included the medial-lateral (ML) dimension, anterior-posterior (AP) dimension, and the aspect ratio (AR) (AR = ML/AP), which were compared between genders with independent sample t-tests. In addition, we plotted the scatter diagram of those morphometric data in Origin software, and the linear fits of ML versus AP and AR versus AP were performed and compared for the six femoral components commonly used in enrolled patients in China. Results:The mean ML dimension, the mean AP dimension, and the mean AR value measured for Chinese knees were 66.62 AE 4.57 mm, 58.10 AE 3.74 mm, and 1.15 AE 0.06 respectively. All dimensions were significantly larger in males than in females, including the calculated values for AR (P < 0.05). The fitted lines for males showed that the ML dimensions tended to be wider compared to femoral components of a given AP dimension. Females tended to have wider ML dimensions compared to small femoral components and, on the other hand, narrower ML dimensions compared to large femoral components. Conclusion:The femoral component of the current commonly used TKA prosthesis in China may not be perfectly matched to the distal femoral resected surface of patients in southwestern China. Male patients tended to underhang in all dimensions of the ML dimension. Female patients with shorter AP lengths are more likely to experience underhang, whereas those with longer AP lengths are more likely to develop overhangs. Therefore, we recommend multiple ML width options for a given AP length to more appropriately match the Chinese femoral anatomy.
ObjectiveThe purpose of this study is to assess the association between the presence and severity of flatfoot and symptoms of knee OA.Methods95 participants with knee OA were recruited from a patient cohort at a regional hospital. Symptoms of knee OA, including knee degeneration, femorotibial alignment, pain, stiffness and dysfunction were assessed using the Kellgren-Lawrence (K-L) grading system, femoral-tibial angle (FTA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Participants were divided into groups with flatfoot (mild, moderate and severe) and without flatfoot based on the Clarke's angle. Linear regression and ordinal logistic regression were used for statistical analysis, as appropriate.ResultsHaving flatfoot was associated with a significantly increased risk of having a higher K-L grade (OR: 20.03; 95% CI, 5.88, 68.27; p < 0.001), smaller FTA (Beta: −2.96; 95% CI, −4.41, −1.50; p < 0.001), higher pain score (Beta: 0.47; 95% CI, 0.24, 0.69; p < 0.001) and greater loss of function (Beta: 0.25; 95% CI, 0.02, 0.48; p = 0.03). Severe grades of flat feet were associated with a higher K-L grade (OR: 0.19; 95% CI, 0.08, 0.44; p < 0.001), smaller FTA (Beta: 1.51; 95% CI, 0.66, 2.35; p = 0.001), higher pain score (Beta: −0.25; 95% CI, −0.39, −0.11; p = 0.001), greater stiffness (Beta: −0.24; 95% CI, −0.38, −0.09; p = 0.002) and greater loss of function (Beta: −0.27; 95% CI, −0.41, −0.14; p < 0.001).ConclusionThe results indicated that the severity of flattening is significantly associated with symptoms of knee OA. For the conservative management of knee OA, both flatfoot and its severity should be carefully considered.
Objective: This study aimed to observe the relationship between education level and outcomes after total knee arthroplasty (TKA).Methods: 1264 patients after TKA in our hospital from April 2016 to April 2020 were reviewed. These patients were divided into 4 groups (A who are illiterate, B who had elementary school degree, C who had junior high school degree, D who had senior high school degree or higher) by the educational level, which was blinded to the observers. The postoperative outcomes of KSS score, pain, joint extension and flexion function were observed 1 month, 6 months and 1 year after discharged from hospital.Results: Among 1253 patients met the inclusion criteria, the average age was 68.63 years, the average weight was 57.73 kg. There are no distinctions among 4 groups one day after the surgery. However, the outcomes of the follow up were that, the KSS score was: 77.84 ± 10.635; 80.70 ± 8.956; 87.92 ± 8.123;91.27 ± 8.262, with significant differences (P < 0.05). The mean VAS scores were: 1.97 ± 1.60; 2.07 ± 1.66; 1.197 ± 1.5265, 1.044 ± 1.4662. Patients in Group C and D had significantly less pain than that in Group A and B (P < 0.05). The knee flexion range of motion (ROM) was: 91.21 ± 11.69 °; 91.77 ± 11.95 °; 102.12 ± 11.38 °; 109.96 ± 10.64 °, Group D performed best, with significant differences (P < 0.05). The knee extension ROM were: – 2.41 ± 4.49 °; – 0.91 ± 2.82 °; – 0.83 ± 2.87 °; – 0.35 ± 1.60 °, with significant difference between Group D and the others (P < 0.05).Conclusion: Education level is an important factor affecting the outcomes after total knee arthroplasty. The patients with higher education level would likely have better outcomes.
Objective. The purpose of this study was to reveal the antibacterial activity of carbon-based nanofilm titanium alloy. Methods. The experiments were performed both in vitro and in vivo of animals using two circular-piece test specimens of the same specification, which were made from carbon-based nanofilm coated titanium alloy and commonly used in artificial joints Co-Cr-Mo alloy, respectively. In the in vitro experiments, the two test specimens were cocultured with standard strains of Staphylococcus aureus and Escherichia coli, and the antibacterial properties of the two test specimens were evaluated via inhibition zone size, scanning electron microscopy, fluorescence staining, colony forming unit count, and others; the cytotoxicities of the two test specimens were evaluated by coculturing and them with rabbit bone marrow mesenchymal stem cells (BMSCs). In the in vivo experiments, the two test specimens were implanted in the muscle tissue of experimental rabbits to evaluate their histocompatibilities. Results. Both in vitro cocultures of the carbon-based nanofilm titanium alloy and the Co-Cr-Mo alloy with Staphylococcus aureus and Escherichia coli failed to form inhibition zone. However, some biofilms were observed on the surface of the Co-Cr-Mo alloy. Fewer bacteria adhered to the carbon-based nanofilm titanium alloy can be observed via scanning electron microscopy and fluorescence staining techniques. Meanwhile, the colony forming counts showed that, compared with the Co-Cr-Mo alloy, the carbon-based nanofilm titanium alloy had fewer bacteria adhered ( P < 0.05 ). After coculture of the two test specimens with rabbit BMSCs, there was no significant difference in cell count, and both cell counts showed no cytotoxicity. In the in vivo experiment of animals, there are relatively fewer giant cells and better histocompatibility in tissues near the carbon-based nanofilm titanium alloy. Conclusion. Compared with Co-Cr-Mo alloy, the novel carbon-based nanofilm titanium alloy enjoys stronger in vitro antibacterial activity and better in vivo histocompatibility.
BACKGROUND/PURPOSE: Patients with hyperuricemia are at risk for increased serum uric acid (SUA) levels and gout attacks in the short term after undergoing bariatric surgery, and the purpose of this study was to evaluate the effectiveness of short-term treatment with uric acid-lowering medications after bariatric surgery for the control of SUA and gout attacks in patients with hyperuricemia. METHODS: A retrospective analysis of 71 patients who underwent bariatric surgery and had a preoperative diagnosis of hyperuricemia was performed, and the patients were classified into a drug-treatment group (DTG,n=32) and a non-drug-treatment group (NDTG,n=39) according to whether they took medication after surgery. Changes in the number of gout attacks, body mass index (BMI), and SUA levels at 1 week, 1 month, 3 months, and 6 months after bariatric surgery were measured in both groups. RESULTS: In the DTG, 22 patients (68.8%) experienced an increase in SUA within 1 week, 1 patient (3.1%) had an acute attack of gout within the first month, and no patient had a gout attack thereafter; in the NDTG, 35 patients (89.7%) experienced an increase in SUA within 1 week, 7 patients (17.9%) had an acute gout attack within the first month, and 2 patients (5.1%) experienced a gout attack between month 1 and month 3 postoperatively. Both groups were free of gout attacks between the 3rd and 6th postoperative month and showed a significant decrease in SUA and BMI by the sixth month. Conclusion: Patients with hyperuricemia have a risk of increased SUA levels in the first month after bariatric surgery, and in patients with obesity combined with hyperuricemia, continued use of uric acid-lowering drugs after surgery is beneficial in reducing this risk and decreasing the number of gout attacks.
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