Observation And Study On The Short-term Effect Of Artificial Knee Arthroplasty In The Treatment Of Straightened Knee Joint Stiffness

Objective:To explore the prosthesis selection and short-term effect of artificial knee arthroplasty in the treatment of straightened knee joint stiffness.Methods:The patients who underwent artificial knee arthroplasty in the Department of Orthopaedics,the first affiliated Hospital of Kunming Medical University from March 2010 to March 2020 were analyzed retrospectively.Patients with ankylosis of knee joint caused by severe knee osteoarthritis,rheumatoid arthritis,ankylosing spondylitis and traumatic joint were selected.54 patients who met the inclusion criteria were selected according to the inclusion criteria and exclusion criteria,and were divided into CR group and PS group according to the different implants.According to the preoperative range of motion of the knee joint,the patients in the two groups were divided into mild group(range of motion 50°to 90°)and severe group(range of motion 0°to 50°).There were 26 patients in CR group,including 30 knees.In mild group,16 patients(20 knees)were aged from 50 to 84 years,with an average of(62.69±10.87)years,including 7 males(8 knees)and 9 females(12 knees).The preoperative ROM was(73.30 ± 10.47)°,and the HSS score was(36.60±7.05).In the severe group,10 cases(10 knees)aged 27-75 years,with an average of(50.0±14.41)years,including 3 males(3 knees)and 7 females(7 knees).The preoperative ROM was(30.60±11.06)°,and the HSS score was(33.10±5.84).There were 28 cases(30 knees)in the PS group,and 18 cases(20 knees)in the mild group aged from 50 to 84 years old,with an average of(64.22 ±11.15)years,including 8 males(9 knees)and 10 females(11 knees).The preoperative ROM was(72.50 ±9.47)°,and the HSS score was(37.95±7.28).In the severe group,10 cases(10 knees)aged from 47 to 80 years old,with an average of(60.30±12.67)years,including 5 males(5 knees)and 5 females(5 knees).The preoperative ROM and HSS score were 29.60 ±10.28°and 34.10±4.82 respectively.Bilateral knee arthroplasty was performed by stages in both groups,with a staging interval of 3.2～6.3 months(mean 3.8 months)in CR group and 3.0～5.4 months(mean 3.4 months)in PS group.After operation,the knee joint motion of the four groups was counted,and the early clinical effects of the two groups were evaluated by pain visual analog score,American special surgery hospital score,American knee joint association score and patient satisfaction.Results:One month after the operation,the ROM values in CR and PS groups were(95.65±6.23)degrees and(93.60±6.32)degrees,respectively.HSS was(60.65±6.53)and(61.50±5.81),respectively.VAS scores were(2.45±1.50)and(2.80±1.40),respectively.AKS clinical scores were(68.60±4.66)and(67.35±5.33),respectively.Functional scores were(48.00±8.34)and(47.00±10.69),respectively,and there was no statistically significant difference(P>0.05).ROM values in CR and PS groups were 53.20±10.39 degrees and 52.40±9.02 degrees,respectively.HSS scores were(63.20±9.75)and(60.90±9.94),respectively.VAS scores were(3.70±1.57)and(3.80±1.55),respectively.AKS clinical scores were(64.50±6.31)and(65.90±6.38),respectively.Functional scores were(39.00±3.94)and(38.50±4.74),respectively,and there was no significant difference(P>0.05).Three months after operation,the ROM value of CR and PS mild group increased to(107.45±5.26)degree and(106.25±5.49)degree,respectively.HSS scores were increased to(68.85±5.20)and(69.30±5.15),respectively.VAS scores were(1.20±1.15)and(1.40±1.23),respectively.AKS clinical scores were(73.25±3.11)and(70.80±5.93),respectively.The functional scores were(83.75±5.10)and(85.25±5.73),respectively,and there was no significant difference(P>0.05).ROM values in CR and PS severe groups were increased to(81.80±4.24)degrees and(82.50±5.89)degrees,respectively.HSS scores were increased to(64.30±6.64)and(65.70±6.88),respectively.VAS scores were(1.90±0.99)and(2.00±0.94),respectively.The clinical scores of AKS were(72.90±5.40)and(68.10±5.47),respectively.The functional scores were(74.50±5.99)and(75.50±7.25),respectively,and there was no significant difference(P>0.05).The ROMs of the mild and severe CR groups were(95.65±6.23)degrees and(53.20±10.39)degrees and(107.45±5.26)degrees and(81.80±4.24)degrees,respectively,1 month and 3 months after operation.The functional scores of AKS at 1 month and 3 months after operation were(48.00±8.34),(39.00±3.94),(83.75±5.10)and(74.50±5.99),respectively,and the differences were statistically significant(P<0.05).The ROMs of the mild and severe PS groups were(93.60±6.32)degrees and(52.40±9.02)degrees at 1 month and(106.25±5.49)degrees and(82.50±5.89)degrees at 3 months after operation,respectively.The functional scores of AKS were(47.00±10.69),(38.50±4.74),(85.25±5.73)and(75.50±7.25)at 1 month and 3 months after operation,respectively,and the differences were statistically significant(P<0.05).All 54 patients(60 knees)were followed up.In CR mild group,4 patients developed peroneal vein thrombosis or intramuscular vein thrombosis.In the severe group,there was 1 case of common peroneal nerve injury,1 case of superficial incision infection,and 1 case of tibial tubercle avulsion during operation.In PS mild group,there were 3 cases of thrombosis in soleus muscle intermuscular vein or intermuscular vein.In the severe group,there were 2 cases of superficial incision infection and 1 case of periprosthesis infection.There were no complications of lower extremity deep vein thrombosis,prosthesis displacement,prolapse of liner and poor wound healing in other patients during hospitalization.Conclusions:1.Artificial knee arthroplasty is feasible for the treatment of straightened knee ankylosis,but the postoperative efficacy and patient satisfaction need to be improved.2.The main indication of artificial knee arthroplasty for the treatment of knee ankylosis is knee joint pain,followed by the improvement of knee joint range of motion.In addition,the expectation of the patient should also be taken into account.3.When knee arthroplasty is performed in patients with mild extension knee stifness,quadriceps myolysis is the first choice for the exposure of surgical visual field.Oblique quadriceps femoris is the first choice for knee arthroplasty in patients with severe knee ankylosis.4.Under the premise that the posterior cruciate ligament is normal and the operator is very familiar with the surgical differences between PS and CR prostheses.CR prosthesis is recommended for patients with mild knee stiffness and younger age.PS prosthesis is recommended for patients with severe knee stiffness and older age.5.The preoperative range of motion and stiffness of the knee joint are related to the postoperative range of motion of the knee joint.The worse the preoperative range of motion,the worse the postoperative range of motion.The cause of knee joint stiffness before operation is related to the postoperative range of motion,but it needs to be further studied.6.The more severe the preoperative stiffness of knee joint,the higher the incidence of postoperative complications.