| Objective: Restrospective study was conducted to analyze the functioninfluenced by the treatment of some related issues during the peri-operationperiod of T KAMethod: 54 patients(58knees) were investigated after TKA, who wereunderwent the operation in our hospital from Jan 2000 to Oct 2004 and Thefollow-up period ranged 6~63 months. There were 10 males(11 knees) with anaverage age of 50.5 years(range 15~78 years) and 44 females(47knees) withan average age of 66.1 years (range 33~81 years) at the time of surgeryrespectively. The underlying diseases include osteoarthritis (OA) in 21 knees,rheumatoid arthritis(RA) in 19 knees, post-traumatic arthritis in 3 knees andbone tumors in 15 knees.39 prosthesis were homemade, the others wereimported. Bone cement was used in all the cases. The rehabitation procedureconsisted of three parts, preoperative period , operative period and postoperation. The evaluation of clinic and X-ray was made before operation; Theskills enforced during operation included the balance of soft tissues, thereplacement of patella and the treatment of tibia bone defect; All patientsreceived rehabilitation instruction and systemic function exercise afteroperation to prevent post-operative complication.Result: 54 patients(58knees) were followed up by phone call and letterwith an average of 37 months (6~63months).The results were evaluated usingthe knee joint point scale of hospital of specific surgery of NewYork(HSS).The HSS score of knee improved from 49.3 to 85.9 on average.The total score is 100 point. The scores higher than 85 were classified asexcellent, 70-84 as good, 60-69 as fair, lower than 60 as poor. The constrainedprosthesis: The patients were divided into two groups based on the types ofprosthesis(non-constrained prosthesis group, constrained prosthesis group),because there is much difference among the operation indications ,method ofsurgery and the type of prosthesis. Of the 43 knees in non-constrainedprosthesis patients, the average preoperative an postoperative scores were 50.7points and 84.1 points respectively.29 knees(67.4%) were excellent,9 knees(20.9%)were good ,3 knees(7.0%)were fair and 2 knees(4.7%) were poor.The excellent and good rate is 88.4%. Among the general evaluation of 15constrained prosthesis patients, the average preoperative and postoperativescores were 45.1. points and 90.5 points.10 knees(66.7%) were excellent,2knees(13.3%)were good ,2 knees(13.3%)were fair and 1 knees(6.7%) werepoor. The excellent and good rate is 80%. The detailed result of HSS of 43knees in non-constrained prosthesis patients were (1) Pain: the averagepreoperative an postoperative scores were 8.8. points and28.2 pointsrespectively, the improved rate is 91.5%. (2)Function: the average preoperativean postoperative scores were 9.7. points and 16.7 points ,the improved rate is58.5%.(3)Range of motion: the average preoperative and postoperativescores were 11.7. points and 12.5 points ,the improved rate was12.7%.Postoperatively, the range of motion was sound except for only 3 knees(7.0%) ,which retained slight instability.1 knee (2.3%) was revised because ofprosthetic loosening. There was 1 knees (2.3%) suffered of deep venousthrombus(DVT),1knee(2.3%) had patellar fracture and patellar subluxation ,4knee(9.3%) had patellar subluxation,1knee suffered of postoperativeinfection .All had recovered after being treated. The detailed scores of theconstrained prosthesis patients(1) Pain: the average preoperative anpostoperative scores were 4.7. points and 29.3 points respectively, theimproved rate was 97.3%. (2)Function: the average preoperative anpostoperative scores were 7.2 points and 17.9 points ,the improved rate was72.3%.(3)Range of motion: the average preoperative an postoperative scoreswere 11.0. points and 14.4points ,the improved rate is 48.3%.Postoperativecomplication included slight instability in 1 knee (6.7%),fracture of prosthesisin 1 knee (6.7%),DVT in 2 knee (13.3%), postoperative infection in 1 knee(6.7%)and two patients died of tumor. All patients achieved satisfactoryimprovement in pain ,function and range of motion. Conclusions: Total knee arthroplasty presents a satisfactory procedurefor treating severe gonarthritis. The handling of perioperative issues in patientsof total knee arthroplasty is of great importance for promotion of functionalrecovery in patients after TKA. Through this method, the improvement ofpain ,function and range of motion can be gained and the complication afteroperation can be relieved such as infection , thrombus, prosthetic looseningetc. Intervention is beneficial to the recovery of the joint function afterreplacement. Detailed plan must be made before the operation of TKA. Thebalance of soft tissue should be gained as possible during operation. It is very... |
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