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      Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide

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      BioMed Research International
      Hindawi

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          Abstract

          Background

          With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA.

          Methods

          Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS).

          Results

          The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C ( P < 0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C ( P < 0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference.

          Conclusion

          3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.

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          Most cited references32

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          Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait.

          The repeatability of gait variables is an important consideration in the clinical use of results of quantitative gait analysis. Statistical measures were used to evaluate repeatability of kinematic, kinetic, and electromyographic data waveforms and spatiotemporal parameters of 40 normal subjects. Subjects were evaluated three times on each test day and on three different test days while walking at their preferred or natural speed. Intrasubject repeatability was excellent for kinematic data in the sagittal plane both within a test day as well as between test days. For joint angle motion in the frontal and transverse planes, the repeatability was good within a test day and poor between test days. Poor between-day repeatability of joint angle motion in the frontal and transverse planes was noted to be partly due to variabilities in the alignment of markers. Vertical reaction and fore-aft shear forces were more repeatable than the mediolateral shear force. Sagittal plane joint moments were more repeatable than frontal or transverse plane moments. For electromyographic data, repeatability within a day was slightly better than between test days. In general, the results demonstrate that with the subjects walking at their natural or preferred speed, the gait variables are quite repeatable. These observations suggest that it may be reasonable to base significant clinical decisions on the results of a single gait evaluation.
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            The epidemiology of failure in total knee arthroplasty: avoiding your next revision.

            Total knee arthroplasty (TKA) is a cost effective and extremely successful operation. As longevity increases, the demand for primary TKA will continue to rise. The success and survivorship of TKAs are dependent on the demographics of the patient, surgical technique and implant-related factors. Currently the risk of failure of a TKA requiring revision surgery ten years post-operatively is 5%. The most common indications for revision include aseptic loosening (29.8%), infection (14.8%), and pain (9.5%). Revision surgery poses considerable clinical burdens on patients and financial burdens on healthcare systems. We present a current concepts review on the epidemiology of failed TKAs using data from worldwide National Joint Registries.
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              Causal Factors for Knee, Hip, and Hand Osteoarthritis: A Mendelian Randomization Study in the UK Biobank

              Objective There is no curative treatment for osteoarthritis (OA), which is the most common form of arthritis. This study was undertaken to identify causal risk factors of knee, hip, and hand OA. Methods Individual‐level data from 384,838 unrelated participants in the UK Biobank study were analyzed. Mendelian randomization (MR) analyses were performed to test for causality for body mass index (BMI), bone mineral density (BMD), serum high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, and triglyceride levels, type 2 diabetes, systolic blood pressure (BP), and C‐reactive protein (CRP) levels. The primary outcome measure was OA determined using hospital diagnoses (all sites, n = 48,431; knee, n = 19,727; hip, n = 11,875; hand, n = 2,330). Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. Results MR analyses demonstrated a robust causal association of genetically determined BMI with all OA (OR per SD increase 1.57 [95% CI 1.44–1.71]), and with knee OA and hip OA, but not with hand OA. Increased genetically determined femoral neck BMD was causally associated with all OA (OR per SD increase 1.14 [95% CI 1.06–1.22]), knee OA, and hip OA. Low systolic BP was causally associated with all OA (OR per SD decrease 1.55 [95% CI 1.29–1.87]), knee OA, and hip OA. There was no evidence of causality for the other tested metabolic factors or CRP level. Conclusion Our findings indicate that BMI exerts a major causal effect on the risk of OA at weight‐bearing joints, but not at the hand. Evidence of causality of all OA, knee OA, and hip OA was also observed for high femoral neck BMD and low systolic BP. However, we found no evidence of causality for other metabolic factors or CRP level.
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                Author and article information

                Contributors
                Journal
                Biomed Res Int
                Biomed Res Int
                BMRI
                BioMed Research International
                Hindawi
                2314-6133
                2314-6141
                2020
                30 June 2020
                : 2020
                : 6485178
                Affiliations
                Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
                Author notes

                Academic Editor: Kwang Gi Kim

                Author information
                https://orcid.org/0000-0002-6051-8421
                https://orcid.org/0000-0002-0389-1932
                https://orcid.org/0000-0003-4424-3840
                https://orcid.org/0000-0002-1493-8740
                Article
                10.1155/2020/6485178
                7345611
                32685514
                7541379c-6db5-4987-aa3a-dba23fa004e5
                Copyright © 2020 Maolin Sun et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 1 December 2019
                : 20 February 2020
                : 18 April 2020
                Funding
                Funded by: Chongqing Science and Technology Commission Fund
                Award ID: CSTC2017shmsA130026
                Funded by: National Key R&D Program of China
                Award ID: 2017YFC0110705
                Categories
                Clinical Study

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