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Influence Factors Analysis of Short-Term Recovery after Total Knee Arthroplasty in Osteoarthritis Patients with 60 Years Old and over

Author: WangGuoWei
Tutor: SunShui
School: Shandong University
Course: Orthopedics
Keywords: total knee arthroplasty (TKA) influence factors HSS score range of motion(ROM) osteoarthritis (OA)
CLC: R687.4
Type: Master's thesis
Year: 2008
Downloads: 189
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Abstract

With the arrival of the aging society,old OA(osteoarthritis) Patients have more and more life quantity,the obstinate pain of hip and knee joint caused by OA has become a great difficult problem of the medical circle.The result is not good to conservative treating at this moment.The condition can form and suffer from the function obstacle of knee joint often while developing,lead to the fact patient’s violent joint paining,have difficulty getting about,joint activity is limited even deformity.Influence the old patient’s life quality when being serious.The orthopedist has a lot of operation methods to the osteoarthritis patient, including joint skill of cleating up,joint clear up skill under the mirror,knee joint ostectomy and the whole knee joint replacement.What kind of treatment methods is chosen,this is a question of clinical decision.It not merely depends on orthopedist’s understanding and its skilled technology to osteoarthritis,every operation curative effect,still depend on basic clinical thinking and judgement that the orthopedist possesses.As to the young patient with great activity,can debridement under arthroscopy improve symptom,and postpone time that joint replaces;As to 60 or younger patient,if has already suffered from serious osteoarthritis,but the patients who can’t improve symptom especially through debridement under arthroscopy, should adopt total knee arthroplasty to improve the joint function,relieve pain, improve life quality.The clinical decision variable,not only osteoarthritis patients accept TKA but also doctor make TKA policy,influenced by a lot of factors especially the judgement of short～term recovery and curative effect by doctors and patients both sides.The judgement of short～term recovery play a decisive role in clinical decision.So,it is very necessary to study the influence factors on TKA postoperative short～term recovery,to judge and offer the theoretical foundation for clinical treatment and prognosis.Objective:The factors that influencing short～term recovery of the knee joint after total knee arthroplasty(TKA) were carried on overall investigation and analysis.HSS score was used to appraise the postoperative early knee joint function of the elderly patients.Lots of variable influence factors and postoperative 2 week HSS of knee joint were studied.The relevance of two described above were analysised and the main influence factors of knee joint function and living quality after TKA were found out.Thus offering the treatment suggestion to a osteoarthritis patient, guiding and evading the surgery risk clinically,and judging the comprehensive effective prognosis to the clinical patient.Methods:72 patients with 72 knees treated by TKA from March,2006 to August,2008 were reviewed.They were assessed the HSS scale,knee function and ROMs(range of knee motion) before and after surgery.The factors that possible influenced TKA postoperative short～term recovery of knee joint were numerous.After selecting a patient and choosing well,we appraised its age first,then BMI index,kind of pathological diseases,knee joint function,knee joint pain,knee joint ROM,other relevant diseases,etc..Pay attention to make selected patient representative,pay attention to the difference that narrowed the individual patients,then maked the observe forms of these cases.The operator person was two reputable chief physicians,relevant measurement were finished by one person before and after operation,without obvious difference in technology.Our routines postoperative goes on resist infection anticoagulatory and rehabilitation,reexamine DR regularly.Make the detailed record——including postoperative knee joint ROM,HSS score(postoperative 1W and 2W),whether have severe complications in perioperative period,postoperative recovery and CPM. Collect preoperative and postoperative information of the patients as accurately as possible.Perfect case observement form in order to make relevance analysis.According to HSS score,we evaluated patient postoperative early knee joint function.Quantized the preoperative and postoperative possible influence factors, and maked relevance analysis with the postoperative 2W knee joint HSS score.Results:1、The old osteoarthritis patient’s operation finished smoothly.Hospital special surgery(HSS) knee score and ROMs was risen respectively from 46.8 to 86.2 and from 68 to 98 pre-operation and postoperation.The difference between preoperative and postoperative HSS has statistics meaning(P＜0.05).2、HSS did not have statistics meaning to mark the difference between case group (TKA) and control group(arthroscopy) before the operations,but did have statistics meaning after the operations(P＜0.05).3、The study revealed that The pre-operative ROM,HSS score,Knee pain, continous passive motion(CPM) at different level(i.e.CPM initial angle) has a prominent positive correlation with HSS score in postoperative 2 weeks.The coefficient correlation was 0.463,0.526,0.410,0.485 respectively,P＜0.05.4、The study revealed that the factors such as patient’s age,height,weight,BMI, muscular strength,etc.weren’t obviously relevant to HSS score in postoperative 2 weeks.5、The observement forms of cases revealed that:The perioperative severe complications(Such as infection,DVT,PE etc.),which took place after operation,Can often lead to the fact the operation failed in early days,cause the joint disease to decrease or the joint was abolished. Conclusions:Total knee arthroplasty was used to treat osteoarthritis patients in our department and good curative effect was achieved.The pre～operative HSS score,knee pain,knee ROM,perioperative severe complications,and postoperative continous passive motion(CPM) initial angle have a positive correlation with knee motion after surgery in patients with age of 60 years old and over.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Joint Surgery
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