Uthraraj Nachappa Sivanesan, Anazor Fitzgerald, Hussain Ali, Raddy Kumar Gaddam, Divekar Anand B, Shrivastava Raj, Relwani Jai
Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR.
Cureus. 2022 Nov 21;14(11):e31750. doi: 10.7759/cureus.31750. eCollection 2022 Nov.
Introduction Osteoarthritis of the knee is a highly prevalent disease globally, causing strain on healthcare resources and leading to a reduced quality of life. There are many treatments proposed for this condition, from conservative measures like analgesics and physiotherapy to surgical options like arthroscopy and total knee arthroplasty (TKA). Arthroscopic debridement and lavage provide significant improvement in a cohort of patients with particular features and can be a temporizing measure before TKA. This study aimed to investigate the results of this procedure, in a case series in the short-term and mid-term, in a low-resource setting. Methods This was a case series of 20 patients, who presented with clinical and radiographic features of mild to moderate (Kellgren-Lawrence grades I-III) primary osteoarthritis of the knee. Arthroscopic debridement and lavage were performed and the Knee Society Score (KSS) was recorded pre-operatively and post-operatively in the short and mid-term at one month, three months, and twelve months. Statistical analyses was done for correlation, with different variables such as the presence of meniscal pathology, loose bodies, grade of osteoarthritis, malalignment, and body mass index (BMI). Results The KSS improved at one month, three months, and twelve months for all the patients. The improvement in the KSS scores was associated with varus malalignment of less than 10 degrees, a BMI of less than 25, and the presence of loose bodies. There were no adverse events or complications from this study. Conclusions There was a significant improvement in a patient cohort with malalignment of less than 10 degrees, BMI of less than 25, meniscal pathology, and loose bodies. We can therefore recommend arthroscopic debridement and lavage as a temporizing measure before TKA in this particular cohort.
引言 膝关节骨关节炎是全球一种高度流行的疾病,给医疗资源带来压力并导致生活质量下降。针对这种疾病提出了许多治疗方法,从镇痛药和物理治疗等保守措施到关节镜检查和全膝关节置换术(TKA)等手术选择。关节镜下清创和灌洗在具有特定特征的患者群体中能带来显著改善,并且可以作为TKA前的一种临时措施。本研究旨在调查在资源匮乏环境下,该手术在短期和中期的病例系列中的结果。
方法 这是一个包含20名患者的病例系列,这些患者表现出轻度至中度(凯尔格伦-劳伦斯分级I-III级)原发性膝关节骨关节炎的临床和影像学特征。进行了关节镜下清创和灌洗,并在术前以及术后1个月、3个月和12个月的短期和中期记录膝关节协会评分(KSS)。对半月板病变、游离体、骨关节炎分级、畸形和体重指数(BMI)等不同变量进行了相关性统计分析。
结果 所有患者在1个月、3个月和12个月时KSS均有所改善。KSS评分的改善与小于10度的内翻畸形、BMI小于25以及游离体的存在有关。本研究未出现不良事件或并发症。
结论 在小于10度畸形、BMI小于25、半月板病变和有游离体的患者群体中,有显著改善。因此,我们可以推荐关节镜下清创和灌洗作为该特定群体TKA前的一种临时措施。