Objective To measure and analyze the relationships among the posterior tibial slope (PTS), meniscal slope (MS), and meniscus posterior horn thickness (MPHT) of the medial and lateral tibial plateau in healthy people and patients with anteromedial osteoarthritis (AMOA) in Heilongjiang province, so as to provide reference basis for appropriate tibial osteotomy and prosthesis placement angles in knee joint surgeries. Methods A retrospective collection of imaging data from knee joint MRI examinations conducted prior to AMOA for various reasons was performed. A total of 103 healthy individuals (healthy group) and 30 AMOA patients (AMOA group) were included. There was no significant difference in the gender composition ratio, side, and body mass index between the two groups (P>0.05); however, the comparison of ages between the two groups showed a significant difference (P<0.05). The collected DICOM format image data was imported into the RadiAnt DICOM Viewer software and measured the medial PTS (MPTS), lateral PTS (LPTS), medial MS (MMS), lateral MS (LMS), medial MPHT (MMPHT), and lateral MPHT (LMPHT) with standard methods. The differences of the above indexes between the two groups and between different genders and sides in the two groups were compared, and Pearson correlation analysis was carried out. At the same time, the measured data of healthy group were compared with the relevant literature reported in the past. Results Compared to the healthy group, the AMOA group exhibited significantly smaller MPTS and LPTS, as well as significantly greater MMPHT and LMPHT, with significant differences (P<0.05). However, there was no significant difference in the MMS and LMS between the two groups (P>0.05). The differences in various indicators between genders and sides within the two groups were not significant (P>0.05). The correlation analysis and regression curves indicated that both MPTS and LPTS in the two groups were positively correlated with their respective ipsilateral MS and MPHT (P<0.05); as PTS increased, the rate of increase in MS and MPHT tend to plateau. Compared to previous related studies, the MPTS and LPTS measured in healthy group were comparable to those of the Turkish population, exhibiting smaller values than those reported in other studies, while MMS and LMS were relatively larger, and MMPHT and LMPHT were smaller. ConclusionIn healthy people and AMOA patients in Heilongjiang province, PTS has great individual differences, but there is no significant individual difference in MS. MPHT can play a certain role in retroversion compensation, and its thickness increase may be used as one of the indicators to predict the progression of AMOA. The above factors should be taken into account when UKA is performed, and the posterior tilt angle of tibial osteotomy should be set reasonably after preoperative examination and evaluation.
ObjectiveTo establish an assessment method for safe acetabular screw placement based on three-dimensional CT reconstruction and the acetabular “clock-face” coordinate system; to quantify the vascular safety length and effective intraosseous length at each screw hole position of the acetabular prosthesis; and to provide a reference basis for individualized acetabular screw placement in total hip arthroplasty (THA). Methods The CT angiographic data of both lower extremities of 64 patients hospitalized for non-orthopedic diseases between January 2022 and December 2024 who met the selection criteria was retrospectively analyzed. There were 32 males and 32 females. Three-dimensional reconstruction was performed using Mimics21.0 software. With the anterior pelvic plane as the reference plane, the acetabular opening was conceptualized as a “clock face”. The intersection of the anterior superior iliac spine-to-acetabular center line (or its projection) with the inferior acetabular rim was defined as the “6 o’clock” reference point. Based on this reference point, the central hole of the prosthesis was aligned toward the 12 o’clock direction to simulate acetabular cup implantation, achieving positional correspondence between the prosthesis screw holes and the clock-face coordinates, with the anterior hole aligned to 1 o’clock and the posterior hole aligned to 11 o’clock. Acetabular prosthesis implantation was simulated at fixed angles (abduction angle 40°, anteversion angle 20°). Cylindrical models matching the diameter of actual screws were used to simulate screw insertion, with axial extension perpendicular to each screw hole. The safe length of the blood vessel or effective intraosseous length at each hole site and the coverage of three commonly used screw lengths (20, 25, 30 mm) at each hole site were measured. Pearson correlation was used to analyze the correlation of each measurement with age and body mass index. Results The safe length from the anterior hole to the external iliac artery and the effective intraosseous length of the middle hole were significantly longer in males than in females (P<0.05). There was no significant difference in the safe length from the posterior hole to the superior gluteal artery between males and females (P>0.05). Pearson correlation analysis showed that only the effective length of the middle hole was negatively correlated with age (P<0.05), while the safe length of the anterior hole to the external iliac artery and the safe length of the posterior hole to the superior gluteal artery were not correlated with age and body mass index (P>0.05). In terms of screw selection, the coverage rate of 20 mm screws in the anterior, middle, and posterior holes of acetabular prosthesis was 100.00% in both males and females, and the safety was good. The coverage rate of 25 mm screws in anterior and posterior holes was 100.00% in both males and females, and the safe length was sufficient; the coverage rate of middle hole was 96.86% in males and 71.86% in females. When the length of screw was further increased to 30 mm, the coverage rate of anterior hole was still 100.00% in males and 68.97% in females, the coverage rate of middle hole was 71.86% in males and 34.36% in females, and the coverage rate of posterior hole was still at a high level, 92.86% in males and 100.00% in females. The decrease in coverage was more pronounced in males when longer screws were used in the anterior and middle hole areas. ConclusionSignificant sex-related differences exist in the safety parameters of acetabular screws in THA. In females, the anterior screw hole is associated with a higher vascular risk, and the effective intraosseous length at the middle hole is shorter; therefore, a middle-hole plus posterior-hole combination is recommended. In males, an anterior-hole plus posterior-hole combination may be considered the preferred reference strategy. In the absence of navigation assistance, a conservative screw placement strategy is recommended to reduce vascular complications and improve the initial stability of the prosthesis.
Objective To conclude the research progress of unicompartmental knee arthroplasty (UKA) in the treatment of elderly patients with knee osteoarthritis (KOA). Methods The literature on UKA at home and abroad in recent years was reviewed to summarize the clinical characteristics of elderly patients with KOA, perioperative management (including evaluating indications preoperatively, intraoperative prosthesis selection, postoperative complication management, etc). Results Through reasonable preoperative evaluation, prosthesis selection, and advanced perioperative management, for elderly patients with KOA who meet the indications, UKA can be considered. Compared with total knee arthroplasty, the incidence of postoperative complications in elderly patients undergoing UKA is lower, joint awareness is reduced, functional improvement and satisfaction are higher. Meanwhile, choosing appropriate prostheses and fixation methods can lead to a good survival rate. ConclusionUKA can provide a safe and effective treatment option for elderly patients with KOA within a certain range of indications.
