| Objective:To study the mid-and long-term clinical effects of total knee arthroplasty(TKA)with Medial Povie prosthesis(MP)and Posterior-Stabilized Prosthesis(PS)in Chinese patients,so as to provide more evidence for doctors to choose prosthesis.At the same time,to study the value of existing serum inflammatory markers in the diagnosis of periprosthetic joint infection(PJI)and found the best serum inflammatory markers.Methods:Part I:A retrospective analysis was made of 527 patients who received TKA in the Department of joint of the Affiliated Hospital of Qingdao University from June 2010to December 2013.Among them,290 patients were treated with Medial Povie prosthesis(group A,MP)and 237 Posterior-Stabilized Prosthesis(group B,PS).The postoperative knee range of motion(ROM),knee scoring system(KSS),the western Ontario and Mc Master universities osteoarthritis index(WOMAC),The forgotten joint score(FJS)and postoperative complications were compared between the two groups.Part II:Retrospective analysis of 46 patients who received knee revision in the Affiliated Hospital of Qingdao University from June 2013 to June 2020,including 32 patients in the infection group and 14 patients in the non-infection group.The data of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),fibrinogen(FIB),platelet count(PC),mean platelet volume(m PV),platelet count/mean platelet volume(PC/m PV),neutrophil/lymphocyte rate(NLR)and platelet/lymphocyte rate(PLR)were collected and calculated.Mann-Whitney U test was used to compare the levels of various indexes between the two groups,and receiver operating characteristic(ROC)curve was used to analyze the diagnostic effectiveness of each index.Results:Part I:The postoperative KSS score and WOMAC score of the two groups were satisfactory,which were better than those before operation,but there was no significant difference between the two groups(P>0.05).The postoperative ROM of MP group and PS group were(113.72±8.43)°and(112.72±8.18)°,respectively.There was no significant difference between the two groups(P>0.05).The FJS scores of MP group and PS group were(68.89±25.04)and(65.29±24.93)respectively,and there was no significant difference between the two groups(P>0.05).In MP group,2 cases had PJI,1case had nonunion of incision half a month after operation,1 case had pain in anterior area of knee,and in group PS,1 case had PJI,3 cases had pain in anterior area of knee,and 5 cases had joint ringing.Part II:The results of ROC curve show that the best cut-off value of CRP was 10.46mg/L,the sensitivity was 83.9%,the specificity was 92.9%,the best cut-off value of ESR was 25.45mm/h,the sensitivity was 77.4%,the specificity was92.9%,the best cut-off value of FIB was 3.52g/L,the sensitivity was 77.4%,and the specificity was 85.7%,the best cut-off value of PC was 232.00×10~9/L,the sensitivity was 64.5%,and the specificity was 85.7%,the best cut-off value of PC/m PV was20.65,the sensitivity was 77.4%,the specificity was 71.4%,the best cut-off value of NLR was 132.15,the sensitivity was 54.8%,and the specificity was 71.4%.Conclusion:Chinese patients can achieve good clinical results in the mid-to-long-term of TKA with MP prosthesis or PS prosthesis,and there was no significant difference between the two groups.Studies have also shown that both prostheses were safe for Chinese patients.In view of the widely used serum inflammatory markers,CRP showed the best sensitivity and specificity in the diagnosis of PJI.Although NLR was related to PJI,the diagnostic effectiveness was not good. |
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