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Guan S, Dumas R, Pandy MG. Tibiofemoral Slip Velocity in Total Knee Arthroplasty is Design-Invariant but Activity-Dependent. Ann Biomed Eng 2024; 52:1779-1794. [PMID: 38530534 DOI: 10.1007/s10439-024-03490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
Tibiofemoral slip velocity is a key contributor to total knee arthroplasty (TKA) component wear, yet few studies have evaluated this quantity in vivo. The aim of the present study was to measure and compare tibiofemoral slip velocities in 3 TKA designs for a range of daily activities. Mobile biplane X-ray imaging was used to measure 6-degree-of-freedom tibiofemoral kinematics and the locations of articular contact in 75 patients implanted with a posterior-stabilized, cruciate-retaining, or medial-stabilized design while each patient performed level walking, step up, step down, sit-to-stand, and stand-to-sit. Using these data, tibiofemoral slip velocity was calculated for the duration of each activity for each TKA design. The pattern of tibiofemoral slip velocity was similar for all 3 TKA designs within each activity but markedly different across the 5 activities tested, with the magnitude of peak slip velocity being significantly higher in level walking (range: 158-211 mm/s) than in all other activities (range: 43-75 mm/s). The pattern of tibiofemoral slip velocity in both the medial and lateral compartments closely resembled the pattern of tibiofemoral (knee) flexion angular velocity, with a strong linear relationship observed between slip velocity and flexion angular velocity (r = 0.81-0.97). Tibiofemoral slip velocity was invariant to TKA design but was significantly affected by activity type. Our measurements of slip velocity and articular contact locations for a wide range of daily activities may be used as inputs in joint simulator testing protocols and computational models developed to estimate TKA component wear.
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Affiliation(s)
- Shanyuanye Guan
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Raphael Dumas
- University of Lyon, University Gustave Eiffel, University Claude Bernard Lyon 1, LBMC UMR T_9406, F-69622, Lyon, France
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia.
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Cheppalli NS, Purudappa PP, Price R, Kolwadkar Y, Metikala S. Isolated lateral-sided knee pain in total knee arthroplasty. A review. Orthop Rev (Pavia) 2024; 16:93014. [PMID: 38505137 PMCID: PMC10950199 DOI: 10.52965/001c.93014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/08/2024] [Indexed: 03/21/2024] Open
Abstract
Isolated lateral-sided knee pain is a unique problem following total knee arthroplasty (TKA). Reported causes include soft tissue impingement against extruded cement, an overhanging tibial tray, remnant osteophytes rubbing against the iliotibial band (ITB), popliteal tendon impingement, fabella syndrome, and synovial tissue impingement in the lateral gutter. In addition, iliotibial band traction syndrome secondary to guided motion Bi-cruciate stabilizing knee arthroplasty has been recognized as a new clinical entity. Initial work up should include ruling out the most common causes of painful TKA including infection, aseptic loosening, and instability. Radiographs and CT scan are utilized to identify potential source of pain. Ultrasound evaluation (with elicited probe tenderness) can increase diagnostic accuracy. Ultrasound guided local anesthetic injections can confirm the source of pain. Anti-inflammatory medications, physical therapy with ITB stretches, and therapeutic local steroid injections are initial treatment modalities. Satisfactory resolution of symptoms may require surgical intervention directed at the specific cause and may avoid the morbidity associated with revision TKA.
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Affiliation(s)
| | | | - Ryan Price
- Orthopedic Surgery University of New Mexico School of Medicine
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Buddhiraju A, Chen TLW, Shimizu M, Seo HH, Esposito JG, Kwon YM. Do preoperative PROMIS scores independently predict 90-day readmission following primary total knee arthroplasty? Arch Orthop Trauma Surg 2024; 144:861-867. [PMID: 37857869 DOI: 10.1007/s00402-023-05093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION The rising demand for total knee arthroplasty (TKA) is expected to increase the total number of TKA-related readmissions, presenting significant public health and economic burden. With the increasing use of Patient-Reported Outcomes Measurement Information System (PROMIS) scores to inform clinical decision-making, this study aimed to investigate whether preoperative PROMIS scores are predictive of 90-day readmissions following primary TKA. MATERIALS AND METHODS We retrospectively reviewed a consecutive series of 10,196 patients with preoperative PROMIS scores who underwent primary TKA. Two comparison groups, readmissions (n = 79; 3.6%) and non-readmissions (n = 2091; 96.4%) were established. Univariate and multivariate logistic regression analyses were then performed with readmission as the outcome variable to determine whether preoperative PROMIS scores could predict 90-day readmission. RESULTS The study cohort consisted of 2170 patients overall. Non-white patients (OR = 3.53, 95% CI [1.16, 10.71], p = 0.026) and patients with cardiovascular or cerebrovascular disease (CVD) (OR = 1.66, 95% CI [1.01, 2.71], p = 0.042) were found to have significantly higher odds of 90-day readmission after TKA. Preoperative PROMIS-PF10a (p = 0.25), PROMIS-GPH (p = 0.38), and PROMIS-GMH (p = 0.07) scores were not significantly associated with 90-day readmission. CONCLUSION This study demonstrates that preoperative PROMIS scores may not be used to predict 90-day readmission following primary TKA. Non-white patients and patients with CVD are 3.53 and 1.66 times more likely to be readmitted, highlighting existing racial disparities and medical comorbidities contributing to readmission in patients undergoing TKA.
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Affiliation(s)
- Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Tony Lin-Wei Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michelle Shimizu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Henry Hojoon Seo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - John G Esposito
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Walker EA, Fox MG, Blankenbaker DG, French CN, Frick MA, Hanna TN, Jawetz ST, Onks C, Said N, Stensby JD, Beaman FD. ACR Appropriateness Criteria® Imaging After Total Knee Arthroplasty: 2023 Update. J Am Coll Radiol 2023; 20:S433-S454. [PMID: 38040463 DOI: 10.1016/j.jacr.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Total knee arthroplasty is the most commonly performed joint replacement procedure in the United States. This manuscript will discuss the recommended imaging modalities for six clinical variants; 1. follow-up of symptomatic or asymptomatic patients with a total knee arthroplasty. Initial imaging, 2. Suspected infection after total knee arthroplasty. Additional imaging following radiographs, 3. Pain after total knee arthroplasty. Infection excluded. Suspect aseptic loosening or osteolysis or instability. Additional imaging following radiographs, 4. Pain after total knee arthroplasty. Suspect periprosthetic or hardware fracture. Additional imaging following radiographs, 5. Pain after total knee arthroplasty. Measuring component rotation. Additional imaging following radiographs, and 6. Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy. Additional imaging following radiographs. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristy N French
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Tarek N Hanna
- Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER
| | | | - Cayce Onks
- Penn State Health, Hershey, Pennsylvania, Primary care physician
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
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Pacheco Elorza S, O'Donnell E, Delman C, Howell SM, Hull ML. Posterior cruciate ligament retention with medial ball-in-socket conformity promotes internal tibial rotation and knee flexion while providing high clinical outcome scores. Knee 2023; 43:153-162. [PMID: 37413777 DOI: 10.1016/j.knee.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/27/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Although retaining the posterior cruciate ligament (PCL) is advantageous in unrestricted kinematically aligned TKA, it is often excised with a medial stabilized implant. The primary objectives were to determine whether PCL retention using an insert with ball-in-socket (B-in-S) medial conformity to maximize A-P stability promotes internal tibial rotation and flexion while providing high patient-reported outcome scores. METHODS Two cohorts of 25 patients each were treated with unrestricted kinematically aligned (KA) TKA using a tibial insert with B-in-S medial conformity and a flat lateral articular surface. One cohort retained the PCL; the other had it excised. Patients performed deep knee bend and step-up exercises during fluoroscopic imaging. Following 3D model-to-2D image registration, anterior-posterior (A-P) positions of the femoral condyles and tibial rotation were determined. RESULTS For deep knee bend, mean internal tibial rotation with PCL retention was significantly greater at maximum flexion (17.7° ± 5.7° versus 10.4° ± 6.5°, p < 0.001) and significantly greater at 30°, 60°, and 90° flexion as well (p ≤ 0.0283). For step-up, mean internal tibial rotation with PCL retention was significantly greater at at 15°, 30°, and 45° flexion (p ≤ 0.0049) but was marginally not significantly greater at 60° (i.e. maximum) flexion (12.3° ± 4.4° versus 10.1° ± 5.4°, p = 0.0794). Mean flexion during active knee flexion with PCL retention was significantly greater (127° ± 8° versus 122° ± 6°, p = 0.0400). Both cohorts had high median Oxford Knee, WOMAC, and Forgotten Joint Scores that were not significantly different (p = 0.0918, 0.1448, and 0.0855, respectively) CONCLUSION: Surgeons that perform unrestricted KA TKA should retain the PCL with an insert that has B-in-S medial conformity, as this maintains extension and flexion gaps while also promoting internal tibial rotation and knee flexion as well as providing high clinical outcome scores.
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Affiliation(s)
- Saúl Pacheco Elorza
- Department of Mechanical Engineering, University of California Davis, Davis, CA 95616, USA
| | - Ed O'Donnell
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817 USA
| | - Connor Delman
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817 USA
| | - S M Howell
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
| | - M L Hull
- Department of Mechanical Engineering, University of California Davis, Davis, CA 95616, USA; Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817 USA; Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA.
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Bernard-de Villeneuve F, Bizzozero P, Fabre-Aubrespy M, Ollivier M, Argenson JN. Does Matching Femoral Size and Shape Improve Bone Fit and Patient-reported Outcomes in TKA? A Matched Controlled Study. Clin Orthop Relat Res 2023; 481:1129-1139. [PMID: 36716085 PMCID: PMC10194518 DOI: 10.1097/corr.0000000000002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Some researchers have suggested that achieving good component coverage over the host bone during TKA (while avoiding implant overhang) may help achieve durable implant fixation and may be associated with better outcomes scores. However, the evidence about this is limited and contradictory. Contemporary morphometric TKA includes a wide array of components with various shapes and sizes, based on large anatomic databases and specific software that simulates bone cuts. Morphometric tibial components have shown improved bone coverage and better clinical outcomes than standardized implants, but the role of morphometric femoral components in bone coverage has not been studied precisely. QUESTIONS/PURPOSES In a retrospective, controlled study that used patient matching, we asked: (1) Does the use of a contemporary morphometric component with more available sizes provide better femoral component fit and bone coverage than an earlier design with fewer sizes? (2) Are component fit and the presence of component overhang or underhang associated with different Knee Society Score (KSS) or Knee Injury and Osteoarthritis Outcome Score (KOOS) for Joint Replacement? METHODS From 2012 to 2013, we performed 403 TKAs according to the following criteria: TKA performed for primary tricompartmental arthritis of the knee; varus, valgus, and flexion deformity less than 15°; and age between 18 and 85 years on the day of surgery. Among these 403 TKAs, 237 were performed using a morphometric implant and 166 with the earlier nonmorphometric implant. At 2 years of follow-up, 3% of patients in the morphometric group and 5% in the nonmorphometric group were lost to follow-up. Based on age, BMI, gender, and preoperative KSS and KOOS, two groups of 30 patients were matched in a 1:1 ratio from this longitudinally maintained database. Clinical outcomes were measured preoperatively and at a minimum follow-up of 2 years in both groups, using the KSS and KOOS. We evaluated postoperative CT images for each patient to analyze femoral implant rotation, bone coverage, and overhang and underhang status. RESULTS The overhang status was similar between the two groups (23% had an overhang component in the morphometric knee group and 27% had an overhang component in the nonmorphometric knee group), and overhang was most frequently found in the lateral distal zone and medial anterior chamfer. Better cortical bone coverage was found in the morphometric knee group, with a thinner bone margin between the component edge and cortical border (morphometric group: 3 mm versus nonmorphometric knee group: 5 mm; p = 0.01). In general, there were few between-group differences in terms of patient-reported outcomes; of the seven metrics we analyzed, only the KSS favored the morphometric knee implant by a margin larger than the minimum clinically important difference (KSS mean difference: 21 points for the morphometric knee group; p < 0.05). Overhang of the femoral component of > 2 mm was associated with poorer KOOS, but not KSS, whereas a thinner bone margin had a beneficial impact on pain and global clinical scores (KOOS and KSS: p < 0.05). CONCLUSION The use of a morphometric femoral component design showed slightly improved bone fit and pain score according to the KSS at midterm follow-up compared with earlier implants with fewer sizes. Overhang > 2 mm was associated with worse KOOS. The tendency toward better outcomes in morphometric implants warrants longer-term evaluation before any definite conclusions about the association between bone fit and clinical results can be drawn.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
| | - Paul Bizzozero
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Maxime Fabre-Aubrespy
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Matthieu Ollivier
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Jean-Noel Argenson
- Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
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Li T, Ma Z, Zhang Y, Yang Z, Li W, Lu D, Liu Y, Qiang L, Wang T, Ren Y, Wang W, He H, Zhou X, Mao Y, Zhu J, Wang J, Chen X, Dai K. Regeneration of Humeral Head Using a 3D Bioprinted Anisotropic Scaffold with Dual Modulation of Endochondral Ossification. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2205059. [PMID: 36755334 PMCID: PMC10131811 DOI: 10.1002/advs.202205059] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/06/2022] [Indexed: 06/18/2023]
Abstract
Tissue engineering is theoretically thought to be a promising method for the reconstruction of biological joints, and thus, offers a potential treatment alternative for advanced osteoarthritis. However, to date, no significant progress is made in the regeneration of large biological joints. In the current study, a biomimetic scaffold for rabbit humeral head regeneration consisting of heterogeneous porous architecture, various bioinks, and different hard supporting materials in the cartilage and bone regions is designed and fabricated in one step using 3D bioprinting technology. Furthermore, orchestrated dynamic mechanical stimulus combined with different biochemical cues (parathyroid hormone [PTH] and chemical component hydroxyapatite [HA] in the outer and inner region, respectively) are used for dual regulation of endochondral ossification. Specifically, dynamic mechanical stimulus combined with growth factor PTH in the outer region inhibits endochondral ossification and results in cartilage regeneration, whereas dynamic mechanical stimulus combined with HA in the inner region promotes endochondral ossification and results in efficient subchondral bone regeneration. The strategy established in this study with the dual modulation of endochondral ossification for 3D bioprinted anisotropic scaffolds represents a versatile and scalable approach for repairing large joints.
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Affiliation(s)
- Tao Li
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine639 Zhizaoju RdShanghai200011China
- Department of OrthopaedicsXinhua Hospital affiliated to Shanghai Jiaotong University School of MedicineNo. 1665 Kongjiang RoadShanghai200092P. R. China
| | - Zhengjiang Ma
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine639 Zhizaoju RdShanghai200011China
| | - Yuxin Zhang
- Department of Oral SurgeryShanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineCollege of StomatologyShanghai Jiao Tong UniversityNational Center for StomatologyNational Clinical Research Center for Oral DiseasesShanghai Key Laboratory of StomatologyShanghai200011China
| | - Zezheng Yang
- Department of OrthopedicsThe Fifth People's Hospital of ShanghaiFudan UniversityMinhang DistrictShanghai200240P. R. China
| | - Wentao Li
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine639 Zhizaoju RdShanghai200011China
| | - Dezhi Lu
- School of MedicineShanghai UniversityJing An DistrictShanghai200444China
| | - Yihao Liu
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine639 Zhizaoju RdShanghai200011China
| | - Lei Qiang
- Southwest JiaoTong University College of MedicineNo. 111 North 1st Section of Second Ring RoadChengdu610036China
| | - Tianchang Wang
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine639 Zhizaoju RdShanghai200011China
| | - Ya Ren
- Southwest JiaoTong University College of MedicineNo. 111 North 1st Section of Second Ring RoadChengdu610036China
| | - Wenhao Wang
- Southwest JiaoTong University College of MedicineNo. 111 North 1st Section of Second Ring RoadChengdu610036China
| | - Hongtao He
- The Third Ward of Department of OrthopedicsThe Second Hospital of Dalian Medical UniversityNo. 467, Zhongshan Road, Shahekou DistrictDalianLiaoning Province116000P. R. China
| | - Xiaojun Zhou
- College of Biological Science and Medical EngineeringState Key Laboratory for Modification of Chemical Fibers and Polymer MaterialsDonghua UniversityShanghai201620P. R. China
| | - Yuanqing Mao
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine639 Zhizaoju RdShanghai200011China
| | - Junfeng Zhu
- Department of OrthopaedicsXinhua Hospital affiliated to Shanghai Jiaotong University School of MedicineNo. 1665 Kongjiang RoadShanghai200092P. R. China
| | - Jinwu Wang
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine639 Zhizaoju RdShanghai200011China
| | - Xiaodong Chen
- Department of OrthopaedicsXinhua Hospital affiliated to Shanghai Jiaotong University School of MedicineNo. 1665 Kongjiang RoadShanghai200092P. R. China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic ImplantDepartment of Orthopaedic SurgeryShanghai Ninth People's Hospital Affiliated Shanghai Jiao Tong University School of Medicine639 Zhizaoju RdShanghai200011China
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Image-Free Robotic-Assisted Total Knee Arthroplasty Results in Quicker Recovery but Equivalent One-Year Outcomes Compared to Conventional Total Knee Arthroplasty. J Arthroplasty 2023; 38:S232-S237. [PMID: 36801477 DOI: 10.1016/j.arth.2023.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Few studies have addressed whether robotic-assisted total knee arthroplasty (RA-TKA) significantly impacts functional outcomes. This study was conducted to determine whether image-free RA-TKA improves function compared to conventional total knee arthroplasty (C-TKA), performed without the utilization of robotics or navigation, using the Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) as measures of meaningful clinical improvement. METHODS A multicenter propensity score-matched retrospective study was conducted of RA-TKA using an image-free robotic system and C-TKA cases at an average follow-up of 14 months (range, 12 months to 20 months). Consecutive patients who underwent primary unilateral TKA and had a preoperative and postoperative Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) were included. The primary outcomes were the MCID and PASS for KOOS-JR. 254 RA-TKA and 762 C-TKA patients were included, with no significant differences in sex, age, body mass index, or comorbidities. RESULTS Preoperative KOOS-JR scores were similar in the RA-TKA and C-TKA cohorts. Significantly greater improvement in KOOS-JR scores were achieved at 4 to 6 weeks postoperatively with RA-TKA compared to C-TKA. While the mean 1-year postoperative KOOS-JR was significantly higher in the RA-TKA cohort, no significant differences were found in the Delta KOOS-JR scores between the cohorts, when comparing preoperative and 1-year postoperative. No significant differences existed in the rates of MCID or PASS being achieved. CONCLUSION Image-free RA-TKA reduces pain and improves early functional recovery compared to C-TKA at 4 to 6 weeks, but functional outcomes at 1 year are equivalent based on the MCID and PASS for KOOS-JR.
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De Oliveira Silva D, Webster KE, Feller JA, McClelland JA. Anterior Knee Pain Following Primary Unilateral Total Knee Arthroplasty With Posterior-Stabilized Prosthesis and Patellar Resurfacing: Prevalence and Clinical Implications. J Arthroplasty 2023; 38:281-285. [PMID: 36067885 DOI: 10.1016/j.arth.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Anterior knee pain following total knee arthroplasty (TKA) is associated with patient dissatisfaction. Factors related to postoperative anterior knee pain and its impact on patient outcomes are poorly understood. The following are the aims of this study: (1) to report the prevalence of anterior knee pain before and after TKA using a posterior-stabilized prosthesis with routine patellar resurfacing; (2) to investigate the association of preoperative clinical factors with the presence of anterior knee pain after TKA; and (3) to explore the association of postoperative anterior knee pain with postoperative self-reported function and quality of life. METHODS This retrospective study included 506 patients who had undergone elective primary unilateral TKA with a posterior-stabilized prosthesis and patellar resurfacing. Outcome measures prior to and 12 months after TKA included self-reported anterior knee pain, knee function, and quality of life. RESULTS Prevalence of anterior knee pain was 72% prior to and 15% following TKA. Patients who had preoperative anterior knee pain had twice the risk of experiencing anterior knee pain after TKA than patients who did not have preoperative anterior knee pain (risk ratio: 2.37, 95% CI 1.73-2.96). Greater severity of preoperative anterior knee pain and worse self-reported function were associated with the presence of postoperative anterior knee pain (rho = 0.15, P < .01; rho = 0.13, P < .01, respectively). Preoperative age, gender, and quality of life were not associated with postoperative anterior knee pain. Greater severity of postoperative anterior knee pain was associated with worse knee function at 12 months postoperative (rho = 0.49, P < .01). CONCLUSION One in 7 patients reported anterior knee pain 12 months following posterior-stabilized and patella-resurfaced TKA. The presence of preoperative anterior knee pain and worse self-reported function are associated with postoperative anterior knee pain.
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Affiliation(s)
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Julian A Feller
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; OrthoSport Victoria Research Unit, Epworth HealthCare, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Thienpont E. Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty at medium-term follow-up. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04754-1. [PMID: 36595031 DOI: 10.1007/s00402-022-04754-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Oxidized zirconium (Oxinium), titanium nitride (TiN) or titanium niobium nitride (TiNbN) coated implants became in recent years available for an increasing amount of total knee arthroplasty (TKA) systems. The hypothesis of this study was that the use of TiNbN-coated components would not lead to inferior results compared to conventional implants and that none of the metal hypersensitivity patients receiving TiNbN-coated implants would require revision for metal allergy. MATERIALS AND METHODS This retrospective study compared 53 Titanium Niobium Nitride coated TKA with 103 conventional chrome cobalt implants of the same design. Patients were evaluated at a minimal follow-up of 3 years. RESULTS No differences in clinical, radiological or patient-reported outcome measurements were observed between these groups. A survivorship of 96% without differences in revision rates was observed at medium-term follow-up of 6.5 years. DISCUSSION Metal allergy leading to contact or generalized dermatitis after TKA is very rare and usually linked to chrome or cobalt hypersensitivity. Nickel release from knee implants has not been shown to lead to cutaneous symptoms, but unexplained pain and swelling, peri-prosthetic osteolysis and component loosening remain potential issues not fully understood. The use of coated implants eliminates this factor from the diagnostic equation in case of postoperative dissatisfaction. CONCLUSION The use of titanium niobium nitride coated implants for primary knee osteoarthritis in self-reported metal hypersensitivity patients shows similar outcomes and survivorship rates as conventional chrome cobalt TKA, with no revisions for allergy at medium-term follow-up.
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Affiliation(s)
- Emmanuel Thienpont
- Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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11
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Maeyama A, Asayama I, Ishimatsu T, Yamamoto T. Effect of the posterior sagging control device to the posterior tibial translation during posterior-stabilized total knee arthroplasty with modified gap technique. J Orthop Surg (Hong Kong) 2022; 30:10225536221144715. [PMID: 36516023 DOI: 10.1177/10225536221144715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE In modern total knee arthroplasty (TKA), flexion and extension gaps between the femur and tibia are equilibrated before implanting the final components. Uncontrolled intraoperative posterior tibial translation (PTT) could cause an artifactual widening of the flexion gap, which could lead surgeons to alter the femoral component size. We designed an intraoperative posterior sagging control device to prevent intraoperative PTT. In this study, we investigated whether the use of this device could prevent artifactual widening of the flexion gap. METHODS Twenty-five patients, 21 women and four men, aged 74.2 years, were enrolled in this prospective study. All patients underwent postero-stabilized TKA using a navigation system. Intraoperative PTT, flexion and extension gaps with or without using the posterior sagging control device were measured with navigation system. These measurements were compared with or without the posterior sagging control device and after the final implantation also. RESULTS There were significant differences between the measurements performed with or without the posterior sagging control device when compared to the post-implantation measurements. The use of the device reduced the number of patients with a >3 mm increase in flexion gap from 7 (28%) to 1 (4%). CONCLUSION This study suggests that the posterior sagging control device prevents PTT and artificial flexion gap widening. This could prevent an unnecessary increase in component size.
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Affiliation(s)
- Akira Maeyama
- Department of Orthopedic Surgery, Faculty of Medicine, 12774Fukuoka University, Fukuoka, Japan
| | - Isao Asayama
- Bone and Joint Research Center, Department of Orthopedic Surgery, Medical Corporation Keijinkai Kawasaki Hospital, Yame, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopedic Surgery, Faculty of Medicine, 12774Fukuoka University, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Faculty of Medicine, 12774Fukuoka University, Fukuoka, Japan
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12
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Mortensen JF, Hald JT, Rasmussen LE, Østgaard SE, Odgaard A. An Investigation of Medial Tibial Component Overhang in Unicompartmental and Total Knee Replacements Using Ultrasound in the Outpatient Department. J Knee Surg 2022; 35:1370-1377. [PMID: 33618398 DOI: 10.1055/s-0041-1723970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tibial component overhang is known to be a contributor to worse outcomes in knee arthroplasty. The aim of this study is to investigate the presence of tibial component overhang, and whether overhang correlates to a higher local tenderness in both medial unicompartmental and total knee replacements. Also, to determine if a rotational projection phenomenon is presented with radiographs when investigating tibial component overhang. A prospective study, including 64 participants, was performed, where ultrasound measurements were compared with postoperative radiographs. Local tenderness was measured as a pressure pain threshold, determined at 3 months postoperatively using algometry. Sixty-two of sixty-four patients had an underdiagnosed medial overhang on radiographs, with a mean difference of 2.4 mm between radiographs and ultrasound (p < 0.001), presenting a rotational projection phenomenon. When comparing sites with ultrasound measured overhang to sites without overhang measured by ultrasound, a higher local tenderness was observed (p < 0.001). A positive linear correlation was found between patients' overhang and local tenderness (r = 0.2; p = 0.045). Subgroup analysis of medial overhang showed significantly higher tenderness than all other locations. No significant differences were seen for lateral overhang. An apparent rotational projection phenomenon of overhang on radiographs was seen, and a linear association between overhang and local tenderness was demonstrated. This study warrants the use of ultrasound when a surgeon is presented with a patient with postoperative medial tenderness, but no overhang can be seen on radiographs. It should also raise awareness of implant selection and positioning during surgery, especially avoiding the overhang to be localized directly medially.
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Affiliation(s)
- Jacob F Mortensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Julius T Hald
- Department of Orthopaedic Surgery, Gentofte Hospital, Hellerup, Denmark
| | | | - Svend E Østgaard
- Department of Orthopaedic Surgery, Aalborg Universitetshospital, Aalborg, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Gentofte Hospital, Hellerup, Denmark
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13
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Jin H, Zuo H, Xu R, Ji Y, Wang Z. A case report of ultrasound-guided knee nerve pulse radiofrequency combined with platelet-rich plasma in the treatment of knee osteoarthritis. Medicine (Baltimore) 2021; 100:e27878. [PMID: 34941033 PMCID: PMC8702092 DOI: 10.1097/md.0000000000027878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONABLE Knee osteoarthritis (KOA) is a disease characterized by noninflammatory degenerative changes of articular cartilage. The main clinical manifestations are joint pain and stiffness. Pulsed radiofrequency (PRF) is thought to treat pain by destroying nerve tissue and changing the physical characteristics of nerve tissue membrane. PATIENT CONCERNS The patients presents with joint pain and tenderness. Touching around the knee joint will induce pain and joint stiffness when the hand is pressed hard. INTERVENTIONS Four patients with knee osteoarthritis underwent pulsed radiofrequency thermocoagulation in the knee joint cavity under ultrasound guidance and injected 2 mL of 10 mg/mL platelet-rich plasma into the joint cavity once a week for a total of 4 times. Record the patient's Visual Analogue Scale (VAS) score and the degree of knee movement limitation before treatment, 1, 3, and 6 months after treatment. DIAGNOSES Four patients with knee osteoarthritis. OUTCOMES After treatment, the patient's VAS score improved, and the knee joint mobility function recovered well. Ultrasound-guided knee nerve pulse radiofrequency combined with intra-articular injection of platelet-rich plasma can effectively improve the knee joint function and reduce the pain of the patient. The clinical effect is significant, and it is worthy of clinical application.
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Affiliation(s)
- Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
| | - Hao Zuo
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
| | - Rui Xu
- Department of Endocrinology, Shanghai National Research Center for Endocrine and Metabolic Disease, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Metabolic Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Youbo Ji
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, PR China
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14
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Takagi K, Inui H, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Sameshima S, Kage T, Tanaka S. Both intraoperative medial and lateral soft tissue balances influence intraoperative rotational knee kinematics in bi-cruciate stabilized total knee arthroplasty: A retrospective investigation. BMC Musculoskelet Disord 2021; 22:830. [PMID: 34579677 PMCID: PMC8477560 DOI: 10.1186/s12891-021-04709-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/11/2021] [Indexed: 11/12/2022] Open
Abstract
Background Tibial internal rotation following total knee arthroplasty (TKA) is important in achieving favorable postoperative clinical outcomes. Studies have reported the effect of intraoperative soft tissue balance on tibial internal rotation in conventional TKA, no studies have evaluated the effects of soft tissue balance at medial or lateral compartments separately on tibial internal rotation in bi-cruciate stabilized (BCS) TKA. The purpose of this study was to clarify the relationship between medial or lateral component gaps and rotational knee kinematics in BCS TKA. Methods One hundred fifty-eight knees that underwent BCS TKA were included in this study. The intraoperative medial and lateral joint laxities which was defined as the value of component gap minus the thickness of the tibial component were firstly divided into two groups, respectively: Group M-stable (medial joint laxity, ≤ 2 mm) or Group M-loose (medial joint laxity, ≥ 3 mm) and Group L-stable (lateral joint laxity, ≤ 3 mm) or Group L-loose (lateral joint laxity, ≥ 4 mm). And finally, the knees enrolled in this study were divided into four groups based on the combination of Group M and Group L: Group A (M-stable and L-stable), Group B (M-stable and L-loose), Group C (M-loose and L-stable), and Group D (M-loose and L-loose). The intraoperative rotational knee kinematics were compared between the four Groups at 0°, 30°, 60°, and 90° flexion, respectively. Results The rotational angular difference between 0° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group A at 30° flexion (*p < 0.05). The rotational angular difference between 30° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group D at 30° flexion (*p < 0.05). The rotational angular differences between 30° or 90° flexion and maximum flexion in Group B at 60° flexion were significantly larger than those in Group A at 60° flexion (*p < 0.05). Conclusion Surgeons should pay attention to the importance of medial joint stability at midflexion and lateral joint laxities at midflexion and 90° flexion on a good tibial internal rotation in BCS TKA.
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Affiliation(s)
- Kentaro Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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15
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Belvedere C, Tamarri S, Ensini A, Durante S, Ortolani M, Leardini A. Can Computer-Assisted Total Knee Arthroplasty Support the Prediction of Postoperative Three-Dimensional Kinematics of the Tibiofemoral and Patellofemoral Joints at the Replaced Knee? J Knee Surg 2021; 34:1014-1025. [PMID: 32074653 DOI: 10.1055/s-0040-1701265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to analyze the extent to which postoperative patellofemoral joint (PFJ) kinematics assessed at 6-month follow-up after total knee arthroplasty (TKA) mimics the intraoperative kinematics after final component implantation. The study hypothesis, already proved in terms of tibiofemoral joint (TFJ) kinematics, is that the intraoperative assessment of PFJ kinematics after component implantation is also capable of predicting postoperative knee kinematics during activities of daily living. Twenty patients selected for TKA with patellar resurfacing were implanted using surgical navigation, including patellar component positioning via a novel computer-assisted procedure. This allowed for intraoperative TFJ and PFJ kinematic assessment after final component implantation. At 6-month follow-up, all patients were contacted for follow-up control; in addition to clinical examination, this implied postoperative kinematics assessments by three-dimensional video fluoroscopy of the replaced knee during standard activities of daily living. Several traditional PFJ, as well as TFJ, rotations and translations were calculated intra- and postoperatively and then statistically compared. Good postoperative replication of the intraoperative measurements was observed for most of PFJ variables analyzed, as well as those for TFJ. Relevant statistical analysis also supported the significant consistency between the intra- and postoperative measurements. Pertaining to the present findings on a statistical basis, intraoperative measurements performed at both TFJ and PFJ kinematics using a surgical navigation system under passive conditions, are predictive of the overall knee kinematics experienced at postoperative follow-ups by the same replaced knees in typical activities of daily living.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Tamarri
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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Röhner E, Heinecke M, Matziolis G. Diagnostic algorithm in aseptic TKA failure - What is evidence-based? J Orthop 2021; 24:248-253. [PMID: 33854292 PMCID: PMC8039505 DOI: 10.1016/j.jor.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Röhner
- Corresponding author. Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | | | - G. Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, 07607, Eisenberg, Germany
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17
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The prevalence of posterolateral tibial baseplate overhang: An anatomical CT study. J Orthop 2021; 23:259-263. [PMID: 33679017 DOI: 10.1016/j.jor.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Total Knee Arthroplasty (TKA) is used in patients with osteoarthritis who have failed conservative management to reduce pain, improve functional outcomes and ultimately quality of life. However, less than optimal patient satisfaction has led to continued improvements in design and technology of TKA. One factor that can limit patient satisfaction is postero-lateral overhang of the tibial baseplate. The purpose of our study is to utilize pre-operative CT scans to assess the prevalence of posterolateral tibial overhang with the use of a symmetric tibial baseplate component in a popular knee system with robotic assistance. Methods Ninety-eight (98) consecutive patients who underwent robotic-assisted total knee arthroplasty (TKA) were included in this study. Using both the most medial aspect of the tibial tubercle and the medial ⅓ of the tibial tubercle as reference points, we quantified the extent of posterolateral overhang when determining the rotation of the tibial component. Results Using the most medial aspect of the tibial tubercle as a reference point for rotation of the tibial baseplate, 63% of the instances of reviewed CT scans (369/588) had posterolateral overhang. Furthermore, 81% (406/588) had posterolateral overhang when using the medial ⅓ aspect of the tibial tubercle as the reference for rotation of the tibial baseplate. The average posterolateral tibial baseplate overhang was 1.5 mm (range 0-8 mm) when using the most medial aspect of the tibial tubercle and 2.4 mm (range 0-8 mm) when using the medial ⅓ tibial tubercle as the centering point for the tibial baseplate. Discussion Tibial baseplate overhang could lead to potential pain from irritation of soft tissues. To our knowledge, this is the first study that was able to valencquantify the amount of tibial baseplate overhang using pre-operative CT scans. Rotational alignment of the tibial baseplate needs to be balanced to ensure minimal lateral overhang while achieving sufficient external rotation of the tibial component. An asymmetric tibial component may provide a compromise in certain situations. Level of evidence Diagnostic level IV case series.
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18
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Ho KW, Pong G, Poon WC, Chung KY, Kwok YY, Chiu KH. Progression of health-related quality of life of patients waiting for total knee arthroplasty. J Eval Clin Pract 2021; 27:69-74. [PMID: 32202045 PMCID: PMC7891587 DOI: 10.1111/jep.13388] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) remains the surgical gold standard treatment for patients suffering from end-stage osteoarthritis (OA) of the knee. However, due to the high demand and scarce medical resources, the waiting time for surgery is astoundingly lengthy. Controversies are shown in numerous studies, on whether physical functionality and mental status decline or remain stable over the waiting period. This study aims to evaluate the progression in patients suffering from end-stage OA while on the waiting list for TKA. METHODS One hundred and twenty-seven patients suffering from end-stage OA who were on the TKA waiting list were prospectively recruited from our orthopaedics specialist clinic. They were assessed once a year for 2 years or until surgery. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), SF-36 self-rated questionnaire and 15D health-related quality of life (HRQoL) questionnaire were used as outcome measurements for functionality and disability assessment. RESULTS Patients on the waiting list for TKA showed a progressive increase in pain and disability level within the first year (P = .035). Those patients waiting for more than 2 years showed worsening HRQoL (P < .05) as time progressed. However, no significant difference was observed between the first and second years. CONCLUSIONS A decline in functionality and increase in disability were shown in follow-up assessments conducted every year. However, a plateau effect is observed with end-stage disease. This emphasizes that more active conservative management programmes should be introduced and implemented while patients are enlisted on the TKA waiting list. Moreover, timely surgical intervention can improve patients' overall function. TRIAL REGISTRATION This study involved human participants and reports health-related outcomes concerning the HRQoL in patients with end-stage OA of the knee. Thus, it was registered, retrospectively, as a clinical trial under the U.S. National Library of Medicine ClinicalTrials.gov (https://clinicaltrials.gov/) on March 4, 2018.
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Affiliation(s)
- Ki Wai Ho
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Gerald Pong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Wai Chin Poon
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Kwong Yin Chung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Yan-Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kwok Hing Chiu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, Hong Kong
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19
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A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:768. [PMID: 33220714 PMCID: PMC7680598 DOI: 10.1186/s12891-020-03794-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background The measurement of patellar height and restoration of the natural position of the joint line are crucial to total knee arthroplasty (TKA). However, there remains a lack of consensus on an optimal measurement method to associate the patellar height with the joint line position. The objective of this study was to introduce a new method and validate the application in TKA both preoperatively and postoperatively. Methods Instead of taking marginal landmarks as the tibial references, the tibial shaft axis was used to construct the new measurement method, which comprises the axis-patella (AP), joint axis-patella (jAP) indices and joint line height (JLH). Patellar heights were measured using the Insall-Salvati (IS), modified Insall-Salvati (mIS), Blackburne-Peel (BP), Caton-Deschamps (CD) indices, and the new method in 175 knees both preoperatively and postoperatively. Intraclass correlation coefficients and Pearson’s correlation analyses were respectively used to evaluate the reliabilities and correlations. Results There were good correlations between the proposed method and the mIS, CD, and BP indices. High inter-observer reproducibility was found for AP (preoperative and postoperative 0.83), jAP (preoperative 0.82; postoperative 0.86) indices and JLH (preoperative 0.88; postoperative 0.95). High intra-observer repeatability was also found for AP (preoperative 0.85; postoperative 0.87), jAP (preoperative 0.83; postoperative 0.87) indices and JLH (preoperative 0.80; postoperative 0.92). Conclusions The new method is reliable for measuring patellar height before and after TKA, providing an alternative to distinguish between true and pseudo patella baja. Furthermore, JLH can be applied to assess and restore the joint line position in TKA.
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20
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Li CY, Ng Cheong Chung KJ, Ali OME, Chung NDH, Li CH. Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis. EFORT Open Rev 2020; 5:534-543. [PMID: 33072405 PMCID: PMC7528670 DOI: 10.1302/2058-5241.5.200031] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Adverse knee pain occurs in 10–34% of all total knee replacements (TKR), and 20% of TKR patients experience more pain post-operatively than pre-operatively. Knee pain is amongst the top five reasons for knee replacement revision in the United Kingdom. The number of TKRs is predicted to continue increasing due to the ageing population. A narrative literature review was performed on the different causes of pain following TKR. A database search on Scopus, PubMed, and Google Scholar was conducted to look for articles related to TKR, pain, and cause. Articles were selected based on relevance, publication date, quality of research and validation. Relevant sections were added to the review. One hundred and fourteen articles were identified and potential causes of TKR pain included: arthrofibrosis, aseptic loosening, avascular necrosis, central sensitization, component malpositioning, infection, instability, nerve damage, overstuffing, patellar maltracking, polyethylene wear, psychological factors and unresurfaced patella. It is important to tailor our approach to address the individual causes of pain. Certain controllable risk factors can be managed pre-operatively to minimize post-operative pain. Risk factors help to predict adverse pain outcomes and identify specific causes. There are multiple causes of pain following TKR. Some factors will require further extensive studies, and as pain is a commonly attributed reason for TKR revision, its underlying aetiologies should be explored. Understanding these factors helps to develop effective methods for diagnosis, prevention and management of TKR pain, which help to improve patient outcomes.
Cite this article: EFORT Open Rev 2020;5:534-543. DOI: 10.1302/2058-5241.5.200031
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Affiliation(s)
- Cheuk Yin Li
- School of Medical Education, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | | | - Omar M E Ali
- School of Medical Education, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Nicholas D H Chung
- School of Medical Education, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Cheuk Heng Li
- School of Medical Education, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
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21
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Saito H, Saito K, Shimada Y, Yamamura T, Sato T, Nozaka K, Kijima H, Fujii M, Kawano T, Miyakoshi N. Successful treatment of a habitual patellar dislocation after a total knee arthroplasty with a closing-wedge distal femoral varus osteotomy and medial patello-femoral ligament reconstruction. J Exp Orthop 2020; 7:63. [PMID: 32875427 PMCID: PMC7462943 DOI: 10.1186/s40634-020-00281-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
A 68-year-old female suffering from habitual patellar dislocations following a mal-positioned total knee arthroplasty (TKA) was successfully treated with a biplanar closed wedge distal femoral osteotomy (CWDFO) and medial patello-femoral ligament (MPFL) reconstruction. To the best of our knowledge, no such case has been previously described. Our experience with this case suggests that treatment for a patella dislocation following valgus mal-positioning of TKA should be considered positively. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Hidetomo Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan. .,Akita Sports Arthroscopy and Knee Group, Akita, Japan.
| | - Kimio Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan.,Akita Sports Arthroscopy and Knee Group, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan
| | - Toshiaki Yamamura
- Sapporo Sports Clinic, Chuo-ku Kita-1-jo, Nishi-2-Tyome, Sapporo, 060-0001, Japan
| | - Takahiro Sato
- Sapporo Sports Clinic, Chuo-ku Kita-1-jo, Nishi-2-Tyome, Sapporo, 060-0001, Japan
| | - Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan.,Akita Sports Arthroscopy and Knee Group, Akita, Japan
| | - Masashi Fujii
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan.,Akita Sports Arthroscopy and Knee Group, Akita, Japan
| | - Tetsuya Kawano
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan.,Akita Sports Arthroscopy and Knee Group, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan
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22
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Radiographs are not sufficient for evaluation of component fit in subtle knee pain after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:2015-2022. [PMID: 32221640 DOI: 10.1007/s00167-020-05940-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the component fit by radiography or computed tomography after total knee arthroplasty and the relation of imaging with clinical examination of residual knee pain. METHODS The study was conducted in 172 patients with residual knee pain after total knee arthroplasty. The patients were examined to determine whether they experienced pain upon palpation at nine regions surrounding the tibial and femoral components, and the results were noted. The Knee Society Clinical Rating System and The Western Ontario and McMaster Universities Arthritis Index pain scale score forms were completed for all patients. Radiologic evaluation was performed using computed tomography and anteroposterior, lateral, and oblique radiographs to determine component overhang/underhang status at these nine regions. Overhang, underhang, and cortical fit groups were created based on the position of the component at the bone margin. A statistical relationship was sought between the clinical scores and the values measured to determine which imaging method showed the best correlation with clinical scores. Consistency of CT and Rx measurements was compared using the McNemar-Bowker test. Comparisons between groups were made using Student's t test for normally distributed data, and the Mann-Whitney U test. RESULTS Computed tomography and radiographic measurements were similar in the medial, anterior, and lateral tibial regions. However, no similarities were observed in the anteromedial, anterolateral, posteromedial, and posterolateral tibial regions, and in the distal-medial and distal-lateral aspects of the femur. Statistical relationships among decreased clinical scores, pain with palpation, and the presence of overhang/underhang were only observed in the medial tibial region for imaging using radiography. A statistically significant relationship was observed in the medial, posteromedial, and posterolateral tibial regions, and in the distal-medial region of the femur for imaging based on computed tomography. CONCLUSIONS Radiography could only aid in assessing the component fit in the anteromedial, medial, and lateral regions of the tibia in patients with residual knee pain following knee arthroplasty, but it was not sufficient in comparison with computed tomography in six other regions. LEVEL OF EVIDENCE Prospective study, level of evidence II.
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Kinematically aligned TKA restores physiological patellofemoral biomechanics in the sagittal plane during a deep knee bend. Knee Surg Sports Traumatol Arthrosc 2020; 28:1497-1507. [PMID: 31147726 DOI: 10.1007/s00167-019-05547-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Although patellofemoral complications after kinematically aligned (KA) TKA are infrequent, the patellar flexion angle and proximal-distal patellar contact location through flexion, and incidence of patellar loss of contact at full extension are unknown. The present study determined whether the patellar flexion angle and proximal-distal patellar contact location of a KA TKA performed with anatomic, fixed-bearing, posterior cruciate-retaining (PCR) components differed from those of the native contralateral knee during a deep knee bend, and determined the incidence of patellar loss of contact at full extension for KA TKA only. METHODS During a deep knee bend from full extension to maximum flexion, both knees were imaged in a lateral view using single-plane fluoroscopy for 25 patients with a calipered KA TKA and a healthy native knee in the contralateral limb. The patellar flexion angle and proximal-distal patellar contact location were measured on images from full extension to maximum flexion in 30° increments. Paired t tests at each flexion angle determined the significance of the difference between the KA TKA knees and the native contralateral knees. In the KA TKA knees, the incidence of patellar loss of contact at full extension was determined. Patient-reported outcome scores also were recorded including the Oxford Knee Score. RESULTS Mean patellar flexion angles were not different between the KA TKA knees and the native contralateral knees throughout the motion arc. The largest statistically significant difference in the mean proximal-distal patellar contact locations was 4 mm. The incidence of patellar loss of contact in the KA TKA knees at full extension was 8% (2 of 25 patients). The median Oxford Knee Score was 46 out of 48. CONCLUSIONS Calipered KA TKA performed with anatomic, fixed-bearing, PCR components restored patellar flexion angles to native and largely restored the proximal-distal patellar contact locations, which at most differed from the native contralateral knee by approximately 10% of the mean proximal-distal patellar length. In the KA TKA knees, the incidence of patellar loss of contact was infrequent. These objective biomechanical results are consistent with the relatively high subjective patient-reported outcome scores herein and support the low incidence of patellofemoral complications following KA TKA previously reported. LEVEL OF EVIDENCE Therapeutic, level III.
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Reddy AG, Sankineani SR, Agrawal R, Thayi C. Comparative study of existing knee prosthesis with anthropometry of Indian patients and other races, a computer tomography 3D reconstruction-based study. J Clin Orthop Trauma 2020; 11:S228-S233. [PMID: 32189946 PMCID: PMC7067989 DOI: 10.1016/j.jcot.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED Background: Appropriate component sizing plays an important role in determining the functional outcome following total knee arthroplasty. Comparative studies of different populations have shown significant differences in the anthropometric parameters of knees in different race groups which negates the possibility of using a single sized implant system across different ethnic groups. This study evaluates the dimensions of femoral and tibial articular surfaces of Indian patients and compares the parameters with other ethnic groups and correlates the dimensions with five different commercially available knee systems.Material & Methods: Computerized tomography (CT) scans of contralateral normal knees of patients who underwent the scan for various ailments of the knee were retrieved retrospectively from the hospital database and 3D reconstruction of the images was done. Mediolateral dimensions (fML,tML), Anteroposterior dimensions (fAP, tAP) and aspect ratio (fML/fAP, tML/tAP) of the femur and tibia respectively were calculated and compared with the dimensions of different ethnic groups as well as the femoral and tibial components of five different knee prosthesis systems. RESULTS The average fML in the study group was less than that of Caucasian knees but was marginally larger than other ethnic groups. The fAP, tML and tAP was found to be smaller than all other ethnic groups but a larger femoral aspect ratio was reported than other ethnic groups. Among the implant systems, only NexGen LPS and Scorpio NRG implant femoral components closely matched the femoral dimensions in the study group whereas all implant systems showed significant mismatch with tibial component dimensions when compared to the study populations. CONCLUSION This study concludes that the dimensions of Indian knees are different from other ethnic groups and the use of commercially available knee Implants designed based on measurements in Caucasian populations can lead to significant mismatch between implant and resected bone surfaces.
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French SR, Munir S, Brighton R. A Single Surgeon Series Comparing the Outcomes of a Cruciate Retaining and Medially Stabilized Total Knee Arthroplasty Using Kinematic Alignment Principles. J Arthroplasty 2020; 35:422-428. [PMID: 31611163 DOI: 10.1016/j.arth.2019.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) designs are developed to optimize kinematics and improve patient satisfaction. The cruciate retaining (CR) and medially stabilized (MS) TKA designs have reported good mid-term follow-up outcomes. However, reasons for consistently high rates of patient dissatisfaction following a TKA remain poorly understood. To further investigate this, we compared the short-term functional outcomes and quality of life, using patient-reported outcome measures (PROMs) and range of motion (ROM), between a CR and MS TKA. METHODS A prospective comparison was made between 2 groups (44 CR-TKAs vs 46 MS-TKAs). The Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS-12, KOOS-Short form, KOOS-Joint Replacement, Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, UCLA Activity Scale, and EuroQuality of life - 5 Dimension were completed preoperatively and 1 year postoperatively. The Forgotten Joint Score (FJS) and Visual Analogue Scale-Satisfaction were completed at 1 year postoperatively. ROM was collected preoperatively and 1 year postoperatively. RESULTS Patients who underwent an MS-TKA scored significantly better than the CR-TKA on the FJS (MS = 79.87, CR = 63.8, P = .005), the KOOS-12 Quality of Life subscale (MS = 82.8, CR = 74.4, P = .43), and the KOOS Quality of Life subscale (MS = 82.8, CR = 74.6, P = .44). There was no difference between the groups in all assessed PROMs or ROM, preoperatively and 1 year postoperatively. CONCLUSION Patients who underwent the MS-TKA scored significantly better on the FJS and the quality of life subscale of the KOOS and KOOS-12 than those who underwent a CR-TKA. All other assessed PROMs and ROM were comparable between the 2 groups and demonstrated that both implants facilitated symptom relief and improved daily function at 1 year postoperatively. These findings suggest that at short-term follow-up, the MS device is more likely to allow a patient to "forget" that a joint has been replaced and restore their quality of life. Long-term assessment of MS-TKA design outcomes in larger cohorts is recommended.
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Affiliation(s)
- Sofie R French
- Research Department, Australian Institute of Musculoskeletal Research, Wollstonecraft, New South Wales, Australia
| | - Selin Munir
- Research Department, Australian Institute of Musculoskeletal Research, Wollstonecraft, New South Wales, Australia
| | - Roger Brighton
- Orthopaedic Department, Westmead Private Hospital, Westmead, New South Wales, Australia
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Bierke S, Häner M, Karpinski K, Hees T, Petersen W. Midterm Effect of Mental Factors on Pain, Function, and Patient Satisfaction 5 Years After Uncomplicated Total Knee Arthroplasty. J Arthroplasty 2020; 35:105-111. [PMID: 31477540 DOI: 10.1016/j.arth.2019.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The effects of psychological factors on the short-term outcome after uncomplicated total knee arthroplasty (TKA) have been described in several studies. However, the effects of mental factors on the midterm (5-year) outcome have not been described in the literature. This study was performed to examine the influence of pain catastrophizing, anxiety, depression symptoms, and somatization dysfunction on the outcome of TKA during a 5-year follow-up. METHODS One hundred fifty patients were enrolled in this prospective study. The following mental parameters were assessed in all patients: pain catastrophizing (Pain Catastrophizing Scale), anxiety (State-Trait Anxiety Inventory), depressive symptoms and somatization dysfunction (Patient Health Questionnaire). The primary outcome measure was postoperative pain on a numerical rating scale. The secondary outcome measures were the Knee Injury and Osteoarthritis Outcome Score and patient satisfaction. Intergroup differences were tested using an independent t-test. Odds ratios were calculated to determine the probability of an unsatisfactory outcome. RESULTS At the 5-year follow-up, only depressive symptoms and somatization dysfunction had a significant effect on postoperative pain (numerical rating scale score). This significant effect was also observed for the different Knee Injury and Osteoarthritis Outcome Score subscales and patient satisfaction (P = .010-.020). Pain catastrophizing and anxiety had only a small effect on the clinical outcome at 5 years postoperatively. CONCLUSION The effects of psychopathological factors (depressive symptoms and somatization dysfunction) on the clinical outcome after uncomplicated TKA persist for up to 5 years. Preoperative screening for and subsequent treatment of these psychological disorders may improve patient-reported outcomes after TKA. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Sebastian Bierke
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Martin Häner
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Katrin Karpinski
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Tilman Hees
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
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Takagi K, Inui H, Taketomi S, Yamagami R, Kono K, Nakazato K, Kawaguchi K, Kage T, Tanaka S. Iliotibial band friction syndrome after knee arthroplasty. Knee 2020; 27:263-273. [PMID: 31883856 DOI: 10.1016/j.knee.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/18/2019] [Accepted: 09/04/2019] [Indexed: 02/02/2023]
Abstract
Iliotibial band (ITB) friction syndrome is known to be one of the main causes of lateral knee pain related to an overuse injury. In the field of knee arthroplasty, ITB traction syndrome has been reported following guided motion total knee arthroplasty, due to posterior femoral translation and internal tibial rotation during knee flexion. However, ITB friction syndrome following conventional knee arthroplasty has not been reported. This paper reports four cases of this syndrome following conventional knee arthroplasty, mainly caused by an obstruction just under the ITB. Cases 1 and 2 presented extruded cement at the femoral component's lateral side after total knee arthroplasty. Case 3 presented a highly sharp-edged bearing at the lateral compartment after bicompartmental knee arthroplasty. Case 4 presented an osteophyte at the femoral component's lateral side after total knee arthroplasty. Although none of the cases responded well to conservative treatment, ITB friction syndrome was completely relieved just after excising the obstruction. Excision of an obstruction should be considered for ITB friction syndrome caused by obstruction just under the ITB following knee arthroplasty.
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Affiliation(s)
- Kentaro Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiu Nakazato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Does total contact of the patella with the femoral trochlea during no thumb test significantly reduce anterior knee pain? Knee 2019; 26:1338-1347. [PMID: 31405630 DOI: 10.1016/j.knee.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/11/2018] [Accepted: 09/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Complications such as anterior knee pain (AKP) and crepitus continue to be causes of dissatisfaction after total knee arthroplasty (TKA). This prospective study aimed to study the significance of total patellar contact with the femoral trochlea of the implant, with the no thumb test during trial reduction, and its effect on reducing AKP. METHODS Between 2014 and 2016, 445 patellofemoral joints (M:F 126:319, age 45-80 years) and their contact with the trochlea of the femoral component were graded at trial reduction without lateral retinaculum release (Grades I, Ia, II, III based on existing publications). The aim was to restore all patellae to pre-operative thickness. Posterior stabilized implants with a domed patella were used in all cases. The Knee Society Score (KSS) and Visual Analogue Scale (VAS) score were noted at follow up between 12 and 24 months after surgery. RESULTS AKP was significantly lower with 100% patellofemoral contact. The KSS and VAS had statistically significant P-values of 0.021 and 0.025 in Grade I and Ia contact, respectively. Better results were achieved where patellar thickness was restored in Grades I and Ia with P-values of 0.041 and 0.046 for VAS change and 0.038 and 0.044 for KSS change, respectively. CONCLUSION At follow up, superior results were obtained where there was a complete patellofemoral contact at trial reduction in Grade I and Grade Ia, and when other confounding factors such as patellar thickness and normal rotation of the femoral and tibial components were standardized. To minimize AKP it is imperative to have total patellar contact with the femoral trochlea.
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Migliorini F, Eschweiler J, Niewiera M, El Mansy Y, Tingart M, Rath B. Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study. Arch Orthop Trauma Surg 2019; 139:1445-1454. [PMID: 31367842 DOI: 10.1007/s00402-019-03246-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a feasible and cost-effective procedure. However, resurfacing of the patella sparks a heated debate. Anterior knee pain after TKA was supposed to be correlated to the patellofemoral joint, and the resurface of the patella was believed to be effective to avoid this complication. AIM A meta-analysis was performed to update current evidence concerning the outcomes of patellar resurfacing versus retaining for total knee arthroplasty. The first outcomes of interest were to compare the rate of anterior knee pain and revision surgeries. MATERIAL AND METHODS This study was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). A comprehensive review of the literature was conducted accessing the main databases: Embase, Google Scholar, PubMed, Scopus. All the prospective clinical trials comparing the outcomes between patellar resurfacing versus retaining were included in this study. Only articles classified as level of evidence I to II were considered for inclusion. Only studies reporting a minimum 24 months follow-up were included. The following data were extracted: demographic baseline, anterior knee pain, reoperations, clinical scores (HSS, KSS and related subscales) and range of motion (ROM). Studies solely reporting quantitative data under the outcomes of interest were included. RESULTS In favor of the resurfacing group, we observed a statistically significant reduced rate of anterior knee pain (odd ratio 1.73) and reoperation (odd ratio 3.24). In the resurfacing group, a prevalence of anterior knee pain of 11.15% was detected, whereas in the retaining group it amounted to 17.39%. Furthermore, a greater KSS pain (+ 0.97%), KSS clinical (+ 0.23%), KSS functional (+ 2.44%), KSS overall (+ 2.47%) and HSS (+ 5.64%) were reported. In the retaining group, we found a better range of motion (+ 3.09°). CONCLUSION Based on the main findings of this meta-analysis, patellar resurfaced TKA was demonstrated to have performed superior overall. Patellar resurfacing detected a lower rate of postoperative anterior knee pain and reoperation. Moreover, the resurfacing group showed greater value of the HSS, KSS and related subscales. In favor of the retaining group, a slightly better ROM was evidenced. LEVEL OF EVIDENCE Level II, meta-analysis of prospective clinical trials.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marc Niewiera
- Department of General Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Yasser El Mansy
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.,Department of Orthopaedics and Traumatology, Alexandria University, Alexandria, Egypt
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Schröder FF, Post CE, Wagenaar FCBM, Verdonschot N, Huis In't Veld RMHA. MRI as Diagnostic Modality for Analyzing the Problematic Knee Arthroplasty: A Systematic Review. J Magn Reson Imaging 2019; 51:446-458. [PMID: 31332865 PMCID: PMC7003732 DOI: 10.1002/jmri.26874] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 12/13/2022] Open
Abstract
Background Various diagnostic modalities are available to assess the problematic knee arthroplasty. Visualization of soft‐tissue structures in relation to the arthroplasty and bone remains difficult. Recent developments in MRI sequences could make MRI a viable addition to the diagnostic arsenal. Purpose To review the diagnostic properties of MRI, to identify certain causes of complaints that may be directly related to implant failure of total (TKA) or unicompartmental knee arthroplasty (UKA); infection, loosening and wear, instability, malalignment, arthrofibrosis, or patellofemoral problems. Study Type Systematic review. Population Twenty‐three studies were included: 16 TKA, four UKA, and three cadaveric studies. Causes of knee arthroplasty complaints analyzed were; infection (three), loosening and wear (11), malalignment (five) and instability (four). Field Strength and Sequences No field strength or sequence restrictions. Assessment PubMed, SCOPUS, and EMBASE were searched. Risk of bias was assessed using the COnsensus‐based Standards for the selection of health Measurement Instruments (COSMIN) and the QUality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2). Statistical Tests The results of the original research articles are stated. Results Fifteen studies assessed the reproducibility of analyzing infection, loosening and wear, and malalignment. Fourteen of 15 studies were deemed as adequate to good quality. Results showed a moderate to excellent agreement (ICC/K 0.55–0.97). Fourteen studies addressed the accuracy. For infection and loosening and wear the sensitivity and specificity estimates varied between 0.85–0.97 and 0.70–1.00, respectively. The accuracy for malalignment was excellent (r ≥ 0.81). For these studies QUADAS‐2 analysis suggested few risks of bias. A meta‐analysis was not possible due to the heterogeneity of the data. Data Conclusion This study supports that MRI can be used with overall reproducible and accurate results for diagnosing infection, loosening and wear, and malalignment after knee arthroplasty. Nonetheless, studies regarding the diagnosis of instability, arthrofibrosis or patellofemoral complaints using MRI are limited and inconclusive. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:446–458.
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Affiliation(s)
- Femke F Schröder
- The OCON, Centre for Orthopaedic Surgery, Hengelo, The Netherlands.,University of Twente, Faculty of Engineering Technology, Biomechanical Engineering, The Netherlands
| | - Corine E Post
- The OCON, Centre for Orthopaedic Surgery, Hengelo, The Netherlands.,University of Twente, Faculty of Engineering Technology, Biomechanical Engineering, The Netherlands.,Orthopaedic Research Laboratory, Radboud University Medical Center, The Netherlands
| | | | - Nico Verdonschot
- University of Twente, Faculty of Engineering Technology, Biomechanical Engineering, The Netherlands.,Orthopaedic Research Laboratory, Radboud University Medical Center, The Netherlands
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Shen S, Chen M, Guo W, Li H, Li X, Huang S, Luo X, Wang Z, Wen Y, Yuan Z, Zhang B, Peng L, Gao C, Guo Q, Liu S, Zhuo N. Three Dimensional Printing-Based Strategies for Functional Cartilage Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:187-201. [PMID: 30608012 DOI: 10.1089/ten.teb.2018.0248] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Shi Shen
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Mingxue Chen
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Weimin Guo
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Haojiang Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
- Department of Microbiology and Immunology, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Xu Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Suqiong Huang
- Department of Liver and Gallbladder Disease, The Affiliated Chinese Traditional Medicine Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Xujiang Luo
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Zhenyong Wang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
- First Department of Orthopedics, First Affiliated Hospital of Jiamusi University, Jiamusi, People's Republic of China
| | - Yang Wen
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Zhiguo Yuan
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Bin Zhang
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Liqing Peng
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Chao Gao
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Quanyi Guo
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Shuyun Liu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, People's Republic of China
| | - Naiqiang Zhuo
- Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
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Daly AC, Kelly DJ. Biofabrication of spatially organised tissues by directing the growth of cellular spheroids within 3D printed polymeric microchambers. Biomaterials 2019; 197:194-206. [PMID: 30660995 DOI: 10.1016/j.biomaterials.2018.12.028] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/07/2018] [Accepted: 12/24/2018] [Indexed: 12/21/2022]
Abstract
Successful tissue engineering requires the generation of human scale implants that mimic the structure, composition and mechanical properties of native tissues. Here, we report a novel biofabrication strategy that enables the engineering of structurally organised tissues by guiding the growth of cellular spheroids within arrays of 3D printed polymeric microchambers. With the goal of engineering stratified articular cartilage, inkjet bioprinting was used to deposit defined numbers of mesenchymal stromal cells (MSCs) and chondrocytes into pre-printed microchambers. These jetted cell suspensions rapidly underwent condensation within the hydrophobic microchambers, leading to the formation of organised arrays of cellular spheroids. The microchambers were also designed to provide boundary conditions to these spheroids, guiding their growth and eventual fusion, leading to the development of stratified cartilage tissue with a depth-dependant collagen fiber architecture that mimicked the structure of native articular cartilage. Furthermore, the composition and biomechanical properties of the bioprinted cartilage was also comparable to the native tissue. Using multi-tool biofabrication, we were also able to engineer anatomically accurate, human scale, osteochondral templates by printing this microchamber system on top of a hypertrophic cartilage region designed to support endochondral bone formation and then maintaining the entire construct in long-term bioreactor culture to enhance tissue development. This bioprinting strategy provides a versatile and scalable approach to engineer structurally organised cartilage tissues for joint resurfacing applications.
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Affiliation(s)
- Andrew C Daly
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland; Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - Daniel J Kelly
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland; Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland; Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland.
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Sorel JC, Veltman ES, Honig A, Poolman RW. The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone Joint J 2019; 101-B:7-14. [PMID: 30601044 DOI: 10.1302/0301-620x.101b1.bjj-2018-0672.r1] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS We performed a meta-analysis investigating the association between preoperative psychological distress and postoperative pain and function after total knee arthroplasty (TKA). MATERIALS AND METHODS Pubmed/Medline, Embase, PsycINFO, and the Cochrane library were searched for studies on the influence of preoperative psychological distress on postoperative pain and physical function after TKA. Two blinded reviewers screened for eligibility and assessed the risk of bias and the quality of evidence. We used random effects models to pool data for the meta-analysis. RESULTS Six prospective cohort studies, with a total of 1525 patients, were included. The random effects models showed significantly poorer outcomes in patients who preoperatively had elevated scores on the pain catastrophizing scale, worse 36-Item Short-Form Health Survey (SF-36) mental health score, symptoms of anxiety and/or depression, and somatization dysfunction. After 12 months, the standard mean difference for pain was -0.74 (95% confidence interval (CI) -1.04 to -0.44) and -0.56 (95% CI -0.80 to -0.32) for function. CONCLUSION Preoperative pain catastrophizing, mental distress, symptoms of anxiety and/or depression, and somatoform disorders appear to adversely affect pain and function after TKA. Some patients undergoing TKA may therefore need psychological support to improve the outcome and quality of life.
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Affiliation(s)
- J C Sorel
- Department of Orthopaedic Surgery and Traumatology, Joint Research OLVG, Amsterdam, The Netherlands
| | - E S Veltman
- Department of Orthopaedic Surgery and Traumatology, Joint Research OLVG, Amsterdam, The Netherlands
| | - A Honig
- Department of Psychiatry, OLVG, Amsterdam and VU Medical Center, Amsterdam, The Netherlands
| | - R W Poolman
- Department of Orthopaedic Surgery and Traumatology, Joint Research OLVG, Amsterdam, The Netherlands
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Bloodpool SPECT as part of bone SPECT/CT in painful total knee arthroplasty (TKA): validation and potential biomarker of prosthesis biomechanics. Eur J Nucl Med Mol Imaging 2019; 46:1009-1018. [PMID: 30600341 DOI: 10.1007/s00259-018-4244-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare bloodpool SPECT with planar imaging in bone SPECT/CT of painful total knee arthroplasty (TKA) with respect to inter-rater agreement, confidence, prosthesis outcome, and biomechanical functioning. METHODS Retrospective study of bloodpool SPECT and planar control images. Four raters used the validated Bruderholz scheme and a 5-point scale to grade uptake. Inter-rater agreement and overall confidence scores were calculated. Variable cluster analysis was performed to identify patterns of uptake, and associations between patterns and prosthesis outcome and biomechanical functioning were examined. RESULTS In all, 55 knees in 43 patients were analyzed (median follow-up 17 months; revision rate 21.8%). SPECT significantly improved inter-rater agreement in 24% of regions (all P < 0.05) and overall confidence by 20% (P < 0.001). Regional uptake cluster analysis showed improved antero-posterior separation with SPECT, and distinct patterns associated with prosthesis survival in lateral femoral (P = 0.041) and medial tibial (P < 0.001) regions. The prognostic value of SPECT outperformed planar imaging for tibial (P < 0.001), patellar (P = 0.009), and synovial (P = 0.040) assessment. Internal femoral malrotation resulted in increased uptake in posteromedial (P = 0.042) and anterolateral (P = 0.016) femoral, and lateral patellar (P = 0.011) regions. Internal tibial malrotation increased uptake in posterolateral (P = 0.026) and posteromedial tibial (P = 0.005), and medial patellar regions (P = 0.004). Bloodpool SPECT improved the prognostic value of late-phase SPECT/CT for the assessment of the medial tibial region. CONCLUSIONS Bloodpool SPECT outperforms planar assessment of painful TKAs and the identification of distinct uptake patterns make it a potentially clinically relevant biomarker of prosthesis survival and biomechanical functioning.
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Cucchi D, Menon A, Compagnoni R, Ferrua P, Fossati C, Randelli P. Significant differences between manufacturer and surgeon in the accuracy of final component size prediction with CT-based patient-specific instrumentation for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:3317-3324. [PMID: 29453487 DOI: 10.1007/s00167-018-4876-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/12/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) may improve component sizing. Little has been reported about accuracy of the default plan created by the manufacturer, especially for CT-based PSI. The goal of this study was to evaluate the reliability of this plan and the impact of the surgeon's changes on the final accuracy of the guide sizes. METHODS Forty-five patients eligible for primary TKA were prospectively enrolled. The planned implant sizes were prospectively recorded from the initial manufacturer's proposal and from the final plan adjusted in light of the surgeon's evaluation; these two sizes where then compared to the actually implanted sizes. Fisher's exact test was used to test differences for categorical variables. Agreement between pre-operative plans and final implant was evaluated with the Bland-Altman method. RESULTS The manufacturer's proposal differed from the final implant in 9 (20.0%) femoral and 23 (51.1%) tibial components, while the surgeon's plan in 6 (13.3%, femoral) and 12 (26.7%, tibial). Modifications in the pre-operative plan were carried out for five (11.1%) femoral and 23 (51.1%) tibial components (p = 0.03). Appropriate modification occurred in 22 (88.0%) and 19 (76.0%) cases of femoral and tibial changes. The agreement between the manufacturer's and the surgeon's pre-operative plans was poor, especially with regard to tibial components. CONCLUSION The surgeon's accuracy in predicting the final component size was significantly different from that of the manufacturer and changes in the initial manufacturer's plan were necessary to get an accurate pre-operative plan of the implant sizes. CLINICAL RELEVANCE Careful evaluation of the initial manufacturer's plan by an experienced knee surgeon is mandatory when planning TKA with CT-based PSI. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Riccardo Compagnoni
- U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Paolo Ferrua
- S.S.D. Chirurgia Articolare del Ginocchio, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
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Awad ME, Padela MT, Sayeed Z, Abaab L, El-Othmani MM, Saleh KJ. Pharmacogenomics Testing for Postoperative Pain Optimization Before Total Knee and Total Hip Arthroplasty. JBJS Rev 2018; 6:e3. [PMID: 30300249 DOI: 10.2106/jbjs.rvw.17.00184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Mohamed E Awad
- Bone and Biomechanics Laboratories, Medical College of Georgia-Augusta University, Augusta, Georgia
| | - Muhammad Talha Padela
- Resident Research Partnership, Detroit, Michigan.,Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery, Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois.,Michigan Musculoskeletal Institute, Madison Heights, Michigan
| | - Zain Sayeed
- Resident Research Partnership, Detroit, Michigan.,Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan.,Department of Orthopaedic Surgery, Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois.,Michigan Musculoskeletal Institute, Madison Heights, Michigan
| | - Leila Abaab
- Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan
| | - Mouhanad M El-Othmani
- Departments of Orthopaedic Surgery and Sports Medicine (M.T.P., Z.S., and M.M.E.) and Anesthesiology (L.A.), Detroit Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- Michigan Musculoskeletal Institute, Madison Heights, Michigan
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Lutz B, Trubrich A, Kappe T, Reichel H, Bieger R. The epicondylar ratio can be reliably used on X-ray of the knee to determine the joint line. Arch Orthop Trauma Surg 2018; 138:1287-1292. [PMID: 30043148 DOI: 10.1007/s00402-018-3003-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Indexed: 02/09/2023]
Abstract
PURPOSE The epicondylar ratio (ER) is used to restore the individual joint line (JL), especially in revision total knee arthroplasty. It was first described in magnetic resonance imaging (MRI) but is usually applied to a.p. radiographs of the knee for preoperative planning. The objective of the current study was to define reliable landmarks in MRI and X-ray images of the knee, which allow comparison of the image modalities. Furthermore, the correlation of the measured ER in MRI and X-rays of the knee was calculated. METHODS A consecutive series of 87 patients who underwent an arthroscopical intervention of the knee were included into the present study. The lateral epicondyle was defined as the most lateral and distal prominence. On the medial side, the measurement was aligned to the epicondylar sulcus. The medial and lateral ER were calculated by dividing the perpendicular distance from the JL to the epicondyle by the transepicondylar distance. One observer determined the ER twice to calculate the intramethod intraobserver agreement, and a second observer obtained the intramethod interobserer agreement. The ER obtained from X-ray and MRI was compared to calculate the intermethod correlation. RESULTS The average lateral ER was 0.29 on X-ray versus 0.28 on MRI. The average medial ER was 0.33 and 0.33, respectively. Intramethod agreement ranged from 0.66 to 0.88 and intermethod correlation from 0.49 to 0.57. CONCLUSIONS The ER can be determined reliably on MRI and X-ray images of the knee. The correlation of the ER in MRI and X-ray is fair.
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Affiliation(s)
- Bernd Lutz
- Department of Orthopaedic Surgery, University of Ulm, Ober Eselsberg 45, 89081, Ulm, Germany.
| | - Angela Trubrich
- Department of Orthopaedic Surgery, University of Ulm, Ober Eselsberg 45, 89081, Ulm, Germany
| | - Thomas Kappe
- Department of Orthopaedic Surgery, University of Ulm, Ober Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Ober Eselsberg 45, 89081, Ulm, Germany
| | - Ralf Bieger
- Department of Orthopaedic Surgery, University of Ulm, Ober Eselsberg 45, 89081, Ulm, Germany
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Hitzl W, Heisinger S, Hobusch GM, Frank K, Cotofana S. Projected numbers of primary total knee replacement in Austria from 2015-2075. DER ORTHOPADE 2018; 48:144-149. [PMID: 30051278 DOI: 10.1007/s00132-018-3605-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2012 and 2013 Austria had the highest rate of primary total knee replacements (TKR) amongst all European countries. This study was carried out to project the numbers of TKR and its associated costs in Austria into the year 2075. METHODS Demographic data and population projections between 2011-2075 were obtained from European and Austrian authorities. Information about the present incidence of primary TKRs was obtained from the Austrian Prosthesis Register. Current TKR associated costs were obtained from federal healthcare insurances as well as federal and state admission agencies. Projections were stratified by age and gender and given for the lower, most likely and upper scenarios. RESULTS Overall cost for the group of patients with primary TKR will increase by 50% for males and 32% for females by 2075. This increase is primarily driven by the increase in the population of men aged 80-90 years and 90+ years leading to an increase of 190% and 567% of the TKR associated costs. In comparison, women in these age groups are estimated to have an increase in TKR costs by 108% and 243%. CONCLUSION These numbers represent a substantial socioeconomic burden to the Austrian society in the near and distant future due to the upcoming demographic changes. The presented results have their limitation in the unpredictable nature of assumptions but might guide Austrian and other European authorities in their efforts to provide more cost-effective and more directed care for patients in need of primary TKR surgery.
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Affiliation(s)
- Wolfgang Hitzl
- Research Office, Biostatistics, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020, Salzburg, Austria
| | - Stephan Heisinger
- Department of Traumatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Traumatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Sebastian Cotofana
- Department of Medical Education, Albany Medical College, 47 New Scotland Avenue MC-135, 12208, Albany, NY, USA.
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Duan G, Liu C, Lin W, Shao J, Fu K, Niu Y, Wang F. Different Factors Conduct Anterior Knee Pain Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2018; 33:1962-1971.e3. [PMID: 29398258 DOI: 10.1016/j.arth.2017.12.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/30/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A systematic review and meta-analysis was performed to investigate the risks associated with anterior knee pain (AKP) following primary total knee arthroplasty (TKA). METHODS A computerized search was performed of the following databases: MEDLINE, Embase, and Cochrane Central (published prior to July 2017). A total of 37 studies, which included 1641 cases of AKP and 168,090 TKAs, were included in the meta-analysis. RESULTS A subgroup analysis revealed that compared with those without the following medical conditions, patients who had an infrapatellar fat pad excision and more than 12 months of follow-up (odds ratio [OR] 12.58, 95% confidence interval [CI] 3.245-48.781) were more likely to have AKP after TKA. Circumpatellar electrocautery (>12 months: OR 0.50, 95% CI 0.326-0.760; ≤12 months: OR 0.59, 95% CI 0.408-0.867) and patellar resurfacing (OR 0.25, 95% CI 0.131-0.485) may decrease the risk of AKP. Other factors, including the prosthesis bearing type (mobile bearing or fixed bearing) and the approach (midvastus compared with the medial parapatellar approach), were not significant risk factors for AKP. CONCLUSION The use of strategies such as patellar denervation and patellar resurfacing in primary TKA is recommended because they are safe and result in good clinical outcomes in preventing AKP. Caution should be taken when using an infrapatellar fat pad excision, because there is an increased risk of AKP at long-term follow-up (>12 months). Future studies should investigate these different strategies to confirm the underlying mechanisms and help prevent the occurrence of AKP after TKA. The timing of AKP onset remains unclear and requires further research.
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Affiliation(s)
- Guman Duan
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Chang Liu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Weiwei Lin
- Department of Neurosurgery, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Jiashen Shao
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Kunpeng Fu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yingzhen Niu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Fei Wang
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, Fox MG, Kransdorf MJ, Mintz DN, Shah NA, Small KM, Smith SE, Tynus KM, Weissman BN. ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty. J Am Coll Radiol 2018; 14:S421-S448. [PMID: 29101982 DOI: 10.1016/j.jacr.2017.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Mary G Hochman
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yulia V Melenevsky
- Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Darlene F Metter
- Co-author, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Kathy M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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Belvedere C, Ensini A, d'Amato M, Barbadoro P, Leardini A. Three-dimensional patellar tendon fibre kinematics in navigated TKA with and without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2017; 25:3834-3843. [PMID: 27738741 DOI: 10.1007/s00167-016-4343-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/23/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Physiological elongation and orientation of patellar tendon fibres are among the scopes of total knee arthroplasty, but little is known in the three dimensions. The study aims to assess in vitro these variations at the intact and replaced knee, with and without patellar resurfacing. It was hypothesised that fibre patterns differ before and after prosthesis implantation, and between specific prosthesis designs. It was also expected that patellar resurfacing would affect relevant results. METHODS Measurements from 16 intact cadaver knees free from anatomical defects are here reported using a surgical navigation system. Data were collected at the intact joint and after implantation with cruciate-retaining or posterior-stabilised prosthesis designs, with and without patellar resurfacing. Relevant anatomical landmarks and patellar tendon attachments were digitised. Anatomical reference frames in the femur, tibia and patella were defined to measure component implantation parameters. Representative tendon fibres were defined as the straight line segments joining the two extremities. Changes in length and orientation of these fibres were calculated and reported versus flexion at the intact knee and after prosthesis implantation, both with and without patellar resurfacing. RESULTS A good intra- and inter-specimen repeatability was found at the intact and replaced knees. In both prosthesis designs, the patterns of fibre lengthening were similar to those in the intact knee, though significant differences were observed before and after patellar resurfacing. Corresponding fibre orientations in the frontal and sagittal planes showed significantly smaller ranges than those in the corresponding intact joints. More natural patterns were observed in the knees implanted with the posterior-stabilised design. Significant correlations were identified between patellar component implantation parameters and both patellar tendon fibre elongation and orientation. CONCLUSIONS Differences, however small, in patellar tendon fibre elongation and orientation were observed after total knee arthroplasty. The posterior-stabilised design provided better results, whereas patellar resurfacing affected significantly normal patellar function. In the clinical practice, the present findings can contribute to the understanding of current prosthesis designs and patellar resurfacing, recommending also enhanced care during this surgery.
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Affiliation(s)
- C Belvedere
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - A Ensini
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.,2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M d'Amato
- 2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P Barbadoro
- 2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Leardini
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
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Influence of anxiety and pain catastrophizing on the course of pain within the first year after uncomplicated total knee replacement: a prospective study. Arch Orthop Trauma Surg 2017; 137:1735-1742. [PMID: 28965133 DOI: 10.1007/s00402-017-2797-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Indexed: 02/09/2023]
Abstract
PURPOSE Prolonged postoperative pain is a frequent problem after uncomplicated total knee replacement (TKR). The purpose of this study was to evaluate the effect of anxiety and pain catastrophizing on postoperative pain after TKR. METHODS A total of 150 patients were enrolled in this prospective study. Preoperatively, anxiety was assessed using the State-Trait Anxiety Inventory (STAI) and pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). The primary outcome measure was postoperative pain on a numerical rating scale (NRS). The secondary outcome parameters were the different Knee Osteoarthritis Outcome Score (KOOS) subscales and patient satisfaction. Intergroup differences were tested with an independent t test. The odds ratio was calculated to determine the probability of an unsatisfactory outcome. RESULTS Preoperatively and at 6 and 12 months postoperatively, patients with anxiety and particularly patients with pain catastrophizing usually had a higher NRS score, lower knee function before and after surgery, and higher dissatisfaction. These intergroup differences were significant preoperatively and at 6 months postoperatively. CONCLUSIONS Psychopathologic factors, particularly pain catastrophizing, have an impact on postoperative pain after TKR. Preoperative screening and concurrent treatment of the diagnosed psychological disorder may improve patient-perceived outcomes.
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Lewallen EA, Salib CG, Trousdale WH, Berry CE, Hanssen GM, Robin JX, Tibbo ME, Viste A, Reina N, Morrey ME, Sanchez-Sotelo J, Hanssen AD, Berry DJ, van Wijnen AJ, Abdel MP. Molecular pathology of total knee arthroplasty instability defined by RNA-seq. Genomics 2017; 110:247-256. [PMID: 29174847 DOI: 10.1016/j.ygeno.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 11/15/2022]
Abstract
Total knee arthroplasty (TKA) is a durable and reliable procedure to alleviate pain and improve joint function. However, failures related to flexion instability sometimes occur. The goal of this study was to define biological differences between tissues from patients with and without flexion instability of the knee after TKA. Human knee joint capsule tissues were collected at the time of primary or revision TKAs and analyzed by RT-qPCR and RNA-seq, revealing novel patterns of differential gene expression between the two groups. Interestingly, genes related to collagen production and extracellular matrix (ECM) degradation were higher in samples from patients with flexion instability. Partitioned clustering analyses further emphasized differential gene expression patterns between sample types that may help guide clinical interpretations of this complication. Future efforts to disentangle the effects of physical and biological (e.g., transcriptomic modifications) risk factors will aid in further characterizing and avoiding flexion instability after TKA.
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Affiliation(s)
- Eric A Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biological Sciences, Hampton University, Hampton, VA, United States.
| | - Christopher G Salib
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - William H Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Charlotte E Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Joseph X Robin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Anthony Viste
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Nicolas Reina
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | | | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Andre J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, United States.
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
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Daly AC, Freeman FE, Gonzalez-Fernandez T, Critchley SE, Nulty J, Kelly DJ. 3D Bioprinting for Cartilage and Osteochondral Tissue Engineering. Adv Healthc Mater 2017; 6. [PMID: 28804984 DOI: 10.1002/adhm.201700298] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/15/2017] [Indexed: 12/16/2022]
Abstract
Significant progress has been made in the field of cartilage and bone tissue engineering over the last two decades. As a result, there is real promise that strategies to regenerate rather than replace damaged or diseased bones and joints will one day reach the clinic however, a number of major challenges must still be addressed before this becomes a reality. These include vascularization in the context of large bone defect repair, engineering complex gradients for bone-soft tissue interface regeneration and recapitulating the stratified zonal architecture present in many adult tissues such as articular cartilage. Tissue engineered constructs typically lack such spatial complexity in cell types and tissue organization, which may explain their relatively limited success to date. This has led to increased interest in bioprinting technologies in the field of musculoskeletal tissue engineering. The additive, layer by layer nature of such biofabrication strategies makes it possible to generate zonal distributions of cells, matrix and bioactive cues in 3D. The adoption of biofabrication technology in musculoskeletal tissue engineering may therefore make it possible to produce the next generation of biological implants capable of treating a range of conditions. Here, advances in bioprinting for cartilage and osteochondral tissue engineering are reviewed.
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Affiliation(s)
- Andrew C. Daly
- Trinity Center for Bioengineering; Trinity Biomedical Sciences Institute; Trinity College Dublin; Dublin Ireland
- Department of Mechanical and Manufacturing Engineering; School of Engineering; Trinity College Dublin; Dublin Ireland
- Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
| | - Fiona E. Freeman
- Trinity Center for Bioengineering; Trinity Biomedical Sciences Institute; Trinity College Dublin; Dublin Ireland
- Department of Mechanical and Manufacturing Engineering; School of Engineering; Trinity College Dublin; Dublin Ireland
- Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
| | - Tomas Gonzalez-Fernandez
- Trinity Center for Bioengineering; Trinity Biomedical Sciences Institute; Trinity College Dublin; Dublin Ireland
- Department of Mechanical and Manufacturing Engineering; School of Engineering; Trinity College Dublin; Dublin Ireland
- Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
| | - Susan E. Critchley
- Trinity Center for Bioengineering; Trinity Biomedical Sciences Institute; Trinity College Dublin; Dublin Ireland
- Department of Mechanical and Manufacturing Engineering; School of Engineering; Trinity College Dublin; Dublin Ireland
- Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
| | - Jessica Nulty
- Trinity Center for Bioengineering; Trinity Biomedical Sciences Institute; Trinity College Dublin; Dublin Ireland
- Department of Mechanical and Manufacturing Engineering; School of Engineering; Trinity College Dublin; Dublin Ireland
- Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
| | - Daniel J. Kelly
- Trinity Center for Bioengineering; Trinity Biomedical Sciences Institute; Trinity College Dublin; Dublin Ireland
- Department of Mechanical and Manufacturing Engineering; School of Engineering; Trinity College Dublin; Dublin Ireland
- Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
- Advanced Materials and Bioengineering Research Center (AMBER); Royal College of Surgeons in Ireland and Trinity College Dublin; Dublin Ireland
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Bonnin MP, de Kok A, Verstraete M, Van Hoof T, Van der Straten C, Saffarini M, Victor J. Popliteus impingement after TKA may occur with well-sized prostheses. Knee Surg Sports Traumatol Arthrosc 2017; 25:1720-1730. [PMID: 27671286 PMCID: PMC5487584 DOI: 10.1007/s00167-016-4330-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/15/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine the mechanisms and extents of popliteus impingements before and after TKA and to investigate the influence of implant sizing. The hypotheses were that (1) popliteus impingements after TKA may occur at both the tibia and the femur, and (2) even with an apparently well-sized prosthesis, popliteal tracking during knee flexion is modified compared to the preoperative situation. METHODS The location of the popliteus in three cadaver knees was measured using computed tomography, before and after implantation of plastic TKA replicas, by injecting the tendon with radiopaque liquid. The pre- and post-operative positions of the popliteus were compared from full extension to deep flexion using normosized, oversized, and undersized implants (one size increments). RESULTS At the tibia, TKA caused the popliteus to translate posteriorly, mostly in full extension: 4.1 ± 2 mm for normosized implants, and 15.8 ± 3 mm with oversized implants, but no translations were observed when using undersized implants. At the femur, TKA caused the popliteus to translate laterally at deeper flexion angles, peaking between 80° and 120°: 2 ± 0.4 mm for normosized implants and 2.6 ± 0.5 mm with oversized implants. Three-dimensional analysis revealed prosthetic overhang at the posterosuperior corner of normosized and oversized femoral components (respectively, up to 2.9 mm and 6.6 mm). CONCLUSIONS A well-sized tibial component modifies popliteal tracking, while an undersized tibial component maintains more physiologic patterns. Oversizing shifts the popliteus considerably throughout the full arc of motion. This study suggests that both femoro- and tibio-popliteus impingements could play a role in residual pain and stiffness after TKA.
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Affiliation(s)
- Michel P. Bonnin
- grid.418176.dCentre Orthopédique Santy, 24 Av Paul Santy, Lyon, France ,Hopital Privé Jean Mermoz, 55 Av Jean Mermoz, 69008 Lyon, France
| | - Arnoud de Kok
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
| | - Matthias Verstraete
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
| | - Tom Van Hoof
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
| | - Catherine Van der Straten
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
| | - Mo Saffarini
- Accelerate Innovation Management, Rue de Hollande 4-6, 1204 Geneva, Switzerland
| | - Jan Victor
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
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Park CN, White PB, Meftah M, Ranawat AS, Ranawat CS. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty. Orthopedics 2016; 39:e246-52. [PMID: 26811953 DOI: 10.3928/01477447-20160119-06] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/22/2015] [Indexed: 02/03/2023]
Abstract
Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly. Because residual pain has been associated with an un-resurfaced patella, this review includes only registry data and total knee arthroplasty with patella replacement. Some suggest that the pathogenesis of residual knee pain may be related to mechanical stimuli that activate free nerve endings around the patellofemoral joint. Various etiologies have been implicated in residual pain, including (1) low-grade infection, (2) midflexion instability, and (3) component malalignment with patellar maltracking. Less common causes include (4) crepitation and patellar clunk syndrome; (5) patellofemoral symptoms, including overstuffing and avascular necrosis of the patella; (6) early aseptic loosening; (7) hypersensitivity to metal or cement; (8) complex regional pain syndrome; and (9) pseudoaneurysm. Because all of these conditions can lead to residual pain, identifying the etiology can be a difficult diagnostic challenge. Often, patients with persistent pain and normal findings on radiographs and laboratory workup may benefit from a diagnostic injection or further imaging. However, up to 10% to 15% of patients with residual pain may have unexplained pain. This literature review summarizes the findings on the causes of residual pain and presents a diagnostic algorithm to facilitate an accurate diagnosis for residual pain after total knee arthroplasty.
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Bannuru RR, Brodie CR, Sullivan MC, McAlindon TE. Safety of Repeated Injections of Sodium Hyaluronate (SUPARTZ) for Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Cartilage 2016; 7:322-32. [PMID: 27688841 PMCID: PMC5029571 DOI: 10.1177/1947603516642271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Though there is no consensus on its efficacy, knee osteoarthritis is symptomatically managed with intra-articular hyaluronic acid (IAHA). Recent reports suggest that IAHA may delay the need for total knee replacement, with the magnitude of delay proportional to the number of injection series. However, the safety of repeated injection series is reported to vary between commercial products. This report describes a systematic review of safety data on repeated treatment courses of SUPARTZ. DESIGN We performed a systematic search of MEDLINE, Cochrane database, EMBASE, Web of Science, Google Scholar, and unpublished data. We included all human randomized controlled trials or observational studies with adverse event (AE) data for SUPARTZ in knee osteoarthritis. Two independent reviewers extracted data and evaluated study quality. Data were analyzed separately for the first and subsequent series of injections. RESULTS The primary sources for repeated-injection data on SUPARTZ were a postmarket registry (N = 7404), 4 prospective studies (N = 127 total), and a retrospective study (N = 220). None of the sources reported increased frequency or severity of AEs with repeated injections. In the registry, 95% of multiple-injection-series patients who reported an AE did so during the first series. None of the AEs was serious, and most resolved spontaneously without medical intervention. The overall adverse event rate after repeat courses of SUPARTZ was 0.008 (95% confidence interval: 0.001-0.055). CONCLUSIONS Multiple courses of SUPARTZ injections appear to be at least as safe, and probably safer, than the first course. This study supports the safety of repeat courses of SUPARTZ injections for knee osteoarthritis.
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Affiliation(s)
- Raveendhara R. Bannuru
- Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA,Raveendhara R. Bannuru, Center for Treatment Comparison and Integrative Analysis (CTCIA), Tufts Medical Center, 800 Washington Street, #406, Boston, MA 02111, USA.
| | | | - Matthew C. Sullivan
- Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Timothy E. McAlindon
- Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
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Kajetanek C, Bouyer B, Ollivier M, Boisrenoult P, Pujol N, Beaufils P. Mid-term survivorship of Mini-keel™ versus Standard keel in total knee replacements: Differences in the rate of revision for aseptic loosening. Orthop Traumatol Surg Res 2016; 102:611-7. [PMID: 27364965 DOI: 10.1016/j.otsr.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To reduce the size of the surgical incision, modular mini-keel tibial components have been developed with or without extensions for the Nexgen™ MIS Tibial Component. Although a smaller component could theoretically result in defective fixation, this has never been evaluated in a large comparative series. Thus, we performed the following case control study to: (1) evaluate intermediate-term survival of a modular "mini-keel" tibial component compared to a reference standard keel component from the same line of products (Nexgen LPS-Flex Tibial Component, Zimmer); (2) to identify any eventual associated factors if the frequency of loosening was increased. HYPOTHESIS The rate of revision for aseptic tibial loosening is comparable for both components. MATERIALS AND METHODS This comparative, retrospective, single center series of 459 consecutive total knee arthroplasties (TKA) was performed between 2007 and 2010: with 212 modular "mini-keel" (MK) tibial components and 247 "standard" (S) components. Survival, rate of revision for aseptic tibial loosening and identification of a radiolucent line were analyzed at the final follow-up. RESULTS After a median follow-up of 5years, the rate of revision for tibial aseptic loosing was significantly higher in the MK group with 12 cases (5.7%) and 4 cases in the S group (1.6%) (P=0.036). The use of the MK component appears to be a prognostic factor for surgical revision (hazard ratio=3.86 (1.23-11.88), P=0.02) but not for the development of a radiolucent line (HR=1.75 (0.9-3.4), P=0.097). The mean delay before revision was 38months (8-64) in the MK group and 15.2months (8-22) in the S group (P=0.006). Individual factors, such as gender, body mass index (BMI) and pre- or postoperative alignment were not prognostic factors for revision or radiolucent lines. CONCLUSION The modular "mini-keel" tibial component was associated with a greater risk of revision for tibial component loosening. LEVEL OF EVIDENCE Case control study, III.
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Affiliation(s)
- C Kajetanek
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
| | - B Bouyer
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - M Ollivier
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - P Boisrenoult
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - N Pujol
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - P Beaufils
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
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Lamotte A, Neri T, Kawaye A, Boyer B, Farizon F, Philippot R. Medial patellofemoral ligament reconstruction for patellar instability following total knee arthroplasty: A review of 6 cases. Orthop Traumatol Surg Res 2016; 102:607-10. [PMID: 27317639 DOI: 10.1016/j.otsr.2016.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 03/02/2016] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patellar instability is a frequent cause of total knee arthroplasty (TKA) failure. In cases of post-arthroplasty patellar instability, the medial structures may be damaged. The objective of this study was to study the effectiveness of medial patellofemoral ligament (MPFL) reconstruction. We hypothesized that MPFL reconstruction will effectively realign the patella, making it a viable treatment option for managing post-arthroplasty patellar instability. MATERIAL AND METHODS In this retrospective study of six patients treated by four different surgeons, patients were included if they had a recurring or permanent patellar dislocation after undergoing TKA. Patients were excluded if the patellar instability was painful but did not result in dislocation. Each patient underwent MPFL reconstruction using the gracilis; additional procedures could be performed depending on the diagnosis. One patient required TKA revision because of an abnormally rotated femoral implant. The main outcome measure was the non-recurrence of the dislocation. The IKDC and Kujala functional scores, joint range of motion and patellar tilt on X-rays were analyzed preoperatively and at the last follow-up. RESULTS At a mean follow-up of 23 months (6-46), none of the patients experienced a recurrence of the patellar dislocation. Only one patient had no improvements in the functional outcome scores. The patellar tilt was reduced in all patients. CONCLUSION MPFL reconstruction-in isolation or with femoral component revision-is effective at treating post-arthroplasty patellar instability. It has its place in the treatment of patellar dislocation following TKA and its indications must be based on exact analysis of the reasons for the instability. LEVEL OF EVIDENCE IV - Retrospective cohort study.
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Affiliation(s)
- A Lamotte
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France.
| | - T Neri
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France; Laboratoire de physiologie de l'exercice, EA 4338, 42000 Saint-Étienne, France
| | - A Kawaye
- Service d'orthopédie et traumatologie, centre hospitalier du Forez, 42600 Montbrison, France
| | - B Boyer
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France
| | - F Farizon
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France; Laboratoire de physiologie de l'exercice, EA 4338, 42000 Saint-Étienne, France
| | - R Philippot
- Service d'orthopédie et traumatologie, CHU de Saint-Étienne, 42000 Saint-Étienne, France; Laboratoire de physiologie de l'exercice, EA 4338, 42000 Saint-Étienne, France
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