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Brendle SA, Krueger S, Grifka J, Müller PE, Grupp TM. A New Methodology for the Accurate Measurement of Tibiofemoral Kinematics in Human Cadaveric Knees: An Evaluation of the Anterior-Posterior Laxity Pre- and Post-Cruciate Ligament Resection. Life (Basel) 2024; 14:877. [PMID: 39063630 PMCID: PMC11278153 DOI: 10.3390/life14070877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Anterior-posterior (AP) stability is an important measure of knee performance after total knee arthroplasty (TKA). To improve the stabilizing effect of implants designed to compensate for the loss of the cruciate ligaments, it is important to understand the tibiofemoral contact situation within the native ligamentous situation of the knee and how it changes after cruciate ligament resection. This in vitro study introduces a new approach to accurately measure the tibiofemoral kinematics in a six-degrees-of-freedom joint motion simulator by tracking landmark-based coordinate systems and their corresponding bone geometries. The tibiofemoral contact situation was investigated by projecting the medial and lateral flexion facet centers onto the tibial plateau under AP shear forces across various flexion angles in thirteen knees. Tests were conducted pre- and post-cruciate ligament resection. Post-cruciate ligament resection, the femoral condyles shifted closer to or even exceeded the posterior border of the tibial plateau, but only slightly closer to the anterior border. This study presents a new methodology for measuring the tibiofemoral kinematics that can be applied to multiple loading profiles. It provides a basis for further investigations, including passive or active muscle forces, to enhance the design of total knee protheses and improve surgical outcomes.
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Affiliation(s)
- Saskia A. Brendle
- Research & Development, Aesculap AG, 78532 Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, LMU Munich, 81377 Munich, Germany
| | - Sven Krueger
- Research & Development, Aesculap AG, 78532 Tuttlingen, Germany
| | - Joachim Grifka
- Department of Orthopaedics, Asklepios Klinikum, 93077 Bad Abbach, Germany
| | - Peter E. Müller
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, LMU Munich, 81377 Munich, Germany
| | - Thomas M. Grupp
- Research & Development, Aesculap AG, 78532 Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, LMU Munich, 81377 Munich, Germany
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Iguchi M, Takahashi T, Ae R, Takeshita K. Comparison of postoperative clinical outcomes and knee stability of cruciate-retaining total knee arthroplasty using the tibia-first gap navigation technique with a computer-aided system and measured-resection technique: A retrospective analysis of a propensity-matched cohort. J Exp Orthop 2024; 11:e12084. [PMID: 38974051 PMCID: PMC11224964 DOI: 10.1002/jeo2.12084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose This study aimed to clarify whether the range of motion (ROM), anterior and posterior (AP) stability and other clinical measures changed in patients who underwent tibia-first total knee arthroplasty (TF-TKA) using navigation with a computer-aided system after surgery. Methods This is a retrospective study and we conducted a matched cohort analysis of 60 measured resection (MR)-TKAs and 52 TF-TKAs performed by a single surgeon. All the surgeries used the same implant and approach. Baseline differences between the groups were adjusted using propensity score matching. We compared each patient's measured ROM and Oxford Knee Score (OKS) and performed knee AP laxity measurements by using a device during routine follow-ups. Results A total of 40 MR-TKAs with a mean age of 73.5 ± 5.6 years and sex (male 10, female 30) were compared to 40 TF-TKAs with a mean age of 74.0 ± 5.7 years and sex (male 13, female 27) at 2-year follow-ups. Two years postoperatively, there was a significant difference in the AP laxity at 30° of knee flexion between both groups (7.0 ± 3.4 mm vs. 5.2 ± 2.3 mm, p < 0.01). In contrast, no differences were found between both groups for knee flexion (120.8 ± 9° vs. 116.7 ± 9.8°, p = 0.07) and OKS score (41.8 ± 6.9 vs. 41.0 ± 5.9, p = 0.61). Conclusion The AP stability in the midflexion obtained using the tibia-first technique remained consistent even after 2 years. However, OKS and ROM were not significantly different from those of the MR-TKA group. Level of Evidence Retrospective comparative LEVEL III study.
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Affiliation(s)
- Masaki Iguchi
- Department of Orthopedic SurgeryMiyazaki Prefectural Nobeoka HospitalNobeokaJapan
- Department of Orthopedic SurgeryJichi Medical UniversityShimotsukeJapan
| | - Tsuneari Takahashi
- Department of Orthopedic SurgeryJichi Medical UniversityShimotsukeJapan
- Department of Orthopedic SurgeryIshibashi General HospitalShimotsukeJapan
| | - Ryusuke Ae
- Division of Public Health, Center for Community MedicineJichi Medical UniversityShimotsukeJapan
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Dobrich J, Bauer S, Elicegui S, LaCour M, Ries M. Effect of Posterior Tibial Slope on Knee Kinematics After Bicruciate-Retaining Total Knee Arthroplasty. Arthroplast Today 2024; 27:101417. [PMID: 38882467 PMCID: PMC11180305 DOI: 10.1016/j.artd.2024.101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/25/2024] [Accepted: 04/28/2024] [Indexed: 06/18/2024] Open
Abstract
Background Following total knee arthroplasty (TKA), normal knee kinematics are rarely replicated. Retention of both cruciate ligaments (bicruciate retaining TKA) has helped this. Postoperative posterior tibial slope (PPTS) may further affect ligament tension and kinematics. The objective of this study is to determine how changes between the preoperative posterior tibial slope (PTS) and PPTS affect knee kinematics. Methods Twenty bicruciate retaining TKAs were performed using standard instrumentation. Fluoroscopic kinematic data were obtained during gait and a single knee bend. Differences (Δ) between radiographic measurements of preoperative and PPTS were correlated with in-vivo knee kinematics. Patients were separated into 2 groups based on their Δ values. Group I consisted of Δ values less than 0.7, indicating either a similar PPTS compared to preoperative PTS or a slightly flatter PPTS. Group II consisted of Δ values above 0.7, indicating a steepened PPTS. Results Preoperative PTS values ranged from -0.5° to 11.2°, with an average of 5.0° ± 3.4°. PPTS values ranged from 3.0° to 12.1°, with an average of 7.1° ± 3.1°. Weight-bearing range of motion (WBROM) measured from 94° to 139°, and femorotibial axial rotation ranged from -2.9° to 17.3°. A t-test revealed average values for WBROM in Group IT (Δ < 0.7) to be significantly greater than those for Group IIT (Δ > 0.7) (P = .01). Conclusions These findings indicate that either a PPTS approximating the preoperative PTS or a slightly flattened PPTS in comparison (Δ < 0.7) is associated with WBROM greater than 130°. Values for axial rotation and anterior sliding were not significantly associated with changes to the PTS.
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Song SJ, Bae DK, Hwang SH, Park HS, Park CH. Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years. J Knee Surg 2024; 37:310-315. [PMID: 37192660 DOI: 10.1055/a-2094-8728] [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] [Indexed: 05/18/2023]
Abstract
A small posterior tibial slope (PTS) is generally recommended in posterior stabilized (PS) total knee arthroplasty (TKA). An unwanted anterior tibial slope (ATS), which can affect postoperative results, may be created in PS TKA because of the inaccuracy of surgical instruments and techniques, as well as high interpatient variability. We compared midterm clinical and radiographic results of PS TKAs with ATS and PTS performed on paired knees using the same prosthesis. One-hundred-twenty-four patients who underwent TKAs with ATS and PTS on paired knees using ATTUNE posterior-stabilized prostheses were retrospectively reviewed after a minimum follow-up period of 5 years. The mean follow-up period was 5.4 years. The Knee Society Knee and Function scores, Western Ontario and McMaster Universities Osteoarthritis Index, Feller and Kujalar scores, and range of motion (ROM) were evaluated. The preferred TKA out of ATS and PTS was also investigated. The hip-knee-ankle angle, component positions, tibial slope, posterior femoral offset, Insall-Salvati ratio, and knee sagittal angle were measured by radiography. There were no significant differences in the clinical results, including ROM, between TKAs with ATS and PTS preoperatively and at the last follow-up. Regarding patient preference, 58 patients (46.8%) were satisfied with bilateral knees, 30 (24.2%) preferred knees with ATS, and 36 (29%) preferred knees with PTS. There was no significant difference in the rate of preference between TKAs with ATS and PTS (p = 0.539). Except for the postoperative tibial slope (-1.8 vs. 2.5 degrees, p < 0.001), there were also no significant differences in the radiographic results, including the knee sagittal angle, preoperatively and at the last follow-up. The midterm outcomes were similar between PS TKAs with ATS and PTS performed on paired knees at a minimum of 5 years of follow-up. Nonsevere ATS did not affect midterm outcomes in PS TKA with proper soft tissue balancing and the current prosthesis of improved design. However, a long-term follow-up study is required to confirm the safety of nonsevere ATS in PS TKA. LEVEL OF EVIDENCE:: III.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Republic of Korea
| | - Sung Hyun Hwang
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hong Sik Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Takahashi T, Hatayama K, Ae R, Saito T, Handa M, Kimura Y, Takeshita K. Association between intraoperative findings and postoperative knee range motion after cruciate-retaining total knee arthroplasty. Technol Health Care 2024; 32:1313-1322. [PMID: 37980576 DOI: 10.3233/thc-220841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) alleviates pain and improves daily living activities in individuals with end-stage osteoarthritis of the knee. However, up to 20% of patients have sub-optimal outcomes after TKA. OBJECTIVE No studies have clarified the intraoperative factors that affect postoperative range of motion (ROM) after cruciate-retaining (CR) TKA. Thus, this study aims to clarify these factors. METHODS Patients with knee osteoarthritis with varus knee deformity who underwent CR-TKA between May 2019 and December 2020 were included in this study. One year after surgery, patients were stratified into two groups based on knee flexion: Group F (over 120∘) and Group NF (below 120∘). Patient backgrounds including age, body mass index, hip knee angle, preoperative range of motion for both extension and flexion, intraoperative center joint-gap measurements of 0∘, 30∘, 45∘, 60∘, 90∘, and 120∘ of knee flexion using a tensor, intraoperative anterior-posterior (AP) laxity measurements of 30∘ and 90∘ of knee flexion using an instrumental laximeter were compared between the groups. Univariate analyses between the groups were used to construct the initial model. The receiver operating characteristic curve was also analyzed. The predictive variables included in the final model were selected by stepwise backward elimination. RESULTS Intraoperative AP laxity with 30∘ of knee flexion smaller than 10.8 mm was a significant positive prognostic factor (OR: 1.39, 95% CI: 1.08-1.79, P= 0.011) of postoperative ROM over 120∘ of knee flexion one year after surgery. The sensitivity, specificity, PPV, and NPV were 70.9%, 82.4%, 92.9%, and 46.7%, respectively. CONCLUSION Intraoperative AP laxity smaller than 10.8 mm was a significant positive predictive factor for obtaining knee flexion greater than 120∘ one year after surgery when using CR-TKA and its PPV was high up to 92.9%.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Kazuhisa Hatayama
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Gunma Central Hospital, Maebashi, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Saito
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Mikiko Handa
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yuya Kimura
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Katsushi Takeshita
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Abdelnasser MK, Abdelhameed MA, Bassem M, Adam MF, Bakr HM, Khalifa YE. Sexual dimorphism of the posterior condylar offset of the femur and the medial posterior slope of the tibia in non-arthritic knees of Egyptian adults: an MRI study. J Orthop Surg Res 2023; 18:353. [PMID: 37173701 PMCID: PMC10176775 DOI: 10.1186/s13018-023-03833-2] [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: 02/23/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The aim of this magnetic resonance imaging (MRI) study was to investigate controversial sexual dimorphism of the posterior condylar offset of the femur (the offset) and the posterior slope of the tibia (the slope) in non-arthritic knees of Egyptian adults. METHODS On 100 male and 100 female MRIs of non-arthritic knees, linear measurements of the distal part of the femur (the offset) and the angular measurements of the proximal part of the tibia (the slope) were performed and compared regarding sex and ethnicity. The intraclass correlation coefficient (ICC) was used to test the interrater agreement. RESULTS Both offsets and the lateral offset ratio were larger in males (p < 0.001), the medial offset ratio, and the medial slope in females (p from < 0.001 to 0.007), whereas the lateral slope was sex-free (p = 0.41). Irrespective of sex, however, the medial offset with its ratio, and the medial slope were larger than their counterparts (p < 0.001). Our means of the offsets, their ratios, and the slopes mostly differed from those of other ethnicities (p from ≤ 0.001 to 0.004). ICCs > 0.8 proved MRI's precision was high. CONCLUSION There was a sexual dimorphism of both the offset and the medial slope in non-arthritic knees of Egyptian adults. We believe future designs of knee implants should consider these differences in order to improve postoperative range of motion and patients' satisfaction after total knee arthroplasty. Level of evidence Level III Retrospective Cohort Study. Trial registration ClinicalTrials.gov identifier: NCT03622034, registered on July 28, 2018.
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Affiliation(s)
| | | | - Micheal Bassem
- Orthopedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Mahmoud Faisal Adam
- Orthopedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Hatem M Bakr
- Orthopedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Yaser E Khalifa
- Orthopedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
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Lee OS, Lee J, Lee MC, Han HS. Effect of Posterior Tibial Slope Change on Postoperative Range of Motion and Clinical Outcomes after Posterior Cruciate-Substituting Total Knee Arthroplasty. J Knee Surg 2023; 36:87-94. [PMID: 33992035 DOI: 10.1055/s-0041-1729967] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the preoperative and postoperative PTS, ROM, visual analog scale pain scale, Western Ontario and McMaster University Index (WOMAC), Hospital for Special Surgery Knee Score, Knee Society Score, and Forgotten Joint Score (FJS). The association of the absolute change in PTS with ROM and clinical scores was analyzed using correlation analysis and multiple regression analysis. As a result, the mean PTS and mean ROM changed from 9.6 ± 3.4 and 120.1 ± 15.4 degrees preoperatively to 2.0 ± 1.3 and 128.4 ± 9.3 degrees postoperatively, and the mean PTS change was 7.6 ± 3.5 degrees. The PTS change had no statistically significant association with the postoperative ROM and clinical scoring systems, although it did have a weak positive correlation with WOMAC function, No 10 (difficulty in rising from sitting) (correlation coefficient = 0.342, p = 0.041), and moderate positive correlation with the FJS, No. 6 (awareness when climbing stairs) (correlation coefficient = 0.470, p = 0.001). The authors concluded that the amount of change in PTS did not affect the postoperative ROM and clinical scores, although proximal tibial resection with a constant target of PTS resulted in individually different changes in the PTS after PS TKA.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si, Korea (the Republic of)
| | - Jangyun Lee
- Department of Orthopedic Surgery, National Medical Center, Seoul, Korea (the Republic of)
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
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Bauer L, Thorwächter C, Steinbrück A, Jansson V, Traxler H, Alic Z, Holzapfel BM, Woiczinski M. Does Posterior Tibial Slope Influence Knee Kinematics in Medial Stabilized TKA? J Clin Med 2022; 11:jcm11226875. [PMID: 36431352 PMCID: PMC9698522 DOI: 10.3390/jcm11226875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During total knee arthroplasty (TKA), one of the key alignment factors to pay attention to is the posterior tibial slope (PTS). The PTS clearly influences the kinematics of the knee joint but must be adapted to the coupling degree of the specific TKA design. So far, there is hardly any literature including clear recommendations for how surgeons should choose the PTS in a medial stabilized (MS) TKA. The aim of the present study is to investigate the effects of different degrees of PTS on femorotibial kinematics in MS TKA. MATERIALS AND METHODS An MS TKA was performed in seven fresh-frozen human specimens successively with 0°, 3°, and 6° of PTS. After each modification, weight-bearing deep knee flexion (30-130°) was performed, and femorotibial kinematics were analyzed. RESULTS A lateral femoral rollback was observed for all three PTS modifications. With an increasing PTS, the tibia was shifted more anteriorly on the lateral side (0° PTS anterior tibial translation -9.09 (±9.19) mm, 3° PTS anterior tibial translation -11.03 (±6.72) mm, 6° PTS anterior tibial translation 11.86 (±9.35) mm). No difference in the tibial rotation was found for the different PTS variants. All PTS variants resulted in internal rotation of the tibia during flexion. With a 3° PTS, the design-specific medial rotation point was achieved more accurately. CONCLUSIONS According to our findings, we recommend a PTS of 3° when implanting the MS prosthesis used in this study.
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Affiliation(s)
- Leandra Bauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Arnd Steinbrück
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
- Orthopaedic Surgical Competence Center Augsburg (OCKA), Vinzenz-von-Paul-Platz 1, 86152 Augsburg, Germany
| | - Volkmar Jansson
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Straße des 17. Juni 106-108, 10623 Berlin, Germany
| | - Hannes Traxler
- Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna (MedUni Vienna), Waehringer Str. 13, 1090 Vienna, Austria
| | - Zumreta Alic
- Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna (MedUni Vienna), Waehringer Str. 13, 1090 Vienna, Austria
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
- Correspondence:
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Radhamony NG, Chaugule A, Bhende HS. The Relationship Between Posterior Tibial Slope and Knee Range of Movements in Posterior Stabilized Total Knee Replacement: A Navigation-Assisted Analysis of 120 Cases. Cureus 2022; 14:e29695. [PMID: 36320977 PMCID: PMC9616099 DOI: 10.7759/cureus.29695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Posterior tibial slope (PTS) is one of the factors that determine the postoperative range of movement (ROM) in total knee replacement (TKR). While biomechanical factors influencing ROM such as PTS, soft-tissue balancing, and choice of implants are surgeon-dependent, non-biomechanical factors such as physiotherapy and pain are subjective and beyond the surgeon’s control. Using navigation, we avoided these factors and objectively correlated the difference in PTS with ROM. Methodology A total of 120 cases of posteriorly stabilized (PS) TKR were included. The X-ray-measured difference in PTS was compared to the corresponding change in the ROM intraoperatively using the TKR navigation system. Based on the change in PTS, the cases were classified into three groups, and the intergroup variability of mean postoperative ROM, mediolateral laxity difference (MLD), and residual flexion (RF) was calculated. Results An average MLD of 1.39 mm in extension and 1.79 mm in flexion and an average RF of 3.18 degrees were seen. This uniformity neutralizes the effects of these factors on the ROM. The mean difference in the PTS in the three groups was 4.45, 10.76, and 17.98 degrees, and the mean change in the ROM was 3.07, 1.47, and 2.84 degrees, respectively. There was no statistically significant change in ROM with that of change in PTS. Conclusions In our study, it was shown statistically that the coronal and sagittal planes were uniformly balanced using navigation assistance, and the PTS and the postoperative ROM were the only variables. The correlated results showed that a change in the PTS does not affect the postoperative ROM in PS TKR using the implant system used in our study.
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10
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Excessive Sagittal Slope of the Tibia Component during Kinematic Alignment-Safety and Functionality at a Minimum 2-Year Follow-Up. J Pers Med 2022; 12:jpm12091407. [PMID: 36143192 PMCID: PMC9506154 DOI: 10.3390/jpm12091407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to assess the safety and functional outcomes of excessive sagittal alignment in the unrestricted kinematic alignment technique for total knee arthroplasty (TKA). A retrospective, single-center study was conducted between 2018 and 2020, including patients undergoing primary TKA with a minimum 2-year follow-up. EOS imaging conducted before and after surgery was reviewed for overall alignment, and a number of measurements were taken, including sagittal tibial slope and other tibia and femur component positioning. Patients were interviewed and asked to fill out several questionnaires including a visual analog scale, the Oxford Knee Score, and the Knee Injury and Osteoarthritis Outcome Score. Overall, 225 patients (66.7%) had a sagittal tibial slope angle above 5° (excessive) and 112 (33.3%) patients had an angle under 5° (moderate). A significant improvement in pain and function scores was observed in both groups following the surgery (p < 0.001). There were no significant differences between the moderate and excessive groups in the average VAS, OKS or the various subtypes of the KOOS score. However, there was a slight but significant difference in the number of patients achieving MCID in KOOS symptoms. There were no cases of early failure or loosening. Unrestricted KA and the excessive sagittal alignment of the tibial component seem to be reliable and safe in terms of restoring daily function and alleviating pain after a minimum of 2 years following the surgery.
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Mizu-Uchi H, Ma Y, Ishibashi S, Colwell CW, Nakashima Y, D'Lima DD. Tibial sagittal and rotational alignment reduce patellofemoral stresses in posterior stabilized total knee arthroplasty. Sci Rep 2022; 12:12319. [PMID: 35854017 PMCID: PMC9296446 DOI: 10.1038/s41598-022-15759-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Patellofemoral joint complications remain an important issue in total knee arthroplasty. We compared the patellofemoral contact status between cruciate-retaining and posterior-stabilized designs with varying degrees of tibial sagittal and rotational alignment using a computer simulation to ensure proper alignments in total knee arthroplasty. Knee kinematics, patellofemoral contact force and quadriceps force were computed using a musculoskeletal modeling program (LifeMOD/KneeSIM 2010; LifeModeler, Inc., San Clemente, California) during a weight-bearing deep knee bend. Two different posterior tibial slope (PTS)s (3° and 7°) and five different tibial tray rotational alignments (neutral, internal 5° and 10°, and external 5° and 10°) were simulated. Patellofemoral contact area and stresses were next computed using finite element analysis. The patellofemoral contact force for the posterior-stabilized design was substantially lower than the cruciate-retaining design after post-cam contact because of increasing femoral roll-back. Neutral rotational alignment of the tibial component resulted in smaller differences in patellofemoral contact stresses between cruciate-retaining and posterior-stabilized designs for PTSs of 3° or 7°. However, the patellar contact stresses in the cruciate-retaining design were greater than those in posterior-stabilized design at 120° of knee flexion with PTS of 3° combined with internal rotation of the tibial component. Our study provides biomechanical evidence implicating lower PTSs combined with internal malrotation of the tibial component and the resultant increase in patellofemoral stresses as a potential source of anterior knee pain in cruciate-retaining design.
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Affiliation(s)
- Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuan Ma
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Clifford W Colwell
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA, 92037, USA
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA, 92037, USA.
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Hees T, Zielke J, Petersen W. Effect of anterior tibial bowing on measurement of posterior tibial slope on conventional X-rays. Arch Orthop Trauma Surg 2022; 143:2959-2964. [PMID: 35761121 DOI: 10.1007/s00402-022-04507-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The posterior tibial slope (PTS) has different biomechanical effects on the knee. Especially in revision ACL reconstruction, a precise analysis is essential. Therefore, we investigate the influence of the anterior tibial bowing angle on the posterior slope measurement. Our hypothesis of the present study is that the short tibial X-rays underestimate the PTS in cases with increased anterior bowing of the tibia. METHODS The PTS was measured on 162 true longitudinal radiographs of the complete tibia (lateral mechanic axis). The average age of the patients was 35.7 years (range 19-59 years) and the most common diagnosis was failed anterior cruciate ligament reconstruction. Using this X-ray, the slope on the short axis and the slope on the entire axis were measured. In addition, the angle of the anterior bowing was determined. RESULTS The mean PTS for the lateral mechanic axis of the tibia was 10.6° (± 3.5) in contrast to 11.6° (± 3.5) for the short tibial axis. These two measurements differ significantly. (p < 0.001). The mean anterior tibial bowing angle on the lateral X-rays of the whole tibia was 2.3° (± 2.0). There is a significant positive, relationship between tibial bowing angle and PTS as referenced by the lateral mechanic axis (Spearman's correlation, r = 0.273 and p < 0.001). CONCLUSION With increasing anterior tibial bowing, the posterior tibial slope on the short knee radiograph is underestimated compared to the slope measurement on the lateral mechanic axis.
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Affiliation(s)
- Tilman Hees
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Straße 27-31, 14193, Berlin, Germany.
| | - Jasmin Zielke
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Straße 27-31, 14193, Berlin, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Grunewald Caspar Theyss Straße 27-31, 14193, Berlin, Germany
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13
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Takahashi T, Sugimoto K, Ae R, Saito T, Kimura Y, Kubo T, Handa M, Takeshita K. Can tibia-first total knee arthroplasty using computer-assisted system improve anterior and posterior knee stability? Technol Health Care 2022; 30:1147-1154. [PMID: 35599511 DOI: 10.3233/thc-213535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a widely performed procedure to alleviate pain and restore function of patients with end-stage knee osteoarthritis. OBJECTIVE The study aim was to determine if tibia-first (TF) total knee arthroplasty (TKA) using a novel computer-assisted surgery (CAS) system can yield better anterior and posterior (AP) knee stability. METHODS Patients with knee osteoarthritis with obvious varus knee who met the indication for and underwent TKA from May 2019 to November 2020 were included. Forty-one measured resection (MR)-TKAs and 32 TF-TKAs were compared. The varus-valgus ligament balance and joint tension at a joint center-gap setting equal to the tibial-baseplate thickness were measured, and appropriate polyethylene inserts with 0∘, 30∘, 45∘, 60∘, 90∘, and 120∘ of knee flexion were placed. A Kneelax 3 arthrometer was used to measure knee AP laxity in the postoperative anesthetized patients with 30∘ and 90∘ of knee flexion. RESULTS The horizontal gap balance was significantly closer in the TF-TKA group than the MR-TKA group for 0∘, 30∘, 45∘, and 60∘ of knee flexion. In contrast, no significant differences were observed for 90∘ and 120∘ of knee flexion. No significant differences in joint-gap tensions among all knee-flexion angles were observed. Translation was significantly smaller in the TF-TKA group than the MR-TKA group for AP laxity with 30∘ of knee flexion (8.8 ± 2.9 mm vs. 10.7 ± 3.1 mm, P= 0.0079). In contrast, no significant AP laxity was observed with 90∘ of knee flexion (7.2 ± 2.8 mm vs. 7.2 ± 3.5 mm). CONCLUSION TF-TKA using a novel CAS system provided better AP knee stability with close to horizontal gap balances.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | | | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Saito
- Department of Orthopedic Surgery, Tochigi Medical Cener Shimotsuga, Tochigi, Japan
| | - Yuya Kimura
- Department of Orthopedic Surgery, Tochigi Medical Cener Shimotsuga, Tochigi, Japan
| | - Tatsuya Kubo
- Department of Orthopedic Surgery, Shin Kaminokawa Hospital, Kaminokawa, Japan
| | - Mikiko Handa
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
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14
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High inter- and intraindividual differences in medial and lateral posterior tibial slope are not reproduced accurately by conventional TKA alignment techniques. Knee Surg Sports Traumatol Arthrosc 2022; 30:882-889. [PMID: 33547913 DOI: 10.1007/s00167-021-06477-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to describe the medial and lateral posterior tibial slope (MPTS and LPTS) on 3D-CT in a Caucasian population without osteoarthritis. It was hypothesised that standard TKA alignment techniques would not reproduce the anatomy in a high percentage of native knees. METHODS CT scans of 301 knees [male:female = 192:109; mean age 30.1 ([Formula: see text] 6.1)] were analysed retrospectively. Tibial slope was measured medially and laterally in relation to the mechanical axis of the tibia. The proportion of MPTS and LPTS was calculated, corresponding to the "standard PTS" of 3°-7°. The proportion of knees accurately reproduced with the recommended PTS of 0°-3° for PS and 5°-7° for CR TKA were evaluated. RESULTS Interindividual mean values of MPTS and LPTS did not differ significantly (mean (range); MPTS: 7.2° ( - 1.0°-19.0°) vs. LPTS: 7.2° ( - 2.4°-17.8°), n.s.). The mean absolute intraindividual difference was 2.9° (0.0°-10.8°). In 40.5% the intraindividual difference between MPTS and LPTS was > 3°. When the standard slope of 3°-7° medial and lateral was considered, only 15% of the knees were covered. The tibial cut for a PS TKA or a CR TKA changes the combined PTS (MPTS + LPTS) in 99.3% and 95.3% of cases, respectively. CONCLUSION A high interindividual range of MPTS and LPTS as well as considerable intraindividual differences were shown. When implementing the recommended slope values for PS and CR prostheses, changes in native slope must be accepted. Further research is needed to evaluate the impact of altering a patient's native slope on the clinical outcome. LEVEL OF EVIDENCE IV.
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15
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Darmanto D, Novriansyah R, Ismail R, Jamari J, Anggoro PW, Bayuseno AP. Reconstruction of the artificial knee joint using a reverse engineering approach based on computer-aided design. J Med Eng Technol 2022; 46:136-147. [DOI: 10.1080/03091902.2022.2026502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- D. Darmanto
- Department of Mechanical Engineering, Faculty of Engineering, Diponegoro University, Semarang, Indonesia
- Department of Mechanical Engineering, Faculty of Engineering, Wahid Hasyim University, Semarang, Indonesia
| | - R. Novriansyah
- Department of Orthopaedic and Traumatology, Dr. Kariadi Hospital, Semarang, Indonesia
| | - R. Ismail
- Department of Mechanical Engineering, Faculty of Engineering, Diponegoro University, Semarang, Indonesia
- Center for Biomechanics Biomaterials Biomechatronics and Biosignal processing (CBIOM3S), Universitas Diponegoro, Semarang, Indonesia
| | - J. Jamari
- Department of Mechanical Engineering, Faculty of Engineering, Diponegoro University, Semarang, Indonesia
| | - P. W. Anggoro
- Department of Industrial Engineering, Faculty of Industrial Technology, University of Atma Jaya Yogyakarta, Yogyakarta, Indonesia
| | - A. P. Bayuseno
- Department of Mechanical Engineering, Faculty of Engineering, Diponegoro University, Semarang, Indonesia
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Flexion contracture can be relieved by concurrent notchplasty in medial open wedge high tibial osteotomy. Orthop Traumatol Surg Res 2021; 107:103020. [PMID: 34314903 DOI: 10.1016/j.otsr.2021.103020] [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: 08/01/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Given that medial open wedge high tibial osteotomy (OWHTO) not only delays the progression of osteoarthritis but also alleviates the resulting pain, surgical outcomes would be improved if limited ROM can also be managed. In this regard, the effect of concurrent notchplasty on flexion contracture has not been evaluated. HYPOTHESIS (1) Concurrent notchplasty in OWHTO would relieve flexion contracture regardless of the severity of osteoarthritis and this effect would be maintained over time, and (2) concurrent notchplasty would not cause any added complications compared to the same procedure without notchplasty. PATIENTS AND METHODS In total, 107 patients who underwent OWHTO between 2011 and 2017 with a mean follow-up period of 46.6months (range: 24-102months) were reviewed. ROM was measured at three time points as follows: before surgery, at 6-12months postoperatively, and at the latest follow-up. The measurements were analyzed using a linear mixed model in terms of notchplasty and other factors, including age, sex, body mass index, preoperative hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, correction angle, concurrent meniscectomy, postoperative posterior slope, and Kellgren-Lawrence grade. Then, ROMs at the three time points were compared between the notchplasty and non-notchplasty groups. RESULTS Of the 107 patients, 47 underwent concurrent notchplasty. The linear mixed model regarding flexion contracture showed a significant notchplasty-by-time interaction (p<0.001). When comparing preoperative flexion contractures between the two groups, a significant difference was found (p<0.001). At 6-12months postoperatively, flexion contractures were relieved regardless of notchplasty; however, the difference between the groups was decreased (p=0.026). At the latest follow-up, flexion contractures were partly aggravated in both groups, but no significant difference was found between the groups (p=0.461). Comparison of flexion contracture between before surgery and at the latest follow-up in each group revealed a significant difference only in the notchplasty group (p<0.001, with notchplasty; p=0.197, without notchplasty). The linear mixed model regarding maximal flexion did not show any factor having a significant interaction with time. There were no surgical complications such as infection, thromboembolic events, and hemarthrosis, in both notchplasty and non-notchplasty groups. CONCLUSION The preoperative difference in flexion contracture was overcome by adding notchplasty to OWHTO, and this improvement was maintained over time. No added complications were noted in the notchplasty group. The results should be interpreted with caution, considering measurement error of ROM. However, concurrent notchplasty in OWHTO deserves further study to validate its efficacy. LEVEL OF EVIDENCE III, retrospective cohort study. IRB INFORMATION Project No. S2020-0081, AMC IRB SOP.
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17
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Shi W, Jiang Y, Zhao X, Zhang H, Wang Y, Li T. The influence of posterior tibial slope on the mid-term clinical effect of medial-pivot knee prosthesis. J Orthop Surg Res 2021; 16:563. [PMID: 34526057 PMCID: PMC8442407 DOI: 10.1186/s13018-021-02704-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/30/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To evaluate the effect of posterior tibial slope (PTS) on the mid-term clinical outcome following a medial-pivot (MP) prosthesis. METHOD Two hundred thirty-three patients from The Affiliated Hospital of Qingdao University, who had undergone a total knee arthroplasty (TKA) with MP prosthesis between January 2015 and December 2015, were retrospectively included in this study. They were divided into 3 groups according to postoperative PTS: A ≤ 5°; B 5-7°; and C ≥ 7°. Multiple assessments were made on the patient postoperatively and recorded in the three groups, the measurements of this study included: the range of motion (ROM), knee scoring system (KSS), Western Ontario and McMaster universities osteoarthritis index (WOMAC), posterior condylar offset (PCO), joint line height, and postoperative complications. RESULTS The average post-operative ROM for groups B and C were 108° and 110° respectively; this was significantly higher than that of group A (98°, P < 0.001). The WOMAC scores of patients in group C were significantly lower than those in groups A and B (P < 0.05). However, there were no significant differences in KSS, PCO, and joint line height among the 3 groups (P > 0.05). Only 2 cases of postoperative complications occurred in group C, these were ameliorated after operation. CONCLUSION With an increase to PTS, the postoperative ROM can be significantly increased for the patient. However, the knee joint function will not be significantly improved, and the stability of knee joint will not be affected when within the limits of appropriate PTS.
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Affiliation(s)
- Weipeng Shi
- Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.,Medical Department of Qingdao University, Qingdao, 266071, Shandong, China
| | - Yaping Jiang
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Xuan Zhao
- Department of Rheumatism and Immunology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Haining Zhang
- Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China
| | - Yingzhen Wang
- Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.
| | - Tao Li
- Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.
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18
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Brown M, Ramasubbu R, Jenkinson M, Doonan J, Blyth M, Jones B. Significant differences in rates of aseptic loosening between two variations of a popular total knee arthroplasty design. INTERNATIONAL ORTHOPAEDICS 2021; 45:2859-2867. [PMID: 34392378 PMCID: PMC8560675 DOI: 10.1007/s00264-021-05151-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/17/2021] [Indexed: 11/11/2022]
Abstract
Purpose The NexGen Legacy Posterior Stabilised (LPS) prosthesis (Zimmer Biomet, Warsaw, IN, USA) has augmentable and non-augmentable tibial baseplate options. We have noted an anecdotal increase in the number of cases requiring early revision for aseptic loosening since adopting the non-augmentable option. The purpose of this study was to ascertain our rates of aseptic tibial loosening for the two implant types within five years of implantation and to investigate the causes for any difference observed. Methods A database search was performed for all patients who underwent primary total knee arthroplasty (TKA) using the NexGen LPS between 2009 and 2015. Kaplan–Meier curves were plotted to assess for differences in revision rates between cohorts. We collected and compared data on gender, age, body mass index, component alignment and cement mantle quality as these were factors thought to affect the likelihood of aseptic loosening. Results Two thousand one hundred seventy-two TKAs were included with five year follow-up. There were 759 augmentable knees of which 14 were revised and 1413 non-augmentable knees of which 48 were revised. The overall revision rate at five years was 1.84% in the augmentable cohort and 3.4% in the non-augmentable cohort. The revision rate for aseptic loosening was 0.26% in the augmentable group and 1.42% in the non-augmentable group (p = 0.0241). Conclusions We have identified increased rates of aseptic loosening in non-augmentable components. This highlights the effect that minor implant changes can have on outcomes. We recommend that clinicians remain alert to implant changes and publish their own results when important trends are observed.
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Affiliation(s)
- Michael Brown
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 82 Castle Street, Gatehouse Building, Glasgow, G4 0RH, UK.
| | - Rohan Ramasubbu
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 82 Castle Street, Gatehouse Building, Glasgow, G4 0RH, UK
| | - Mark Jenkinson
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 82 Castle Street, Gatehouse Building, Glasgow, G4 0RH, UK
| | - James Doonan
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 82 Castle Street, Gatehouse Building, Glasgow, G4 0RH, UK
| | - Mark Blyth
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 82 Castle Street, Gatehouse Building, Glasgow, G4 0RH, UK
| | - Bryn Jones
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 82 Castle Street, Gatehouse Building, Glasgow, G4 0RH, UK
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19
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Takemura S, Ikawa T, Ohyama Y, Kim M, Takaoka K, Minoda Y, Kadoya Y. The posterior tibial slope does not influence the flexion angle in posterior-stabilized mobile-bearing total knee arthroplasty. ARTHROPLASTY 2021; 3:28. [PMID: 35236482 PMCID: PMC8796609 DOI: 10.1186/s42836-021-00085-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
Background It remains uncertain whether an increase in the tibial slope leads to better flexion in posterior-stabilized (PS) total knee prostheses. Purpose To compare the intra-operative flexion angle between standard and an additional 10° posterior slope inserts. Patients and methods Between December 2014 and February 2015, 22 patients (25 knees) who underwent PS mobile-bearing primary total knee arthroplasty (TKA) were included. Flexion angles were measured using either standard or specially-made inserts. Differences in flexion angles between the two situations were analyzed to determine the relationship between changes in flexion angle and pre-operative flexion angle or body mass index (BMI), and between intra- and post-operative flexion angle. Results The difference between the average flexion angle of standard inserts and specially-made inserts was not statistically significant. Although the correlations between changes in flexion angle due to insert difference and flexion angle, pre-operative flexion angle or BMI were not significant, there was a positive correlation between intra-operative and post-operative flexion at 2 years. Conclusion The results showed an additional posterior tibial slope by 10° did not affect the intra-operative flexion angle. Surgeons performing PS mobile-bearing TKA do not need to excessively slope the tibial bone cutting to improve the post-operative flexion angle. Level of evidence I, Experimental study. Supplementary Information The online version contains supplementary material available at 10.1186/s42836-021-00085-5.
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Affiliation(s)
- Susumu Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Tessyu Ikawa
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital Osaka, 2-10-39, Shibata, Kita-ku, Osaka, 530-0012, Japan
| | - Yohei Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Mitsunari Kim
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
| | - Kunio Takaoka
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshinori Kadoya
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
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20
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Farooq H, Deckard ER, Arnold NR, Meneghini RM. Machine Learning Algorithms Identify Optimal Sagittal Component Position in Total Knee Arthroplasty. J Arthroplasty 2021; 36:S242-S249. [PMID: 33744081 DOI: 10.1016/j.arth.2021.02.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Advanced technologies, like robotics, provide enhanced precision for implanting total knee arthroplasty (TKA) components; however, the optimal targets for implant position specifically in the sagittal plane do not exist. This study identified sagittal implant position which may predict improved outcomes using machine learning algorithms. METHODS A retrospective review of 1091 consecutive TKAs was performed. All TKAs were posterior cruciate ligament retaining or sacrificing with an anterior-lip (49.4%) or conforming bearing (50.6%) and performed with modern perioperative protocols. Preoperative and postoperative tibial slope and postoperative femoral component flexion were measured with standardized radiographic protocols. Analysis groups were categorized by satisfaction scores and the Knee Society Score question 'does this knee feel normal to you?' Machine learning algorithms were used to identify optimal sagittal alignment zones that predict superior satisfaction and knees "always feeling normal" scores. RESULTS Mean age and median body mass index were 66 years and 34 kg/m2, respectively, with 67% being female. The machine learning model predicted an increased likelihood of being "satisfied or very satisfied" and a knee "always feeling normal" with a change in tibial slope closer to native (-2 to +2°) and femoral component flexion 0 to +7°. Worse outcomes were predicted with any femoral component extension, femoral component flexion beyond +10°, and adding or removing >5° of native tibial slope. CONCLUSION Superior patient-reported outcomes were predicted with approximating native tibial slope and incorporating some femoral component flexion. Deviation from native tibial slope and excessive femoral flexion or any femoral component extension were predictive of worse outcomes. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Hassan Farooq
- Indiana University School of Medicine, Indianapolis, IN
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Nicholas R Arnold
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
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21
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Nakajima A, Yamada M, Sonobe M, Akatsu Y, Saito M, Yamamoto K, Saito J, Norimoto M, Koyama K, Takahashi H, Aoki Y, Suguro T, Nakagawa K. Three-year clinical and radiological results of a cruciate-retaining type of the knee prosthesis with anatomical geometry developed in Japan. BMC Musculoskelet Disord 2021; 22:241. [PMID: 33658001 PMCID: PMC7927405 DOI: 10.1186/s12891-021-04114-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background The FINE total knee was developed in Japan and clinical use began in 2001. It has unique design features, including an oblique 3o femorotibial joint line that reproduces anatomical geometry. Although 20 years have passed since the FINE knee was clinically used for the first time in Japan, a formal clinical evaluation including patient-reported and radiographic outcomes has not been undertaken. Methods A total of 175 consecutive primary cruciate-retaining (CR)-FINE total knee arthroplasties (TKAs) at our hospital between February 2015 and March 2017 were included in this study. Three years postoperatively, range of motion (ROM), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score (FJS) were recorded and compared with preoperative scores. Radiographic analyses including mechanical alignment, component alignment, and incidence of radiolucent lines also were undertaken based on the radiographs 3 years postoperatively. Results One-hundred twenty-two knees (70%) were available for 3-year follow-up data using KOOS, except for the sports subscale. Postoperative KOOS-symptom, −pain and -ADL were > 85 points, but KOOS-sports, −QOL and FJS were less satisfactory. ROM, KSS and all the subscales of KOOS were significantly improved compared with preoperative scores. Postoperative mean FJS was 66 and was significantly correlated with all the subscales of KOOS, but not with postoperative ROM. Radiolucent lines ≧1 mm wide were detected in five knees (4.1%). There were no major complications needing revision surgeries. Conclusions Patient-reported outcomes (PROs) for symptoms, pain and ADL after the CR-FINE TKA were generally improved, but those for sports, QOL and FJS were improved less. The incidence of radiolucent lines was rare but detected around the femoral components. With the mid- to long-term follow-up, improvements of surgical technique will be necessary to achieve better PROs from patients receiving the FINE knee.
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Affiliation(s)
- Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan.
| | - Manabu Yamada
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Yorikazu Akatsu
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Masahiko Saito
- Department of Orthopaedic Surgery, Chiba Medical Center, 1-7-1 Minami-cho, Chuo-ku, Chiba, 261-0013, Japan
| | - Keiichiro Yamamoto
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Keita Koyama
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuchika Aoki
- Department of General Medical Sciences, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.,Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Toru Suguro
- Japan Research Institute of Artificial Joint, 725-1 Sugo, Kisarazu, Chiba, 292-0036, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
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Watanabe T, Gamada K, Koga H, Sekiya I, Muneta T, Jinno T. Characteristic kinematics of floor-sitting activities after posterior-stabilized total knee arthroplasty determined using model-based shape-matching techniques. Knee 2021; 29:571-579. [PMID: 33602618 DOI: 10.1016/j.knee.2020.12.028] [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: 05/17/2020] [Revised: 08/12/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Detailed kinematics of floor-sitting activities after total knee arthroplasty (TKA) have not been well explored. Knee kinematics of cross-legged sitting, seiza-sitting, and side-sitting after TKA were examined to clarify the differences in tibiofemoral kinematics of each activity. METHODS Subjects were 40 knees in 20 osteoarthritic patients who underwent bilateral TKA with a high-flexion fixed-bearing posterior-stabilized prosthesis. Dynamic radiographs of floor-sitting activities were taken, and the knee kinematics were compared among the three activities. The patients were also divided into two groups (possible/easy group and impossible/no-try group) for each activity, and group comparisons were conducted. RESULTS The maximum implant flexion angle was significantly greater in seiza-sitting. In valgus/varus rotation, seiza-sitting demonstrated neutral rotation, while cross-legged sitting showed varus of about 10°, and side-sitting exhibited valgus. In tibial internal/external rotation, seiza-sitting demonstrated a constant rotational angle, while cross-legged sitting showed tibial internal rotation with flexion, and side-sitting exhibited tibial external rotation with flexion. The kinematic pathway during deep flexion illustrated the medial pivot pattern in cross-legged sitting, a small amount of bicondylar rollback in seiza-sitting, and the weak lateral pivot pattern in side-sitting. A greater flexion angle was the important factor for the performance of each floor-sitting activity followed by varus laxity at 10° knee flexion. CONCLUSIONS This study successfully revealed characteristic kinematic patterns of TKA knees in three floor-sitting activities. Obtaining a greater knee flexion with adequate lateral laxity is the key to enhancing postoperative floor-sitting activities.
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Affiliation(s)
- Toshifumi Watanabe
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
| | - Kazuyoshi Gamada
- Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Hiroshima, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tetsuya Jinno
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Hada M, Mizu-Uchi H, Okazaki K, Murakami K, Kaneko T, Higaki H, Nakashima Y. Posterior tibial slope and anterior post-cam contact can change knee kinematics in extension in bi-cruciate stabilized total knee arthroplasty. Bone Joint Res 2020; 9:761-767. [PMID: 33135422 PMCID: PMC7649504 DOI: 10.1302/2046-3758.911.bjr-2020-0076.r2] [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] [Indexed: 11/16/2022] Open
Abstract
Aims This study aims to investigate the effects of posterior tibial slope (PTS) on knee kinematics involved in the post-cam mechanism in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) using computer simulation. Methods In total, 11 different PTS (0° to 10°) values were simulated to evaluate the effect of PTS on anterior post-cam contact conditions and knee kinematics in BCS TKA during weight-bearing stair climbing (from 86° to 6° of knee flexion). Knee kinematics were expressed as the lowest points of the medial and lateral femoral condyles on the surface of the tibial insert, and the anteroposterior translation of the femoral component relative to the tibial insert. Results Anterior post-cam contact in BCS TKA was observed with the knee near full extension if PTS was 6° or more. BCS TKA showed a bicondylar roll forward movement from 86° to mid-flexion, and two different patterns from mid-flexion to knee extension: screw home movement without anterior post-cam contact and bicondylar roll forward movement after anterior post-cam contact. Knee kinematics in the simulation showed similar trends to the clinical in vivo data and were almost within the range of inter-specimen variability. Conclusion Postoperative knee kinematics in BCS TKA differed according to PTS and anterior post-cam contact; in particular, anterior post-cam contact changed knee kinematics, which may affect the patient’s perception of the knee during activities. Cite this article: Bone Joint Res 2020;9(11):761–767.
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Affiliation(s)
- Masaru Hada
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koji Murakami
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Takao Kaneko
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, Fukuoka, Japan
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Wang Y, Yan S, Zeng J, Zhang K. The biomechanical effect of different posterior tibial slopes on the tibiofemoral joint after posterior-stabilized total knee arthroplasty. J Orthop Surg Res 2020; 15:320. [PMID: 32787891 PMCID: PMC7425532 DOI: 10.1186/s13018-020-01851-y] [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: 03/29/2020] [Accepted: 07/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background Different posterior tibial slopes (PTS) after posterior-stabilized total knee arthroplasty (PS-TKA) may lead to different biomechanical characteristics of knee joint. This cadaveric study was designed to investigate the tibiofemoral kinematics and contact pressures after PS-TKA with different PTS. Methods Nine human cadaveric knee specimens were used for PS-TKA with the PTS of 3°, 6°, and 9°. The tibiofemoral kinematics and contact pressures were measured during knee flexion angle changing from 0 to 120° (with an increment of 10°) with an axial load of 1000 N at each angle. Results The root mean square (RMS) of the tibiofemoral contact area and the mean and peak contact pressures during knee flexion were 586.2 mm2, 1.85 MPa, and 5.39 MPa before TKA and changed to 130.2 mm2, 7.56 MPa, and 17.98 MPa after TKA, respectively. Larger contact area and smaller mean and peak contact pressures were found in the joints with the larger PTS after TKA. The RMS differences of femoral rotation before and after TKA were more than 9.9°. The posterior translation of the lateral condyle with larger PTS was more than that with smaller PTS, while overall, the RMS differences before and after TKA were more than 11.4 mm. Conclusion After TKA, the tibiofemoral contact area is reduced, and the contact pressure is increased greatly. Approximately 80% of the femoral rotation is lost, and only about 60% of the femoral translation of lateral condyle is recovered. TKA with larger PTS results in more posterior femoral translation, larger contact area, and smaller contact pressure, indicating that with caution, it may be beneficial to properly increase PTS for PS-TKA.
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Affiliation(s)
- Yingpeng Wang
- School of Biomedical Engineering, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Songhua Yan
- School of Biomedical Engineering, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Jizhou Zeng
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 110149, China.
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
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Active maximum flexion after total knee arthroplasty is not related to posterior tibial slope, body mass index, or patient satisfaction: A retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fujito T, Tomita T, Yamazaki T, Oda K, Yoshikawa H, Sugamoto K. Influence of Posterior Tibial Slope on Kinematics After Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty 2018; 33:3778-3782.e1. [PMID: 30195655 DOI: 10.1016/j.arth.2018.07.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the influence of posterior tibial slope (PTS) on knee kinematics after cruciate-retaining total knee arthroplasty (CR-TKA). These influences were evaluated using a prosthesis designed with high geometric conformity to the medial articular surface under the weight-bearing condition of deep knee bending. METHODS We evaluated 71 knees (52 patients) after CR-TKA using 2- to 3-dimensional registration techniques. All patients were categorized into 2 groups: group A (PTS ≤ 7°) and group B (PTS ≥ 8°). We compared in vivo knee kinematics during deep knee bending under weight-bearing conditions between the 2 groups. The anteroposterior position of the nearest points, flexion angles, and external rotation angles of the femoral components relative to the tibial components were evaluated. Additionally, the knee flexion angles of the femur relative to the tibia obtained from the installation angles of the components were evaluated. RESULTS PTS did not affect the external rotation angles and anteroposterior position. The postoperative maximum flexion angle and range of motion between the femur and tibia in group B were significantly greater than those in group A. CONCLUSION PTS of 8° or more in CR-TKA using prosthetics designed with high geometric conformity to the medial articular surface did not affect the anteroposterior position and external rotation, but increased the postoperative maximum flexion angle and range of motion.
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Affiliation(s)
- Toshitaka Fujito
- Department of Orthopaedic Biomaterial Science, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Saitama Institute of Technology, Fukaya, Saitama, Japan
| | - Kosaku Oda
- Department of Orthopaedic Surgery, Takatsuki Red Cross Hospital, Takatsuki, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
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Kang KT, Kwon SK, Son J, Kwon OR, Lee JS, Koh YG. The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:3188-3195. [PMID: 29623377 DOI: 10.1007/s00167-018-4925-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to clarify the influence of the posterior tibial slope (PTS) on knee joint biomechanics after posterior-stabilized (PS) total knee arthroplasty (TKA) using a computer simulation. METHODS A validated TKA computational model was used to evaluate and quantify the effects of an increased PTS. In order to conduct a squat simulation, models with a - 3° to 15° PTS using increments of 3° were developed. Forces on the quadriceps and collateral ligament, a tibial posterior translation, contact point on a polyethylene (PE) insert, and contact stress on the patellofemoral (PF) joint and post in a PE insert were compared. RESULTS The maximum force on the quadriceps and the PF contact stress decreased with increases in the PTS. The kinematics on the tibiofemoral (TF) joint translated in an increasingly posterior manner, and the medial and lateral contact points on a PE insert were located in posterior regions with increases in the PTS. Additionally, increases in the PTS decreased the force on the collateral ligament and increased the contact stress on the post in a PE insert. A higher force on the quadriceps is required when the PTS decreases with an equivalent flexion angle. CONCLUSIONS A surgeon should be prudent in terms of determining the PTS because an excessive increase in the PTS may lead to the progressive loosening of the TF joint due to a reduction in collateral ligament tension and failure of the post in a PE insert. Thus, we support a more individualized approach of optimal PTS determination given the findings of the study.
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Affiliation(s)
- Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sae Kwang Kwon
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Juhyun Son
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Oh-Ryong Kwon
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Jun-Sang Lee
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea.
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30
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Ahmad R, Patel A, Mandalia V, Toms A. Posterior Tibial Slope: Effect on, and Interaction with, Knee Kinematics. JBJS Rev 2018; 4:e31-6. [PMID: 27487427 DOI: 10.2106/jbjs.rvw.o.00057] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Posterior tibial slope should be measured on a long lateral or an expanded lateral radiograph. Posterior tibial slope decreases the quadriceps force needed to exert knee extension moment. Posterior tibial slope parallel to natural tibial slope minimizes tibial component subsidence. Posterior tibial slope should be increased rather than releasing the posterior cruciate ligament (PCL) to restore normal kinematics in a knee that is tight in flexion. Larger tibial slope widens the flexion gap in posterior stabilized total knee replacement.
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Affiliation(s)
- Riaz Ahmad
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, United Kingdom
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Hada M, Mizu-Uchi H, Okazaki K, Kaneko T, Murakami K, Ma Y, Hamai S, Nakashima Y. Bi-cruciate stabilized total knee arthroplasty can reduce the risk of knee instability associated with posterior tibial slope. Knee Surg Sports Traumatol Arthrosc 2018; 26:1709-1716. [PMID: 28940016 DOI: 10.1007/s00167-017-4718-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the relationship between posterior tibial slope and knee kinematics in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA), which has not been previously reported. METHODS This computer simulation study evaluated Journey 2 BCS components (Smith & Nephew, Inc., Memphis, TN, USA) implanted in a female patient to simulate weight-bearing stair climbing. Knee kinematics, patellofemoral contact forces, and quadriceps forces during stair climbing (from 86° to 6° of flexion) were computed in the simulation. Six different posterior tibial slope angles (0°-10°) were simulated to evaluate the effect of posterior tibial slope on knee kinematics and forces. RESULTS At 65° of knee flexion, no anterior sliding of the tibial component occurred if the posterior tibial slope was less than 10°. Anterior contact between the anterior aspect of the tibial post- and the femoral component was observed if the posterior tibial slope was 6° or more. An increase of 10° in posterior tibial slope (relative to 0°) led to a 4.8% decrease in maximum patellofemoral contact force and a 1.2% decrease in maximum quadriceps force. CONCLUSION BCS TKA has a wide acceptable range of posterior tibial slope for avoiding knee instability if the posterior tibial slope is less than 10°. Surgeons should prioritize avoiding adverse effects over trying to achieve positive effects such as decreasing patellofemoral contact force and quadriceps force by increasing posterior tibial slope. Our study helps surgeons determine the optimal posterior tibial slope during surgery with BCS TKA; posterior tibial slope should not exceed 10° in routine clinical practice.
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Affiliation(s)
- Masaru Hada
- Department of Orthopaedic Surgery, Toho University School of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takao Kaneko
- Department of Orthopaedic Surgery, Toho University School of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Koji Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Yuan Ma
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
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Han HS, Kang SB. Interactive effect of femoral posterior condylar offset and tibial posterior slope on knee flexion in posterior cruciate ligament-substituting total knee arthroplasty. Knee 2018. [PMID: 29525547 DOI: 10.1016/j.knee.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND This work aimed to evaluate the changes in the femoral posterior condylar offset (PCO) and tibial slope after posterior cruciate ligament (PCL)-substituting total knee arthroplasty (TKA), and to address the presence of any interactive effect between the two on knee flexion. METHODS Fifty-two PCL-substituting TKAs were performed using a posterior referencing system. Three-dimensional reconstructed computed tomographic (CT) images were used to evaluate PCO and tibial slope before and after arthroplasty. Range of motion and clinical scores were evaluated at a mean of 3.1years postoperatively. Multivariate linear model with interaction terms was used to evaluate and compare the relationships among changes in PCO, tibial slope, and postoperative knee flexion angles. RESULTS The degree of change in PCO was greater in the lateral condyle than in the medial condyle (3.1±2.5mm and -0.5±2.8mm, respectively). Postoperative medial and lateral tibial slopes were 1.4°±1.8 and 1.4°±2.0, respectively. The mean degree of postoperative knee flexion was 125°. Analysis with interaction terms and covariate adjustment demonstrated that medial PCO and tibial slope were significantly related to knee flexion with interactive effect (P=0.011). In cases with <3° posterior tibial slope, the postoperative PCO was positively correlated to the degree of knee flexion angle. However, in cases with >3° tibial slope, PCO was negatively correlated to knee flexion. CONCLUSION Medial femoral PCO and tibial slope showed interactive effect on knee flexion after PCL-substituting TKAs. Reconstitution of the proper PCO and avoiding excessive tibial slope may be necessary.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea.
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Biomechanical Effects of Posterior Condylar Offset and Posterior Tibial Slope on Quadriceps Force and Joint Contact Forces in Posterior-Stabilized Total Knee Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4908639. [PMID: 29349074 PMCID: PMC5733759 DOI: 10.1155/2017/4908639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/14/2017] [Accepted: 10/25/2017] [Indexed: 11/24/2022]
Abstract
This study aimed to determine the biomechanical effect of the posterior condylar offset (PCO) and posterior tibial slope (PTS) in posterior-stabilized (PS) fixed-bearing total knee arthroplasty (TKA). We developed ±1, ±2, and ±3 mm PCO models in the posterior direction and −3°, 0°, 3°, and 6° PTS models using a previously validated FE model. The influence of changes in the PCO and PTS on the biomechanical effects under deep-knee-bend loading was investigated. The contact stress on the PE insert increased by 14% and decreased by 7% on average as the PCO increased and decreased, respectively, compared to the neutral position. In addition, the contact stress on post in PE insert increased by 18% on average as PTS increased from −3° to 6°. However, the contact stress on the patellar button decreased by 11% on average as PTS increased from −3° to 6° in all different PCO cases. The quadriceps force decreased by 14% as PTS increased from −3° to 6° in all PCO models. The same trend was found in patellar tendon force. Changes in PCO had adverse biomechanical effects whereas PTS increase had positive biomechanical effects. However, excessive PTS should be avoided to prevent knee instability and subsequent failure.
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Shi X, Li H, Zhou Z, Shen B, Yang J, Kang P, Pei F. Individual valgus correction angle improves accuracy of postoperative limb alignment restoration after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:277-283. [PMID: 25552406 DOI: 10.1007/s00167-014-3496-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/18/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of the current study was to compare and investigate the effect of fixed and individual valgus correction angle (VCA) on postoperative alignment restoration. It is hypothesized that individual VCA would be more accurate than fixed VCA in postoperative limb alignment restoration. METHODS Four hundred and fifty-two patients with 546 consecutive uncomplicated primary total knee arthroplasties performed by a single surgeon, with 302 knees that had individual VCA (group A) and 244 knees that had fixed 5° VCA (group B), were enroled in this study. Preoperative and postoperative full-length standing hip-to-ankle radiographs were used to assess limb alignment. Postoperative hip-knee-ankle angle (θ), femoral component angle (α) and tibial component angle (β) were measured and compared between the two groups. RESULTS Mean postoperative θ angle and α angle were 178.9° (SD 1.3°) and 89.1° (SD 1.1°) in the group A, whereas they were 177.8° (SD 1.9°) and 87.9° (SD 1.5°) in the group B. There were significant differences in both parameters between the two groups (p = 0.021 and 0.016, respectively). Mean postoperative β was 89.8° (SD 1.2°) in the group A and 89.7° (SD 1.3°) in the group B, and no significant difference was detected. There were 114 (37.7 %), 221 (73.2 %) and 265 (87.7 %) knees that had restoration of mechanical axis to ±1°, ±2°, ±3° of neutral, respectively, and 37 (12.3 %) outliers (>±3°) in the group A, whereas there were 48 (19.7 %), 122 (50.0 %) and 170 (69.7 %) knees that had restoration of mechanical axis to ±1°, ±2°, ±3° of neutral, respectively, and 74 (30.3 %) outliers in the group B. Group A had a higher percentage of restoration of limb alignment and fewer outliers than those in the group B, and this difference was statistically significant (p < 0.001). CONCLUSIONS The results from the present study demonstrated that individual VCA for distal femoral resection could enhance the accuracy of postoperative limb alignment restoration compared with fixed VCA. For clinical relevance, individual VCA should be recommended for routine use in all patients in order to achieve the expected postoperative neutral limb alignment and reduce the risk of postoperative malalignment due to the planning error of a fixed VCA. LEVEL OF EVIDENCE Prospective comparative study, Level II.
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Affiliation(s)
- Xiaojun Shi
- The Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Li
- The Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Zongke Zhou
- The Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China.
| | - Bin Shen
- The Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- The Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Pengde Kang
- The Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Fuxing Pei
- The Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
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Lampe F, Marques CJ, Fiedler F, Sufi-Siavach A, Carita AI, Matziolis G. Patient-specific and intra-operatively modifiable factors assessed by computer navigation predict maximal knee flexion one year after TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24:3457-3465. [PMID: 27129369 DOI: 10.1007/s00167-016-4134-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/14/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE There are multiple factors affecting maximal knee flexion (MKF) after total knee arthroplasty (TKA). The aim of the study was to investigate whether patient-specific factors (PSF) and surgically modifiable factors (SMF), measured by means of a computer-assisted navigation system, can predict the MKF after TKA. METHODS Data from 99 patients collected during a randomized clinical trial were used for this secondary data analysis. The MKF of the patients was measured preoperatively and 1-year post-surgery. Multiple regression analyses were performed to investigate which combination of variables would be the best to predict the 1-year MKF. RESULTS When considering SMF alone, the combination of three factors significantly predicted the 1-year MKF (p = 0.001), explaining 22 % of its variation. When considering only PSF, the combination of pre-op MKF and BMI significantly predicted the 1-year MKF (p < 0.001), explaining 23 % of its variation. When considering both groups of potential predictors simultaneously, the combination of five SMF with two PSF significantly predicted the 1-year MKF (p = 0.001), explaining 32 % of its variation. CONCLUSIONS Computer navigation variables alone could explain 22 % of the variance in the 1-year MKF. The larger proportion (32 %) of the 1-year MKF variation could be explained with a combination of SMF and PSF. The results of studies in this area could be used to identify patients at risk of poor outcomes. LEVEL OF EVIDENCE Level II, Prognostic study.
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Affiliation(s)
- Frank Lampe
- Research Center of the Orthopedic and Joint Replacement Department, Schoen Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany.,Faculty of Life Sciences, Hamburg University of Applied Sciences, Lohbrügger Kirchstraße 65, 21033, Hamburg, Germany
| | - Carlos J Marques
- Research Center of the Orthopedic and Joint Replacement Department, Schoen Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany.
| | - Franziska Fiedler
- Department of Orthopedics and Joint Replacement, Schoen Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany
| | - Anusch Sufi-Siavach
- Department of Orthopedics and Joint Replacement, Schoen Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany
| | - Ana I Carita
- Mathematic Methods Department, Faculty of Human Kinetics, Lisbon University, Estrada da Costa, 1499-002, Cruz Quebrada, Portugal
| | - Georg Matziolis
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Ji HM, Han J, Jin DS, Seo H, Won YY. Kinematically aligned TKA can align knee joint line to horizontal. Knee Surg Sports Traumatol Arthrosc 2016; 24:2436-41. [PMID: 26811035 DOI: 10.1007/s00167-016-3995-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 01/13/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The joint line of the native knee is horizontal to the floor and perpendicular to the vertical weight-bearing axis of the patient in a bipedal stance. The purposes of this study were as follows: (1) to find out the distribution of the native joint line in a population of normal patients with normal knees; (2) to compare the native joint line orientation between patients receiving conventional mechanically aligned total knee arthroplasty (TKA), navigated mechanically aligned TKA, and kinematically aligned TKA; and (3) to determine which of the three TKA methods aligns the postoperative knee joint perpendicular to the weight-bearing axis of the limb in bipedal stance. METHODS To determine the joint line orientation of a native knee, 50 full-length standing hip-to-ankle digital radiographs were obtained in 50 young, healthy individuals. The angle between knee joint line and the line parallel to the floor was measured and defined as joint line orientation angle (JLOA). JLOA was also measured prior to and after conventional mechanically aligned TKA (65 knees), mechanically aligned TKA using imageless navigation (65 knees), and kinematically aligned TKA (65 knees). The proportion of the knees similar to the native joint line was calculated for each group. RESULTS The mean JLOA in healthy individuals was parallel to the floor (0.2° ± 1.1°). The pre-operative JLOA of all treatment groups slanted down to the lateral side. Postoperative JLOA slanted down to the lateral side in conventional mechanically aligned TKA (-3.3° ± 2.2°) and in navigation mechanically aligned TKA (-2.6° ± 1.8°), while it was horizontal to the floor in kinematically aligned TKA (0.6° ± 1.7°). Only 6.9 % of the conventional mechanically aligned TKA and 16.9 % of the navigation mechanically aligned TKA were within one SD of the mean JLOA of the native knee, while the proportion was significantly higher (50.8 %) in kinematically aligned TKA. The portion was statistically greater in mechanically aligned TKA group than the other two. CONCLUSION Postoperative joint line orientation after kinematically aligned TKA was more similar to that of native knees than that of mechanically aligned TKA and horizontal to the floor. Kinematically aligned TKA can restore pre-arthritic knee joint line orientation, while mechanically aligned TKA is inefficient in achieving the purpose even if navigation TKA is employed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hyung-Min Ji
- Department of Orthopaedic Surgery, Ajou University College of Medicine, 164, World Keobro, Suwonsi Yeongtong-gu, Gyeonggi-do, 443-721, Republic of Korea
| | - Jun Han
- Department of Orthopaedic Surgery, Ajou University College of Medicine, 164, World Keobro, Suwonsi Yeongtong-gu, Gyeonggi-do, 443-721, Republic of Korea
| | - Dong San Jin
- Department of Orthopaedic Surgery, Ajou University College of Medicine, 164, World Keobro, Suwonsi Yeongtong-gu, Gyeonggi-do, 443-721, Republic of Korea
| | - Hyunseok Seo
- Department of Orthopaedic Surgery, Ajou University College of Medicine, 164, World Keobro, Suwonsi Yeongtong-gu, Gyeonggi-do, 443-721, Republic of Korea
| | - Ye-Yeon Won
- Department of Orthopaedic Surgery, Ajou University College of Medicine, 164, World Keobro, Suwonsi Yeongtong-gu, Gyeonggi-do, 443-721, Republic of Korea.
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Shi X, Li H, Zhou Z, Shen B, Yang J, Pei F. Comparison of Postoperative Alignment Using Fixed vs Individual Valgus Correction Angle in Primary Total Knee Arthroplasty With Lateral Bowing Femur. J Arthroplasty 2016; 31:976-83. [PMID: 26787012 DOI: 10.1016/j.arth.2015.10.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/02/2015] [Accepted: 10/30/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lateral bowing of the femur, commonly observed among Asian populations, may cause malalignment after primary total knee arthroplasty (TKA). Therefore, in this study, a fixed valgus correction angle (VCA) technique for TKA was compared with individual VCA to determine which surgical technique leads to better limb and component alignment. METHODS Patients with primary TKAs with lateral bowing femurs (n = 133) were randomized to 2 groups: individual VCA (group A) and fixed VCA (group B). Full-length standing hip-knee-ankle radiographs were used to measure the VCA and limb alignment. The postoperative mechanical axis, femoral component, and tibial component alignment were measured and compared between the 2 groups. RESULTS The mean postoperative mechanical axis and femoral component alignment were 178.1° and 88.3°, respectively, in group A, compared with 175.9° and 86.4°, respectively, in group B (P < .05). There were 52 (77.6%) knees with ±3° mechanical axis deviation from the neutral axis in group A, compared with 19 (28.8%) in group B (P < .001). There were 56 (83.6%) knees with femoral component alignment deviation within ±3° in group A, compared with 26 (39.4%) in group B (P < .001). CONCLUSION The individual VCA achieves a better radiographic limb and femoral component alignment than fixed VCA in our study patients. Preoperative hip-knee-ankle radiographs are imperative for distinguishing a bowing femur and performing accurate planning of the distal femoral resection.
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Affiliation(s)
- Xiaojun Shi
- Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Li
- Department of orthopedic surgery, Chengdu first People's Hospital, Chengdu, China
| | - Zongke Zhou
- Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
| | - Fuxing Pei
- Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China
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Song SJ, Bae DK, Kim KI, Jeong HY. Changes in Femoral Posterior Condylar Offset, Tibial Posterior Slope Angle, and Joint Line Height after Cruciate-Retaining Total Knee Arthroplasty. Knee Surg Relat Res 2016; 28:27-33. [PMID: 26955610 PMCID: PMC4779802 DOI: 10.5792/ksrr.2016.28.1.27] [Citation(s) in RCA: 6] [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: 07/27/2015] [Revised: 10/25/2015] [Accepted: 01/18/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose Changes in the femoral posterior condylar offset (PCO), tibial posterior slope angle (PSA), and joint line height (JLH) after cruciate-retaining total knee arthroplasty (CR-TKA) were evaluated to determine their influence on the flexion angle. Materials and Methods A total of 125 CR-TKAs performed on 110 patients were retrospectively reviewed. Pre- and postoperative PCO, PSA, and JLH were compared using correlation analysis. Independent factors affecting the postoperative flexion angle of the knee were analyzed. Results The PCO was 28.2±2.0 mm (range, 24.5 to 33.1 mm) preoperatively and 26.7±1.8 mm (range, 22.2 to 31.2 mm) postoperatively (r=0.807, p<0.001). The PSA was 10.4°±4.9° (range, 1.6° to 21.2°) preoperatively and decreased to 4.9°±2.0° (2.2° to 10.7°) postoperatively (r=–0.023, p=0.800). The JLH was 16.2±3.0 mm (range, 10.2 to 27.5 mm) preoperatively and 16.1±2.6 mm (range, 11.1 to 24.8 mm) postoperatively (r=0.505, p<0.001). None of the independent factors affected the flexion angle (p>0.291). Conclusions Although the PCO and JLH did not change significantly after CR-TKA, the PSA decreased by 5.5° with a small range of variation. Restoration of the PCO and JLH could promote optimization of knee flexion in spite of the decreased PSA after CR-TKA.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kang Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ho Yeon Jeong
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Lampe F, Fiedler F, Marques CJ, Sufi-Siavach A, Matziolis G. Surgically modifiable factors measured by computer-navigation together with patient-specific factors predict knee society score after total knee arthroplasty. BMC Musculoskelet Disord 2016; 17:78. [PMID: 26873695 PMCID: PMC4752747 DOI: 10.1186/s12891-016-0929-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose was to investigate whether patient-specific factors (PSF) and surgically modifiable factors (SMF), measured by means of a computer-assisted navigation system, can predict the Knee Society Scores (KSS) after total knee arthroplasty (TKA). METHODS Data from 99 patients collected during a randomized clinical trial were used for this secondary data analysis. The KSS scores of the patients were measured preoperatively and at 4-years follow-up. Multiple regression analyses were performed to investigate which combination of variables would be the best to predict the 4-years KSS scores. RESULTS When considering SMF alone the combination of four of them significantly predicted the 4-years KSS-F score (p = 0.009), explaining 18 % of its variation. When considering only PSF the combination of age and body weight significantly predicted the 4-years KSS-F (p = 0.008), explaining 11 % of its variation. When considering both groups of predictors simultaneously the combination of three PSF and two SMF significantly predicted the 4-years KSS-F (p = 0.007), explaining 20 % of its variation. CONCLUSIONS Younger age, better preoperative KSS-F scores and lower BMI before surgery, a positive tibial component slope and small changes in femoral offset were predictors of better KSS-F scores at 4-years.
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Affiliation(s)
- Frank Lampe
- Research Center of the Department of Orthopedics and Joint Replacement at the Schoen Klinik Hamburg Eilbek, Dehnhaide 120, D-22081, Hamburg, Germany. .,Faculty of Life Sciences at the Hamburg University of Applied Sciences, Lohbrügger Kirchstraße 65, D-21033, Hamburg, Germany.
| | - Franziska Fiedler
- Department of Orthopedics and Joint Replacement at the Schoen Klinik Hamburg Eilbek, Dehnhaide 120, D-22081, Hamburg, Germany.
| | - Carlos J Marques
- Research Center of the Department of Orthopedics and Joint Replacement at the Schoen Klinik Hamburg Eilbek, Dehnhaide 120, D-22081, Hamburg, Germany.
| | - Anusch Sufi-Siavach
- Department of Orthopedics and Joint Replacement at the Schoen Klinik Hamburg Eilbek, Dehnhaide 120, D-22081, Hamburg, Germany.
| | - Georg Matziolis
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, D-07607, Eisenberg, Germany.
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Huang CC, Jiang CC, Hsieh CH, Tsai CJ, Chiang H. Local bone quality affects the outcome of prosthetic total knee arthroplasty. J Orthop Res 2016. [PMID: 26222735 DOI: 10.1002/jor.23003] [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: 02/04/2023]
Abstract
Osteoporosis and osteoarthritis commonly coexist in the elderly. In patients undergoing prosthetic total knee arthroplasty (TKA), the bone quality around the knee joint may affect the safety of prosthetic implantation and consequently satisfaction with the surgical outcome. We recruited 50 postmenopausal women undergoing TKA for primary osteoarthritis; 43 completed the study protocol. The bone quality parameters of the operated knee, including bone mineral density assessed using dual-energy X-ray absorptiometry and microarchitecture variables assessed using micro-computed tomography, were determined. Surgical outcomes were assessed according to immediate (<1 week) postoperative pain quantified using the visual analog scale and knee function quantified using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 2 and 6 months postoperatively. The influence of bone quality parameters on surgical outcomes was analyzed using simple and multiple regression analyses. Volumetric bone mineral density (R(2) = 0.187-0.234, p < 0.01), the structural model index (R(2) = 0.103-0.181, p < 0.05), and trabecular separation (R(2) = 0.289-0.424, p < 0.05) were significantly associated with postoperative pain and improvement according to the KOOS. In conclusion, local bone quality, including mineral content and microarchitecture, affects the surgical outcome of TKA.
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Affiliation(s)
- Chuan-Ching Huang
- Department of Orthopaedic Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Ching-Chuan Jiang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hsun Hsieh
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Jung Tsai
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hongsen Chiang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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White PB, Ranawat AS. Patient-Specific Total Knees Demonstrate a Higher Manipulation Rate Compared to "Off-the-Shelf Implants". J Arthroplasty 2016; 31:107-11. [PMID: 26318082 DOI: 10.1016/j.arth.2015.07.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 02/01/2023] Open
Abstract
Patient-specific total knee replacements have been designed in hopes of providing better functional outcomes compared to "off-the-shelf" implants in primary total knee arthroplasty (TKA). We prospectively evaluated manipulation rates and clinical outcomes of 21 patient-specific TKAs matched with 42 posterior-stabilized and 11 cruciate-retaining "off-the-shelf" TKAs. Postoperatively, the patient-specific group had a range of motion significantly less than both control groups (P<0.01). Six of the 21 (28.6%) patient-specific TKAs required manipulation to improve range of motion. No manipulations were reported in either control groups. At minimum two-year follow-up the patient-specific TKAs had similar motion, but worse satisfaction and KSS pain scores. Radiographic analysis provided no insight to the cause of stiffness. Early manipulation is recommended for stiffness with patient-specific TKA.
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Niki Y, Takeda Y, Harato K, Suda Y. Factors affecting the achievement of Japanese-style deep knee flexion after total knee arthroplasty using posterior-stabilized prosthesis with high-flex knee design. J Orthop Sci 2015; 20:1012-8. [PMID: 26275557 DOI: 10.1007/s00776-015-0769-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Achievement of very deep knee flexion after total knee arthroplasty (TKA) can play a critical role in the satisfaction of patients who demand a floor-sitting lifestyle and engage in high-flexion daily activities (e.g., seiza-sitting). Seiza-sitting is characterized by the knees flexed >145º and feet turned sole upwards underneath the buttocks with the tibia internally rotated. The present study investigated factors affecting the achievement of seiza-sitting after TKA using posterior-stabilized total knee prosthesis with high-flex knee design. METHODS Subjects comprised 32 patients who underwent TKA with high-flex knee prosthesis and achieved seiza-sitting (knee flexion >145º) postoperatively. Another 32 patients served as controls who were capable of knee flexion >145º preoperatively, but failed to achieve seiza-sitting postoperatively. Accuracy of femoral and tibial component positions was assessed in terms of deviation from the ideal position using a two-dimensional to three-dimensional matching technique. Accuracies of the component position, posterior condylar offset ratio and intraoperative gap length were compared between the two groups. RESULTS The proportion of patients with >3º internally rotated tibial component was significantly higher in patients who failed at seiza-sitting (41 %) than among patients who achieved it (13 %, p = 0.021). Comparison of intraoperative gap length between patient groups revealed that gap length at 135º flexion was significantly larger in patients who achieved seiza-sitting (4.2 ± 0.4 mm) than in patients who failed at it (2.7 ± 0.4 mm, p = 0.007). Conversely, no significant differences in gap inclination were seen between the groups. CONCLUSIONS From the perspective of surgical factors, accurate implant positioning, particularly rotational alignment of the tibial component, and maintenance of a sufficient joint gap at 135º flexion appear to represent critical factors for achieving >145º of deep knee flexion after TKA.
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Affiliation(s)
- Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yuki Takeda
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasunori Suda
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Okamoto S, Mizu-uchi H, Okazaki K, Hamai S, Nakahara H, Iwamoto Y. Effect of Tibial Posterior Slope on Knee Kinematics, Quadriceps Force, and Patellofemoral Contact Force After Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2015; 30:1439-43. [PMID: 25791671 DOI: 10.1016/j.arth.2015.02.042] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/13/2015] [Accepted: 02/27/2015] [Indexed: 02/01/2023] Open
Abstract
We used a musculoskeletal model validated with in vivo data to evaluate the effect of tibial posterior slope on knee kinematics, quadriceps force, and patellofemoral contact force after posterior-stabilized total knee arthroplasty. The maximum quadriceps force and patellofemoral contact force decreased with increasing posterior slope. Anterior sliding of the tibial component and anterior impingement of the anterior aspect of the tibial post were observed with tibial posterior slopes of at least 5° and 10°, respectively. Increased tibial posterior slope contributes to improved exercise efficiency during knee extension, however excessive tibial posterior slope should be avoided to prevent knee instability. Based on our computer simulation we recommend tibial posterior slopes of less than 5° in posterior-stabilized total knee arthroplasty.
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Affiliation(s)
- Shigetoshi Okamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Mizu-uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Nakahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Hutt J, Massé V, Lavigne M, Vendittoli PA. Functional joint line obliquity after kinematic total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2015; 40:29-34. [DOI: 10.1007/s00264-015-2733-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022]
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45
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Factors affecting range of motion after total knee arthroplasty in patients with more than 120 degrees of preoperative flexion angle. INTERNATIONAL ORTHOPAEDICS 2015; 39:1535-40. [DOI: 10.1007/s00264-015-2710-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
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Bou Monsef J, Schraut N, Gonzalez M. Failed Total Knee Arthroplasty. JBJS Rev 2014; 2:01874474-201412000-00001. [PMID: 27490508 DOI: 10.2106/jbjs.rvw.n.00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jad Bou Monsef
- Department of Orthopedic Surgery, University of Illinois at Chicago, 835 South Walcott Avenue, Room E270, Chicago, IL, 60612
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Okazaki K, Tashiro Y, Mizu-uchi H, Hamai S, Doi T, Iwamoto Y. Influence of the posterior tibial slope on the flexion gap in total knee arthroplasty. Knee 2014; 21:806-9. [PMID: 24856090 DOI: 10.1016/j.knee.2014.02.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/11/2014] [Accepted: 02/18/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adjusting the joint gap length to be equal in both extension and flexion is an important issue in total knee arthroplasty (TKA). It is generally acknowledged that posterior tibial slope affects the flexion gap; however, the extent to which changes in the tibial slope angle directly affect the flexion gap remains unclear. This study aimed to clarify the influence of tibial slope changes on the flexion gap in cruciate-retaining (CR) or posterior-stabilizing (PS) TKA. METHODS The flexion gap was measured using a tensor device with the femoral trial component in 20 cases each of CR- and PS-TKA. A wedge plate with a 5° inclination was placed on the tibial cut surface by switching its front-back direction to increase or decrease the tibial slope by 5°. The flexion gap after changing the tibial slope was compared to that of the neutral slope measured with a flat plate that had the same thickness as that of the wedge plate center. RESULTS When the tibial slope decreased or increased by 5°, the flexion gap decreased or increased by 1.9 ± 0.6mm or 1.8 ± 0.4mm, respectively, with CR-TKA and 1.2 ± 0.4mm or 1.1 ± 0.3mm, respectively, with PS-TKA. CONCLUSIONS The influence of changing the tibial slope by 5° on the flexion gap was approximately 2mm with CR-TKA and 1mm with PS-TKA. CLINICAL RELEVANCE This information is useful when considering the effect of manipulating the tibial slope on the flexion gap when performing CR- or PS-TKA.
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Affiliation(s)
- Ken Okazaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yasutaka Tashiro
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Mizu-uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshio Doi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Gøthesen Ø, Espehaug B, Havelin LI, Petursson G, Hallan G, Strøm E, Dyrhovden G, Furnes O. Functional outcome and alignment in computer-assisted and conventionally operated total knee replacements. Bone Joint J 2014; 96-B:609-18. [DOI: 10.1302/0301-620x.96b5.32516] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed a randomised controlled trial comparing computer-assisted surgery (CAS) with conventional surgery (CONV) in total knee replacement (TKR). Between 2009 and 2011 a total of 192 patients with a mean age of 68 years (55 to 85) with osteoarthritis or arthritic disease of the knee were recruited from four Norwegian hospitals. At three months follow-up, functional results were marginally better for the CAS group. Mean differences (MD) in favour of CAS were found for the Knee Society function score (MD: 5.9, 95% confidence interval (CI) 0.3 to 11.4, p = 0.039), the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for ‘pain’ (MD: 7.7, 95% CI 1.7 to 13.6, p = 0.012), ‘sports’ (MD: 13.5, 95% CI 5.6 to 21.4, p = 0.001) and ‘quality of life’ (MD: 7.2, 95% CI 0.1 to 14.3, p = 0.046). At one-year follow-up, differences favouring CAS were found for KOOS ‘sports’ (MD: 11.0, 95% CI 3.0 to 19.0, p = 0.007) and KOOS ‘symptoms’ (MD: 6.7, 95% CI 0.5 to 13.0, p = 0.035). The use of CAS resulted in fewer outliers in frontal alignment (> 3° malalignment), both for the entire TKR (37.9% vs 17.9%, p = 0.042) and for the tibial component separately (28.4% vs 6.3%, p = 0.002). Tibial slope was better achieved with CAS (58.9% vs 26.3%, p < 0.001). Operation time was 20 minutes longer with CAS. In conclusion, functional results were, statistically, marginally in favour of CAS. Also, CAS was more predictable than CONV for mechanical alignment and positioning of the prosthesis. However, the long-term outcomes must be further investigated. Cite this article: Bone Joint J 2014; 96-B:609–18.
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Affiliation(s)
- Ø. Gøthesen
- Haugesund Hospital, Karmsundgt
120, Haugesund, 5521, Norway
| | - B. Espehaug
- The Norwegian Arthroplasty Register, Department
of Orthopaedic Surgery, Haukeland University
Hospital, 5021 Bergen, Norway
| | - L. I. Havelin
- The Norwegian Arthroplasty Register, Department
of Orthopaedic Surgery, Haukeland University
Hospital, 5021 Bergen, Norway
| | - G. Petursson
- Lovisenberg Diakonale Hospital, Lovisenberggata
17, N-0440 Oslo, Norway
| | - G. Hallan
- The Norwegian Arthroplasty Register, Department
of Orthopaedic Surgery, Haukeland University
Hospital, 5021 Bergen, Norway
| | - E. Strøm
- Department of Radiology, Haukeland University
Hospital, 5021 Bergen, Norway
| | - G. Dyrhovden
- Department of Clinical Medicine, Faculty
of Medicine and Dentistry, University of Bergen, 5021
Bergen, Norway
| | - O. Furnes
- The Norwegian Arthroplasty Register, Department
of Orthopaedic Surgery, Haukeland University
Hospital, 5021 Bergen, Norway
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Geijsen GJP, Heesterbeek PJC, van Stralen G, Anderson PG, Wymenga AB. Do tibiofemoral contact point and posterior condylar offset influence outcome and range of motion in a mobile-bearing total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2014; 22:550-5. [PMID: 23677140 DOI: 10.1007/s00167-013-2525-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 05/06/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE The posterior condylar offset (PCO) and the tibiofemoral contact point (CP) have been reported as important factors that can influence range of motion and clinical outcome after total knee arthroplasty. A mobile-bearing knee implant with an anterior posterior gliding insert would in theory be more sensitive for changes in PCO and CP. For this reason, we analysed the PCO and CP and the relation with outcome and range of motion in 132 patients from a prospectively documented cohort in this type of implant. METHODS The prosthesis used was a posterior cruciate retaining AP gliding mobile-bearing total knee replacement (SAL II Sulzer Medica, Switzerland). In 132 knees, the pre- and postoperative PCO and postoperative CP were evaluated. Measurements were made on X-rays of the knee taken in approximately 90° of flexion and with less than 3-mm rotation of the femur condyles. The outcome parameters, range of motion (ROM) and the knee society score (KSS), for each knee were determined preoperatively and at 5-year follow-up. RESULTS The mean KSS improved from 91 to 161 at 5-year follow-up (p < 0.001) and the mean ROM from 102 to 108 (p < 0.05). The mean PCO difference (postoperative PCO-preoperative PCO) was--0.05 mm (SD 2.15). The CP was on average 53.9% (SD 5.5%). ROM was different between the 3 PCO groups (p = 0.05): patients with 3 or more mm decrease in PCO had the best postoperative ROM (p = 0.047). There was no statistical difference between the postoperative ROM between patients with a stable PCO and those with an increased PCO. There was no correlation between the difference in PCO and the difference in ROM; R Pearson = -0.056. There was no difference in postoperative ROM or postoperative total KSS between CP <60% and CP >60%: p = 0.22, p = 0.99, for ROM and KSS, respectively. Scatter plots showed uniform clouds of values: increase or decrease in PCO and CP had no significant influence on ROM or KSS. CONCLUSION The hypotheses that a stable PCO and a more natural CP increase postoperative ROM and improve clinical outcome could not be confirmed. On the contrary, a decreased PCO seemed to improve knee flexion. Furthermore, a relationship between PCO and CP could not be found. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- G J P Geijsen
- Sint Maartens Clinic, Hengstdal 3, 6574 NA, Ubbergen, The Netherlands,
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50
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Sasanuma H, Sekiya H, Takatoku K, Ajiki T, Hagiwara H. Accuracy of a proximal tibial cutting method using the anterior tibial border in TKA. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24:1525-30. [PMID: 24449002 DOI: 10.1007/s00590-014-1415-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/27/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE In conventional total knee arthroplasty (TKA) using extramedullary alignment guides, it is not always easy to cut the proximal tibia precisely perpendicular to the tibial axis. The purpose of this study was to compare the radiographic accuracy of cutting the proximal tibia between the use of the bony landmarks of the anterior tibial border and the use of the conventional technique. METHODS A total of 173 patients underwent primary TKA. In 76 TKAs, we used the bony landmark method, and in 97 TKAs, we used the conventional method. In the bony landmark method, we set the coronal alignment in reference to the line connecting the proximal and distal one-third of the anterior tibial border, and we determined the 5° posterior slope in reference to this line. Six months postoperatively, radiological evaluations were performed using full-length standing anteroposterior and lateral radiographs of the knee. RESULTS No significant differences in the coronal tibial component angle were found between the groups. The posterior tilt of the tibial component was significantly smaller in the bony landmark method than in the conventional method (5.1° ± 2.9° vs. 6.4° ± 3.2°, respectively; p = 0.007). The percentage of patients whose posterior tilt of the tibial component was within ±3° of 5° was significantly larger in the bony landmark method than in the conventional method (70 vs. 62%, respectively; p = 0.04). CONCLUSIONS The bony landmark method provided a more accurate posterior tibial slope than the conventional method. However, there was no difference in coronal alignment compared with the conventional method.
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Affiliation(s)
- Hideyuki Sasanuma
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan,
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