1
|
Wei M, Hao K, Kang H, Kong L, Wang F. Lateral distal femoral condyle has more uniform cartilage wear in varus knee osteoarthritis. Sci Rep 2024; 14:86. [PMID: 38168489 PMCID: PMC10762106 DOI: 10.1038/s41598-023-50168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
Bone resection is highly valued in total knee arthroplasty (TKA), but how to determine the amount of distal femur resection is still controversial. The purpose of this study was to explore how to use lateral condyle as a reference for distal femoral osteotomy in TKA. Magnetic resonance imaging (MRI) and Radiographic images from 118 nonarthritic subjects and 123 osteoarthritis (OA) subjects were used to assess the cartilage wear pattern of the distal femur in varus knees. Measurements were performed on three-dimensional reconstruction after virtual bone cutting. The difference between the resection amount of distal (0°) and posterior (90°) was calculated when the medial condyle was used as a reference in OA patients. The osteotomy amount on lateral was calculated in nonarthritic subjects when the medial condylar osteotomy was consistent with the thickness of the implants. In 43% of OA patients, there was > 1 mm difference between the 0° and 90° in medial condyle cartilage, and no difference was observed in lateral. When using medial condyle as a reference for osteotomy, there was a difference of 1.3 ± 0.56 mm between the resection amount of 0° and 90°, and the difference was 0.24 ± 0.27 mm when using lateral condyle. Statistical analysis showed that there was a linear correlation between the resection amount of lateral condyle and mechanical lateral distal femoral angle (mLDFA) in nonarthritic subjects (r = 0.845, p < 0.001). Lateral distal femoral condyle has more uniform cartilage wear in varus knee osteoarthritis. Using the lateral condyle as the reference for distal femoral osteotomy is more suitable for the cartilage wear pattern of the varus knee. The position of cutting guide can be adjusted by preoperative measurements of mLDFA.
Collapse
Affiliation(s)
- Maozheng Wei
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, NO 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Kuo Hao
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, NO 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Huijun Kang
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, NO 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Lingce Kong
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, NO 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Fei Wang
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, NO 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| |
Collapse
|
2
|
Luo Z, Zhou K, Wang H, Pei F, Zhou Z. Comparison between Mid-Term Results of Total Knee Arthroplasty with Single-Radius versus Multiple-Radii Posterior-Stabilized Prostheses. J Knee Surg 2022; 35:204-214. [PMID: 32659818 DOI: 10.1055/s-0040-1713897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Single-radius (SR) prostheses and multiple-radii (MR) prostheses have different theoretical advantages; however, few comparative studies have been reported. The aim of the study was to compare mid-term clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Two hundred consecutive patients who underwent TKA between January 2012 and July 2013 were enrolled in the SR group (100 patients) and an MR group (100 patients), with a minimum follow-up of 5 years. Functional, radiological, satisfaction, and survival rates were evaluated. There was a significantly higher range of motion (ROM) in the SR group than in the MR group (flexion, 123.65 ± 10.12 degrees vs. 115.52 ± 10.03 degrees, p < 0.001). Quadriceps strength (3.05 ± 0.43 vs. 2.68 ± 0.58 kg, p = 0.025) and chair test results (80 [93.02%] vs. 69 [83.13%], p = 0.027) were better in the SR group than in the MR group. The SR group also had significantly less anterior knee pain (6 [6.98%] vs. 15 [18.07%], p < 0.05) and a better satisfaction rate than those in the MR group. No significant differences were observed in clinical scale scores such as Hospital for Special Surgery (HSS), Knee Society Score (KSS), and Short-Form 12 (SF-12), radiological results in terms of component position and radiolucent lines. The Kaplan-Meier survival curve estimates at 5 years were not significantly different (96.91% [95% confidence interval [CI]: 93.5-99.5%] vs. 94.86% [95% CI: 90.6-98.6%], p = 0.4696). The SR prosthesis design was better than that of the MR in terms of ROM, reduced anterior knee pain, contributions to better recovery of the extension mechanism, and higher satisfaction rates. The SR had similar results in clinical scales such as HSS, KSS, SF-12, radiological, or survival results to MR prostheses. More accurate measurements and longer-term follow-up are required.
Collapse
Affiliation(s)
- Zhenyu Luo
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| | - Kai Zhou
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| | - Haoyang Wang
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| | - Fuxing Pei
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| | - Zongke Zhou
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| |
Collapse
|
3
|
Jenny JY, Bercovy M, Cazenave A, Gaillard T, Châtain F, Jolles BE, Rouvillain JL, Saragaglia D. No difference in 13-year survival after medial pivot or central pivot mobile bearing total knee arthroplasty. A propensity matched comparative analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3648-3653. [PMID: 33165636 DOI: 10.1007/s00167-020-06355-0] [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: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study was designed to evaluate the long-term results (more than 10 years) of mobile bearing total knee arthroplasty (TKA) and to compare the survival of medial pivot axis (MPA) and central pivot axis (CPA) TKAs. The primary hypothesis was that the 10- to 15-year survival rate of MPA TKAs will be better than CPA TKAs. METHODS A national, multicenter, retrospective study was performed in France. In this case-control design, 1154 TKAs were paired into the CPA group (control group: 577 cases) and MPA group (study group: 577 cases) based on a logistic regression analysis of age, gender, body mass index and severity of the coronal deformity, defining the propensity score for each case. Final survival information follow-up was obtained for 946 cases (82%). RESULTS There was no significant difference between the control and study groups for any baseline data. Twenty-two prosthetic revisions (2%) were performed for mechanical reasons during the follow-up period. There was no significant difference between the 13-year survival rates of CPA (98%) and MPA (97%) TKAs. There was no significant difference between groups in their final Oxford and Knee Society scores. CONCLUSION Our findings do not support the assumption that medialization of the pivot axis of a mobile bearing TKA improves clinical results or survival. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Jean-Yves Jenny
- University Hospital Strasbourg, CCOM, 10 avenue Baumann, 67400, Illkirch, France.
| | - Michel Bercovy
- Clinique Arago, 187A Rue Raymond Losserand, 75014, Paris, France
| | - Alain Cazenave
- Institut CALOT, Department of Orthopedic Surgery, 52 rue du Dr Calot, 62600, Berck-sur-Mer, France
| | - Thierry Gaillard
- Polyclinique du Beaujolais, 120 Ancienne Route de Beaujeu, 69400, Arnas, France
| | - Frédéric Châtain
- Pole Santé Axone, 75 Avenue Gabriel Péri, 38400, Saint-Martin-d'Hères, France
| | - Brigitt E Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Avenue Louis-Ruchonnet 57, 1003, Lausanne, Switzerland.,Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, 1015, Lausanne, Switzerland
| | - Jean-Louis Rouvillain
- Department of Orthopaedic and Trauma Surgery, Hôpital Zobda Quitman, 97261, Fort-de-France, France
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, 38130, Echirolles, France
| | | |
Collapse
|
4
|
Li M, Zhang L, Zhang R, Ma Y, Liao J, Li Q, Deng Z, Zheng Q. Better quadriceps and hamstring strength is achieved after Total knee Arthroplasty with single radius femoral prostheses: a retrospective study based on isokinetic and isometric data. ARTHROPLASTY 2020; 2:5. [PMID: 35236469 PMCID: PMC8796515 DOI: 10.1186/s42836-020-0022-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Strength deficits, muscle imbalances, and quadriceps inhibition are common after the total knee arthroplasty (TKA). It was suggested that theoretically single radius (SR) femoral protheses could provide longer extensor moment arm compared to the multiple radius (MR) design. However, quantitative evidence has not yet been reported. Thus, the aim of the study was to investigate the differences in isokinetic data and to compare the patient-reported outcome scores between TKA SR and MR design. Method The present retrospective study included 36 TKA involving 16 knees (9 patients) using SR design implant and 20 knees (11 patients) using MR design implant. The mean follow-up time was longer than 1 year. Isokinetic knee flexion and extension torques of the operated leg were evaluated at 60°/s and 180°/s. Quadriceps and hamstring torques and ratios, work and power were recorded. Angle-specific torques were also collected at different extension or flexion angles. Results Both groups showed improvement in knee society scores (KSS) and knee injury, and osteoarthritis outcome score (KOOS) after operation. Patients in SR group had significantly higher scores in KSS-knee, symptoms and activities of daily living KOOS sub-score than those in the MR group at the end of the follow-up. The peak knee flexion torque, peak knee extension torque and maximum knee flexion work were greater in SR group at 180°/s and 60°/s. At 60°/s, and SR group had higher average knee flexion power and average knee extension power than MR group. In the isometric contraction test, the knee extension torque was higher in SR group than in MR group. At 180°/s, SR group showed higher flexion torques at 30°, 40°, 50°, 60° compared with MR group. At 60°/s, SR group showed higher flexion torques at 30°, 40°, 50°, 60°, 80° when compared with MR group. Additionally, SR group also provided higher extension torques at 40°, 50°, 60° than the MR group. There were no differences in other isokinetic and isometric parameters between the two groups. Conclusion Femoral design exerted an influence on quadriceps and hamstring strength after TKA, and SR design shows advantages, in terms of higher extension and flexion strength, over MR design.
Collapse
|
5
|
Kim J, Min KD, Lee BI, Kim JB, Kwon SW, Chun DI, Kim YB, Seo GW, Lee JS, Park S, Choi HS. Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Relat Res 2020; 32:52. [PMID: 33008475 PMCID: PMC7531164 DOI: 10.1186/s43019-020-00067-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. MATERIALS AND METHODS We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. RESULTS The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSS-knee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. CONCLUSIONS The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.
Collapse
Affiliation(s)
- Jahyung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Kyung-Dae Min
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
| | - Byung-Ill Lee
- Department of Orthopaedic Surgery, Smarton Hospital, Bucheon, South Korea
| | - Jun-Bum Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea
| | - Sai-Won Kwon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Yong-Beom Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Gi-Won Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, South Korea
| | - Jeong Seok Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital Seoul, Seoul, South Korea
| | - Hyung-Suk Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea.
| |
Collapse
|
6
|
Jenny JY, Saragaglia D, Bercovy M, Cazenave A, Gaillard T, Châtain F, Jolles B, Rouvillain JL. Inconsistent relationship between body weight/body mass index prior to total knee arthroplasty and the 12-year survival. Knee 2019; 26:1372-1378. [PMID: 31635946 DOI: 10.1016/j.knee.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/06/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The primary hypothesis was that body weight (BW) and body mass index (BMI) significantly impact the long-term survival rate after implantation of a mobile bearing total knee arthroplasty (TKA). METHODS A national, multicentric, retrospective study was performed in France. A total of 1604 TKAs were included. The 10-year follow-up was documented, and the influence of BW and BMI on the survival rate was assessed. RESULTS There was a significant influence of the BW on the 12-year survival rate for any reason and for infection; but this influence was not proportional to the BW or BMI. There was no significant influence of the BMI on the 12-year survival rate for any reason, for any mechanical reason or for infection. CONCLUSION Our results suggest that a higher BMI should not be considered as a risk factor for revision for mechanical purpose if a mobile bearing TKA with confirming design is implanted.
Collapse
Affiliation(s)
- Jean-Yves Jenny
- University Hospital Strasbourg, Pôle Locomax, 1 Avenue Molière, Strasbourg, France.
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, Echirolles, France
| | - Michel Bercovy
- Clinique Arago, 187A Rue Raymond Losserand, Paris, France
| | - Alain Cazenave
- Institut CALOT, Department of Orthopedic Surgery, 52 rue du Dr Calot, Berck-sur-Mer, France
| | - Thierry Gaillard
- Polyclinique du Beaujolais, 120 Ancienne Route de Beaujeu, Arnas, France
| | - Frédéric Châtain
- Pole Santé Axone, 75 Avenue Gabriel Péri, Saint-Martin-d'Hères, France
| | - Brigitte Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Avenue Louis-Ruchonnet 57, Lausanne, Switzerland; Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, Lausanne, Switzerland
| | - Jean-Louis Rouvillain
- Department of Orthopaedic and Trauma Surgery, Hôpital Zobda Quitman, Fort-de-France, France
| | | |
Collapse
|
7
|
Jenny JY, Saragaglia D. No Detectable Polyethylene Wear 15 Years After Implantation of a Mobile-Bearing Total Knee Arthroplasty With Electron Beam-Irradiated Polyethylene. J Arthroplasty 2019; 34:1690-1694. [PMID: 31000400 DOI: 10.1016/j.arth.2019.03.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The present study was designed to evaluate the risk of significant polyethylene (PE) wear 10 years or more after implantation of a total knee arthroplasty (TKA) using electron beam-irradiated highly cross-linked PE component. METHODS All patients operated between 2001 and 2004 for implantation of this particular TKA in the two participating centers were eligible for this study. All patients were contacted after the 10-year follow-up for repeat clinical examination and radiological evaluation. The occurrence of a revision prior to the final evaluation and its reason were recorded. The thickness of the PE piece was measured on plain X-rays. RESULTS Five hundred seventy-eight TKAs were implanted during the study time-frame. One hundred sixteen patients deceased prior to the 10-year follow-up (20%). An additional 121 patients were lost to follow-up prior to the 10-year follow-up (21%). Complete follow-up at 10 years or more (including death or revision) was obtained for 448 cases (78%). Ten prosthetic revisions were performed for mechanical reasons during the follow-up time (2%). One single revision was performed because PE wear after 13 years. No significant PE wear was detected at the final radiographic evaluation for nonrevised cases. The 10-year survival rate for mechanical revision only was 98.0% and decreased to 96.2% at 15 years. CONCLUSION The use of electron beam-irradiated PE was associated with an extremely low incidence of wear. This technology may be considered as safe regarding PE behavior for TKA after more than 10 years. Further improvement of PE manufacturing may be not required.
Collapse
Affiliation(s)
- Jean-Yves Jenny
- Pole Locomax, University Hospital Strasbourg, Strasbourg, France
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, Echirolles, France
| |
Collapse
|
8
|
Luo Z, Luo Z, Wang H, Xiao Q, Pei F, Zhou Z. Long-term results of total knee arthroplasty with single-radius versus multi-radius posterior-stabilized prostheses. J Orthop Surg Res 2019; 14:139. [PMID: 31097037 PMCID: PMC6521522 DOI: 10.1186/s13018-019-1183-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/03/2019] [Indexed: 02/05/2023] Open
Abstract
Background Single-radius (SR) prostheses and multi-radius (MR) prostheses have different theoretical advantages; however, there has been a paucity of evaluations comparing the two. This study was designed to compare the 10-year clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Methods In this retrospective cohort study, 220 consecutive patients undergoing TKA between October 2006 and October 2007 were divided into the SR group (106 patients, Stryker Scorpio NRG) and the MR group (114 patients, DePuy Sigma PFC), with a minimum follow-up of 10 years. Clinical, functional, and radiological outcomes, as well as satisfaction rates and survival results, were evaluated. Results Hospital for Special Surgery and Short Form-12 health survey scores were all significantly improved in both groups at the final follow-up (P < 0.05), but the groups did not differ. The SR group had significantly less anterior knee pain (AKP) and painless crepitation (P < 0.05). Radiological results in terms of radiolucent lines and component position angle showed no differences between groups. The Kaplan-Meier survival curve estimates at 10 years were not significantly different between the groups (P = 0.4172). Conclusion Both SR and MR posterior-stabilized prostheses can lead to satisfactory outcomes. The SR prosthesis design gave less anterior knee pain than did the MR prostheses. Two prostheses showed no differences in terms of clinical scales, radiological results, satisfaction rates, and survival results at a long-term follow-up. More accurate measurements are required.
Collapse
Affiliation(s)
- Zhenyu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Zeyu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Haoyang Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Qiang Xiao
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China.
| |
Collapse
|
9
|
Radiographic measurement of the posterior femoral offset is not precise. Knee Surg Sports Traumatol Arthrosc 2017; 25:2609-2615. [PMID: 26537598 DOI: 10.1007/s00167-015-3855-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The posterior femoral offset may significantly impact the final flexion range after total knee arthroplasty (TKA). The purpose of the present study was to compare a conventional, radiologic-based technique with an intra-operative, surgical navigation-based technique for the measurement of posterior femoral offset. The tested hypothesis was that the two measurement techniques produce different results both before and after TKA. METHODS One-hundred consecutive cases referred for end-stage knee osteoarthritis have been studied. Posterior femoral offsets, measured pre- and post-TKA from radiographs, as well as those measured from a navigation system intra-operatively, were analysed. The pre-TKA measured offsets, post-TKA measured offsets and the changes (pre- vs. post-TKA) in the offsets were statistically compared between the radiologic and the navigated measurement techniques at a 0.05 level of significance. RESULTS The mean paired difference between pre-TKA radiologic and navigated measurement was 4 ± 4 mm (p < 0.001). There was a significant and moderate positive correlation with a good coherence between the two measurements. The mean paired difference between post-TKA radiologic and navigated measurement was 6 ± 5 mm (p < 0.001). There was a significant and moderate positive correlation but a poor coherence between the two measurements. CONCLUSIONS The conventional radiologic technique for the measurement of the posterior femoral offset cannot be reliably used either for pre-TKA planning of the posterior femoral resection and antero-posterior sizing of the femoral component, or for post-TKA quality control of the reconstruction of the posterior femoral offset. LEVEL OF EVIDENCE Level IV.
Collapse
|
10
|
Value of the cumulative sum test for the assessment of a learning curve: Application to the introduction of patient-specific instrumentation for total knee arthroplasty in an academic department. Knee 2017; 24:615-621. [PMID: 28396050 DOI: 10.1016/j.knee.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/08/2017] [Accepted: 03/16/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of the study was to use the cumulative summation (CUSUM) test to assess the learning curve during the introduction of a new surgical technique (patient-specific instrumentation) in total knee arthroplasty (TKA) in an academic department. METHODS The first 50TKAs operated on at an academic department using patient-specific templates (PSTs) were scheduled to enter the study. All patients had a preoperative computed tomography scan evaluation to plan bone resections. The PSTs were positioned intraoperatively according to the best-fit technique and their three-dimensional orientation was recorded by a navigation system. The position of the femur and tibia PST was compared to the planned position for four items for each component: coronal and sagittal orientation, medial and lateral height of resection. Items were summarized to obtain knee, femur and tibia PST scores, respectively. These scores were plotted according to chronological order and included in a CUSUM analysis. The tested hypothesis was that the PST process for TKA was immediately under control after its introduction. RESULTS CUSUM test showed that positioning of the PST significantly differed from the target throughout the study. There was a significant difference between all scores and the maximal score. No case obtained the maximal score of eight points. The study was interrupted after 20 cases because of this negative evaluation. CONCLUSION The CUSUM test is effective in monitoring the learning curve when introducing a new surgical procedure. Introducing PST for TKA in an academic department may be associated with a long-lasting learning curve. The study was registered on the clinical.gov website (Identifier NCT02429245).
Collapse
|
11
|
Hinarejos P, Puig-Verdie L, Leal J, Pelfort X, Torres-Claramunt R, Sánchez-Soler J, Monllau JC. No differences in functional results and quality of life after single-radius or multiradius TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24:2634-40. [PMID: 26658566 DOI: 10.1007/s00167-015-3894-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The main objective of this study was to compare the functional results and the impact on quality of life after a single-radius or a multiradius TKA implantation. The secondary objectives were to compare range of motion, satisfaction and the ability to perform daily life activities with both types of implant. It was hypothesized that the single-radius TKA would lead to better functional results and better quality of life than the multiradius TKA. METHODS This is a prospective non-randomized study that included 250 cases of a single-radius TKA and 224 of a multiradius posterior-stabilized TKA implanted with the same surgical and rehabilitation protocol. RESULTS In the 1- and 5-year follow-up, we found similar knee KSS scores (89.7 ± 12.1 in the multiradius group and 90.3 ± 11.7 in the single-radius group) and functional KSS scores (78.6 ± 21.4 in the multiradius group and 75.8 ± 20.9 in the single-radius group). The pain and the Physical SF-36 scores were also similar. Range of motion (112° ± 12° in the multiradius group and 112 ± 12° in the single-radius group), patients' satisfaction and the ability to perform daily life activities were also similar in both groups. CONCLUSION The use of a single-radius or a multiradius posterior-stabilized knee prosthesis can improve the function of the knee and the patients' quality of life in a similar way at the short-term and midterm follow-up. Moreover, range of motion, patient satisfaction and the ability to perform daily life activities are similar with both types of prosthesis. As both types of prosthesis can improve the function and quality of life of the patients in a similar way, the sagittal radius of the femoral component should not be considered the main factor when choosing the model of TKA. LEVEL OF EVIDENCE Therapeutic study: Prospective comparative study, Level II.
Collapse
Affiliation(s)
- Pedro Hinarejos
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain.
| | - Lluis Puig-Verdie
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Joan Leal
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Xavier Pelfort
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Joan C Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| |
Collapse
|
12
|
Albrecht DC, Ottersbach A. Retrospective 5-Year Analysis of Revision Rate and Functional Outcome of TKA With and Without Patella Implant. Orthopedics 2016; 39:S31-5. [PMID: 27219724 DOI: 10.3928/01477447-20160509-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/04/2016] [Indexed: 02/03/2023]
Abstract
The aim of this study was to compare a patient cohort after total knee arthroplasty (TKA) in terms of the revision rate and the functional outcome, with and without patella resurfacing. Sixty-six patients (71 TKAs) were implanted with the mobile-bearing knee prosthesis system e.motion UC (Aesculap AG, Tuttlingen, Germany). These patients were divided into 2 groups, 1 of which received primary patella resurfacing (PPR; 51 TKAs) and 1 of which did not (non-PPR; 20 TKAs), with an average follow-up of 65.6 months (±6.9). The cohort was recorded consecutively. The evaluation was performed using the Knee Society Score and selected questions relating to the Knee Injury and Osteoarthritis Outcome Score, as well as with radiographs. Results showed that PPR was no better than non-PPR in terms of functional outcome. Two knees (10%) were revised in the non-PPR group, and 1 knee (1.96%) in the PPR group (not significant). In this cohort, 100% of implants, including the 5 TKAs of patients who did not attend the follow-up examination, had neither explanted nor loosened at the time of follow-up examination. The authors concluded that the revision rate for PPR is slightly lower, and this avoids the need for secondary patella resurfacing. The risk for complications is low, and the functional outcome is comparable. [Orthopedics. 2016; 39(3):S31-S35.].
Collapse
|
13
|
Liu S, Long H, Zhang Y, Ma B, Li Z. Meta-Analysis of Outcomes of a Single-Radius Versus Multi-Radius Femoral Design in Total Knee Arthroplasty. J Arthroplasty 2016; 31:646-54. [PMID: 26614746 DOI: 10.1016/j.arth.2015.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although the single-radius (SR) femoral design is known to have theoretical advantages in many aspects, studies of clinical outcomes that compare the SR with the multiple-radius (MR) femoral design are controversial. We performed a meta-analysis to address the hypothesis that a SR femoral design in primary total knee arthroplasty improves patient outcomes. METHODS The meta-analysis identified 15 articles reporting the clinical outcomes of 2212 knee replacements using the SR (n = 948) compared with the multiradius (MR; n = 1361) femoral design. Comparing SR with MR, we examined the Knee Society Score for the knee (KSS-knee), KSS-function, knee flexion, range of motion, complications, isometric peak torque of knee, and survival rate. RESULTS The range of motion of SR knees was lower than that of MR knees. No differences were found in the analyses of KSS-knee, KSS-function, knee flexion, complications, isometric peak torque of the knee, and survival rate. CONCLUSION Our meta-analysis does not provide clinical support for the previously reported theoretical advantages of the SR implant design.
Collapse
Affiliation(s)
- Shiluan Liu
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Hua Long
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Yinglong Zhang
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Baoan Ma
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Zhao Li
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| |
Collapse
|
14
|
Kim DH, Kim DK, Lee SH, Kim KI, Bae DK. Is Single-Radius Design Better for Quadriceps Recovery in Total Knee Arthroplasty? Knee Surg Relat Res 2015; 27:240-6. [PMID: 26676282 PMCID: PMC4678245 DOI: 10.5792/ksrr.2015.27.4.240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/21/2015] [Accepted: 10/19/2015] [Indexed: 11/04/2022] Open
Abstract
Purpose Although single-radius (SR) designs have a theoretical advantage in quadriceps recovery following total knee arthroplasty (TKA), there has been a paucity of objective evaluation studies. Materials and Methods One hundred and twenty minimally invasive TKAs were prospectively randomized by a single surgeon into 2 groups: SR design TKA group and multi-radius design TKA group. Quadriceps force and power were assessed using a dynamometer, and clinical data were investigated preoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. Results There were no differences between two groups in quadriceps recovery and clinical results throughout the follow-up period. Furthermore, the proportion of patients whose postoperative quadriceps force and power reached preoperative level was similar in both groups. Conclusions Femoral component design itself would not significantly influence quadriceps recovery after TKA.
Collapse
Affiliation(s)
- Duk-Hyun Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dong-Kyoon Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dae-Kyung Bae
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| |
Collapse
|
15
|
No difference in clinical and radiologic outcomes after total knee arthroplasty with a new ultra-congruent mobile bearing system and rotating platform mobile bearing systems after minimum 5-year follow-up. J Arthroplasty 2015; 30:379-83. [PMID: 25449590 DOI: 10.1016/j.arth.2014.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/10/2014] [Accepted: 09/25/2014] [Indexed: 02/01/2023] Open
Abstract
We retrospectively compared the clinical and radiographic results between 76 primary total knee arthroplasties (TKAs) using the e.motion Ultra-Congruent prosthesis and 155 primary TKAs using the Low Contact Stress rotating platform. All patients had a minimum 5-year follow-up. Range of motion, Hospital for Special Surgery score, Knee Society Knee Score and Knee Society Functional Score significantly increased in both groups postoperatively, but there was no significant difference between the two groups. The mechanical femorotibial angle improved in both groups postoperatively. Coronal and sagittal component angles were well maintained at the final follow-up. This study demonstrates that a new mobile-bearing prosthesis, designed to be highly congruent with a rotating bearing, could be considered with theoretical advantages and comparable outcomes of established mobile-bearing prostheses.
Collapse
|
16
|
A comparison of stability and clinical outcomes in single-radius versus multi-radius femoral design for total knee arthroplasty. J Arthroplasty 2014; 29:2402-6. [PMID: 24793892 DOI: 10.1016/j.arth.2014.03.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 02/01/2023] Open
Abstract
We compared the intraoperative varus-valgus stability from 0° to 90° of flexion and postoperative clinical outcomes in patients receiving TKA via either a single-radius femoral design (50 TKA, SR group) or multi-radius femoral design (50 TKA, MR group). We measured stabilities at 0°, 30°, 60° and 90° of flexion using a navigation system. The clinical outcomes including HSS scores, WOMAC scores and VAS score during stair climbing were compared after a minimum of 2-year follow-up. The single-radius femoral designs in TKA showed better intra-operative stability at 30° of flexion (7.6 vs. 8.3) compared with the multi-radius femoral design, but not at other angles. However, the clinical outcomes revealed no other significant differences in terms of HSS scores, WOMAC scores and VAS score between two groups.
Collapse
|
17
|
Maas A, Kim TK, Miehlke RK, Hagen T, Grupp TM. Differences in anatomy and kinematics in Asian and Caucasian TKA patients: influence on implant positioning and subsequent loading conditions in mobile bearing knees. BIOMED RESEARCH INTERNATIONAL 2014; 2014:612838. [PMID: 25538943 PMCID: PMC4258361 DOI: 10.1155/2014/612838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 11/17/2022]
Abstract
The objective of our study was to determine the mechanical stress conditions under tibiofemoral loading with an overlay of knee kinematics in deep flexion on two different mobile bearing designs in comparison to in vivo failure modes. This study investigates the seldom but severe complication of fatigue failure of polyethylene components at mobile bearing total knee arthroplasty designs. Assuming a combination of a floor-based lifestyle and tibial malrotation as a possible reason for a higher failure rate in Asian countries we developed a simplified finite element model considering a tibiofemoral roll-back angle of 22° and the range of rotational motion of a clinically established floating platform design (e.motion FP) at a knee flexion angle of 120° in order to compare our results to failure modes found in retrieved implants. Compared to the failure mode observed in the clinical retrievals the locations of the occurring stress maxima as well as the tensile stress distribution show analogies. From our observations, we conclude that the newly introduced finite element model with an overlay of deep knee flexion (lateral roll-back) and considerable internally rotated tibia implant positioning is an appropriate analysis for knee design optimizations and a suitable method to predict clinical failure modes.
Collapse
Affiliation(s)
- Allan Maas
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
| | - Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - Rolf K. Miehlke
- Knee Division, The Rhine-Main Centre for Joint Diseases, Wilhelmstraße 30, 65183 Wiesbaden, Germany
- Knee Division, The Muensterland Centre for Joint Diseases, Buelt 13, 48143 Muenster, Germany
| | - Thomas Hagen
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
| | - Thomas M. Grupp
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany
| |
Collapse
|
18
|
Hunt NC, Ghosh KM, Blain AP, Athwal KK, Rushton SP, Amis AA, Longstaff LM, Deehan DJ. How does laxity after single radius total knee arthroplasty compare with the native knee? J Orthop Res 2014; 32:1208-13. [PMID: 24841798 DOI: 10.1002/jor.22645] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/18/2014] [Indexed: 02/04/2023]
Abstract
Patients with total knee arthroplasties (TKAs) continue to report dissatisfaction in functional outcome. Stability is a major factor contributing to functionality of TKAs. Implants with single-radius (SR) femoral components are proposed to increase stability throughout the arc of flexion. Using computer navigation and loaded cadaveric legs, we characterized the "envelope of laxity" (EoL) offered by a SR cruciate retaining (CR)-TKA compared with that of the native knee through the arc of flexion in terms of anterior drawer, varus/valgus stress, and internal/external rotation. In both the native knee and the TKA laxity increased with increasing knee flexion. Laxities measured in the three planes of motion were generally comparable between the native knee and TKA from 0° to 110° of flexion. Our results indicate that the SR CR-TKA offers appropriate stability in the absence of soft tissue deficiency.
Collapse
Affiliation(s)
- Nicola C Hunt
- Institute of Cellular Medicine, Framlington Place Newcastle University, Newcastle upon Tyne, United Kingdom; Freeman Hospital, High Heaton, Newcastle upon Tyne, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|