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Hu M, Xiang S, Xu H, Wang Y, Lv C, Zhang H. Equivalence of clinical and radiological outcomes in cruciate-retaining and cruciate-substituting total knee arthroplasty with medial pivot knee: A comparative study. Heliyon 2023; 9:e22741. [PMID: 38213584 PMCID: PMC10782168 DOI: 10.1016/j.heliyon.2023.e22741] [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: 04/01/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
Introduction Total knee arthroplasty (TKA) has been recognized as the most efficacious surgical intervention for individuals suffering from advanced arthritis; however, there is ongoing debate on the technical details of the procedure. It remains unknown whether preservation of the posterior cruciate ligament (PCL) significantly affects the mid-to long-term performance of ADVANCE® medial-pivotal (AMP) knee implants to enhance patient satisfaction. The hypothesis of this study was to investigate whether the preservation of the PCL has a substantial impact on the functional outcomes of medial pivot (MP) implants in patients undergoing TKA. Therefore, this study aimed to compare the midterm clinical and radiographic outcomes of cruciate-retaining (CR) and cruciate-substituting (CS) TKA using MP prostheses. Methods We included 376 consecutive patients who underwent unilateral TKA between January 2011 and April 2014. Follow-up evaluations were conducted in April 2021. After propensity score matching analysis, clinical and radiological outcomes and complication rates were compared between patients in the CR and CS groups. Results The postoperative outcomes in the two groups significantly improved the preoperative conditions of the patients (all p > 0.05). The postoperative outcomes (WOMAC score, p = 0.517; KSS, p = 0.107; KSFS, p = 0.240; ROM, p = 0.795; FJS, p = 0.822) and radiographic outcomes (preoperative FTA, p = 0.997; postoperative FTA, p = 0.646; aLDFA, p = 0.094; aMPTA, p = 0.970; PTS, p = 0.243) were comparable between the two groups. The complication and revision rates between the groups were not statistically significant (p = 0.34). The Kaplan-Meier cumulative survival of patients in the CRTKA and CSTKA groups was 100 % and 98.6 %, respectively. Conclusions This study supports the hypothesis that when MP prostheses are used, both CR and CS procedures achieve equally good mid-to long-term clinical and radiographic outcomes and complication rates. These findings suggest that PCL preservation may not significantly affect the overall performance of MP implants in patients undergoing TKA.
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Affiliation(s)
| | | | - Hao Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengyu Lv
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Budhiparama NC, Lumban-Gaol I, Novito K, Hidayat H, De Meo F, Cacciola G, Cavaliere P. PCL retained is safe in medial pivot TKA-a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:5856-5863. [PMID: 37962615 PMCID: PMC10719124 DOI: 10.1007/s00167-023-07634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Medial pivot (MP) designs resemble native knee kinematics and restore the "natural" kinematics of a knee after total knee arthroplasty (TKA). However, whether to preserve or resect the posterior cruciate ligament (PCL) is still under debate. We inquired whether sacrificing the PCL would improve range of motion, functional outcomes, and limb alignment compared to preserving the PCL in TKA using medial pivot implants (MP-TKA). METHODS This prospective, double-blinded, randomized controlled trial consisted of 33 patients (66 knees) undergoing bilateral simultaneous MP-TKA. In one knee, a PCL preservation technique was performed, and in the contralateral knee, the PCL was resected. The primary outcome was postoperative range of motion (ROM). The secondary outcomes were visual analogue scale (VAS) score for knee pain at walking, Knee Injury and Osteoarthritis Outcome Score for symptoms (KOOS-S) and quality of life (KOOS-QoL), Oxford knee score (OKS), and Forgotten Joint Score (FJS), and measurement of the mechanical femoral-tibial axis (mFTA) on X-ray images. All patients were followed up for a minimum of 2 years after surgery. RESULTS Patients who underwent MP-TKA with PCL preservation had a similar ROM at 2 years (125.45 ± 7.00 vs. 126.21 ± 6.73, p = 0.65) as those who underwent MP-TKAs with PCL resection. There was also no difference in VAS score (1.94 ± 0.79 vs. 2.00 ± 0.71, respectively, p = 0.51), OKS (39.97 ± 2.01 vs. 39.67 ± 2.03, respectively, p = 0.52), KOOS-S (84.41 ± 3.77 vs. 84.19 ± 3.57, respectively, p = 0.92), KOOS-QoL (82.94 ± 4.76 vs. 82.75 ± 4.70, respectively, p = 0.84), or FJS (72.66 ± 8.99 vs. 72.35 ± 8.64, respectively, p = 0.76) at the 2-year follow-up. No difference in the measurement of the mFTA was found between the two groups (180.27 ± 2.25 vs. 181.30 ± 2.13, respectively, p = 0.59). CONCLUSION This study demonstrated that both medial pivot TKA with PCL preservation and PCL resection achieved excellent results. There was no difference at the 2-year follow-up in terms of postoperative ROM, patient-reported outcomes, or radiographic evaluation. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Nicolaas C Budhiparama
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands.
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia.
| | - Imelda Lumban-Gaol
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Kiki Novito
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Hendy Hidayat
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Federico De Meo
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Pietro Cavaliere
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
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Pacheco Elorza S, O'Donnell E, Delman C, Howell SM, Hull ML. Posterior cruciate ligament retention with medial ball-in-socket conformity promotes internal tibial rotation and knee flexion while providing high clinical outcome scores. Knee 2023; 43:153-162. [PMID: 37413777 DOI: 10.1016/j.knee.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/27/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Although retaining the posterior cruciate ligament (PCL) is advantageous in unrestricted kinematically aligned TKA, it is often excised with a medial stabilized implant. The primary objectives were to determine whether PCL retention using an insert with ball-in-socket (B-in-S) medial conformity to maximize A-P stability promotes internal tibial rotation and flexion while providing high patient-reported outcome scores. METHODS Two cohorts of 25 patients each were treated with unrestricted kinematically aligned (KA) TKA using a tibial insert with B-in-S medial conformity and a flat lateral articular surface. One cohort retained the PCL; the other had it excised. Patients performed deep knee bend and step-up exercises during fluoroscopic imaging. Following 3D model-to-2D image registration, anterior-posterior (A-P) positions of the femoral condyles and tibial rotation were determined. RESULTS For deep knee bend, mean internal tibial rotation with PCL retention was significantly greater at maximum flexion (17.7° ± 5.7° versus 10.4° ± 6.5°, p < 0.001) and significantly greater at 30°, 60°, and 90° flexion as well (p ≤ 0.0283). For step-up, mean internal tibial rotation with PCL retention was significantly greater at at 15°, 30°, and 45° flexion (p ≤ 0.0049) but was marginally not significantly greater at 60° (i.e. maximum) flexion (12.3° ± 4.4° versus 10.1° ± 5.4°, p = 0.0794). Mean flexion during active knee flexion with PCL retention was significantly greater (127° ± 8° versus 122° ± 6°, p = 0.0400). Both cohorts had high median Oxford Knee, WOMAC, and Forgotten Joint Scores that were not significantly different (p = 0.0918, 0.1448, and 0.0855, respectively) CONCLUSION: Surgeons that perform unrestricted KA TKA should retain the PCL with an insert that has B-in-S medial conformity, as this maintains extension and flexion gaps while also promoting internal tibial rotation and knee flexion as well as providing high clinical outcome scores.
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Affiliation(s)
- Saúl Pacheco Elorza
- Department of Mechanical Engineering, University of California Davis, Davis, CA 95616, USA
| | - Ed O'Donnell
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817 USA
| | - Connor Delman
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817 USA
| | - S M Howell
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
| | - M L Hull
- Department of Mechanical Engineering, University of California Davis, Davis, CA 95616, USA; Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817 USA; Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA.
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Fang C, Luan Y, Wang Z, Shao L, Qu T, Cheng CK. Moderate External Rotation of Tibial Component Generates More Natural Kinematics Than Internal Rotation After Total Knee Arthroplasty. Front Bioeng Biotechnol 2022; 10:910311. [PMID: 35910010 PMCID: PMC9327137 DOI: 10.3389/fbioe.2022.910311] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the influence of tibial malrotation on knee kinematics after total knee arthroplasty (TKA). A symmetric fixed-bearing posterior-stabilized prosthesis was implanted in the validated knee model with different rotational alignments of the tibial component (neutral, 3° external rotation, 5° external rotation, 3° internal rotation, and 5° internal rotation). Computational kinematic simulations were used to evaluate the postoperative kinematics of the knee joint including anteroposterior translation femoral condyles and axial rotation of tibial component during 0°–135° knee flexion. The results revealed that the neutral position of the tibial component was not the closest kinematics to the intact knee, the model with 5° external rotation of the tibial component showed the closest lateral condyle translation and tibial axial rotation, and moderate external rotation could improve the kinematics after TKA.
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Affiliation(s)
- Chaohua Fang
- Department of Joint Surgery, Ningbo No. 6 Hospital, Ningbo, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
| | - Yichao Luan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zhiwei Wang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Beijing, China
| | - Long Shao
- Department of Joint Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Tiebing Qu
- Department of Orthopaedics, Beijing Boai Hospital, Beijing, China
- The Center of Diagnosis and Treatment for Joint Disease, China Rehabilitation Research Center, Beijing, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- *Correspondence: Cheng-Kung Cheng,
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Inokuchi T, Ishida K, Takayama K, Shibanuma N, Hayashi S, Kurosaka M, Kuroda R, Matsumoto T. Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:2816-2822. [PMID: 31324963 DOI: 10.1007/s00167-019-05624-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the correlation between intraoperative tibiofemoral anteroposterior changes at 90° of flexion and postoperative maximum flexion angles in navigated cruciate-substituting TKA. The hypothesis of this study was that intraoperative tibiofemoral anteroposterior changes at 90° of flexion indirectly reflect posterior cruciate ligament (PCL) function and associate with postoperative maximum flexion angles. METHODS Fifty-five consecutive patients with varus osteoarthritis treated with primary TKA were retrospectively analysed. All patients received the same type of implant, placed with an image-free navigation system. The PCL was retained, and cruciate-substituting inserts were used in all cases. The mean follow-up was 44 ± 8 months. The preoperative and postoperative kinematics were measured intraoperatively with a navigation system, and the preoperative and postoperative tibiofemoral anteroposterior positions at 90° of flexion were determined. The correlation between intraoperative anteroposterior position changes and postoperative maximum flexion angles was investigated. The correlation between the change of anteroposterior position and tibiofemoral rotational angles was also assessed. RESULTS The intraoperative anteroposterior position change was -1.7 ± 3.4 mm (a positive value indicates tibial posterior shift). Flexion angle improvement was negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2 = 0.17, p < 0.005). Postoperative maximum flexion angles were also negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2 = 0.09, p < 0.05). The postoperative amount of tibial internal rotation was positively correlated with the preoperative amount (R2 = 0.60, p < 0.0001); however, the intraoperative anteroposterior position change was not correlated with the postoperative amount of tibial internal rotation (n.s.). CONCLUSION A navigation system may be able to indirectly evaluate PCL function and predict the postoperative flexion angles in cruciate-substituting TKA. Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting TKA. LEVEL OF EVIDENCE Level 3, retrospective comparative study.
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Affiliation(s)
- Takao Inokuchi
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.,Department of Orthopedic Surgery, Kobe Rehabilitation Center Hospital, 1070 Akebono, Nishi, Kobe, 651-2181, Japan
| | - Kazunari Ishida
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.
| | - Koji Takayama
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Nao Shibanuma
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Masahiro Kurosaka
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
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Canham CD, Incavo SJ. The Medial Stabilized Knee Guides Knee Motion. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Choi NY, In Y, Bae JH, Do JH, Chung SJ, Koh IJ. Are Midterm Patient-Reported Outcome Measures Between Rotating-Platform Mobile-Bearing Prosthesis and Medial-Pivot Prosthesis Different? A Minimum of 5-Year Follow-Up Study. J Arthroplasty 2017; 32:824-829. [PMID: 27667531 DOI: 10.1016/j.arth.2016.08.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 07/23/2016] [Accepted: 08/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Both rotating-platform (RP) mobile-bearing and medial-pivot (MP) fixed-bearing prostheses allow axial femorotibial rotation using a highly conforming polyethylene insert. However, limited comparative data are available between the 2 designs. This study was performed to compare the midterm clinical outcomes and patient-reported outcome measures (PROMs) of RP and MP prostheses. METHODS We retrospectively reviewed the records of 52 total knee arthroplasties using RP mobile-bearing prosthesis and 49 total knee arthroplasties using MP fixed prosthesis with a minimum follow-up period of 5 years. Clinical and radiological outcomes, failure rates, and PROMs, including the Western Ontario and McMaster Universities Osteoarthritis Index score and satisfaction, were compared. RESULTS There was no difference in clinical or radiographic outcomes (P > .1 for all comparisons), with the exception of the larger flexion contracture (FC) in the MP group (0.3° in RP vs 2.3° in MP, P < .01). No failure in either group was recorded during the study period. PROMs were comparable (P > .1 in all comparisons), with the exception of higher satisfactions in the RP group while performing light household duties (P < .01) and leisure or recreational activities (P = .014) in patients without FC. CONCLUSION The midterm clinical results with both the RP mobile-bearing and MP fixed-bearing prostheses were satisfactory. Although both prostheses provided comparable PROMs, patients with an RP prosthesis were more satisfied than those with an MP prosthesis for highly demanding activities that are strongly associated with the presence of postoperative FC.
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Affiliation(s)
- Nam Y Choi
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jae-Ho Bae
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea
| | - Jung-Hoon Do
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea
| | - Seung J Chung
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In J Koh
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
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Atzori F, Salama W, Sabatini L, Mousa S, Khalefa A. Medial pivot knee in primary total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:6. [PMID: 26855942 DOI: 10.3978/j.issn.2305-5839.2015.12.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.
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Affiliation(s)
- Francesco Atzori
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Wael Salama
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Luigi Sabatini
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Shazly Mousa
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Abdelrahman Khalefa
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
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