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Yang B, Yuan FZ, Wang HJ, Gong X, Chang YH, Yu JK. Femoral anterior condyle height decreases as the distal anteroposterior size increases in total knee arthroplasty: A comparative study. PLoS One 2024; 19:e0297634. [PMID: 38408088 PMCID: PMC10896507 DOI: 10.1371/journal.pone.0297634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE The anterior flange height of the current femoral component increases with an increasing distal femoral anteroposterior dimension. During total knee arthroplasty (TKA), we have observed that a large femur may have a thinner anterior condyle, whereas a small femur may have a thicker anterior condyle. The first purpose of this study was to examine whether the femoral anterior condyle height decreases as the distal femoral anteroposterior size increases and whether gender differences exist in anterior condyle height. METHODS A total of 1218 knees undergoing TKA intraoperative and computed tomography scans from 303 healthy knees were used to measure the anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and the lateral anteroposterior (LAP) and medial anteroposterior (MAP) dimensions of distal femurs. The LAP and MAP measurements were used for adjustments to determine whether gender differences exist in anterior condyle heights. Linear regression analysis was performed to determine correlations between ALCH and LAP or between AMCH and MAP. RESULTS There were significant differences between males and females in ALCH in both the CT and TKA groups and AMCH in the CT group (all P<0.01). After adjusting for LAP and MAP, there were significant gender differences in the lateral and medial condylar heights in both groups (P<0.01). There were significant negative correlations between ALCH and LAP values and between AMCH and MAP values in both CT and TKA measurements, with the LAP and MAP values increasing as ALCH and AMCH decreased. CONCLUSIONS The results demonstrate that femoral anterior condylar height decreased with increasing anteroposterior dimension in both the medial and lateral condyle. In addition, this study also showed that anterior condylar heights are highly variable, with gender differences. The data may provide an important reference for designing femoral anterior flange thickness to precisely match the natural anterior condylar anatomy.
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Affiliation(s)
- Bo Yang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, The Third Affiliated hospital of Xi'an jiaotong University, Xi'an, China
| | - Fu-Zhen Yuan
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Hai-Jun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xi Gong
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yan-Hai Chang
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, The Third Affiliated hospital of Xi'an jiaotong University, Xi'an, China
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Changping District, Beijing, China
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Effect of total knee arthroplasty for valgus knee correction on clinical outcome and patellar position. INTERNATIONAL ORTHOPAEDICS 2023; 47:735-743. [PMID: 36645475 PMCID: PMC9931837 DOI: 10.1007/s00264-023-05689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/01/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose was to investigate the effect of different degrees of valgus deformity correction on patellar position and clinical outcome in patients with valgus knees after total knee arthroplasty (TKA). METHODS We retrospectively analyzed and followed 118 patients with valgus knees. Based on the post-operative hip-knee-ankle (HKA), patients were divided into three groups: neutral (±3°), mild (3-6°), and severe (> 6°). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and Knee Society Score (KSS) were used to evaluate post-operative clinical efficacy. Also, the patellar tilt angle (ε-angle), congruence angle (θ-angle), and Insall-Salvati index (ISI) were used to represent the patellar position. Post-operative observation indicators included HKA, angle of the femur (α-angle), tibial angle (β-angle), femoral component flexion angle (γ-angle), and tibial component posterior slope angle (δ-angle). RESULTS All patients showed significant improvements in HKA, ROM, WOMAC, and KSS after operation (P < 0.001). Regarding patellar position, the ISI values decreased to varying degrees (P < 0.05). The patellar tilt angle was significantly increased in the severe valgus group compared to that in the mild valgus and neutral groups (P < 0.001). Univariate analysis showed that the degree of post-operative residual valgus was significantly affected by WOMAC, KSS, α-, ε-, and θ-angles. CONCLUSION Minor valgus undercorrection did not affect the short-term outcome after TKA; however, when the residual valgus angle was > 6°, the post-operative scores were significantly reduced. Inadequate valgus correction does not result in significant changes in patellar height but may increase the risk of poor patellar tracking.
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Kebbach M, Geier A, Darowski M, Krueger S, Schilling C, Grupp TM, Bader R. Computer-based analysis of different component positions and insert thicknesses on tibio-femoral and patello-femoral joint dynamics after cruciate-retaining total knee replacement. Knee 2023; 40:152-165. [PMID: 36436384 DOI: 10.1016/j.knee.2022.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/29/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Positioning of the implant components and tibial insert thickness constitute critical aspects of total knee replacement (TKR) that influence the postoperative knee joint dynamics. This study aimed to investigate the impact of implant component positioning (anterior-posterior and medio-lateral shift) and varying tibial insert thickness on the tibio-femoral (TF) and patello-femoral (PF) joint kinematics and contact forces after cruciate-retaining (CR)-TKR. METHOD A validated musculoskeletal multibody simulation (MMBS) model with a fixed-bearing CR-TKR during a squat motion up to 90° knee flexion was deployed to calculate PF and TF joint dynamics for varied implant component positions and tibial insert thicknesses. Evaluation was performed consecutively by comparing the respective knee joint parameters (e.g. contact force, quadriceps muscle force, joint kinematics) to a reference implant position. RESULTS The PF contact forces were mostly affected by the anterior-posterior as well as medio-lateral positioning of the femoral component (by 3 mm anterior up to 31 % and by 6 mm lateral up to 14 %). TF contact forces were considerably altered by tibial insert thickness (24 % in case of + 4 mm increase) and by the anterior-posterior position of the femoral component (by 3 mm posterior up to 16 %). Concerning PF kinematics, a medialised femoral component by 6 mm increased the lateral patellar tilt by more than 5°. CONCLUSIONS Our results indicate that regarding PF kinematics and contact forces the positioning of the femoral component was more critical than the tibial component. The positioning of the femoral component in anterior-posterior direction on and PF contact force was evident. Orthopaedic surgeons should strictly monitor the anterior-posterior as well as the medio-lateral position of the femoral component and the insert thickness.
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Affiliation(s)
- Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Germany.
| | - Andreas Geier
- Department of Orthopaedics, Rostock University Medical Center, Germany; Department of Modern Mechanical Engineering, Waseda University, Tokyo, Japan
| | - Martin Darowski
- Department of Orthopaedics, Rostock University Medical Center, Germany
| | - Sven Krueger
- Aesculap AG, Research and Development, Tuttlingen, Germany
| | | | - Thomas M Grupp
- Aesculap AG, Research and Development, Tuttlingen, Germany; Ludwig Maximilians University Munich, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Campus Grosshadern, Munich, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Germany
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Hamada R, Nankaku M, Murao M, Kawano T, Ito H, Nakamura S, Ikeguchi R, Matsuda S. Functional characteristics of female patients based on ambulatory ability 1 year after total knee arthroplasty. Knee 2021; 33:298-304. [PMID: 34739961 DOI: 10.1016/j.knee.2021.10.015] [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: 05/09/2021] [Revised: 08/12/2021] [Accepted: 10/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is commonly performed to reduce knee pain and improve physical function. Compared with the values for healthy, age-matched women, previous studies have reported large deficits in functional ability, such as muscle strength and ambulatory ability, in women 1 year post-TKA. Ambulatory ability is to move around, particularly by walking and is clinically assessed by the timed up and go test (TUG). AIM This study aimed to clarify the characteristics of knee functions in female patients whose ambulatory ability recovered to a normal level at 1 year after TKA. METHODS This cross-sectional study included 151 female patients who underwent TKA. The muscle strength of the lower extremity was measured, and the 2011 Knee Society Scoring (2011 KSS) system was used postoperatively. The TUG was conducted to assess ambulatory ability after TKA; then the patients were classified into the fast and slow ambulation groups based on previously reported gait-speed values of healthy female individuals. Then, we identified significant indicators of ambulatory ability at 1 year after TKA. RESULTS Forty-nine percent of patients after TKA achieved the level of ambulatory ability of a healthy female. Logistic regression analysis identified that the non-operative side knee extensor strength and the functional activity score, as assessed by the 2011 KSS, were variables significantly associated with the mid-term ambulatory ability after TKA. CONCLUSION Female patients with high non-operative knee extensor strength and a functional activity score at 1 year postoperatively can achieve better ambulatory ability than those of healthy, age-matched females.
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Affiliation(s)
- Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan; Department of Advanced Medicine for Rheumatic Diseases, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan; Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan; Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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Duan G, Cai S, Lin W, Pan Y. Risk Factors for Patellar Clunk or Crepitation after Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis. J Knee Surg 2021; 34:1098-1109. [PMID: 32131098 DOI: 10.1055/s-0040-1701515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patellar clunk and crepitation (PCC) have been reported as a consequence of primary total knee arthroplasty (TKA). The incidence and contributing factors have not been fully defined. We performed this systematic review to evaluate factors associated with PCC following primary TKA. We identified studies on PCC following TKA from an electronic search of articles in Medline, Embase and the Cochrane databases (dated up to May 2018). Eighteen studies altogether, including 600 cases of PCC within 8,131 TKAs, were included in the meta-analysis. Several factors including demographic, intraoperative, clinical variables, and radiographic measurements were pooled for meta-analysis. Among intraoperative and clinical variables, patients involved with patellar retention (odds ratio [OR] = 9.420; confidence interval [CI]: 5.770-13.070), lateral reticular release (OR = 2.818; CI: 1.114-7.125), and previous surgery (OR = 2.724; CI: 1.549-4.790) were more likely to having PCCs. Among radiographic measurements, increased anterior tibial offset (weighted mean difference [WMD] = 0.387; CI: 0.139-0.634), increased joint line changes (WMD = 1.325; CI: 0.595-2.055), and increased knee flexion angle (WMD = 3.592; CI: 1.811-5.374) were considered risk factors associated with PCC. Demographic factors (age, gender, body mass index [BMI], and diagnosis) and other reported radiographic measurements were not associated with PCCs. This study identified intraoperative variables (patellar retention and lateral reticular release), clinical variables (previous surgery), and radiographic measurements (increased anterior tibial offset, increased joint line changes, and increased postoperative knee flexion angle) that contribute to an increased risk for PCC. Modifiable factors (patellar retention and lateral reticular release) should be considered and addressed to limit the risk for PCC following TKA. Patients with conditions that may not be modifiable may benefit from counseling about their increased risks for PCC to limit potential dissatisfaction with their procedure.
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Affiliation(s)
- Guman Duan
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Sijia Cai
- Department of Endocrinology, Beijing Hepingli Hospital, Beijing, People's Republic of China
| | - Weiwei Lin
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yongwei Pan
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
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Song SJ, Kim KI, Suh DU, Park CH. Comparison of Patellofemoral-Specific Clinical and Radiographic Results after Total Knee Arthroplasty Using a Patellofemoral Design-Modified Prosthesis and Its Predecessor. Clin Orthop Surg 2021; 13:175-184. [PMID: 34094008 PMCID: PMC8173230 DOI: 10.4055/cios20188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/06/2022] Open
Abstract
Backgroud One recently developed total knee arthroplasty (TKA) prosthesis was designed to alter the patellofemoral geometry and optimize patellar tracking compared to its predecessor. Despite an expectation that the improved design would contribute to optimal patellofemoral compatibility, its effect has not been confirmed with patellofemoral-specific clinical scoring systems and radiographic parameters. Our purpose was to compare patellofemoral-specific clinical and radiographic results after TKA using a patellofemoral design-modified prosthesis and its predecessor. Methods The results of 200 TKAs with Attune (group A) were compared to those of 200 TKAs with PFC Sigma (group B). Clinically, the presence of anterior knee pain (AKP), patellar crepitation, and Kujala score were checked. Radiographically, anterior femoral offset (AFO), posterior femoral offset (PFO), position of patellar ridge, and patellar tilt and translation were compared. Results In group A, AKP and patellar crepitation occurred less frequently (AKP: 3% vs. 8%, p = 0.028; patellar crepitation: 2.5% vs. 9%, p = 0.005) and Kujala score was higher (81.8 vs. 77.9, p < 0.001), when compared to group B. The AFO decreased in group A postoperatively but increased in group B (-1.2 vs. 1.1 mm, p < 0.001). The change in PFO was smaller in group A than group B (-1.2 vs. -3.6 mm, p < 0.001). The change in patellar ridge after TKA was smaller in group A than group B (1.4% vs. 8.3%, p < 0.001). The postoperative patella of group A was more laterally tilted (5.9° vs. 2.2°, p < 0.001) and less laterally translated (0.9 vs. 2.6 mm, p < 0.001). The proportion of incompatible patella tilt angle (≥ ± 10°) was greater in group A than group B (21.7% vs. 4.5%, p < 0.001). Conclusions TKA using Attune provided better patellofemoral-specific clinical results and favorable radiographic parameters related with patellar ridge, AFO, and PFO than TKA using PFC Sigma did. However, the current prosthesis did not provide better radiographic patellar tracking, which might be due to the medial location of the patellar ridge.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kang Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong Uk Suh
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Wang Z, Zhang YQ, Ding CR, Wang YZ, Xu H. Early Patellofemoral Function of Medial Pivot Prostheses Compared with Posterior-Stabilized Prostheses for Unilateral Total Knee Arthroplasty. Orthop Surg 2021; 13:417-425. [PMID: 33403815 PMCID: PMC7957395 DOI: 10.1111/os.12895] [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: 02/25/2020] [Revised: 10/03/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To systematically evaluate the patellofemoral joint design of medial pivot prosthesis, which incorporates a variety of “patella‐friendly” design features, by comparing clinical and radiographic results with another prosthesis. Methods All consecutive patients who underwent unilateral total knee arthroplasty (TKA) with medial pivot prosthesis (Group MP, 126 cases) between September 2016 and April 2018 were enrolled in this retrospective study. For each patient reviewed, a control patient was matched, according to age, gender, side, body mass index (BMI), preoperative range of motion (ROM), and operating period, who had received primary unilateral TKA with a conventional posterior‐stabilized prosthesis at the same period as the study group (Group PS, 126 cases). All patients underwent at least 1‐year follow‐up. At the preoperative and final follow‐up periods, data on the Knee Society Score (KSS) score, WOMAC score, Kujala score, and ROM were collected. Merchant views were taken with the knee flexion at 30°, 60°, and 90° to measure patella shift and tilt. Preoperative posterior condylar angle (PCA) was also measured. Postoperative complications, including anterior knee pain, maltracking, patellar clunk or crepitus (PCC), were evaluated. Results There were no significant differences in the demographics or clinical characteristics between the two groups. No statistically significant difference was identified in the KSS total score, including knee score and function score, or in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between the two groups after the operation. We found statistically significant differences in the postoperative Kujala scores and the ROMs between the two groups. The mean Kujala score in group MP was better than in group PS (MP 77.16 ± 3.80 vs PS 75.97 ± 4.06, P < 0.05), while the ROM in group PS was significantly higher than in group MP (MP 122.24° ± 4.45° vs PS 123.78° ± 6.05°, P < 0.05). Simultaneously, the preoperative/postoperative Kujala score improvement in group MP was observed to be significantly larger than in group PS (MP 27.82 ± 5.31 vs PS 26.17 ± 4.89, P < 0.05), but the average ROM improvement in group PS was significantly greater than in group MP (MP 19.00° ±9.90° vs PS 21.57° ± 9.62°). In the 90° Merchant view, the mean patella tilt of group MP was statistically smaller than that of group PS (MP 4.21° ± 1.62° vs PS 4.74° ± 1.95°, P < 0.05), and the average patella tilt change in group MP was significantly greater than in group PS (MP –3.8° ± 1.43° vs PS –3.23° ± 1.33°, P < 0.05). Preoperative PCA did not show significant differences between the two groups. Two cases of PCC and three cases of anterior knee pain were noted in group MP, and nine cases and six cases, respectively, were observed in group PS. The incidence of PCC was significantly lower in group MP (1.6% vs 7.1%, P < 0.05). There was no significant difference in follow‐up time between the two groups. Conclusion The medial pivot prosthesis could achieve satisfactory outcomes with better patellofemoral performance attributed to its “patella‐friendly” design characteristics compared to the conventional posterior‐stabilized prosthesis.
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Affiliation(s)
- Zhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Yu-Qing Zhang
- Ophthalmology Department, Affiliated Qingdao Central Hospital, Qingdao University, Qingdao, China
| | - Chang-Rong Ding
- Department of Electrocardiogram, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying-Zhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hao Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Sequeira SB, Scott J, Novicoff W, Cui Q. Systematic review of the etiology behind patellar clunk syndrome. World J Orthop 2020; 11:184-196. [PMID: 32280608 PMCID: PMC7138860 DOI: 10.5312/wjo.v11.i3.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/24/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is one of the most successful operations performed worldwide today. Patellar clunk syndrome (PCS) is a postoperative complication that arises due to the development of a fibrous nodule along the undersurface of the quadriceps tendon. The current literature on PCS has not yet come to a consensus regarding its etiology. To date, this is the first study that analyzes the existing literature on PCS in order to generate a conclusion regarding its etiology. It is hypothesized that prosthesis design is the main component behind the development of PCS.
AIM To determine the etiology of PCS and its association with pre and post-operative characteristics of the prosthesis and native knee.
METHODS We conducted a systematic review according to the PRISMA guidelines by searching through PubMed, Cochrane, and Google Scholar from May-July 2018 for cases of PCS using search MeSH terms “patella OR patellar” AND “clunk” OR “catch” OR “crepitus”. The search included case series and clinical trials and excluded review articles, yielding 30 articles from the original search and 3 additional articles from reference lists. We extracted data upon the outcomes in patients afflicted with PCS to determine the etiology of PCS. We performed additional bias assessments to validate our search algorithm and results.
RESULTS Prosthesis design was the metric most frequently implicated in the incidence of PCS, though several other metrics were contributory toward its pathogenesis. Later prosthetic designs incorporate a reduced intercondylar box ratio and box width to reduce contact between the proximal patellar pole and the intercondylar box, thereby reducing incidence of PCS.
CONCLUSION The etiology of PCS is multifactorial, owing to the growing metrics that have associations with its incidence. This conclusion is validated by the significance of prosthesis design as the most likely parameter involved in developing PCS since different prosthesis designs are often the result of different parameters. Future studies should be directed at isolating individual prosthetic parameters of prosthesis designs in order to determine what permutation of parameters is most closely associated with the development of PCS.
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Affiliation(s)
- Sean Bertram Sequeira
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - James Scott
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Wendy Novicoff
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Quanjun Cui
- Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
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Song SJ, Kang SG, Lee YJ, Kim KI, Park CH. An intraoperative load sensor did not improve the early postoperative results of posterior-stabilized TKA for osteoarthritis with varus deformities. Knee Surg Sports Traumatol Arthrosc 2019; 27:1671-1679. [PMID: 30511096 DOI: 10.1007/s00167-018-5314-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/29/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE In the present study, the early results of sensor-assisted versus manually balanced posterior-stabilized total knee arthroplasty (TKA) for osteoarthritis with varus deformities were prospectively compared. METHODS Fifty patients undergoing sensor-assisted TKA (group S) and 50 patients receiving manually balanced TKA (group M) were prospectively compared. The groups did not differ in terms of demographics, preoperative clinical status, or severity of deformity. The knee and function scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM) were evaluated clinically. The mechanical axes and positions of components were assessed radiographically. In sensor-assisted TKA, the medial and lateral compartment loads were compared based on the patellar positions of inversion and eversion. RESULTS There was no between-group difference in the postoperative KS or FS (n.s., respectively). The average postoperative WOMAC score was 17.0 in group S and 18.0 in group M (n.s.). The ROM was 131.2° in group S and 130.8° in group M (n.s.). Neither the postoperative alignment of the mechanical axis nor the component positioning differed between the groups (n.s.). In sensor-assisted TKA, the difference between the medial and lateral compartment loads was less than 15 lbs (6.8 kg) in each knee. The lateral compartment load increased after patellar eversion (p < 0.001). CONCLUSION There are concerns about the cost-benefit ratio of the intraoperative load sensor, despite its advantage of more precisely assessing ligament balance without patellar eversion, which resulted in a smaller lateral gap. A long-term follow-up study with a large cohort is required. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Se Gu Kang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Yeon Je Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Kang Il Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-872, South Korea.
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Lee SS, Kwon KB, Lee YI, Moon YW. Navigation-Assisted Total Knee Arthroplasty for a Valgus Knee Improves Limb and Femoral Component Alignment. Orthopedics 2019; 42:e253-e259. [PMID: 30763446 DOI: 10.3928/01477447-20190211-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/10/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the influence of navigation-assisted surgery on radiographic and clinical outcomes after total knee arthroplasty (TKA) for a valgus knee. The authors identified all patients who underwent TKA for a valgus knee between January 2005 and December 2015. Among 83 conventional TKA cases and 55 navigation-assisted TKA cases, propensity score matching was performed for age, sex, body mass index, and preoperative lower limb mechanical axis. Fifty knees were matched to 50 knees. Each case was evaluated regarding lower limb mechanical axis, mechanical lateral distal femoral angle, medial proximal tibial angle, patellar tilt angle, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society score, and range of motion. Lower outliers of lower limb mechanical axis (30% vs 8%, P=.008) and mechanical lateral distal femoral angle (24% vs 10%, P=.046) were found in navigation-assisted TKA. However, outliers of medial proximal tibial angle, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society score, and range of motion were similar between the 2 different surgical techniques. Navigation-assisted surgery is correlated with fewer outliers of postoperative lower limb alignment and femoral component position but not tibial component position in TKA for preoperative valgus knee. Clinical outcomes for navigation-assisted TKA were not superior to those for conventional TKA. [Orthopedics. 2019; 42(2):e253-e259.].
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Song SJ, Kang SG, Park CH, Bae DK. Comparison of Clinical Results and Risk of Patellar Injury between Attune and PFC Sigma Knee Systems. Knee Surg Relat Res 2018; 30:334-340. [PMID: 30173500 PMCID: PMC6254870 DOI: 10.5792/ksrr.18.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/24/2018] [Accepted: 05/27/2018] [Indexed: 12/31/2022] Open
Abstract
Purpose The purposes of this study were to compare clinical results after total knee arthroplasty (TKA) using the Attune and PFC Sigma knee designs and to investigate whether the use of the Attune prosthesis increased the risk of patellar injury in Asian patients. Materials and Methods Three hundred knees that underwent TKA using Attune (group A) were compared to 300 knees that underwent TKA using PFC Sigma (group B). The Knee Society Knee Score (KS) and Function Score (FS), and range of motion (ROM) were compared. The residual patellar thickness was compared to evaluate the risk of patellar injury. Results The postoperative KS and ROM of group A were better than those of group B (93.1 vs. 88.8, p<0.001 and 131.4° vs. 129.0°, p=0.008, respectively). The postoperative FS did not differ significantly between the two groups (80.9 vs. 78.7, p=0.427). The residual patella was thinner in group A (14.8 mm vs. 15.7 mm, p=0.003), which made up a higher proportion of the high-risk group for patellar fractures with a residual thickness of <12 mm (7.5% vs. 2.1%, p=0.003). Conclusions TKA using the Attune prosthesis provided more favorable clinical results than TKA using PFC Sigma. However, the risk of injury in the residual patella was increased with use of the Attune prosthesis in Asian patients.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Se Gu Kang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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Lee SS, Lee H, Lee DH, Moon YW. Slight under-correction following total knee arthroplasty for a valgus knee results in similar clinical outcomes. Arch Orthop Trauma Surg 2018; 138:1011-1019. [PMID: 29770878 DOI: 10.1007/s00402-018-2957-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Restoration of correct coronal alignment is one of the main goals of total knee arthroplasty (TKA). Traditionally, TKA has been considered successful when a neutral mechanical hip-knee-ankle (HKA) axis within 3° is achieved. Recent studies have reported no differences or improved clinical outcomes following a slight under-correction of the HKA axis for a varus knee. However, the influence of under-correction of a valgus knee has not been reported. This study investigated the influence of post-operative HKA alignment in TKA patients with valgus deformity on clinical outcomes. METHODS Ninety-three knees (93 patients) with pre-operative valgus alignment were evaluated with a mean follow-up period of 60 months. All patients were classified into three groups based on post-operative HKA alignment: neutral (0 ± 3°), mild valgus (3°-6°), and severe valgus (> 6°). These groups were compared using the Western Ontario and McMaster Universities osteoarthritis (WOMAC) index, the Knee Society (KS) knee score, KS function score, α-angle, β-angle, patella tilt angle, and the congruence angle. RESULTS Sixty-nine knees were included in the neutral group, seventeen knees in the mild valgus group, and seven knees in the severe valgus group. In all cases, post-operative clinical and functional scores significantly improved compared to pre-operative scores. There were no differences between the three groups in post-operative clinical and functional scores. More post-operative patellar tilt angle outliers (> 10°) and congruence angle outliers (> 16°) were apparent in the severe valgus group (patellar tilt angle, 13 vs. 17 vs. 57.1%, p = 0.022; congruence angle, 32 vs. 47 vs. 71%, p = 0.035). CONCLUSIONS Slight under-correction following TKA for a valgus knee resulted in similar clinical outcomes. A residual valgus angle of more than 6° can induce patellar maltracking. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, Seoul, 06351, South Korea
| | - Hyeon Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, Seoul, 06351, South Korea
| | - Dae-Hee Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, Seoul, 06351, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, Seoul, 06351, South Korea.
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Duan G, Liu C, Lin W, Shao J, Fu K, Niu Y, Wang F. Different Factors Conduct Anterior Knee Pain Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2018; 33:1962-1971.e3. [PMID: 29398258 DOI: 10.1016/j.arth.2017.12.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/30/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A systematic review and meta-analysis was performed to investigate the risks associated with anterior knee pain (AKP) following primary total knee arthroplasty (TKA). METHODS A computerized search was performed of the following databases: MEDLINE, Embase, and Cochrane Central (published prior to July 2017). A total of 37 studies, which included 1641 cases of AKP and 168,090 TKAs, were included in the meta-analysis. RESULTS A subgroup analysis revealed that compared with those without the following medical conditions, patients who had an infrapatellar fat pad excision and more than 12 months of follow-up (odds ratio [OR] 12.58, 95% confidence interval [CI] 3.245-48.781) were more likely to have AKP after TKA. Circumpatellar electrocautery (>12 months: OR 0.50, 95% CI 0.326-0.760; ≤12 months: OR 0.59, 95% CI 0.408-0.867) and patellar resurfacing (OR 0.25, 95% CI 0.131-0.485) may decrease the risk of AKP. Other factors, including the prosthesis bearing type (mobile bearing or fixed bearing) and the approach (midvastus compared with the medial parapatellar approach), were not significant risk factors for AKP. CONCLUSION The use of strategies such as patellar denervation and patellar resurfacing in primary TKA is recommended because they are safe and result in good clinical outcomes in preventing AKP. Caution should be taken when using an infrapatellar fat pad excision, because there is an increased risk of AKP at long-term follow-up (>12 months). Future studies should investigate these different strategies to confirm the underlying mechanisms and help prevent the occurrence of AKP after TKA. The timing of AKP onset remains unclear and requires further research.
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Affiliation(s)
- Guman Duan
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Chang Liu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Weiwei Lin
- Department of Neurosurgery, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Jiashen Shao
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Kunpeng Fu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yingzhen Niu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Fei Wang
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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Lee SS, Lee YI, Kim DU, Lee DH, Moon YW. Factors affecting femoral rotational angle based on the posterior condylar axis in gap-based navigation-assisted total knee arthroplasty for valgus knee. PLoS One 2018; 13:e0197335. [PMID: 29763429 PMCID: PMC5953479 DOI: 10.1371/journal.pone.0197335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/28/2018] [Indexed: 11/25/2022] Open
Abstract
Background Achieving proper rotational alignment of the femoral component in total knee arthroplasty (TKA) for valgus knee is challenging because of lateral condylar hypoplasia and lateral cartilage erosion. Gap-based navigation-assisted TKA enables surgeons to determine the angle of femoral component rotation (FCR) based on the posterior condylar axis. This study evaluated the possible factors that affect the rotational alignment of the femoral component based on the posterior condylar axis. Materials and methods Between 2008 and 2016, 28 knees were enrolled. The dependent variable for this study was FCR based on the posterior condylar axis, which was obtained from the navigation system archives. Multiple regression analysis was conducted to identify factors that might predict FCR, including body mass index (BMI), Kellgren-Lawrence grade (K-L grade), lateral distal femoral angles obtained from the navigation system and radiographs (NaviLDFA, XrayLDFA), hip-knee-ankle (HKA) axis, lateral gap under varus stress (LGVS), medial gap under valgus stress (MGVS), and side-to-side difference (STSD, MGVS − LGVS). Results The mean FCR was 6.1° ± 2.0°. Of all the potentially predictive factors evaluated in this study, only NaviLDFA (β = −0.668) and XrayLDFA (β = −0.714) predicted significantly FCR. Conclusions The LDFAs, as determined using radiographs and the navigation system, were both predictive of the rotational alignment of the femoral component based on the posterior condylar axis in gap-based TKA for valgus knee. A 1° increment with NaviLDFA led to a 0.668° decrement in FCR, and a 1° increment with XrayLDFA led to a 0.714° decrement. This suggests that symmetrical lateral condylar hypoplasia of the posterior and distal side occurs in lateral compartment end-stage osteoarthritis with valgus deformity.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong-In Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Uk Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae-Hee Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- * E-mail:
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15
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Zha GC, Feng S, Chen XY, Guo KJ. Does the grading of chondromalacia patellae influence anterior knee pain following total knee arthroplasty without patellar resurfacing? INTERNATIONAL ORTHOPAEDICS 2017; 42:513-518. [PMID: 28986675 DOI: 10.1007/s00264-017-3658-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/24/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The influence of chondromalacia patellae (CMP) on post-operative anterior knee pain (AKP) following total knee arthroplasty (TKA) remains controversial, and few studies have focused on the relationship between them. The purpose of this study was to determine whether different CMP grades affect the incidence of AKP after TKA without patellar resurfacing. METHODS We performed a retrospective analysis of prospectively collected data on 290 TKAs with the use of the low contact stress mobile-bearing prosthesis, without patellar resurfacing in 290 patients from February 2009 to January 2013. Patients were assessed by the Outerbridge classification for CMP, visual analog scale for AKP, the Knee Society clinical scoring system of knee score (KS), function score (FS), the patellar score (PS) for clinical function, and patients' satisfaction. RESULTS The intra-operative grading of CMP: grade I in 30 patients, grade II in 68 patients, grade III in 97 patients, and grade IV in 95 patients. The incidence of AKP at 36-month follow-up was 10.3% (30/290). No statistical difference was detected among the different CMP grades in terms of the incidence of AKP (p = 0.995), patients' satisfaction (p = 0.832), KS (p = 0.228), FS (p = 0.713), and PS (p = 0.119) at 36-month follow-up. CONCLUSIONS The findings may suggest no relevant influence of CMP grading on the incidence of AKP after TKA without patellar resurfacing.
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Affiliation(s)
- Guo-Chun Zha
- Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221002, People's Republic of China.
| | - Shuo Feng
- Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Xiang-Yang Chen
- Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221002, People's Republic of China
| | - Kai-Jin Guo
- Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221002, People's Republic of China.
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