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Hall AJ, Cullinan R, Alozie G, Chopra S, Greig L, Clarke J, Riches PE, Walmsley P, Ohly NE, Holloway N. Total knee arthroplasty using a cemented single-radius, condylar-stabilized design performed without posterior cruciate ligament sacrifice. Bone Joint J 2024; 106-B:808-816. [PMID: 39084655 DOI: 10.1302/0301-620x.106b8.bjj-2023-1371.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims Total knee arthroplasty (TKA) with a highly congruent condylar-stabilized (CS) articulation may be advantageous due to increased stability versus cruciate-retaining (CR) designs, while mitigating the limitations of a posterior-stabilized construct. The aim was to assess ten-year implant survival and functional outcomes of a cemented single-radius TKA with a CS insert, performed without posterior cruciate ligament sacrifice. Methods This retrospective cohort study included consecutive patients undergoing TKA at a specialist centre in the UK between November 2010 and December 2012. Data were collected using a bespoke electronic database and cross-referenced with national arthroplasty audit data, with variables including: preoperative characteristics, intraoperative factors, complications, and mortality status. Patient-reported outcome measures (PROMs) were collected by a specialist research team at ten years post-surgery. There were 536 TKAs, of which 308/536 (57.5%) were in female patients. The mean age was 69.0 years (95% CI 45.0 to 88.0), the mean BMI was 32.2 kg/m2 (95% CI 18.9 to 50.2), and 387/536 (72.2%) survived to ten years. There were four revisions (0.7%): two deep infections (requiring debridement and implant retention), one aseptic loosening, and one haemosiderosis. Results Kaplan-Meier analysis demonstrated no difference in implant survival according to sex, age, or obesity status. Ten-year PROMs were available for 196/387 (50.6%) surviving patients and were excellent: mean Oxford Knee Score 34.4 (95% CI 32.7 to 36.1); mean Forgotten Joint Score (FJS) 51.2 (95% CI 16.1 to 86.3); mean EuroQol five-dimension five-level questionnaire score 69.9 (95% CI 46.8 to 93.0); 141/196 (71.9%) achieved the 22-point FJS patient-acceptable symptom state (PASS); and 156/196 (79.6%) were "very satisfied or satisfied". Conclusion This is the only large study reporting ten-year implant survival and functional outcomes of TKA using a cemented single-radius design and with a CS tibial bearing construct. The findings of excellent implant survival, safety, and functional outcomes indicate that this combination is a safe and effective option in routine TKA. Further investigation of this single-radius design TKA with CS tibial bearings with well-matched patient study groups will allow further insight into the performance of these implants.
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Affiliation(s)
- Andrew J Hall
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- School of Medicine, University of St Andrews, St Andrews, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
- Fife Orthopaedics, National Treatment Centre, Kirkcaldy, UK
| | - Rachael Cullinan
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - Glory Alozie
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Swati Chopra
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - Leanne Greig
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
| | - Jon Clarke
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
- Scottish Arthroplasty Project, Public Health Scotland, Edinburgh, UK
| | - Philip E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Phil Walmsley
- School of Medicine, University of St Andrews, St Andrews, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
- Fife Orthopaedics, National Treatment Centre, Kirkcaldy, UK
- Scottish Arthroplasty Project, Public Health Scotland, Edinburgh, UK
| | - Nicholas E Ohly
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
| | - Nicholas Holloway
- Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
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McNamara I, Pomeroy V, Clark AB, Creelman G, Whitehouse C, Wells J, Harry B, Smith TO, High J, Swart AM, Clarke C. Comparison of the Journey II bicruciate stabilised (JII-BCS) and GENESIS II total knee arthroplasty for functional ability and motor impairment: the CAPAbility, blinded, randomised controlled trial. BMJ Open 2023; 13:e061648. [PMID: 36599639 PMCID: PMC9815016 DOI: 10.1136/bmjopen-2022-061648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To determine if a newer design of total knee replacement (TKR) (Journey II BCS) produces superior patient-reported outcomes scores and biomechanical outcomes than the older, more established design (Genesis II). SETTING Patients were recruited from an NHS University Hospital between July 2018 and October 2019 with surgery at two sites. Biomechanical and functional capacity measurements were at a University Movement and Exercise Laboratory. PARTICIPANTS 80 participants undergoing single-stage TKR. INTERVENTIONS Patients were randomised to receive either the Journey II BCS (JII-BCS) or Genesis II TKR. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the Oxford Knee Score (OKS), at 6 months. Secondary outcomes were: OKS Activity and Participation Questionnaire, EQ-5D-5L and UCLA Activity scores, Timed Up and Go Test, 6 min walk test, lower limb kinematics and lower limb muscle activity during walking and balance. RESULTS This study found no difference in the OKS between groups. The OKS scores for the JII-BCS and Genesis II groups were mean (SD) 42.97 (5.21) and 43.13 (5.20) respectively, adjusted effect size 0.35 (-2.01,2.71) p=0.771In secondary outcome measures, the Genesis II group demonstrated a significantly greater walking range-of-movement (50.62 (7.33) vs 46.07 (7.71) degrees, adjusted effect size, 3.14 (0.61,5.68) p=0.02) and higher peak knee flexion angular velocity during walking (mean (SD) 307.69 (38.96) vs 330.38 (41.40) degrees/second, adjusted effect size was 21.75 (4.54,38.96), p=0.01) and better postural control (smaller resultant centre of path length) during quiet standing than the JII-BCS group (mean (SD) 158.14 (65.40) vs 235.48 (176.94) mm, adjusted effect size, 59.91 (-105.98, -13.85) p=0.01.). CONCLUSIONS In this study population, the findings do not support the hypothesis that the Journey II BCS produces a better outcome than the Genesis II for the primary outcome of the OKS at 6 months after surgery. TRIAL REGISTRATION NUMBER ISRCTN32315753.
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Affiliation(s)
- Iain McNamara
- Norfolk and Norwich University Hospital, Norwich, UK
- University of East Anglia, Norwich, UK
| | | | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - J Wells
- University of East Anglia, Norwich, UK
| | - B Harry
- Department of clinical neurosciences, University of Cambridge, Cambridge, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - Ann Marie Swart
- University of East Anglia, Norwich, UK
- Health Sciences, University of East Anglia, Norwich, UK
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Lei T, Jiang Z, Qian H, Backstein D, Lei P, Hu Y. Comparison of Single-Radius with Multiple-Radius Femur in Total Knee Arthroplasty: A Meta-Analysis of Prospective Randomized Controlled Trials. Orthop Surg 2022; 14:2085-2095. [PMID: 35924690 PMCID: PMC9483041 DOI: 10.1111/os.13391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Whether there was clinical superiority for the single-radius prosthesis over the multi-radius prothesis in total knee arthroplasty (TKA) still remains to be clarified. We updated a meta-analysis including prospective randomized controlled trials (RCTs) to compare the clinical prognosis of patients receiving single-radius TKA (SR-TKA) or multi-radius TKA (MR-TKA). METHODS We searched the databases of PubMed, Web of Science, EMBASE, Cochrane Library, MEDLINE for eligible RCTs. Two reviewers evaluated the study quality according to the Risk of Bias tool of the Cochrane Library and extracted the data in studies individually. The extracted data included the baseline data and clinical outcome. The baseline data include the author's name, country, and year of included studies, the name of knee prosthesis used in studies, sample size, follow-up time, and BMI of patients. The clinical data comprised primary indicators including postoperative knee range of motion (ROM), sit-to-stand rest, severe postoperative scorings, such as visual analog scale (VAS), American Knee Society knee score (AKS), Oxford knee scoring (OKS), and SF-36 Quality of Life Scale, as well as various secondary indicators of complications including anterior knee pain, postoperative infection, aseptic prosthesis loosening, and prosthesis revision. The data analysis was performed using Review Manager 5.3 software and STATA 12.0. The sensitivity analysis was performed using STATA 12.0. RESULTS A total of 13 RCTs, along with 1720 patients and 1726 knees, were finally included in our present meta-analysis. We found that patients in SR-TKA group performed better in the sit-to-stand test (OR = 1.89, 95% CI: 1.05-3.41, p = 0.03) and satisfaction evaluation (OR = 3.27, 95% CI: 1.42-7.53, p = 0.005), which were only evaluated in two included RCTs. While no significant difference was found between SR-TKA and MR-TKA groups in terms of postoperative ROM, VAS scoring, AKS scoring, SF-36 scoring, OKS scoring, and various complications including anterior knee pain, postoperative infection, aseptic prosthesis loosening, and prosthesis revision. CONCLUSION In conclusion, our present meta-analysis indicated that SR implants were noninferior to MR implants in TKA, and SR implants could be an alternative choice over MR implants, since patients after SR-TKA felt more satisfied and performed better in the sit-to-stand test, with no significant difference in complications between SR-TKA and MR-TKA groups. While more relevant clinical trials with long-term follow-up time and specific tests evaluating the function of knee extension mechanism should be carried out to further investigate the clinical performance of SR implants.
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Affiliation(s)
- Ting Lei
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Zichao Jiang
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Hu Qian
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
| | | | - Pengfei Lei
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Yihe Hu
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
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Paravlic AH, Meulenberg CJ, Drole K. The Time Course of Quadriceps Strength Recovery After Total Knee Arthroplasty Is Influenced by Body Mass Index, Sex, and Age of Patients: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:865412. [PMID: 35692543 PMCID: PMC9174520 DOI: 10.3389/fmed.2022.865412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction For patients with osteoarthritis who have undergone total knee arthroplasty (TKA), quadriceps strength is a major determinant of general physical function regardless of the parameters adopted for functional assessment. Understanding the time course of quadriceps strength recovery and effectiveness of different rehabilitation protocols is a must. Therefore, the aim of this study was to: (i) determine the magnitude of maximal voluntary strength (MVS) loss and the time course of recovery of the quadriceps muscle following TKA, (ii) identify potential moderators of strength outcomes, and (iii) investigate whether different rehabilitation practices can moderate the strength outcomes following TKA, respectively. Design General scientific databases and relevant journals in the field of orthopedics were searched, identifying prospective studies that investigated quadriceps’ MVS pre-to post-surgery. Results Seventeen studies with a total of 832 patients (39% males) were included. Results showed that in the early post-operative days, the involved quadriceps’ MVS markedly declined, after which it slowly recovered over time in a linear fashion. Thus, the greatest decline of the MVS was observed 3 days after TKA. When compared to pre-operative values, the MVS was still significantly lower 3 months after TKA and did not fully recover up to 6 months following TKA. Furthermore, a meta-regression analysis identified that the variables, time point of evaluation, patient age, sex, and BMI, significantly moderate the MVS of the quadriceps muscle. Conclusion The analyzed literature data showed that the decrease in strength of the involved quadriceps muscles following TKA is considerable and lasts for several months post-surgery. Therefore, we recommend to specifically target the strengthening of knee extensor muscles, preserve motor control, and apply appropriate nutrition to ensure a holistic quadriceps muscle recovery. Since age, sex, and BMI were found to be moderating factors in patients’ recovery, further research should include specific analyses considering these moderators.
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Affiliation(s)
- Armin H. Paravlic
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sport Studies, Masaryk University, Brno, Czechia
- *Correspondence: Armin H. Paravlic,
| | - Cécil J. Meulenberg
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
| | - Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
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Gradual-radius femoral component with s-curve post-cam provides stable kinematics at mid-flexion after total knee arthroplasty. J Orthop Sci 2022; 27:665-671. [PMID: 33933328 DOI: 10.1016/j.jos.2021.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/08/2021] [Accepted: 02/26/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mid-flexion instability is the one of the reasons for patient dissatisfaction after total knee arthroplasty (TKA). The purposes of this study were to evaluate in vivo knee kinematics and clinical outcomes using a novel TKA design with a gradual femoral radius component and s-curve post-cam, which are intended to prevent the instability initiated by sudden reductions in the femoral radius observed with conventional components. METHODS We used radiographic-based, image-matching techniques to analyze femorotibial anteroposterior translation, axial rotation, and anterior/posterior cam-post contact during two dynamic movements, squatting and stair climbing, in 20 knees that had undergone posterior-stabilized fixed-bearing TKA with an improved sagittal profiles of the femoral component and post-cam mechanism. We also evaluated patient-reported outcomes assessed by the 2011 Knee Society Score (KSS 2011). RESULTS Squatting and stair climbing produced a similar trend in anteroposterior translation and a relatively small standard deviation at mid-flexion. Although the rotation angles varied widely during squatting and stair climbing, the femoral component was consistently externally rotated. Anterior/posterior cam-post contact during squatting and stair climbing were observed in 0/17 knees and 0/0 knees, respectively. The "Symptoms", "Satisfaction", and "Functional activities" subscales of the KSS 2011 were significantly (P < 0.05) improved postoperatively compared to preoperatively ("Symptoms", 10 to 21; "Satisfaction", 15 to 26; "Functional activities", 25 to 71). CONCLUSION A gradual femoral radius component with an s-curve post-cam provided stable kinematics and favorable clinical results during squatting and stair climbing at 1 year after surgery.
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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.
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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
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Herndon CL, McCormick KL, Gazgalis A, Bixby EC, Levitsky MM, Neuwirth AL. Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review. Arthroplast Today 2021; 11:239-251. [PMID: 34692962 PMCID: PMC8517286 DOI: 10.1016/j.artd.2021.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/08/2021] [Accepted: 08/29/2021] [Indexed: 12/16/2022] Open
Abstract
Background The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R = 0.14, P = .002) and between FI and P values (R = 0.197, P = .000012). Conclusions This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence Level I; Systematic Review.
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Affiliation(s)
- Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kyle L McCormick
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Anastasia Gazgalis
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Elise C Bixby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew M Levitsky
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Morelli I, Maffulli N, Brambilla L, Agnoletto M, Peretti GM, Mangiavini L. Quadriceps muscle group function and after total knee arthroplasty-asystematic narrative update. Br Med Bull 2021; 137:51-69. [PMID: 33517365 DOI: 10.1093/bmb/ldaa041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND This article systematically summarizes the present evidences, published in the last 20 years, regarding the pre- and post-operative factors, which may influence recovery of the function of the quadriceps muscle group following total knee arthroplasty (TKA). We following the PRISMA methodology, including meta-analyses and high-level evidence studies (prospective trials, and, when unavailable, retrospective studies). SOURCES OF DATA Pubmed and Cochrane databases: 582 articles were identified and 54 of them were selected. AREAS OF AGREEMENT Tourniquets inflated at high pressure exert a detrimental effect on the quadriceps muscle group. Faster quadriceps recovery takes place using mini-invasive approaches, an eight-week rehabilitation period including balance training and the use of nutraceuticals. AREAS OF DISAGREEMENT Pre-habilitation and pre-operative factors, analgesic methods and different TKA implants. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH Telerehabilitation seems a cost-effective tool for rehabilitation after TKA. Patients' optimization protocols before TKA should include standardized nutraceuticals intake.
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Affiliation(s)
- Ilaria Morelli
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Nicola Maffulli
- San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Via San Leonardo, 84125 Salerno, Italy.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, Staffordshire ST5 5BG United Kingdom.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, United Kingdom
| | - Lorenzo Brambilla
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Marco Agnoletto
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Giuseppe Maria Peretti
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, via Luigi Mangiagalli 31, 20133 Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, via Luigi Mangiagalli 31, 20133 Italy
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Lizaur-Utrilla A, Miralles-Muñoz FA, Ruiz-Lozano M, González-Parreño S, Alonso-Montero C, Lopez-Prats FA. Better clinical outcomes and overall higher survival with hybrid versus cemented primary total knee arthroplasty: a minimum 15 years follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:832-837. [PMID: 32347345 DOI: 10.1007/s00167-020-06028-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare the clinical outcomes and survival at long-term between hybrid and cemented primary total knee arthroplasty (TKA). A better clinical outcome and survival following a follow-up as long as 15 years with the use of hybrid fixation as compared with cemented fixation was hypothesized. METHODS Case-control study of 126 patients with a mean age of 62.4 years who underwent hybrid TKA matched with 126 patients underwent cemented TKA. Clinical outcome was assessed by the Knee Society scores (KSS) and reduced Western Ontario and MacMaster Universities questionnaire (WOMAC). Radiological assessment was made by the Knee Society method. RESULTS The mean follow-up was 15.7 (range 15-17) years. At the final follow-up, clinical scores were significantly better in the hybrid group, although the differences were not clinically relevant. Revisions for all reasons were performed in five knees in the hybrid group and 15 knees in the cemented group (p = 0.033). In the hybrid group, there was one aseptic femoral loosening and no aseptic tibial loosening. In the cemented group, the main reasons for aseptic revisions were polyethylene wear (six knees) and tibial loosening (four knees). Cemented fixation was a significant risk factor for aseptic revision (hazard ratio 2.3; 95% CI 1.3-3.7%; p = 0.004). Survival at 15 years for aseptic reasons was 96.5% (95% CI 93.4-98.7%) in hybrid groups and 90.3% (95% CI 88.7-93.9%) in cemented group (p = 0.020). CONCLUSION After a minimum follow-up of 15 years, hybrid fixation of primary TKA for osteoarthritis provide significantly higher clinical benefits compared with cemented fixation, but the differences were not clinically relevant. Hybrid fixation provides longer overall survival, although the femoral component survival was similar between groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain.
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain.
| | - Fancisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Matias Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Santiago González-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Carolina Alonso-Montero
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain
| | - Fernando A Lopez-Prats
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain
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Sachdeva S, Baker JF, Bauwens JE, Smith LS, Sodhi N, Mont MA, Malkani AL. Can Revision TKA Patients Achieve Similar Clinical Functional Improvement Compared to Primaries? J Knee Surg 2020; 33:1219-1224. [PMID: 31357221 DOI: 10.1055/s-0039-1693415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The etiology of failure following primary total knee arthroplasty (TKA) leading to revision surgery are multifactorial, including infection, instability, loosening, contracture, and wear. Although the majority of patients have successful outcomes following revision TKA, postoperative complications are still increased in these patients when compared to primary patients. For this reason, there has been a continued search to identify options, including prosthesis types, to potentially improve outcomes. Therefore, the purpose of this study was to determine if the clinical results achieved following revision TKA are comparatively similar to primaries using the same implant design. Specifically, we compared (1) Knee Society Functional and Range-of-Motion Knee Scores and (2) component survivorship. This was a retrospective analysis of 100 patients undergoing revision TKA due to an aseptic etiology, who were matched to a cohort of 100 patients who underwent primaries with the same prosthesis. There were no differences in the groups with respect to age at surgery, sex, and body mass index. The mean follow-up was 57 months in the revision group (range 24-105 months) and 67 months in the primary TKA group (range 55-123 months). American Knee Society Scores (KSS) and range of motion measurements recorded preoperatively and at the most recent postoperative visit were compared between both cohorts in order to compare postoperative outcomes. A p value of 0.05 was used for significance. The average improvement between the pre- and postoperative KSS function scores in both groups was similar, with both cohorts demonstrating a 28-point improvement. At 2-year follow-up, all-cause survivorship of the aseptic revision surgeries was 87%. Patients undergoing revision TKA for aseptic loosening can potentially expect similar improvements in clinical function scores and survivorship compared to primary TKA when controlling for implant type.
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Affiliation(s)
- Shikha Sachdeva
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - James F Baker
- Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - Jesse E Bauwens
- Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - Langan S Smith
- Orthopedic Associates, KentuckyOne Health Ringgold Standard Institution, Louisville, Kentucky
| | - Nipun Sodhi
- Orthopaedic Surgery, Lenox Hill Hospital Ringgold Standard Institution, New York
| | - Michael A Mont
- Orthopaedic Surgery, Lenox Hill Hospital Ringgold Standard Institution, New York
| | - Arthur L Malkani
- Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
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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.
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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.
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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.
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Li M, Fu G, Huang W, Lin B, Zhang R, Zhang Y, Ma Y, Zheng Q. Alterations of kinematics in knees after single versus multiple radius femoral prostheses total knee arthroplasty: a retrospective study. BMC Musculoskelet Disord 2020; 21:434. [PMID: 32622357 PMCID: PMC7334846 DOI: 10.1186/s12891-020-03425-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Design modifications in prostheses may cause alterations in gait kinematics, thus influencing functional restoration of knees after total knee arthroplasty (TKA). The aim of the study was to investigate the differences in gait kinematics and clinical outcomes after single radius (SR) versus multiple radius (MR) TKA. METHOD The present retrospective study included 38 unilateral TKA involving 20 knees using MR design implant and 18 knees using SR design implant. Thirty-six healthy volunteers were also recruited. The mean follow-up time was 16 ± 3 months. At the end of follow-up, the 6 degrees of freedom (DOF) kinematics of knees and range of motion (ROM) were measured with a portable optical tracking system. Knee society score (KSS) and knee injury, and osteoarthritis outcome score (KOOS) were also collected. RESULTS Patients in the SR group had significantly higher scores in activities of daily living (84.7 ± 15.9) and sports and recreation (67.5 ± 25.2) KOOS sub-score than MR group (69.9 ± 17.6, P = 0.012; 50.0 ± 20.8, P = 0.027, respectively). Significant differences were detected between MR knees and SR knees (1.82° ± 3.11° vs 4.93° ± 3.58°, P = 0.009), and MR knees and healthy knees (1.82° ± 3.11° vs 3.62° ± 3.52°, P = 0.032) in adduction/abduction ROM. The proximal/distal translation was significantly smaller in MR knees (0.58 ± 0.54 cm) compared with SR knees (1.03 ± 0.53 cm, P = 0.003) or healthy knees (0.84 ± 0.45 cm, P = 0.039). SR knees (0.24 ± 0.40 cm) had smaller translation compared with the MR group (0.54 ± 0.33 cm, P = 0.017) and control group (0.67 ± 0.36 cm, P = 0.028). No significant difference was detected in the other DOFs during the gait cycle. Significant difference was detected in extension/flexion, internal/external rotation, adduction/abduction, proximal/distal and medial/lateral among MR, SR and healthy knees. CONCLUSION After TKA, patients have altered gait kinematics compared with the control group. MR and SR design showed varied characteristics in 6 DOF gait kinematics, which could be the cause of the difference in functional outcome.
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Affiliation(s)
- Mengyuan Li
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Guangtao Fu
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Wenhan Huang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Bofu Lin
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
- Shantou University Medical College, Shantou, 515063, PR China
| | - Ruiying Zhang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Yu Zhang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Yuanchen Ma
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China.
| | - Qiujian Zheng
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China.
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Nishitani K, Kuriyama S, Nakamura S, Morita Y, Ito H, Matsuda S. Valgus position of the femoral component causes abnormal kinematics in the presence of medial looseness in total knee arthroplasty: a computer simulation model of TKA for valgus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2019; 27:2051-2060. [PMID: 30374567 DOI: 10.1007/s00167-018-5264-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/23/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Total knee arthroplasty (TKA) for valgus knee osteoarthritis is challenging. Although overcorrection in TKA for valgus knee osteoarthritis is recommended, supportive data based on biomechanics have rarely been reported. The purpose of this study was to elucidate whether coronal rotation of the femoral compartment causes abnormal kinematics with or without medial looseness. METHODS Multi- and single-radius posterior-stabilised TKA implants were utilised in a computer simulation. A total of 4 mm of slack were provided in the medial collateral ligament (MCL) with varus or valgus position of the femoral component to simulate the context of valgus knee osteoarthritis. Kinematics during gait and squatting activities were evaluated in each condition. RESULTS During squatting, medial looseness and valgus replacement caused anterior translation of the medial femoral component in mid-flexion in the multi-radius implant. In the worst condition (7° valgus replacement with MCL looseness), there was rapid anterior translation in the multi-radius implant, and moderate anterior translation in the single-radius implant. Although medial looseness alone did not cause abnormal kinematics during gait, the worst condition exhibited an anterior translation to 4.9 mm in the multi-radius implant. This worst condition also exhibited a marked lift-off of 8.0 and 2.9 mm in the multi- and single-radius implants, respectively. Varus position caused little abnormal kinematics even with MCL looseness. CONCLUSION Valgus, not varus position of the femoral component caused abnormal kinematics with MCL looseness. To avoid valgus position, the safety target angle of femoral component would be slight varus rather than neutral in valgus knee OA.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, 606-8507, Kyoto, Japan.
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, 606-8507, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, 606-8507, Kyoto, Japan
| | - Yugo Morita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, 606-8507, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, 606-8507, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo, 606-8507, Kyoto, Japan
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Scott CEH, Bell KR, Ng RT, MacDonald DJ, Patton JT, Burnett R. Excellent 10-year patient-reported outcomes and survival in a single-radius, cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1106-1115. [PMID: 30276434 PMCID: PMC6435607 DOI: 10.1007/s00167-018-5179-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/20/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Over 2 million Triathlon single-radius total knee arthroplasties (TKAs) have been implanted worldwide. This study reports the 10-year survival and patient-reported outcome of the Triathlon TKA in a single independent centre. METHODS From 2006 to 2007, 462 consecutive cruciate-retaining Triathlon TKAs were implanted in 426 patients (median age 69 (21-89), 289 (62.5%) female). Patellae were not routinely resurfaced. Patient-reported outcome measures (SF-12, Oxford Knee Scores (OKS), satisfaction) were assessed preoperatively and at 1, 5 and 10 years when radiographs were reviewed. Forgotten Joint Scores (FJS) were collected at 10 years. Kaplan-Meier survival analysis was performed. RESULTS At 10-11.6 years, 123 patients (128 TKAs) had died and 8 TKAs were lost to follow-up. There were four aseptic failures (two cases of tibial loosening, two cases of instability) and four septic failures requiring revision. Symptomatic aseptic radiographic loosening was present in three further cases at 11 years. Four (1%) patellae were secondarily resurfaced. OKS score improved by 17.7 ± 9.7 points at 1 year (p < 0.001), and was maintained at 34.7 ± 9.6 at 10 years with FJS 48.5 ± 31.4. Patient satisfaction was 88% at each timepoint. Ten-year survival was 97.9% (95% confidence interval 96.5-99.3) for revision for any reason, 98.9% (97.7-100) for mechanical failure, and 98.6% (97.4-99.8) for aseptic loosening (symptomatic radiographic or revised). CONCLUSION The Triathlon TKA continues to show excellent longer-term results with high implant survivorship, low rates of aseptic failure, consistently maintained PROMs and excellent patient satisfaction rates of 88% at 10 years. LEVEL OF EVIDENCE II, Prospective cohort study.
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Affiliation(s)
- Chloe E. H. Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Katrina R. Bell
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Richard T. Ng
- Department of Orthopaedics, University of Calgary, 401 9th Ave SW, Suite 335, Calgary, AB T2P
3C5 Canada
| | - Deborah J. MacDonald
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - James T. Patton
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Richard Burnett
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
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Wellman SS, Klement MR, Queen RM. Performance Comparison of Single-Radius Versus Multiple-Curve Femoral Component in Total Knee Arthroplasty: A Prospective, Randomized Study Using the Lower Quarter Y-Balance Test. Orthopedics 2017; 40:e1074-e1080. [PMID: 29116326 DOI: 10.3928/01477447-20171020-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/08/2017] [Indexed: 02/03/2023]
Abstract
Midflexion stability after total knee arthroplasty (TKA) is dependent, in part, on implant design. Midflexion performance of a single-radius (SR) design and a multi-radius, or J-curve (JC), design were compared using the Lower Quarter Y-Balance Test (YBT-LQ). Patient-reported outcomes and measures of physical performance were also compared. The authors hypothesized that the SR design would provide superior midflexion stability and, therefore, a greater reach distance in the YBT-LQ when compared with the JC design. Patients undergoing primary, unilateral TKA were prospectively enrolled and block randomized to receive either the SR (n=30) or the JC (n=30) implant. Patients reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Knee Society Score, and University of California at Los Angeles Activity Score), performed the YBT-LQ, and completed physical performance measures (walking speed, timed up-and-go test, and sit-to-stand test) before surgery and 1 year postoperatively. One year postoperatively, 40 patients (20 SR, 20 JC) were available for analysis. There were no significant differences between the groups regarding age, sex, body mass index, American Society of Anesthesiologists score, YBT-LQ results, or any other variable of interest. In both groups, significant improvements were observed for all variables of interest when compared from preoperatively to 1 year postoperatively. Implant type did not affect patient-reported or physical performance outcomes following TKA; however, patients showed significant improvement in most outcome measures by 1 year postoperatively. The significant limitations in strength and balance in this cohort of patients likely outweigh any subtle differences in implant design. [Orthopedics. 2017; 40(6):e1074-e1080.].
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