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León-Román VE, García-Mato D, López-Torres II, Vaquero-Martín J, Calvo-Haro JA, Pascau J, Sanz-Ruíz P. Is a greater degree of constraint really harmful? Clinical biomechanical comparative study between condylar constrained knee and rotating hinge prosthesis. Clin Biomech (Bristol, Avon) 2024; 111:106149. [PMID: 37976691 DOI: 10.1016/j.clinbiomech.2023.106149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The real degree of constraint of rotating hinge knee and condylar constrained prostheses is a matter of discussion in revision knee arthroplasty. The objective of this study is to compare the tibial rotation between implants in the clinical settings. METHODS An investigator blinded experimental study was designed including 20 patients: in 10 of them a rotating hinge knee prosthesis (Endomodel®, LINK) was implanted and in the remaining 10 a constrained condylar knee prosthesis (LCCK®, Zimmer) was used. A medial parapatellar approach was performed and implantation was performed according to conventional surgical technique. Tibial rotation was measured with two accelerometers in full extension and at 30°, 60° and 90° of flexion. Pre and postoperative Knee Injury and Osteoarthritis Outcome Score was recorded. FINDINGS Both groups were homogenous in age (73.4 years in rotating hinge knee prosthesis vs 74 years in constrained condylar knee group), sex, laterality and preoperative Knee Injury and Osteoarthritis Outcome Score (p > 0.05). The postoperative Knee Injury and Osteoarthritis Outcome Score was significantly higher in the rotating hinge knee prosthesis group (80.98 vs 76.28). The degrees of tibial rotation measured by inertial sensors in the rotating hinge knee prosthesis group were also significantly higher than those measured in the constrained condylar knee group (5.66° vs 2.1°) with p = 0.001. INTERPRETATION Rotating hinge knee prosthesis appears to represent a lower rotational constraint degree than constrained condylar knee systems in clinical practice and it may increase the clinical satisfaction. The clinical significance: Rotating hinge knee prosthesis appears to represent a lower constraint degree than constrained condylar knee systems in clinical practice.
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Affiliation(s)
- Víctor-Estuardo León-Román
- Villalba General Hospital, Carretera de Alpedrete a Moralzarzal M-608 km 41, 28400 Collado Villalba, Madrid, Spain.
| | - David García-Mato
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avda. de la Universidad, 30, 28911 Leganés, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | | | - Javier Vaquero-Martín
- Gregorio Marañón General Hospital, C/ Doctor Esquerdo 46, 28007, Madrid, Spain; Surgery Department, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - José Antonio Calvo-Haro
- Gregorio Marañón General Hospital, C/ Doctor Esquerdo 46, 28007, Madrid, Spain; Surgery Department, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain
| | - Javier Pascau
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avda. de la Universidad, 30, 28911 Leganés, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Pablo Sanz-Ruíz
- Gregorio Marañón General Hospital, C/ Doctor Esquerdo 46, 28007, Madrid, Spain; Surgery Department, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain
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Stroobant L, de Taeye T, Byttebier P, Van Onsem S, Jacobs E, Burssens A, Victor J. Condylar constrained and rotating hinged implants in revision knee arthroplasty show similar survivorship and clinical outcome: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5365-5380. [PMID: 37747534 DOI: 10.1007/s00167-023-07572-z] [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] [Received: 06/02/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA. METHODS Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component. RESULTS A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants (p = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°). CONCLUSION This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lenka Stroobant
- Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium.
| | - Thijmen de Taeye
- Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium
| | - Paul Byttebier
- Department Orthopaedic Surgery, ASZ Aalst, Aalst, Belgium
| | | | - Ewoud Jacobs
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Arne Burssens
- Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium
| | - Jan Victor
- Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium
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Zhang C, Wang Y. Biomechanical Analysis of Axial Gradient Porous Dental Implants: A Finite Element Analysis. J Funct Biomater 2023; 14:557. [PMID: 38132811 PMCID: PMC10743419 DOI: 10.3390/jfb14120557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
The porous structure can reduce the elastic modulus of a dental implant and better approximate the elastic characteristics of the material to the alveolar bone. Therefore, it has the potential to alleviate bone stress shielding around the implant. However, natural bone is heterogeneous, and, thus, introducing a porous structure may produce pathological bone stress. Herein, we designed a porous implant with axial gradient variation in porosity to alleviate stress shielding in the cancellous bone while controlling the peak stress value in the cortical bone margin region. The biomechanical distribution characteristics of axial gradient porous implants were studied using a finite element method. The analysis showed that a porous implant with an axial gradient variation in porosity ranging from 55% to 75% was the best structure. Under vertical and oblique loads, the proportion of the area with a stress value within the optimal stress interval at the bone-implant interface (BII) was 40.34% and 34.57%, respectively, which was 99% and 65% higher compared with that of the non-porous implant in the control group. Moreover, the maximum equivalent stress value in the implant with this pore parameter was 64.4 MPa, which was less than 1/7 of its theoretical yield strength. Axial gradient porous implants meet the strength requirements for bone implant applications. They can alleviate stress shielding in cancellous bone without increasing the stress concentration in the cortical bone margin, thereby optimizing the stress distribution pattern at the BII.
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Affiliation(s)
- Chunyu Zhang
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha 410008, China;
- Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha 410008, China
- Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha 410008, China
| | - Yuehong Wang
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha 410008, China;
- Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha 410008, China
- Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha 410008, China
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Zhang ZH, Qi YS, Wei BG, Bao HRC, Xu YS. Application strategy of finite element analysis in artificial knee arthroplasty. Front Bioeng Biotechnol 2023; 11:1127289. [PMID: 37265991 PMCID: PMC10230366 DOI: 10.3389/fbioe.2023.1127289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/27/2023] [Indexed: 06/03/2023] Open
Abstract
Artificial knee arthroplasty, as the most effective method for the treatment of end-stage joint diseases such as knee osteoarthritis and rheumatoid arthritis, is widely used in the field of joint surgery. At present, Finite element analysis (FEA) has been widely used in artificial knee replacement biomechanical research. This review presents the current hotspots for the application of FEA in the field of artificial knee replacement by reviewing the existing research literature and, by comparison, summarizes guidance and recommendations for artificial knee replacement surgery. We believe that lower contact stress can produce less wear and complications when components move against each other, in the process of total knee arthroplasty (TKA), mobile-bearing prostheses reduce the contact surface stress of the tibial-femoral joint compared with fixed-bearing prostheses, thus reducing the wear of the polyethylene insert. Compared with mechanical alignment, kinematic alignment reduces the maximum stress and maximum strain of the femoral component and polyethylene insert in TKA, and the lower stress reduces the wear of the joint contact surface and prolongs the life of the prosthesis. In the unicompartmental knee arthroplasty (UKA), the femoral and tibial components of mobile-bearing prostheses have better conformity, which can reduce the wear of the components, while local stress concentration caused by excessive overconformity of fixed-bearing prostheses should be avoided in UKA to prevent accelerated wear of the components, the mobile-bearing prosthesis maintained in the coronal position from 4° varus to 4° valgus and the fixed-bearing prosthesis implanted in the neutral position (0°) are recommended. In revision total knee arthroplasty (RTKA), the stem implant design should maintain the best balance between preserving bone and reducing stress around the prosthesis after implantation. Compared with cemented stems, cementless press-fit femoral stems show higher fretting, for tibial plateau bone defects, porous metal blocks are more effective in stress dispersion. Finally, compared with traditional mechanical research methods, FEA methods can yield relatively accurate simulations, which could compensate for the deficiencies of traditional mechanics in knee joint research. Thus, FEA has great potential for applications in the field of medicine.
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Affiliation(s)
- Zi-Heng Zhang
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
- Graduate School, Inner Mongolia Medical University, Hohhot, China
| | - Yan-Song Qi
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Bao-Gang Wei
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Hu-Ri-Cha Bao
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Yong-Sheng Xu
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
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Zhang C, Zeng C, Wang Z, Zeng T, Wang Y. Optimization of stress distribution of bone-implant interface (BII). BIOMATERIALS ADVANCES 2023; 147:213342. [PMID: 36841109 DOI: 10.1016/j.bioadv.2023.213342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
Many studies have found that the threshold of occlusal force tolerated by titanium-based implants is significantly lower than that of natural teeth due to differences in biomechanical mechanisms. Therefore, implants are considered to be susceptible to occlusal trauma. In clinical practice, many implants have shown satisfactory biocompatibility, but the balance between biomechanics and biofunction remains a huge clinical challenge. This paper comprehensively analyzes and summarizes various stress distribution optimization methods to explore strategies for improving the resistance of the implants to adverse stress. Improving stress resistance reduces occlusal trauma and shortens the gap between implants and natural teeth in occlusal function. The study found that: 1) specific implant-abutment connection design can change the force transfer efficiency and force conduction direction of the load at the BII; 2) reasonable implant surface structure and morphological character design can promote osseointegration, maintain alveolar bone height, and reduce the maximum effective stress at the BII; and 3) the elastic modulus of implants matched to surrounding bone tissue can reduce the stress shielding, resulting in a more uniform stress distribution at the BII. This study concluded that the core BII stress distribution optimization lies in increasing the stress distribution area and reducing the local stress peak value at the BII. This improves the biomechanical adaptability of the implants, increasing their long-term survival rate.
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Affiliation(s)
- Chunyu Zhang
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China.
| | - Chunyu Zeng
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China
| | - Zhefu Wang
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China
| | - Ting Zeng
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China
| | - Yuehong Wang
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China; Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha, 410008, Hunan, China.
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Mei F, Li JJ, Lin J, Zhou D, Xing D. Constrained Condylar Prostheses for the Treatment of Charcot Arthropathy: A Case Report and Literature Review. Orthop Surg 2023; 15:1423-1430. [PMID: 36859755 PMCID: PMC10157705 DOI: 10.1111/os.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Neuroarthropathy of the knee or Charcot knee, leading to chronic joint destruction, is a rare disease that is difficult to diagnose. The treatment of this condition is difficult and controversial. CASE PRESENTATION A 74-year-old Asian woman has had bilateral knee pain for 22 years and deformity for 10 years, which has been aggravating for 2 months. Physical examination showed bilateral knee varus deformity greater than 15°, and -20 to 90° range of motion. X-ray revealed bilateral varus deformity with massive free body hyperplasia. Combined with medical history as syringomyelia, the patient was diagnosed with bilateral Charcot knees and bilateral joint replacements were performed using Legacy Constrained Condylar Knee prostheses (LCCK; Zimmer, USA). The patient reported satisfactory treatment outcomes, pain relief, and improved range of motion in both knees, without postoperative complications or prosthesis loosening at 2 year after operation. CONCLUSIONS Total knee arthroplasty (TKA) may be considered a viable option for treating the Charcot knee. The use of constrained condylar prostheses can produce satisfactory results. Attention should be given to survival risks, complications, and other potential determining factors associated with TKA when devising a treatment strategy for the Charcot knee.
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Affiliation(s)
- Fengyao Mei
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Sydney, Australia
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Diange Zhou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Dan Xing
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
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Miralles-Muñoz FA, Pineda-Salazar M, Rubio-Morales M, González-Parreño S, Ruiz-Lozano M, Lizaur-Utrilla A. Similar outcomes of constrained condylar knee and rotating hinge prosthesis in revision surgery for extension instability after primary total knee arthroplasty. Orthop Traumatol Surg Res 2022; 108:103265. [PMID: 35257946 DOI: 10.1016/j.otsr.2022.103265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/08/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instability is one of the most common reasons for total knee arthroplasty (TKA) failure. Constrained prosthesis can be used for significant ligamentous laxity, but there is not much evidence on the appropriate level of restriction for unstable varus-valgus TKA. The objective of this study was to compare the outcome and survival at a minimum follow-up of five years between rotating hinge knee prosthesis (RHK) and constrained condylar knee prosthesis (CCK) for extension instability following primary TKA. HYPOTHESIS For symptomatic extension instability after primary TKA, good functional outcomes and survival can be achieved with both designs. MATERIAL AND METHODS Consecutive patients with unstable primary TKA who underwent revision with either RHK (n=34) or CCK (n=30) were retrospectively compared. Assessments were performed by the Knee Society Scores (KSS), and visual analogue scales (VAS) for pain and patient satisfaction. Radiological evaluation was made. Complications and re-operations were analyzed. RESULTS Mean post-operative follow-up was 10.3 (range 5-16) years for both groups. At the final follow-up, there was no significant difference between groups in the KSS-knee (p=0.228) or KSS-function (p=0.324) score, VAS-pain (p=0.563), VAS-satisfaction (p=0.780), major complication rate (p=0.194), or TKA survival at 10 years (p=0.091). CONCLUSION The present study showed comparable good functional outcomes and survival at long-term between RHK and CCK arthroplasties. Both designs can be recommended for revision of total knee arthroplasty with symptomatic extension instability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain.
| | - Manuel Pineda-Salazar
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Marta Rubio-Morales
- 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
| | - Matías Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - 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, San Juan de Alicante, Alicante, Spain
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Sanz-Ruiz P, León-Román VE, Matas-Diez JA, Villanueva-Martínez M, Vaquero J. Long-term outcomes of one single-design varus valgus constrained versus one single-design rotating hinge in revision knee arthroplasty after over 10-year follow-up. J Orthop Surg Res 2022; 17:135. [PMID: 35246182 PMCID: PMC8896104 DOI: 10.1186/s13018-022-03026-3] [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: 01/10/2022] [Accepted: 02/18/2022] [Indexed: 08/30/2023] Open
Abstract
Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the use of the lowest possible constraint. This study aimed to compare the long-term clinical and survival results of revision with rotation hinge knee (RHK) VS constrained condylar constrained knee (CCK) implants. Methods Overall, 117 revision case were prospectively reviewed and dividing into two groups based on the degree of constraint used, using only one prosthetic model in each group (61 CCK vs 56 RHK). All implants were evaluated for a minimum of 10 years. Survival of both implants at the end of follow-up, free from revision for any cause, aseptic loosening, and septic cause was compared. Results Better results were seen with use of the RHK in joint ranges of (p = 0.023), KSCS (p = 0.015), KSFS (p = 0.043), and KOOS (p = 0.031). About 22.2% of the cases required repeat surgery (11.7% RHK vs 29.6% CCK, p = 0.023). Constrained condylar implants had a significantly lower survival rates than rotating hinge implants (p = 0.005), due to a higher aseptic loosening rate (p = 0.031). Conclusion Using a specific RHK design with less rotational constraint has better clinical and survival outcomes than implants with greater rotational constraint, such as one specific CCK.
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Affiliation(s)
- Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain. .,Faculty of Medicine, Complutense University of Madrid, Pza. Ramón y Cajal, Square, University City, 28040, Madrid, Spain.
| | - Víctor Estuardo León-Román
- Department of Traumatology and Orthopaedic Surgery, Villalba Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Collado Villalba, Spain
| | - José Antonio Matas-Diez
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain
| | | | - Javier Vaquero
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Pza. Ramón y Cajal, Square, University City, 28040, Madrid, Spain
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9
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Good to excellent long-term survival of a single-design condylar constrained knee arthroplasty for primary and revision surgery. Knee Surg Sports Traumatol Arthrosc 2022; 30:3184-3190. [PMID: 34125255 PMCID: PMC9418349 DOI: 10.1007/s00167-021-06636-2] [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: 03/30/2021] [Accepted: 06/08/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE The purpose of the study was to determine the long-term survivorship, functional outcomes of a single-design condylar constrained (CCK) TKA in primary and revision cases as well as to assess specific risk factors for failure. It was hypothesized that primary CCK TKA had a better survival than revision knees. METHODS One hundred and forty three patients who underwent revision TKA (n = 119) or complex primary TKA (n = 24) using a single-design condylar constrained knee system (Genesis CCK, Smith & Nephew) performed at a single institution between 1999 and 2008 were retrospectively included. The median follow-up amounted to 11.8 years (IQR 10.3-14.4). Implant survivorship was analyzed using Kaplan-Meier survival estimates and multivariate Cox regression analysis to identify risk factors for failure. Function was determined using the Oxford Knee Score (OKS). RESULTS The implant survival was 86.4% after five, 85.5% after ten and 79.8% at 15 years. A reduced implant survivorship was found in males (HR 5.16, p = 0.001), smokers (HR 6.53, p = 0.004) and in obese patients (HR 2.26, p = 0.095). Patients who underwent primary TKA had a higher revision-free implant survivorship compared to revision TKA at 15 years (100% vs. 76%, p = 0.036). The main cause for re-revision was infection in 10% of all revision TKA performed with the CCK design included, while no case was revised for instability. The median OKS was 39 (IQR 35-44) in 102 patients available for long-term functional outcome. CONCLUSION CCK implants are associated with excellent long-term survival when used in primary TKA; however, survival was worse when used during revision TKA. Males, smokers, obese patients and are at higher risk for revision. While instability and aseptic loosening were rare, infection remains a major concern. LEVEL OF EVIDENCE Level IV, retrospective observational study.
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Pietsch M, Hochegger M, Djahani O, Mlaker G, Eder-Halbedl M, Hofstädter T. Handheld computer-navigated constrained total knee arthroplasty for complex extra-articular deformities. Arch Orthop Trauma Surg 2021; 141:2245-2254. [PMID: 34255171 DOI: 10.1007/s00402-021-04053-1] [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: 02/08/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The present study aimed to assess the postoperative alignment and clinical outcomes of patients with complex extra-articular deformities (EADs) undergoing computer-assisted surgery (CAS) for constrained total knee arthroplasty (TKA) with modular stem extensions. MATERIALS AND METHODS From May 2015 to July 2018, ten patients with EADs scheduled for constrained TKA were enrolled retrospectively. The preoperative average deviation from neutral (= 180°) mechanical axis was 15.3° (range of coronal alignment: 150.9° varus-202.9° valgus). Alignment was assessed using an accelerometer-based handheld CAS system. On long-leg films, the positions of the components and possible stems were analysed and templated preoperatively. The average follow-up was 3.3 years (range: 2.0-4.6 years). RESULTS The postoperative mechanical axis was within ± 3.0° from neutral in nine patients. In all patients, the Knee Society score (KSS) and range of motion improved significantly. A constrained condylar and a rotating hinge prosthesis were used in five patients each. In eight patients, the 100-mm cementless stem that was preferred by the authors was found to be unusable for the femur or the tibia in the planning stage. For the femur, a cementless 100-mm stem was used in three, and a cemented 30-mm stem in five patients; a femoral stem was not usable in two patients. For the tibia, a cementless 100-mm stem was used in six, and a cemented 30-mm stem in two patients; a monoblock rotating hinge tibia was used in two patients. CONCLUSIONS Complex EADs were excellently managed during constrained TKA implantation using the handheld CAS system. Templating allowed the possible stem lengths to be identified and prevented anatomical conflict with the CAS-configured mechanical alignment. Limb alignment and function improved significantly after surgery. No intra- or postoperative complications occurred. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- M Pietsch
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria.
| | - M Hochegger
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - O Djahani
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - G Mlaker
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - M Eder-Halbedl
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - Th Hofstädter
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Abstract
Ligament balancing in revision knee arthroplasty is crucial to the success of the procedure. The medial collateral ligament and lateral ligament complex are the primary ligamentous structures that provide stability. Revisions can be performed with nonconstrained cruciate-retaining, posterior cruciate substituting, or anterior-stabilized/ultracongruent inserts when there are symmetrical flexion/extension gaps and intact collateral ligaments. When the collateral ligaments are insufficient either due to attenuation or incompetence from bone loss, a more constrained knee system is needed. Constrained condylar knees provide increased stability to both varus/valgus and rotation forces with a nonlinked construct. This increased constraint, however, does lead to increased stress at the implant-bone interface which requires more robust metaphyseal fixation. In cases of significant soft tissue disruption, severe flexion/extension gap mismatch or extensor mechanism disruption, a rotating hinge knee is needed to restore stability. Advances in revision implant design have led to improved outcomes and longer survivorship then earlier iterations of these implants. Surgeons should always strive to use the least constraint needed to achieve stability but must have a low threshold to increase constraint when ligament integrity is compromised.
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León-Román VE, García-Mato D, López-Torres II, Vaquero-Martín FJ, Calvo-Haro JA, Pascau J, Sanz-Ruíz P. The knee prosthesis constraint dilemma: Biomechanical comparison between varus-valgus constrained implants and rotating hinge prosthesis. A cadaver study. J Orthop Res 2021; 39:1533-1539. [PMID: 32881027 DOI: 10.1002/jor.24844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/22/2020] [Accepted: 08/31/2020] [Indexed: 02/04/2023]
Abstract
The real degree of constriction of rotating hinge knee (RHK) and condylar constrained prostheses (CCK) is a matter of discussion in revision knee arthroplasty. The objectives of this study are to compare the tibial rotation of both implants and validate the use of inertial sensors with optical tracking system as movement measurement tools. A total of 16 cadaver knees were used. Eight knees were replaced using a RHK (Endomodel LINK), and the remaining eight received a CCK prosthesis (LCCK, Zimmer). Tibial rotation range of motion was measured in full extension and at 30°, 60°, and 90° of flexion, with four continuous waveforms for each measurement. Measurements were made using two inertial sensors with specific software and compared with measurements obtained using the gold standard technique - the motion capture camera. The comparison of the accuracy of both measurement methods showed no statistically significant differences between inertial sensors and motion capture cameras, with p > .1; the mean error for tibial rotation was 0.21°. Tibial rotation in the RHK was significantly greater than in the CCK (5.25° vs. 2.28°, respectively), p < .05. We have shown that RHK permit greater tibial rotation, being closer to physiological values than CCKs. Inertial sensors have been validated as an effective and accurate method of measuring knee movement. The clinical significance: RHK appears to represent a lower constriction degree than CCK systems.
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Affiliation(s)
- V E León-Román
- Department of Orthopaedics and Trauma, Villalba General Hospital, Madrid, Spain
| | - D García-Mato
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - I I López-Torres
- Department of Orthopaedics and Trauma, Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - F J Vaquero-Martín
- Department of Orthopaedics and Trauma, Gregorio Marañón General Hospital, Madrid, Spain.,Surgery Department, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - J A Calvo-Haro
- Department of Orthopaedics and Trauma, Gregorio Marañón General Hospital, Madrid, Spain.,Surgery Department, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - J Pascau
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - P Sanz-Ruíz
- Department of Orthopaedics and Trauma, Gregorio Marañón General Hospital, Madrid, Spain.,Surgery Department, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Athwal KK, Willinger L, Manning W, Deehan D, Amis AA. A constrained-condylar fixed-bearing total knee arthroplasty is stabilised by the medial soft tissues. Knee Surg Sports Traumatol Arthrosc 2021; 29:659-667. [PMID: 32322947 PMCID: PMC7892729 DOI: 10.1007/s00167-020-05995-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/10/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Revision constrained-condylar total knee arthroplasty (CCK-TKA) is often used to provide additional mechanical constraint after failure of a primary TKA. However, it is unknown how much this translates to a reliance on soft-tissue support. The aim of this study was therefore to compare the laxity of a native knee to the CCK-TKA implanted state and quantify how medial soft-tissues stabilise the knee following CCK-TKA. METHODS Ten intact cadaveric knees were tested in a robotic system at 0°, 30°, 60° and 90° flexion with ± 90 N anterior-posterior force, ± 8 Nm varus-valgus and ± 5 Nm internal-external torques. A fixed-bearing CCK-TKA was implanted and the laxity tests were repeated with the soft tissues intact and after sequential cutting. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were sequentially transected and the percentage contributions of each structure to restraining the applied loads were calculated. RESULTS Implanting a CCK-TKA did not alter anterior-posterior laxity from that of the original native knee, but it significantly decreased internal-external and varus-valgus rotational laxity (p < 0.05). Post CCK-TKA, the sMCL restrained 34% of the tibial displacing load in anterior drawer, 16% in internal rotation, 17% in external rotation and 53% in valgus, across the flexion angles tested. The dMCL restrained 11% of the valgus rotation moment. CONCLUSIONS With a fully-competent sMCL in-vitro, a fixed-bearing CCK-TKA knee provided more rotational constraint than the native knee. The robotic test data showed that both the soft-tissues and the semi-constrained implant restrained rotational knee laxity. Therefore, in clinical practice, a fixed-bearing CCK-TKA knee could be indicated for use in a knee with lax, less-competent medial soft tissues. LEVEL OF EVIDENCE Controlled laboratory study.
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Affiliation(s)
- Kiron K Athwal
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Lukas Willinger
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - William Manning
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle, UK
| | - David Deehan
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle, UK
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK.
- Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, London, UK.
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Petershofer A, Trieb K. Rotating Hinge Implants in Knee Arthroplasty. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:383-389. [PMID: 31404939 DOI: 10.1055/a-0896-2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Due to demographic transition an increasing number of primary knee arthroplasty is expected. A consequence is a rise in frequency in revision knee arthroplasty. Rotating hinge prostheses are a development of former hinge prostheses, due to changes in implant design the outcome of modern rotating hinge implants clearly improved in comparison to former models. Interpretation of outcome in present literature is difficult due to the small number of cases and the heterogeneous indications. Nevertheless the use of rotating hinge knee prostheses in primary and revision arthroplasty is associated with good clinical outcomes, when indicated appropriately.
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Affiliation(s)
| | - Klemens Trieb
- University of Applied Sciences Upper Austria, Wels, Austria
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Park CH, Bae JK, Song SJ. Factors affecting the choice of constrained prostheses when performing revision total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 43:1831-1840. [PMID: 30327936 DOI: 10.1007/s00264-018-4200-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purposes of the present study were to assess the levels of prosthetic constraint chosen during revision total knee arthroplasty (TKA) and to identify factors influencing the choice of a constrained prosthesis. METHODS We retrospectively reviewed data on 274 revision TKAs. The mean follow-up period after revision TKA was 7.2 years. The femorotibial angle (FTA), joint line height (JLH), and Insall-Salvati ratio (ISR) were radiographically evaluated. Factors affecting the extent of constraint chosen were evaluated in terms of age, gender, body mass index, primary diagnosis, the cause of revision TKA, the Anderson Orthopedic Research Institute (AORI) classification, and changes in the JLH and ISR. RESULTS Totals of 247 (90.1%), 11 (4.0%), and 9 (3.4%) knees received posteriorly stabilized prostheses, constrained condylar knees, and rotating hinge prostheses, respectively. On multivariate analysis, the cause of revision TKA including loosening and instability and the changes in the JLH and ISR affected independently the choice of a constrained prosthesis. CONCLUSIONS The frequency of implantation of constrained prostheses was 7.4% in the present study. Consideration of various factors including the cause of revision TKA and changes in the JLH and ISR will aid the TKA surgeon in selecting prostheses with appropriate constraints when performing revision TKAs.
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Affiliation(s)
- Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Jung Kwon Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, South Korea.
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