1
|
Mancino F, Fontalis A, Kayani B, Magan A, Plastow R, Haddad FS. The current role of CT in total knee arthroplasty. Bone Joint J 2024; 106-B:892-897. [PMID: 39216858 DOI: 10.1302/0301-620x.106b9.bjj-2023-1303.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Advanced 3D imaging and CT-based navigation have emerged as valuable tools to use in total knee arthroplasty (TKA), for both preoperative planning and the intraoperative execution of different philosophies of alignment. Preoperative planning using CT-based 3D imaging enables more accurate prediction of the size of components, enhancing surgical workflow and optimizing the precision of the positioning of components. Surgeons can assess alignment, osteophytes, and arthritic changes better. These scans provide improved insights into the patellofemoral joint and facilitate tibial sizing and the evaluation of implant-bone contact area in cementless TKA. Preoperative CT imaging is also required for the development of patient-specific instrumentation cutting guides, aiming to reduce intraoperative blood loss and improve the surgical technique in complex cases. Intraoperative CT-based navigation and haptic guidance facilitates precise execution of the preoperative plan, aiming for optimal positioning of the components and accurate alignment, as determined by the surgeon's philosophy. It also helps reduce iatrogenic injury to the periarticular soft-tissue structures with subsequent reduction in the local and systemic inflammatory response, enhancing early outcomes. Despite the increased costs and radiation exposure associated with CT-based navigation, these many benefits have facilitated the adoption of imaged based robotic surgery into routine practice. Further research on ultra-low-dose CT scans and exploration of the possible translation of the use of 3D imaging into improved clinical outcomes are required to justify its broader implementation.
Collapse
Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- The Bone & Joint Journal , London, UK
| |
Collapse
|
2
|
Jeong HW, Yoo HJ, Park SY, Lee YS. Clinical Relevance of Posterior Osteophyte Formation in Ultra-congruent Total Knee Arthroplasty: Midterm Radiographic Rollback and Impingement Analysis. Clin Orthop Surg 2024; 16:413-421. [PMID: 38827750 PMCID: PMC11130627 DOI: 10.4055/cios23061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/04/2024] Open
Abstract
Background Posterior femoral condylar osteophytes were frequently observed in patients with the ultra-congruent (UC) deep-dish design prosthesis. Therefore, the purpose of the present study was to verify the clinical relevance of osteophyte formation in the UC design. Methods From March 2014 to February 2018, a comparative study was conducted on 96 knees using the UC design. They were divided into 2 groups (group 1: osteophyte +, group 2: osteophyte -). Intraoperative findings, indirect femoral rollback assessment using 30° flexion and active full flexion lateral radiographs, serial change of the osteophyte, and outcomes were compared. Results The mean follow-up period was 49.35 ± 3.47 months in group 1 and 47.52 ± 3.37 months in group 2. Posterior component coverage was significantly different between the groups: group 1 exhibited more underhang and group 2 exhibited more overhang (p = 0.022). On the indirect assessment of the femoral rollback, there was a statistically significant difference in deep flexion and change in distance (p < 0.001 and p < 0.001, respectively). There was no statistical difference between the 2 groups in the American Knee Society knee and function score, and group 2 showed significant improvement in pain compared to group 1 in Western Ontario and McMaster University Arthritis Index pain score (p = 0.029). Conclusions Posterior condylar osteophyte formation was related to posterior impingement. It was more frequently observed in the underhang of the femoral component and insufficient femoral rollback. In addition, it changed with time and caused negative effects, including a gradual decrease in flexion and more pain.
Collapse
Affiliation(s)
- Ho Won Jeong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Jin Yoo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
3
|
Yoo HJ, Kim YB, Jeong HW, Park SB, Nam HS, Lee YS. Clinical relevance of roll-back replacement of ultra congruent total knee arthroplasty: comparison of mid-term outcomes with posterior stabilizing design. Arch Orthop Trauma Surg 2023; 143:6805-6813. [PMID: 37488457 DOI: 10.1007/s00402-023-04918-7] [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: 08/31/2022] [Accepted: 05/21/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The outcomes of total knee arthroplasty (TKA) remain controversial, and we do not know which factors are important for successful outcomes. This study aimed to compare the mid-term outcomes of different conceptual designs by evaluating the radiological and clinical outcomes. MATERIALS AND METHODS A total of 478 total knee arthroplasties (TKAs) were enrolled and allocated into groups I [posterior stabilizing (PS) with anterior referencing (AR)], II [PS with posterior referencing (PR), and III [ultra-congruent (UC) TKA)]. Preoperative findings, last follow-up clinical outcomes, and final follow-up radiological and indirect assessments of the femoral rollback were compared between the groups. RESULTS The mean follow-up period was 72.6 ± 12.9 months. The tourniquet was used samely applied to every group. Flexion contracture was significantly larger in group III than in groups I and II (3.3 ± 2.7, p < 0.001), and further flexion was significantly smaller in group III (130.0° ± 2.7°, p < 0.001). Among the radiological parameters, posterior osteophyte formation was the most common in group III (67.8%). The rollback distance was significantly smaller in group III than in groups I and II (p < 0.001). The active deep flexion angle was affected by the posterior condylar offset (PCO) ratio, and the contact point changed the distance (p < 0.05). CONCLUSION PS TKAs showed better ROMs than UC TKAs; however, no differences were noted in the clinical outcome scales. The flexion angle was affected by the PCOR and rollback at both PS and UC TKAs. However, rollback negatively affected the flexion angle during UC TKAs. An inappropriate femoral rollback was identified, and femoral osteophyte formation was determined to be the most prominent in UC TKAs. Level of evidence Level III comparative study.
Collapse
Affiliation(s)
- Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Yong Beom Kim
- Department of Orthopaedic Surgery, Soonchunyang University Hospital, Seoul, Korea
| | - Ho Won Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Sung Bae Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Hee Seung Nam
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
| |
Collapse
|
4
|
Sodhi N, Jacofsky DJ, Chee A, Mont MA. Benefits of CT Scanning for the Management of Knee Arthritis and Arthroplasty. J Knee Surg 2021; 34:1296-1303. [PMID: 32268407 DOI: 10.1055/s-0040-1708041] [Citation(s) in RCA: 3] [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
This review investigated the potential value of computed tomography (CT) scans for the evaluation and management of knee arthritis and arthroplasty. Specifically, we evaluated the following: (1) assessment of arthritis within knee compartments, (2) patellofemoral joint assessment, (3) implant sizing prediction, (4) component alignment, (5) soft-tissue protection, and (6) potential concerns with radiation exposure. To compare if CT or X-ray imaging is more accurate and clinically relevant, a search was performed using Boolean search operators and terms: "CT," "radiograph," "joint alignment," "knee," and "arthroplasty," which yielded 661 results. Studies were evaluated based on (1) assessment of arthritis within knee compartments, (2) patellofemoral joint assessment, (3) implant sizing prediction, (4) component alignment, (5) soft-tissue protection, and (6) potential concerns with radiation exposure. Correlative and comparative analyses of imaging modalities to pre-, intra-, and postoperative clinical and patient-related factors were performed for the 63 included studies. CT scans were found to better detect medial and lateral arthritic changes, bony deformities, subchondral cysts, and cartilage losses. CT scans were shown to 99% accurately predict prosthetic sizes preoperatively. CT scans can also help better visualize surrounding anatomy, such as the posterior cruciate ligament, and have therefore been linked to better soft tissue protection during total knee arthroplasty. Although radiation is a potential concern, newer imaging protocols have comparable exposure to plain radiographs. Compared with plain radiographs, CT scans were found to be more accurate and provide more clinically relevant data. Therefore, the authors recommend the use of CT for the evaluation of certain patients with arthritis and for preoperative planning for knee arthroplasty.
Collapse
Affiliation(s)
- Nipun Sodhi
- Long Island Jewish Medical Center, Northwell Health, New York, New York
| | - David J Jacofsky
- Department of Orthopaedic Surgery, Adult Reconstruction, The CORE Institute, Phoenix, Arizona
| | - Alexander Chee
- Department of Orthopaedic Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York, New York
| |
Collapse
|
5
|
Mak WK, Bin Abd Razak HR. Hard truths about preoperative knee X-rays. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1196. [PMID: 33241045 PMCID: PMC7576035 DOI: 10.21037/atm-20-2686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wai-Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore, Singapore
| | | |
Collapse
|
6
|
Posterior clearance increases the knee extension angle in cruciate retaining type total knee arthroplasty: Intraoperative evaluation using a navigation system. J Orthop Sci 2020; 25:861-867. [PMID: 31734086 DOI: 10.1016/j.jos.2019.10.010] [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] [Received: 05/28/2019] [Revised: 09/30/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Posterior osteophyte of the femur can impinge on the tibia insert in total knee arthroplasty (TKA). Although osteophyte removal [posterior clearance (PC)] improves the flexion angle, its influence on the gaps and extension angle are unclear. This study investigated the effect of PC on the gaps and range of motion (ROM) using a navigation system, as well as PC's relationship with osteophyte size. METHODS Twenty-seven knees that underwent cruciate-retaining (CR)-type TKA were examined. Before and after PC, the ROM, hip-knee-ankle (HKA) angle, and flexion and extension gaps were recorded using a navigation system. Osteophyte size was measured in the lateral view in radiographs, and in the sagittal and axial planes of computed tomography (CT) images. The effects of PC on the gaps and ROM were analysed statistically. RESULTS PC caused the extension gap to increase by 0.7 ± 0.9 mm in the medial (p < 0.001), and 0.9 ± 1.5 mm in the lateral compartment (p = 0.006). The extension angle increased by 4.9 ± 1.6°, flexion angle increased by 6.5 ± 5.0°, and HKA decreased by 0.3°. The increase in extension angle by PC was significantly correlated with the preoperative HKA angle (r = 0.594) and with the osteophyte area in radiographs and CT (r = 0.626 to 0.681). CONCLUSIONS The extension and flexion gaps increased less than 1 mm in the medial and lateral compartments. PC achieving an additional 5° extension angle could promote full extension in severely deformed knees with a large posterior osteophyte. The extension angle increase by PC was correlated with the preoperative HKA angle and osteophyte size.
Collapse
|
7
|
Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty. J Orthop 2019; 19:76-83. [PMID: 32021042 DOI: 10.1016/j.jor.2019.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/30/2019] [Accepted: 10/30/2019] [Indexed: 02/03/2023] Open
Abstract
Removing osteophytes from the posterior compartment of the femur eliminates the tenting effects on the joint capsule and consequently increases the extension gap in total knee arthroplasty. However, there is no clear association with the size of osteophytes removed and the potential degree of additional extension achieved at time of surgery. Aims Correlate the size of posterior osteophytes removed with the degree of extension gained intraoperatively in total knee arthroplasty and develop a radiological classification system to grade these osteophytes. Methods Patients who underwent a TKA had pre and post operative sagittal radiographs assessed and classified according to 4 different categories of a proposed classification system. Knee extension was then assessed by a computer navigated system before incision and after implant insertion. Confounding factors were controlled and considered on the analysis. The study was done retrospectively. Results 147 patients were included in the study. Ninety-three (63.2%) patients had osteophytes on the posterior aspect of the femur completely removed and fifty-four patients (36.8%) did not have radiological evidence of osteophytes on the posterior aspect of the femur. There was a positive and linear correlation (Pearson correlation 0.327, p .005) between osteophyte size and degree of extension corrected at time of surgery. On Multivariate Logistic Regression Analysis, we found that small osteophytes (Grade 1) did not seem to affect the extension, while removing Grade 2 or Grade 3 osteophytes lead to a gain in extension of 2.7 and 4.5° respectively. Conclusion Removing large osteophytes (Grade 2 and Grade 3) from the posterior femoral compartment can be used as an adjuvant strategy to ensure that intraoperative extension is optimal. However removing small osteophytes (Grade 1) should not be expected to affect extension at the time of surgery in TKA and could increase intra-operative time and morbidity.
Collapse
|
8
|
Abstract
An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor β plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.
Collapse
Affiliation(s)
- Siu Him Janus Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | | | | |
Collapse
|
9
|
Kim SH, Lim JW, Ko YB, Song MG, Lee HJ. Comparison of ultra-congruent mobile- and fixed-bearing navigation-assisted total knee arthroplasty with minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2016; 24:3466-3473. [PMID: 27145772 DOI: 10.1007/s00167-016-4147-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to compare the midterm outcomes between fixed and mobile ultra-congruent (UC) bearings in total knee arthroplasty (TKA). METHODS This is a retrospective matched-pairs case-control study of patients who underwent primary navigation-assisted TKA with a minimum 5-year follow-up. A total of 182 cases involved the fixed UC bearing system as Group 1 and 101 cases involved mobile UC bearing system group as Group 2. After 1:1 matching, 73 knees in each group were enrolled. Clinical and radiographic outcomes were evaluated. RESULTS The overall survival was 143 of 146 cases (97.9 %) at final follow-up, and 72 of 73 cases (96.3 %) in Group 1 and 71 of 73 cases (95.8 %) in Group 2 at final follow-up based on an endpoint of revision surgery. The reasons of revision TKA were periprosthetic fracture in Group 1, infection and bearing dislocation in Group 2. There was no statistical difference in Hospital for Special Surgery (HSS) scores, Knee Society Scores (KSS), WOMAC index score evaluations between groups. CONCLUSIONS This study demonstrated that the fixed-bearing UC prosthesis could provide satisfactory performance compared with that of the mobile-bearing UC prosthesis with minimum 5-year follow-up. The fixed-bearing UC prosthesis could be considered in navigation-assisted TKA with theoretical advantages of UC design. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Seong Hwan Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 156-755, South Korea
| | - Jung-Won Lim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 156-755, South Korea
| | - Young-Bong Ko
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 156-755, South Korea
| | - Min-Gu Song
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 156-755, South Korea
| | - Han-Jun Lee
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-ku, Seoul, 156-755, South Korea.
| |
Collapse
|
10
|
Lockwood KA, Chu BT, Anderson MJ, Haudenschild DR, Christiansen BA. Comparison of loading rate-dependent injury modes in a murine model of post-traumatic osteoarthritis. J Orthop Res 2014; 32:79-88. [PMID: 24019199 PMCID: PMC4140447 DOI: 10.1002/jor.22480] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/14/2013] [Indexed: 02/04/2023]
Abstract
Post-traumatic osteoarthritis (PTOA) is a common long-term consequence of joint injuries such as anterior cruciate ligament (ACL) rupture. In this study we used a tibial compression overload mouse model to compare knee injury induced at low speed (1 mm/s), which creates an avulsion fracture, to injury induced at high speed (500 mm/s), which induces midsubstance tear of the ACL. Mice were sacrificed at 0 days, 10 days, 12 weeks, or 16 weeks post-injury, and joints were analyzed with micro-computed tomography, whole joint histology, and biomechanical laxity testing. Knee injury with both injury modes caused considerable trabecular bone loss by 10 days post-injury, with the Low Speed Injury group (avulsion) exhibiting a greater amount of bone loss than the High Speed Injury group (midsubstance tear). Immediately after injury, both injury modes resulted in greater than twofold increases in total AP joint laxity relative to control knees. By 12 and 16 weeks post-injury, total AP laxity was restored to uninjured control values, possibly due to knee stabilization via osteophyte formation. This model presents an opportunity to explore fundamental questions regarding the role of bone turnover in PTOA, and the findings of this study support a biomechanical mechanism of osteophyte formation following injury.
Collapse
Affiliation(s)
- Kevin A. Lockwood
- Department of Orthopaedic Surgery; University of California-Davis Medical Center; 4635 2nd Ave, Suite 2000 Sacramento California 95817
| | - Bryce T. Chu
- Department of Orthopaedic Surgery; University of California-Davis Medical Center; 4635 2nd Ave, Suite 2000 Sacramento California 95817
| | - Matthew J. Anderson
- Department of Orthopaedic Surgery; University of California-Davis Medical Center; 4635 2nd Ave, Suite 2000 Sacramento California 95817
| | - Dominik R. Haudenschild
- Department of Orthopaedic Surgery; University of California-Davis Medical Center; 4635 2nd Ave, Suite 2000 Sacramento California 95817
| | - Blaine A. Christiansen
- Department of Orthopaedic Surgery; University of California-Davis Medical Center; 4635 2nd Ave, Suite 2000 Sacramento California 95817
| |
Collapse
|
11
|
Dowsey MM, Dieppe P, Lohmander S, Castle D, Liew D, Choong PFM. The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis. Knee 2012; 19:860-5. [PMID: 22445613 DOI: 10.1016/j.knee.2012.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 01/22/2012] [Accepted: 02/19/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the association between radiographic osteoarthritis (OA) and pre-operative function in patients undergoing primary knee replacement. METHODS Single centre study examining pre-operative outcomes in a consecutive series of 525 patients who underwent primary knee replacement for OA between January 2006 and December 2007. Pre-operative data included: demographics, American Society of Anaesthesiologists (ASA) status and OA in the contralateral knee. The International Knee Society (IKS) rating and Short Form-12 (SF-12) were recorded for each patient. Pre-operative radiographs were read by a single observer for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Multiple linear regression was used to assess the strength of associations between radiographic OA severity and function, adjusting for clinically relevant variables. RESULTS Lateral tibiofemoral osteophyte grade was an independent predictor of pre-operative function as determined by the functional sub-scale of the IKS in patients undergoing primary knee replacement (coefficient=2.58, p=0.033). No associations were evident between pre-operative function and modified K&L, joint space narrowing, Ahlbäck attrition and coronal plane deformity. Other statistically significant predictors of poorer pre-operative function included: advancing age, female gender, knee pain and poorer SF-12 mental component summary scores which including osteophyte grade accounted for 24.6% of the variation in functional scores, (r=0.496). CONCLUSION Osteophytes in the lateral compartment of the knee were associated with pre-operative function in patients with advanced knee OA. Further studies are required which examine individual radiographic features specifically in patients with advanced knee OA to determine their relationship to pre-operative pain and function.
Collapse
Affiliation(s)
- Michelle M Dowsey
- Department of Orthopaedics and The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Australia
| | | | | | | | | | | |
Collapse
|
12
|
Mizu-Uchi H, Colwell CW, Fukagawa S, Matsuda S, Iwamoto Y, D'Lima DD. The importance of bony impingement in restricting flexion after total knee arthroplasty: computer simulation model with clinical correlation. J Arthroplasty 2012; 27:1710-6. [PMID: 22595182 DOI: 10.1016/j.arth.2012.03.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 03/26/2012] [Indexed: 02/01/2023] Open
Abstract
We constructed patient-specific models from computed tomography data after total knee arthroplasty to predict knee flexion based on implant-bone impingement. The maximum flexion before impingement between the femur and the tibial insert was computed using a musculoskeletal modeling program (KneeSIM; LifeModeler, Inc, San Clemente, California) during a weight-bearing deep knee bend. Postoperative flexion was measured in a clinical cohort of 21 knees (low-flex group: 6 knees with <100° of flexion and high-flex group: 15 size-matched knees with >125° of flexion at 2 years). Average predicted flexion angles were within 2° of clinical measurements for the high-flex group. In the low-flex group, 4 cases had impingement involving the bone cut at the posterior condyle, and the average predicted knee flexion was 102° compared with 93° measured clinically. These results indicate that the level of the distal femoral resection should be carefully planned and that exposed bone proximal to the tips of the posterior condyles of the femoral component should be removed if there is risk of impingement.
Collapse
Affiliation(s)
- Hideki Mizu-Uchi
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic Scripps Health, La Jolla, California, USA
| | | | | | | | | | | |
Collapse
|
13
|
Colwell CW, Gelber JD, Pulido PA, Casey KM. Early range of motion of the scorpio non-restrictive geometry cruciate-retaining total knee system. J Arthroplasty 2011; 26:751-5. [PMID: 21036012 DOI: 10.1016/j.arth.2010.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 07/18/2010] [Indexed: 02/01/2023] Open
Abstract
Flexion following total knee arthroplasty in the US population generally falls between 100° and 120°. Because of these relatively low flexion arcs, total knee arthroplasty prosthetic designs emerged allowing "high flexion" (≥125°). We hypothesized that a high-flexion implant design, Scorpio Non-Restrictive Geometry cruciate-retaining knee prosthesis, would allow clinical early maximum flexion of at least 125°. A prospective observational cohort study enrolled 87 unselected patients (94 knees) evaluated preoperation and 3 months and 1 year postoperation for clinical flexion, arc of motion, and Knee Society scores. At 1 year, 67% of knees had improved flexion and 23% achieved flexion of at least 125°. Clinically, flexion improved by 6.9° and total arc of motion improved by 10.6° from preoperation to 1-year postoperation. Although this high-flexion design allows increased flexion, many patients fail to achieve flexion of at least 125°.
Collapse
Affiliation(s)
- Clifford W Colwell
- Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic, La Jolla, California 92037, USA
| | | | | | | |
Collapse
|
14
|
Ng FY, Wong HL, Yau WP, Chiu KY, Tang WM. Comparison of range of motion after standard and high-flexion posterior stabilised total knee replacement. INTERNATIONAL ORTHOPAEDICS 2007; 32:795-8. [PMID: 17891397 PMCID: PMC2898944 DOI: 10.1007/s00264-007-0409-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 05/14/2007] [Accepted: 05/15/2007] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to compare the range of motion after standard version posterior stabilised TKR and high-flexion version TKR in patients receiving bilateral total knee replacement. Thirty-five patients were recruited. The range of motion of the knees was measured clinically with a goniometer in both the pre-operative period and the most recent follow-up. It was found that the pre-operative range of motion was comparable in the two groups. The average post-operative flexion was 105 degrees +/- 13 degrees in the standard version group and 106 degrees +/- 14 degrees in the high-flexion design group (p = 0.201, paired t-test; beta error = 0.073). A slight loss in flexion was observed in the standard version group (0.5 degrees ) as opposed to a slight gain in the high-flexion design group (2 degrees ). However, this was not statistically significant (p = 0.251, paired t-test; beta error = 0.105).
Collapse
Affiliation(s)
- F Y Ng
- Department of Orthopaedic and Traumatology, Queen Mary Hospital, The University of Hong Kong, No. 102, Pokfulam Road, Pokfulam, Hong Kong.
| | | | | | | | | |
Collapse
|
15
|
Cebesoy O. Residual posterior femoral condyle osteophyte affects the flexion range after total knee replacement. INTERNATIONAL ORTHOPAEDICS 2006; 30:312; author reply 313. [PMID: 16622667 PMCID: PMC2532133 DOI: 10.1007/s00264-006-0119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 02/21/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Oguz Cebesoy
- Faculty of Medicine Orthopedic and Traumatology Department, Gaziantep University, Gaziantep, 2700 Turkey
| |
Collapse
|