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Kage T, Inui H, Tomita T, Yamazaki T, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Sameshima S, Tanaka S. In vivo kinematics of a newly updated posterior-stabilised mobile-bearing total knee arthroplasty in weight-bearing and non-weight-bearing high-flexion activities. Knee 2021; 29:183-189. [PMID: 33640617 DOI: 10.1016/j.knee.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to clarify the in vivo kinematics of a newly updated posterior-stabilised (PS) mobile-bearing total knee arthroplasty during high-flexion activities in weight-bearing (WB) and non-weight-bearing (NWB) conditions. The hypothesis was that the kinematics would differ between the WB and NWB conditions, and the kinematics would be affected by the WB condition. METHODS The kinematics of 19 knees were investigated under fluoroscopy during squatting (WB) and active-assisted knee flexion (NWB) with two- and three-dimensional registration technique. Accordingly, the range of motion, anteroposterior (AP) translation of the medial and lateral contact points, axial rotation of the femoral component relative to the tibial component, and kinematic pathway were evaluated. RESULTS There was no difference in the knee's range of motion between the WB and NWB conditions. The medial AP translation of the femur did not differ in each flexion angle between WB and NWB conditions except for flexions of 70°. There was no difference in the lateral AP translation of the femur at all tested flexion angles between the WB and NWB conditions. The external femoral rotation and the medial pivot motion were observed throughout all flexion angles in WB conditions. The clinical relevance is that this implant could produce ideal medial AP stability and medial pivot motion. CONCLUSION The medial AP translation of the femur was stable for AP direction when it was in both WB and NWB conditions. In WB conditions, the medial pivot motion was observed throughout all flexion angles. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama 369-0293, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Lin W, Dai Y, Niu J, Yang G, Li M, Wang F. Pigmented villonodular synovitis does not influence the outcomes following cruciate-retaining total knee arthroplasty: a case-control study with minimum 5-year follow-up. J Orthop Surg Res 2020; 15:388. [PMID: 32894157 PMCID: PMC7487817 DOI: 10.1186/s13018-020-01933-x] [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: 02/26/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare synovial disease with benign hyperplasia, which has been successfully treated with total knee arthroplasty (TKA). The purpose of this study was to investigate the middle-term follow-up outcomes of cruciate-retaining (CR) TKA in patients with PVNS. METHODS From January 2012 to December 2014, a retrospective study was conducted in 17 patients with PVNS who underwent CR TKA as PVNS group. During this period, we also selected 68 patients with osteoarthritis who underwent CR TKA (control group) for comparison. The two groups matched in a 1:4 ratio based on age, sex, body mass index, and follow-up time. The range of motion, Knee Society Score, revision rate, disease recurrence, wound complications, and the survivorship curve of Kaplan-Meier implant were assessed between the two groups. RESULTS All patients were followed up at least 5 years. There was no difference in range of motion and Knee Society Score between the two groups before surgery and at last follow-up after surgery (p > 0.05). In the PVNS group, no patients with the recurrence of PVNS were found at the last follow-up, one patient underwent revision surgery due to periprosthetic fracture, and three patients had stiffness one year after surgery (17.6% vs 1.5%, p = 0.005; ROM 16-81°), but no revision was needed. At 7 years, the implant survivorship was 90.0% in the PVNS group and 96.6% in the control group (p = 0.54). CONCLUSIONS This study demonstrated that the function of patients with PVNS who underwent CR TKA had been significantly improved, and the survival rate of implants in these patients was similar to the patients with OA. Consequently, the patients with PVNS who underwent CR TKA might be an achievable option. However, these patients should pay more attention to the occurrence of postoperative stiffness complications.
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Affiliation(s)
- Wei Lin
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yike Dai
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Jinghui Niu
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Guangmin Yang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Ming Li
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Zhang B, Cheng CK, Qu TB, Hai Y, Lin Y, Pan J, Wang ZW, Wen L. Partial versus Intact Posterior Cruciate Ligament-retaining Total Knee Arthroplasty: A Comparative Study of Early Clinical Outcomes. Orthop Surg 2017; 8:331-7. [PMID: 27627716 DOI: 10.1111/os.12269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/24/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Whether the entire posterior cruciate ligament (PCL) should be retained during cruciate-retaining total knee arthroplasty (CR TKA) is controversial. The goal of this study was to compare the early clinical outcomes of partial versus intact PCL-retaining TKA. METHODS Ninety-two patients who had undergone unilateral CR TKA from March 2012 to June 2013 were enrolled in this study. Forty-six of these patients were randomly selected to undergo intact PCL-retaining TKA (intact group), whereas the remaining 46 patients underwent tibial osteotomy together with anterolateral bundle and bone island resection (partial group). All operations were performed by a senior orthopedic surgeon and the PCL was released to some extent in both groups. After TKA, active and passive flexion and extension exercises of the knee and lower limb strength exercises were maintained until at least 3 months after surgery. Before surgery and 6, 12, and 24 months after surgery, range of motion, Knee Society Clinical Rating System scores (including clinical and functional scores of the knee) and maximum anteroposterior (AP) displacement of the knee at 30° and 90° of knee flexion were evaluated in both groups. RESULTS Fourteen patients were rejected from the final analysis because of loss to follow-up or development of complications. Thus, 40 patients from the partial group and 38 from the intact group were followed up for 24-41 months (mean 32.8 months). Knee functional scores were significantly higher in the intact than in the partial group (88.1 vs. 84.8 points) 24 months after surgery There were no significant differences in range of motion or knee clinical scores between the two groups at any time point. However, 12 and 24 months after surgery, the mean maximum AP displacement of the knee in 90° knee flexion was significantly greater in the partial than in the intact group (12 months: 6.3 vs. 5.7 mm; 24 months: 7.0 vs. 6.2 mm). CONCLUSION Double-bundle PCL plays an important role in maintaining knee stability; the entire PCL should therefore be retained during CR TKA.
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Affiliation(s)
- Bo Zhang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Cheng-Kung Cheng
- Department of Biological Science and Medical Engineering, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing, China.,Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Tie-Bing Qu
- Department of Joint Functional Reconstruction, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China.
| | - Yong Hai
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Yuan Lin
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiang Pan
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhi-Wei Wang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liang Wen
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Goebel D, Schultz W. The Columbus Knee System: 4-Year Results of a New Deep Flexion Design Compared to the NexGen Full Flex Implant. ARTHRITIS 2012; 2012:213817. [PMID: 22496976 PMCID: PMC3310259 DOI: 10.1155/2012/213817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 12/17/2011] [Accepted: 12/19/2011] [Indexed: 11/17/2022]
Abstract
The Columbus knee system is designed as a standard knee implant to allow high flexion without additional bone resection. Between August, 2004 and March, 2010 we performed 109 total knee arthroplasties of the Columbus knee system in 101 consecutive patients suffering from primary arthrosis of the knee. Mean age was 72.4 years in women and 70.3 years in men. Mean followup was 47.3 months. The 4-year results of a group of patients who received the NexGen Full Flex implant operated by the same surgeon were used for comparison. Mean total knee score was Columbus: 175.6 and NexGen Flex: 183.4; P = 0.037. Mean operation time was 53 min for Columbus and 66 min for NexGen Flex; P < 0.001. With new streamlined instruments operative time became 60 min for the Columbus; P > 0.05. Radiological assessment showed no signs of loosening for both groups. Therefore, the Columbus knee system can be recommended for flexion angles up to 140°.
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Affiliation(s)
- D. Goebel
- Orthopaedic Clinic Donaueschingen, Karlstraβe 10, 78 166 Donaueschingen, Germany
| | - W. Schultz
- Orthopaedic Department, University of Göttingen, Robert Koch Straβe 40, 37 075 Göttingen, Germany
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Yue B, Varadarajan KM, Rubash HE, Li G. In vivo function of posterior cruciate ligament before and after posterior cruciate ligament-retaining total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 36:1387-92. [PMID: 22270863 DOI: 10.1007/s00264-011-1481-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/30/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE The object of this study was to investigate the in vivo function of the posterior cruciate ligament (PCL) in patients before and after a PCL-retaining total knee arthroplasty (TKA). METHODS Eleven patients with advanced osteoarthritis (OA) of the knee were recruited. Magnetic resonance scans of each OA knee were obtained, and 3D computer models, including the femoral and tibial insertion areas of the anterolateral and posteromedial bundles of the PCL, were created. Before and after PCL-retaining TKA, dual fluoroscopic images of each knee were acquired during weight-bearing knee flexion. The images and computer models were used to reproduce the in vivo motion of the knee. The function of the PCL bundles was described in terms of elongation, elevation and deviation. Twenty-two healthy controls were also included as normal references. RESULTS PCL bundles of the OA knees were overstretched during late knee flexion and orientated more medially throughout flexion compared with normal knees. After PCL-retaining TKA, PCL bundles were further overstretched during late flexion and changed from medially directed in normal and OA knees to almost sagittally directed, which may compromise function in controlling knee rotation. CONCLUSIONS The current PCL-retaining TKA systems and surgical techniques may not adequately re-establish normal biomechanics of PCL bundles after PCL-retaining TKA.
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Affiliation(s)
- Bing Yue
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, USA
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Comparative study of tibial posterior slope angle following cruciate-retaining total knee arthroplasty using one of three implants. INTERNATIONAL ORTHOPAEDICS 2011; 36:755-60. [PMID: 22143313 DOI: 10.1007/s00264-011-1395-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/11/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE Pre- and postoperative tibial posterior slope angles (PSAs) were assessed in patients who underwent cruciate-retaining total knee arthroplasty (TKA). MATERIAL AND METHODS A total of 386 cruciate retaining TKA were performed in 308 patients and retrospectively reviewed. Based on the prostheses, 202 cases using NexGen were classified as group I, 120 cases using PFC sigma as group II, and 64 cases using Vanguard as group III. Postoperative PSA of groups I, II, and III were compared. RESULTS In groups I, II, and III, postoperative PSA was 6.0˚, 6.0˚, and 4.5˚, respectively (p < 0.001). Between preoperative measurement and final follow-up examination, mean knee score (59.7 to 97.3), function score (54.2 to 90.5), and range of motion (ROM; 126.7° to 132.2°) improved. These three values did not differ significantly among groups. CONCLUSIONS The 3° slope of the Vanguard polyethylene insert caused the difference in PSAs. This design characteristic should be considered when using this implant in TKA.
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Schnurr C, Eysel P, König DP. Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable? INTERNATIONAL ORTHOPAEDICS 2011; 36:83-8. [PMID: 21706197 DOI: 10.1007/s00264-011-1295-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 05/28/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE It is broadly supposed that in total knee arthroplasty, the flexion/extension gap ratio is increased after resection of the posterior cruciate ligament (PCL). However, studies are rare and results are inconsistent. Therefore, this study was conducted to determine whether PCL release regularly increases the flexion gap. METHODS Data from 50 consecutive posterior stabilised knee prostheses were analysed retrospectively. Using imageless computer navigation, the joint-gap width was measured over the entire range of motion before and after PCL release. RESULTS PCL release had no effect on the extension gap, but it increased the flexion gap significantly. An increase of >3 mm occurred in 36% of patients and of >5 mm in 12%. No clinically relevant effect (<2 mm) was found in 44% of patients. CONCLUSION PCL release increased the flexion/extension gap ratio on average, but the individual effect could not be predicted. Therefore, we recommend PCL release before the femoral resections are performed, as this step mainly determines the ratio between extension and flexion gap.
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Affiliation(s)
- Christoph Schnurr
- LVR Klinik für Orthopädie Viersen, Horionstrasse 2, 41749 Viersen, Germany.
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High-flexion TKA in patients with a minimum of 120 degrees of pre-operative knee flexion: outcomes at six years of follow-up. INTERNATIONAL ORTHOPAEDICS 2010; 35:1321-6. [PMID: 20972786 DOI: 10.1007/s00264-010-1140-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 09/27/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
We prospectively evaluated outcomes of high-flexion total knee arthroplasty in 165 patients who had advanced arthritis with a minimum 120-degree pre-operative knee flexion, with a mean follow-up of 77 months. Patients were divided into two groups according to their ability to perform full-range (heel-to-buttock) pre-operative knee flexion (group A) and the inability to do so (group B). The overall clinical rating was "excellent" in 96% of patients and "good" in 4% of patients. Mean maximum knee flexion decreased from 137.9° to 134.8°, with no statistical difference between pre- and post-operative knee flexion. However, patients in group A had significantly decreased knee flexion (146.2° vs. 135.0°, p < 0.001), whereas patients in group B exhibited no change in knee flexion (133.7° vs. 134.7°, p = 0.14). We found that 14.7%, 36.5% and 43.0% of the studied patients could engage in kneeling, Thai polite style sitting and cross-legged sitting, respectively, with no significant differences between groups A and B. The survival rates for any reoperation and prosthesis-related problem (such as early loosening) at six years were 98.3% and 100%, respectively. At six-year follow-up in patients with well preserved pre-operative knee flexion, the high-flexion knee prosthesis provided a favourable outcome without improving knee flexion.
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