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Sappey-Marinier E, Fernandez A, Shatrov J, Batailler C, Servien E, Huten D, Lustig S. Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review. SICOT J 2024; 10:11. [PMID: 38530205 DOI: 10.1051/sicotj/2024007] [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: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture. MATERIALS AND METHODS Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded. RESULTS Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model. DISCUSSION This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elliot Sappey-Marinier
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Andréa Fernandez
- Service de chirurgie Orthopédique, Centre chirurgical Emile Gallé, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jobe Shatrov
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Cécile Batailler
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Elvire Servien
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Université Claude Bernard Lyon 1, Lyon, France
| | - Denis Huten
- Chirurgie Orthopédique, Réparatrice et Traumatologique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sébastien Lustig
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
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Han C, Liu J, Wu Y, Chong Y, Chai X, Weng X. To Predict the Length of Hospital Stay After Total Knee Arthroplasty in an Orthopedic Center in China: The Use of Machine Learning Algorithms. Front Surg 2021; 8:606038. [PMID: 33777997 PMCID: PMC7990876 DOI: 10.3389/fsurg.2021.606038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives: Total knee arthroplasty (TKA) is widely performed to improve mobility and quality of life for symptomatic knee osteoarthritis patients. The accurate prediction of patients' length of hospital stay (LOS) can help clinicians for rehabilitation decision-making and bed assignment planning, which thus makes full use of medical resources. Methods: Clinical characteristics were retrospectively collected from 1,298 patients who received TKA. A total of 36 variables were included to develop predictive models for LOS by multiple machine learning (ML) algorithms. The models were evaluated by the receiver operating characteristic (ROC) curve for predictive performance and decision curve analysis (DCA) for clinical values. A feature selection approach was used to identify optimal predictive factors. Results: The areas under the ROC curve (AUCs) of the nine models ranged from 0.710 to 0.766. All the ML-based models performed better than models using conventional statistical methods in both ROC curves and decision curves. The random forest classifier (RFC) model with 10 variables introduced was identified as the best predictive model. The feature selection indicated the top five predictors: tourniquet time, distal femoral osteotomy thickness, osteoporosis, tibia component size, and post-operative values of Hb within 24 h. Conclusions: By analyzing clinical characteristics, it is feasible to develop ML-based models for the preoperative prediction of LOS for patients who received TKA, and the RFC model performed the best.
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Affiliation(s)
- Chang Han
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Eight-Year MD Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianghao Liu
- Eight-Year MD Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yijun Wu
- Eight-Year MD Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuming Chong
- Eight-Year MD Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiran Chai
- Eight-Year MD Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Ishida K, Shibanuma N, Takayama K, Kurosaka M, Kuroda R, Matsumoto T. Posterior Reference Position Affects Intraoperative Kinematic and Soft Tissue Balance in Navigated Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2018; 33:2851-2857. [PMID: 29805103 DOI: 10.1016/j.arth.2018.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The importance of medial compartment stability is recognized in total knee arthroplasty (TKA). To manage the medial extension-flexion gap, the posterior reference position can be changed from conventional posterior center to posterior medial in measured resection techniques. This study aimed to compare the intraoperative soft tissue balance and rotational kinematics between the posterior medial and posterior center reference groups. METHODS We enrolled 57 consecutive patients with varus osteoarthritis undergoing posterior-stabilized (PS) TKA using an image-free navigation system. The detailed surgical plan in both groups and intraoperative kinematics were recorded using navigation, and soft tissue balance measured with an offset-type tensor was statistically compared between groups. RESULTS Patients were divided into the posterior center reference group (n = 32) and posterior medial reference group (n = 25). The posterior medial and posterior lateral condyles were significantly thicker in the posterior center reference group (P < .05). Although preoperative rotational kinematics were comparable between groups, the tibial rotational position was significantly more externally rotated in the posterior center reference group than in the posterior medial reference group at 45°, 60°, and 90° of flexion (P < .05). The varus angle and joint component gap were significantly smaller in the posterior medial reference group than in the posterior center reference group at 60° and 90° of flexion (P < .05). CONCLUSION The posterior reference position affects intraoperative kinematics and soft tissue balance in navigated PS TKA. Posterior medial reference PS TKA decreases the excessive tibial external rotation during midflexion and increases the flexion stability compared with conventional posterior center reference PS TKA.
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Affiliation(s)
- Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Radiographic measurement of the posterior femoral offset is not precise. Knee Surg Sports Traumatol Arthrosc 2017; 25:2609-2615. [PMID: 26537598 DOI: 10.1007/s00167-015-3855-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The posterior femoral offset may significantly impact the final flexion range after total knee arthroplasty (TKA). The purpose of the present study was to compare a conventional, radiologic-based technique with an intra-operative, surgical navigation-based technique for the measurement of posterior femoral offset. The tested hypothesis was that the two measurement techniques produce different results both before and after TKA. METHODS One-hundred consecutive cases referred for end-stage knee osteoarthritis have been studied. Posterior femoral offsets, measured pre- and post-TKA from radiographs, as well as those measured from a navigation system intra-operatively, were analysed. The pre-TKA measured offsets, post-TKA measured offsets and the changes (pre- vs. post-TKA) in the offsets were statistically compared between the radiologic and the navigated measurement techniques at a 0.05 level of significance. RESULTS The mean paired difference between pre-TKA radiologic and navigated measurement was 4 ± 4 mm (p < 0.001). There was a significant and moderate positive correlation with a good coherence between the two measurements. The mean paired difference between post-TKA radiologic and navigated measurement was 6 ± 5 mm (p < 0.001). There was a significant and moderate positive correlation but a poor coherence between the two measurements. CONCLUSIONS The conventional radiologic technique for the measurement of the posterior femoral offset cannot be reliably used either for pre-TKA planning of the posterior femoral resection and antero-posterior sizing of the femoral component, or for post-TKA quality control of the reconstruction of the posterior femoral offset. LEVEL OF EVIDENCE Level IV.
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Wang JT, Zhang Y, Liu Q, He Q, Zhang DL, Zhang Y, Xiao JX, Mu X, Hu M. Effect of posterior condylar offset on clinical results after posterior-stabilized total knee arthroplasty. Chin J Traumatol 2017; 18:259-66. [PMID: 26777708 DOI: 10.1016/j.cjtee.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To determine the effect of the posterior condylar offset (PCO) on clinical results after total knee arthroplasty (TKA) using a high-flex posterior-stabilized (PS) fixed-bearing prosthesis. METHODS We prospectively studied the clinical and radiographic materials of 89 consecutive female patients (89 knees), who had undergone primary TKAs for end-stage osteoarthritis. All operations were performed by a single senior surgeon or under his supervision using the same operative technique. Based on the corrected PCO change, we divided all cases into two groups: group A (corrected PCO change ≥0 mm, 58 knees) and group B (corrected PCO change<0 mm, 31 knees). One-year postoperatively, clinical and radiographic variables from the two groups were compared by independent t-test. The associations between the corrected PCO changes and the improvements of clinical variables in all patients were analyzed by Pearson linear correlation. RESULTS One-year postoperatively, the Knee Society Scores, the Western Ontario and McMaster Universities Osteoarthritis Index, non-weight-bearing active and passive range of knee flexion, flexion contracture, extensor lag, and their improvements had no statistical differences between the two groups (all p>0.05). The corrected PCO change was not significantly correlated with the improvement of any clinical variable (all p>0.05). Group A demonstrated greater flexion than group B during active weight bearing (p<0.05). CONCLUSIONS Restoration of PCO plays an important role in the optimization of active knee flexion during weight-bearing conditions after posterior-stabilized TKA, while it has no benefit to non-weight-bearing knee flexion or any other clinical result.
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Affiliation(s)
- Jian-Tao Wang
- Department of Orthopedics, Nankai University Tianjin Union Medical Center, Tianjin 300121, China
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Fujimoto E, Sasashige Y, Tomita T, Sasaki H, Touten Y, Fujiwara Y, Ochi M. Intra-operative gaps affect outcome and postoperative kinematics in vivo following cruciate-retaining total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2015; 40:41-9. [PMID: 26133289 DOI: 10.1007/s00264-015-2847-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/30/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The following investigation evaluates the effect of intra-operative gaps after posterior cruciate ligament-retaining total knee arthroplasty using two-dimensional/three-dimensional registration and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). METHODS Patients were divided into two groups according to their 90°-0° component gap changes using a device designed by our laboratory. The wide gap group was defined as more than 3 mm (4.3 ± 0.7 mm), and the narrow gap group was defined as less than 3 mm (1.3 ± 1.3 mm). RESULTS Under non-WB (weight bearing) conditions, the wide flexion gap group (N = 10) showed a significant anterior displacement of the medial femoral condyle as compared with the narrow flexion gap group (N = 20). Despite no significant differences observed under WB conditions, both femoral condyle positions during flexion were significantly more posterior than during extension. WOMAC of the tight gap group showed worse scores for two functional items demanding knee flexion (bending to floor and getting on/off toilet). CONCLUSION The large flexion gap could influence the late rollback under non-WB conditions and better WOMAC functional scores in the flexion items. Three to four millimetre laxity at 90°-0° component gaps may be adequate and might be necessary to carry out daily life activities.
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Affiliation(s)
- Eisaku Fujimoto
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan.
| | - Yoshiaki Sasashige
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hirofumi Sasaki
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Yoriko Touten
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Yuusuke Fujiwara
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
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Nagai K, Muratsu H, Matsumoto T, Takahara S, Kuroda R, Kurosaka M. Influence of Intraoperative Soft Tissue Balance on Postoperative Active Knee Extension in Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2015; 30:1155-9. [PMID: 25697891 DOI: 10.1016/j.arth.2015.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/28/2015] [Accepted: 01/31/2015] [Indexed: 02/01/2023] Open
Abstract
We evaluated the influence of intraoperative soft tissue balance on postoperative active knee extension using Offset Repo-Tensor® among 73 varus osteoarthritic knees underwent primary posterior-stabilized total knee arthroplasty. The joint center gap between osteotomized surfaces and the component gap after femoral trial component placement were measured using a joint distraction force of 40lb. The active knee extension angle was measured 4weeks after surgery. The postoperative extension angle was not correlated with the joint center gap at 0°, but positively correlated with the component gap at 0°, and the joint looseness at 0° which was calculated by subtracting insert thickness from the component gap. Thus, intraoperative soft tissue measurement with femoral trial component placement would be useful to predict the postoperative knee extension angle.
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Affiliation(s)
- Kanto Nagai
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Takahara
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Are the long term results of a high-flex total knee replacement affected by the range of flexion? INTERNATIONAL ORTHOPAEDICS 2013; 38:761-6. [PMID: 24287979 DOI: 10.1007/s00264-013-2179-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to examine the effect of deep flexion on the long-term durability of a high-flex ceramic implant in total knee arthroplasty. METHODS Five hundred and five consecutive knees replaced with a Bi-Surface knee system (Kyocera Medical, Osaka, Japan) were divided into two groups according to the range of flexion by 135° postoperatively. Comparison of implant durability was made between the high- and low-flexion groups after a minimum ten year follow-up. RESULTS With revision for any surgery as the end point, the survival rates at ten years were 95.5% and 96.2% in the high- and low-flexion group, respectively (p = 0.63). With revision for mechanical failure as the end point, survival rates were 98.7% and 98.5%, respectively (p = 0.94). CONCLUSION Implant survival rate was similar for both groups. Deep flexion seemed not to affect long-term durability.
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