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The Impact of Total Knee Replacement with a Customized Cruciate-Retaining Implant Design on Patient-Reported and Functional Outcomes. J Pers Med 2022; 12:jpm12020194. [PMID: 35207682 PMCID: PMC8880382 DOI: 10.3390/jpm12020194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To treat patients with tricompartimental knee osteoarthritis (OA), a customized cruciate-retaining total knee arthroplasty (CCR-TKA) system can be used, including both individualized instrumentation and implants. The objective of this monocentric cohort study was to analyze patient-reported and functional outcomes in a series of patients implanted with the second generation of this customized implant. Methods: At our arthroplasty center, we prospectively recruited a cohort of patients with tricompartmental gonarthrosis to be treated with total knee replacement (TKA) using a customized cruciate-retaining (CCR) implant design. Inclusion criteria for patients comprised the presence of intact posterior cruciate and collateral ligaments and a knee deformity that was restricted to <15° varus, valgus, or flexion contracture. Patients were assessed for their range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form (SF)-12 physical and mental scores, preoperatively, at 3 and 6 months, as well as at 1, 2, 3, and 5 years of follow-up (FU) postoperatively. Results: The average age of the patient population was 64 years (range: 40–81), the average BMI was 31 (range: 23–42), and in total, 28 female and 45 male patients were included. Implant survivorship was 97.5% (one septic loosening) at an average follow-up of 2.5 years. The KSS knee and function scores improved significantly (p < 0.001) from, respectively, 41 and 53 at the pre-operative visit, to 92 and 86, respectively, at the 5-year post-operative time point. The SF-12 Physical and Mental scores significantly (p < 0.001) improved from the pre-operative values of 28 and 50, to 50 and 53 at the 5-year FU, respectively. Patients experienced significant improvements in their overall knee range of motion, from 106° at the preoperative visit to 122°, on average, 5 years postoperatively. The total WOMAC score significantly (p < 0.001) improved from 49.1 preoperatively to 11.4 postoperatively at 5-year FU. Conclusions: Although there was no comparison to other implants within this study, patients reported high overall satisfaction and improvement in functional outcomes within the first year from surgery, which continued over the following years. These mid-term results are excellent compared with those reported in the current literature. Comparative long-term studies with this device are needed. Level of evidence 3b (individual case–control study).
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Luo Z, Zhou K, Wang H, Pei F, Zhou Z. Comparison between Mid-Term Results of Total Knee Arthroplasty with Single-Radius versus Multiple-Radii Posterior-Stabilized Prostheses. J Knee Surg 2022; 35:204-214. [PMID: 32659818 DOI: 10.1055/s-0040-1713897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Single-radius (SR) prostheses and multiple-radii (MR) prostheses have different theoretical advantages; however, few comparative studies have been reported. The aim of the study was to compare mid-term clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Two hundred consecutive patients who underwent TKA between January 2012 and July 2013 were enrolled in the SR group (100 patients) and an MR group (100 patients), with a minimum follow-up of 5 years. Functional, radiological, satisfaction, and survival rates were evaluated. There was a significantly higher range of motion (ROM) in the SR group than in the MR group (flexion, 123.65 ± 10.12 degrees vs. 115.52 ± 10.03 degrees, p < 0.001). Quadriceps strength (3.05 ± 0.43 vs. 2.68 ± 0.58 kg, p = 0.025) and chair test results (80 [93.02%] vs. 69 [83.13%], p = 0.027) were better in the SR group than in the MR group. The SR group also had significantly less anterior knee pain (6 [6.98%] vs. 15 [18.07%], p < 0.05) and a better satisfaction rate than those in the MR group. No significant differences were observed in clinical scale scores such as Hospital for Special Surgery (HSS), Knee Society Score (KSS), and Short-Form 12 (SF-12), radiological results in terms of component position and radiolucent lines. The Kaplan-Meier survival curve estimates at 5 years were not significantly different (96.91% [95% confidence interval [CI]: 93.5-99.5%] vs. 94.86% [95% CI: 90.6-98.6%], p = 0.4696). The SR prosthesis design was better than that of the MR in terms of ROM, reduced anterior knee pain, contributions to better recovery of the extension mechanism, and higher satisfaction rates. The SR had similar results in clinical scales such as HSS, KSS, SF-12, radiological, or survival results to MR prostheses. More accurate measurements and longer-term follow-up are required.
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Affiliation(s)
- Zhenyu Luo
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| | - Kai Zhou
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| | - Haoyang Wang
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| | - Fuxing Pei
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
| | - Zongke Zhou
- Sichuan University West China Hospital-Orthopedics, Chengdu, Sichuan, China
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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Steinert AF, Sefrin L, Jansen B, Schröder L, Holzapfel BM, Arnholdt J, Rudert M. Patient-specific cruciate-retaining total knee replacement with individualized implants and instruments (iTotal™ CR G2). OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 33:170-180. [PMID: 33289871 DOI: 10.1007/s00064-020-00690-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/02/2019] [Accepted: 06/11/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Treatment of tricompartimental osteoarthritis (OA) using customized instruments and implants for cruciate-retaining total knee arthroplasty. Use of patient-specific instruments and implants (ConforMIS iTotalTM CR G2) together with a 3D-planning protocol (iView®). Retropatellar resurfacing is optional. INDICATIONS Symptomatic tricompartmental OA of the knee (Kellgren-Lawrence stage IV) with preserved posterior cruciate ligament (PCL) after unsuccessful conservative or joint-preserving surgical treatment. CONTRAINDICATIONS Knee ligament instabilities of the posterior cruciate or collateral ligaments. Infection. Relative contraindication: knee deformities >15° (varus, valgus, flexion); prior partial knee replacement. SURGICAL TECHNIQUE Midline or parapatellar medial skin incision, medial arthrotomy; distal femoral resection with patient-specific cutting block; tibial resection using either a cutting jig for the anatomic slope or a fixed 5° slope. Balancing the knee in extension and flexion gap using patient-specific spacer. The final tibial preparation achieved with gap-balanced placement of the femoral cutting jigs. Kinematic testing using anatomic trial components. Final implant components are cemented in extension. Wound layers are sutured. Drainage is optional. POSTOPERATIVE MANAGEMENT Sterile wound dressing; compressive bandage. No limitation of the active and passive range of motion. Optional partial weight bearing during the first 2 weeks, then transition to full weight bearing. Follow-up directly after surgery, at 12 and 52 weeks, then every 1-2 years. RESULTS Overall 60 patients with tricompartmental knee OA and preserved PCL were treated. Mean age was 66 (range 45-76) years. Minimum follow-up was 12 months. There was 1 septic revision after a low-grade infection, 1 reoperation to replace the patellar due to patellar osteoarthritis and 3 manipulations under anesthesia (MUAs) to increase range of motion. Radiographic analyses demonstrated an ideal implant fit with less than 2 mm subsidence or overhang. The WOMAC score improved from 154.8 points preoperatively to 83.5 points at 1 year and 59.3 points at 2 years postoperatively. The EuroQol-5D Score also improved from 11.1 points preoperatively to 7.7 points at 1 year postoperatively.
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Affiliation(s)
- Andre F Steinert
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany. .,Campus Bad Neustadt, Klinik für Orthopädie, Unfallchirurgie, Schulterchirurgie und Endoprothetik, Rhön Klinikum, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany.
| | | | - Björn Jansen
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
| | - Lennart Schröder
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
| | - Boris M Holzapfel
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
| | - Jörg Arnholdt
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
| | - Maximilian Rudert
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
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Li M, Zhang L, Zhang R, Ma Y, Liao J, Li Q, Deng Z, Zheng Q. Better quadriceps and hamstring strength is achieved after Total knee Arthroplasty with single radius femoral prostheses: a retrospective study based on isokinetic and isometric data. ARTHROPLASTY 2020; 2:5. [PMID: 35236469 PMCID: PMC8796515 DOI: 10.1186/s42836-020-0022-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Strength deficits, muscle imbalances, and quadriceps inhibition are common after the total knee arthroplasty (TKA). It was suggested that theoretically single radius (SR) femoral protheses could provide longer extensor moment arm compared to the multiple radius (MR) design. However, quantitative evidence has not yet been reported. Thus, the aim of the study was to investigate the differences in isokinetic data and to compare the patient-reported outcome scores between TKA SR and MR design. Method The present retrospective study included 36 TKA involving 16 knees (9 patients) using SR design implant and 20 knees (11 patients) using MR design implant. The mean follow-up time was longer than 1 year. Isokinetic knee flexion and extension torques of the operated leg were evaluated at 60°/s and 180°/s. Quadriceps and hamstring torques and ratios, work and power were recorded. Angle-specific torques were also collected at different extension or flexion angles. Results Both groups showed improvement in knee society scores (KSS) and knee injury, and osteoarthritis outcome score (KOOS) after operation. Patients in SR group had significantly higher scores in KSS-knee, symptoms and activities of daily living KOOS sub-score than those in the MR group at the end of the follow-up. The peak knee flexion torque, peak knee extension torque and maximum knee flexion work were greater in SR group at 180°/s and 60°/s. At 60°/s, and SR group had higher average knee flexion power and average knee extension power than MR group. In the isometric contraction test, the knee extension torque was higher in SR group than in MR group. At 180°/s, SR group showed higher flexion torques at 30°, 40°, 50°, 60° compared with MR group. At 60°/s, SR group showed higher flexion torques at 30°, 40°, 50°, 60°, 80° when compared with MR group. Additionally, SR group also provided higher extension torques at 40°, 50°, 60° than the MR group. There were no differences in other isokinetic and isometric parameters between the two groups. Conclusion Femoral design exerted an influence on quadriceps and hamstring strength after TKA, and SR design shows advantages, in terms of higher extension and flexion strength, over MR design.
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Kim J, Min KD, Lee BI, Kim JB, Kwon SW, Chun DI, Kim YB, Seo GW, Lee JS, Park S, Choi HS. Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Relat Res 2020; 32:52. [PMID: 33008475 PMCID: PMC7531164 DOI: 10.1186/s43019-020-00067-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. MATERIALS AND METHODS We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. RESULTS The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSS-knee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. CONCLUSIONS The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Kyung-Dae Min
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
| | - Byung-Ill Lee
- Department of Orthopaedic Surgery, Smarton Hospital, Bucheon, South Korea
| | - Jun-Bum Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea
| | - Sai-Won Kwon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Yong-Beom Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Gi-Won Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, South Korea
| | - Jeong Seok Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital Seoul, Seoul, South Korea
| | - Hyung-Suk Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea.
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Does Knee Prosthesis Survivorship Improve When Implant Designs Change? Findings from the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478:1156-1172. [PMID: 32324669 PMCID: PMC7319368 DOI: 10.1097/corr.0000000000001229] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND TKA generally has excellent long-term survivorship. When a new knee system supersedes a previous model, increased survivorship, improved functional performance, or both may be expected, because key areas of design modification are often targeted to address wear, stability, and the patellofemoral articulation. However, not all design changes are beneficial, and to our knowledge, knee arthroplasty has not been systematically evaluated in the context of design changes that occur during the development of new knee arthroplasty systems. QUESTIONS/PURPOSES Using the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) we performed multiple old-to-new comparisons of frequently used contemporary knee implants to ask: (1) does overall prosthesis survivorship free from revision increase when a new knee prosthesis system is introduced to replace a prior prosthesis system? (2) Has survivorship free from revision improved for the revision indications of wear, instability, and patellofemoral articulation issues, where development efforts have been concentrated? METHODS Data from the AOANJRR from September 1999 to December 2017 were used to compare the survivorship of prostheses free from revision at a maximum of 17 years in procedures where a new design model was introduced to replace a prior knee system from the same manufacturer. Only prosthesis systems used in a minimum of 2000 primary TKA procedures for osteoarthritis that had a minimum of 5 years of follow-up were included. Varus-valgus constrained and hinge TKA designs were excluded. Cruciate-retaining, posterior-stabilized, and medial pivot-design knees were considered separately. The new and old prosthesis systems were paired for analysis. Survivorship was calculated with Kaplan Meier estimates and comparisons were performed using the Cox proportional hazards method. Subanalyses according to the three main revision indications were performed, and where possible, analyses were performed based on polyethylene types (highly cross-linked polyethylene and ultra-high-molecular-weight polyethylene), combined and separated. Revision was defined as a reoperation of a previous knee arthroplasty in which one or more of the components was removed, replaced, or added. There were 323,955 TKA procedures and 11 new prosthesis system designs that were introduced to replace an earlier knee system from the same manufacturer. Of these prosthesis system pairs, six were cruciate-retaining prostheses, four were posterior-stabilized designs, and one was a medial pivot design. RESULTS Six of the 11 knee system pairs showed improved survivorship with the new design, three were no different, and in two, the newer prosthesis systems had a higher rate of revision than the old one did. When revision for wear was analyzed, five prosthesis systems showed improvement, five were no different, and one had a higher rate of revision than the previous system did. There was no improvement in the rate of revision for instability; seven new prosthesis systems showed no difference from the previous system and four new prosthesis systems had a higher rate of revision than the previous system did. A subanalysis of revision for patellofemoral complications showed improvement in two comparisons, no difference in six, and a higher revision rate in two; one could not be calculated because of an insufficient number of revisions for this reason. CONCLUSIONS It is difficult to predict whether a new system will demonstrate better survival than a previous one, and widespread uptake of a new design before a benefit is shown in robust clinical studies is unwise. Similarly, adoption of a new system for which there is no difference in survivorship from a previous model may be premature because a new device may have associated unknown and unintended consequences. Healthcare policy makers and therapeutic device regulators should similarly be guided by results and seek out peer-reviewed evidence before accepting change to established practice. Surgeons must be aware that implant changes may not translate into better survivorship and must seek compelling evidence of improvement in survival and/or function before changing systems. LEVEL OF EVIDENCE Level III, therapeutic study.
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Luo Z, Luo Z, Wang H, Xiao Q, Pei F, Zhou Z. Long-term results of total knee arthroplasty with single-radius versus multi-radius posterior-stabilized prostheses. J Orthop Surg Res 2019; 14:139. [PMID: 31097037 PMCID: PMC6521522 DOI: 10.1186/s13018-019-1183-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/03/2019] [Indexed: 02/05/2023] Open
Abstract
Background Single-radius (SR) prostheses and multi-radius (MR) prostheses have different theoretical advantages; however, there has been a paucity of evaluations comparing the two. This study was designed to compare the 10-year clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Methods In this retrospective cohort study, 220 consecutive patients undergoing TKA between October 2006 and October 2007 were divided into the SR group (106 patients, Stryker Scorpio NRG) and the MR group (114 patients, DePuy Sigma PFC), with a minimum follow-up of 10 years. Clinical, functional, and radiological outcomes, as well as satisfaction rates and survival results, were evaluated. Results Hospital for Special Surgery and Short Form-12 health survey scores were all significantly improved in both groups at the final follow-up (P < 0.05), but the groups did not differ. The SR group had significantly less anterior knee pain (AKP) and painless crepitation (P < 0.05). Radiological results in terms of radiolucent lines and component position angle showed no differences between groups. The Kaplan-Meier survival curve estimates at 10 years were not significantly different between the groups (P = 0.4172). Conclusion Both SR and MR posterior-stabilized prostheses can lead to satisfactory outcomes. The SR prosthesis design gave less anterior knee pain than did the MR prostheses. Two prostheses showed no differences in terms of clinical scales, radiological results, satisfaction rates, and survival results at a long-term follow-up. More accurate measurements are required.
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Affiliation(s)
- Zhenyu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Zeyu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Haoyang Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Qiang Xiao
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China.
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Scott CEH, Bell KR, Ng RT, MacDonald DJ, Patton JT, Burnett R. Excellent 10-year patient-reported outcomes and survival in a single-radius, cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1106-1115. [PMID: 30276434 PMCID: PMC6435607 DOI: 10.1007/s00167-018-5179-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/20/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Over 2 million Triathlon single-radius total knee arthroplasties (TKAs) have been implanted worldwide. This study reports the 10-year survival and patient-reported outcome of the Triathlon TKA in a single independent centre. METHODS From 2006 to 2007, 462 consecutive cruciate-retaining Triathlon TKAs were implanted in 426 patients (median age 69 (21-89), 289 (62.5%) female). Patellae were not routinely resurfaced. Patient-reported outcome measures (SF-12, Oxford Knee Scores (OKS), satisfaction) were assessed preoperatively and at 1, 5 and 10 years when radiographs were reviewed. Forgotten Joint Scores (FJS) were collected at 10 years. Kaplan-Meier survival analysis was performed. RESULTS At 10-11.6 years, 123 patients (128 TKAs) had died and 8 TKAs were lost to follow-up. There were four aseptic failures (two cases of tibial loosening, two cases of instability) and four septic failures requiring revision. Symptomatic aseptic radiographic loosening was present in three further cases at 11 years. Four (1%) patellae were secondarily resurfaced. OKS score improved by 17.7 ± 9.7 points at 1 year (p < 0.001), and was maintained at 34.7 ± 9.6 at 10 years with FJS 48.5 ± 31.4. Patient satisfaction was 88% at each timepoint. Ten-year survival was 97.9% (95% confidence interval 96.5-99.3) for revision for any reason, 98.9% (97.7-100) for mechanical failure, and 98.6% (97.4-99.8) for aseptic loosening (symptomatic radiographic or revised). CONCLUSION The Triathlon TKA continues to show excellent longer-term results with high implant survivorship, low rates of aseptic failure, consistently maintained PROMs and excellent patient satisfaction rates of 88% at 10 years. LEVEL OF EVIDENCE II, Prospective cohort study.
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Affiliation(s)
- Chloe E. H. Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Katrina R. Bell
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Richard T. Ng
- Department of Orthopaedics, University of Calgary, 401 9th Ave SW, Suite 335, Calgary, AB T2P
3C5 Canada
| | - Deborah J. MacDonald
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - James T. Patton
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Richard Burnett
- Department of Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
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10
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Scott DF. Prospective Randomized Comparison of Posterior-Stabilized Versus Condylar-Stabilized Total Knee Arthroplasty: Final Report of a Five-Year Study. J Arthroplasty 2018; 33:1384-1388. [PMID: 29276123 DOI: 10.1016/j.arth.2017.11.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/12/2017] [Accepted: 11/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This report presents the minimum 5-year results of a prospective, randomized, Level of Evidence I study that evaluated cruciate-sacrificing total knee arthroplasty using either a posterior-stabilized (PS) device or a condylar-stabilized (CS) device. We hypothesized that the clinical outcomes of both groups would be equivalent and that there would be differences in operative time and/or blood loss parameters. METHODS One-hundred eleven patients undergoing total knee arthroplasty were randomized to receive either a post-cam style tibial insert (PS, n = 56) or a more congruent anterior-lipped tibial insert (CS, n = 55). All posterior cruciate ligaments were sacrificed. RESULTS Comparison of the clinical scores and radiographic results between both groups were essentially equivalent with no statistically significant differences at the final 5-year evaluation, although the CS knee group had significantly fewer incidences of postoperative mechanical sensations (P = .01). CONCLUSION These results demonstrate that the CS knee provides excellent clinical, functional, and radiographic outcomes that are comparable to the results achieved with the PS knee, with a lower incidence of mechanical sensations, and support the use of a CS device as an alternative to the PS device.
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Affiliation(s)
- David F Scott
- Spokane Joint Replacement Center, Spokane, Washington; Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Spokane, Washington
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11
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Deehan DJ, Ghosh KM, Blain A, Longstaff L, Rushton S. Sagittal flexion arc evaluation for a modern generation single-radius femoral component design. Proc Inst Mech Eng H 2018; 232:412-417. [PMID: 29473455 DOI: 10.1177/0954411918759136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Single-radius femoral total knee design aims to deliver improved kinematic behaviour when compared to the standard two-radii geometry. This study has evaluated the behaviour, through a functional range of motion in the sagittal plane, of a single-radius femoral component compared to a dual-radius standard knee construct. Particular focus was placed on how the flexion axes of the native and replaced knee approximated to the transepicondylar axis through a loaded navigated knee design. Significant differences in flexion arcs were noted between the native and total knee arthroplasty state. These arcs were not uniform in all knees and did not display single-radius behaviour. There were no significant differences in the location of flexion axes in the native and total knee arthroplasty knee. Both exhibited similar posterior and inferior transverse axes of motion with respect to the anatomical epicondylar axis. This work has cast doubt on the reliability under loaded conditions of the single-radius concept, but the close proximity of the flexion axes of each replaced knee in relation to the functional flexion axis of the native knee may be the true basis of this purported improved kinematic performance.
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Affiliation(s)
- David John Deehan
- 1 Freeman Hospital, Newcastle upon Tyne, UK
- 2 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alasdair Blain
- 3 School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | | | - Steven Rushton
- 3 School of Biology, Newcastle University, Newcastle upon Tyne, UK
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12
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Collados-Maestre I, Lizaur-Utrilla A, Gonzalez-Navarro B, Miralles-Muñoz FA, Marco-Gomez L, Lopez-Prats FA, Gil-Guillen V. Better functional outcome after single-radius TKA compared with multi-radius TKA. Knee Surg Sports Traumatol Arthrosc 2017; 25:3508-3514. [PMID: 27522590 DOI: 10.1007/s00167-016-4273-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine whether the design of the femoral component influenced patient outcomes. METHODS Two hundred and thirty-seven patients were randomized to compare functional outcomes between single-radius TKA (SR, 118 patients) and multi-radius TKA (MR, 119 patients) with a minimum follow-up of 5 years. Prospective pre- and postoperative assessments were performed by the clinical and radiological criteria of the Knee Society Score (KSS), WOMAC and Short-Form 12 (SF12) questionnaires. The extension mechanism was assessed based on the quadriceps strength and chair test. Patient satisfaction was also assessed. RESULTS The median follow-up was 5.7 (range 5-7) years. At last follow-up, significant better KSSs (p = 0.001), range of motion (p = 0.001), extension lag (p = 0.020), quadriceps strength (p = 0.004), chair test (p = 0.032) and WOMAC pain (p = 0.002) were found in the SR group. Moreover, the improvements of these variables were early in the SR group (from 6 postoperative months). There were no significant differences in WOMAC function or SF12 physical and mental components. The revision rate and implant survival were similar in both groups. Satisfaction rate was significantly higher in SR group (p = 0.032). CONCLUSION This study shows better results with SR cruciate-retaining femoral component than MR component. The use of SR system is recommended because, although the clinically relevant differences were moderate, the functional improvement was earlier and the patient satisfaction higher with this design. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Isabel Collados-Maestre
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain. .,Traumatology and Orthopaedia, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain.
| | - Blanca Gonzalez-Navarro
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Luis Marco-Gomez
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Fernando A Lopez-Prats
- Traumatology and Orthopaedia, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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13
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Wellman SS, Klement MR, Queen RM. Performance Comparison of Single-Radius Versus Multiple-Curve Femoral Component in Total Knee Arthroplasty: A Prospective, Randomized Study Using the Lower Quarter Y-Balance Test. Orthopedics 2017; 40:e1074-e1080. [PMID: 29116326 DOI: 10.3928/01477447-20171020-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/08/2017] [Indexed: 02/03/2023]
Abstract
Midflexion stability after total knee arthroplasty (TKA) is dependent, in part, on implant design. Midflexion performance of a single-radius (SR) design and a multi-radius, or J-curve (JC), design were compared using the Lower Quarter Y-Balance Test (YBT-LQ). Patient-reported outcomes and measures of physical performance were also compared. The authors hypothesized that the SR design would provide superior midflexion stability and, therefore, a greater reach distance in the YBT-LQ when compared with the JC design. Patients undergoing primary, unilateral TKA were prospectively enrolled and block randomized to receive either the SR (n=30) or the JC (n=30) implant. Patients reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Knee Society Score, and University of California at Los Angeles Activity Score), performed the YBT-LQ, and completed physical performance measures (walking speed, timed up-and-go test, and sit-to-stand test) before surgery and 1 year postoperatively. One year postoperatively, 40 patients (20 SR, 20 JC) were available for analysis. There were no significant differences between the groups regarding age, sex, body mass index, American Society of Anesthesiologists score, YBT-LQ results, or any other variable of interest. In both groups, significant improvements were observed for all variables of interest when compared from preoperatively to 1 year postoperatively. Implant type did not affect patient-reported or physical performance outcomes following TKA; however, patients showed significant improvement in most outcome measures by 1 year postoperatively. The significant limitations in strength and balance in this cohort of patients likely outweigh any subtle differences in implant design. [Orthopedics. 2017; 40(6):e1074-e1080.].
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14
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Nam D, Kopinski JE, Meyer Z, Rames RD, Nunley RM, Barrack RL. Perioperative and Early Postoperative Comparison of a Modern Cemented and Cementless Total Knee Arthroplasty of the Same Design. J Arthroplasty 2017; 32:2151-2155. [PMID: 28238584 DOI: 10.1016/j.arth.2017.01.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/09/2017] [Accepted: 01/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) designs that incorporate a highly porous, titanium surface have the potential to achieve biologic fixation and improve component survivorship. This study's purpose was to compare perioperative and early postoperative outcomes of a cemented vs cementless TKA of the same design. METHODS This was a retrospective review of a consecutive series of TKAs performed at a single institution using a cemented or cementless TKA of the same design (Triathlon, Stryker Inc, Mahwah, NJ). All patients with a minimum of 1-year clinical and radiographic follow-up were reviewed, with 1:1 matching performed for age, gender, body mass index, and preoperative Oxford Knee Score. Chi-square or independent student t tests were used for statistical analyses. RESULTS Overall, 62 cemented and 66 cementless TKAs were reviewed, with secondary analyses performed after 1:1 matching of 38 patients in each cohort. In both overall and secondary 1:1 matching analyses, there was no difference in baseline demographics (P = .6-.9). Total operative times were decreased in the cementless cohort (P = .03), but there was no difference in the estimated blood loss or change in hemoglobin levels (P = .2-.7). At a mean of 1.4 ± .5 years postoperatively, patients in both cohorts demonstrated similar improvements in Oxford Knee Scores and satisfaction scores (P = .2-.8), with no patients requiring a revision surgical procedure. CONCLUSION A recently introduced cementless TKA design demonstrates excellent perioperative and early postoperative results without failures. Continued surveillance is necessary to elucidate the survivorship and potential long-term benefits of this cementless design.
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Affiliation(s)
- Denis Nam
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Judith E Kopinski
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Zachary Meyer
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Richard D Rames
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
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15
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Hinarejos P, Puig-Verdie L, Leal J, Pelfort X, Torres-Claramunt R, Sánchez-Soler J, Monllau JC. No differences in functional results and quality of life after single-radius or multiradius TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24:2634-40. [PMID: 26658566 DOI: 10.1007/s00167-015-3894-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The main objective of this study was to compare the functional results and the impact on quality of life after a single-radius or a multiradius TKA implantation. The secondary objectives were to compare range of motion, satisfaction and the ability to perform daily life activities with both types of implant. It was hypothesized that the single-radius TKA would lead to better functional results and better quality of life than the multiradius TKA. METHODS This is a prospective non-randomized study that included 250 cases of a single-radius TKA and 224 of a multiradius posterior-stabilized TKA implanted with the same surgical and rehabilitation protocol. RESULTS In the 1- and 5-year follow-up, we found similar knee KSS scores (89.7 ± 12.1 in the multiradius group and 90.3 ± 11.7 in the single-radius group) and functional KSS scores (78.6 ± 21.4 in the multiradius group and 75.8 ± 20.9 in the single-radius group). The pain and the Physical SF-36 scores were also similar. Range of motion (112° ± 12° in the multiradius group and 112 ± 12° in the single-radius group), patients' satisfaction and the ability to perform daily life activities were also similar in both groups. CONCLUSION The use of a single-radius or a multiradius posterior-stabilized knee prosthesis can improve the function of the knee and the patients' quality of life in a similar way at the short-term and midterm follow-up. Moreover, range of motion, patient satisfaction and the ability to perform daily life activities are similar with both types of prosthesis. As both types of prosthesis can improve the function and quality of life of the patients in a similar way, the sagittal radius of the femoral component should not be considered the main factor when choosing the model of TKA. LEVEL OF EVIDENCE Therapeutic study: Prospective comparative study, Level II.
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Affiliation(s)
- Pedro Hinarejos
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain.
| | - Lluis Puig-Verdie
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Joan Leal
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Xavier Pelfort
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Joan C Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
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16
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Liu S, Long H, Zhang Y, Ma B, Li Z. Meta-Analysis of Outcomes of a Single-Radius Versus Multi-Radius Femoral Design in Total Knee Arthroplasty. J Arthroplasty 2016; 31:646-54. [PMID: 26614746 DOI: 10.1016/j.arth.2015.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although the single-radius (SR) femoral design is known to have theoretical advantages in many aspects, studies of clinical outcomes that compare the SR with the multiple-radius (MR) femoral design are controversial. We performed a meta-analysis to address the hypothesis that a SR femoral design in primary total knee arthroplasty improves patient outcomes. METHODS The meta-analysis identified 15 articles reporting the clinical outcomes of 2212 knee replacements using the SR (n = 948) compared with the multiradius (MR; n = 1361) femoral design. Comparing SR with MR, we examined the Knee Society Score for the knee (KSS-knee), KSS-function, knee flexion, range of motion, complications, isometric peak torque of knee, and survival rate. RESULTS The range of motion of SR knees was lower than that of MR knees. No differences were found in the analyses of KSS-knee, KSS-function, knee flexion, complications, isometric peak torque of the knee, and survival rate. CONCLUSION Our meta-analysis does not provide clinical support for the previously reported theoretical advantages of the SR implant design.
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Affiliation(s)
- Shiluan Liu
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Hua Long
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Yinglong Zhang
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Baoan Ma
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Zhao Li
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
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17
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Kim DH, Kim DK, Lee SH, Kim KI, Bae DK. Is Single-Radius Design Better for Quadriceps Recovery in Total Knee Arthroplasty? Knee Surg Relat Res 2015; 27:240-6. [PMID: 26676282 PMCID: PMC4678245 DOI: 10.5792/ksrr.2015.27.4.240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/21/2015] [Accepted: 10/19/2015] [Indexed: 11/04/2022] Open
Abstract
Purpose Although single-radius (SR) designs have a theoretical advantage in quadriceps recovery following total knee arthroplasty (TKA), there has been a paucity of objective evaluation studies. Materials and Methods One hundred and twenty minimally invasive TKAs were prospectively randomized by a single surgeon into 2 groups: SR design TKA group and multi-radius design TKA group. Quadriceps force and power were assessed using a dynamometer, and clinical data were investigated preoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. Results There were no differences between two groups in quadriceps recovery and clinical results throughout the follow-up period. Furthermore, the proportion of patients whose postoperative quadriceps force and power reached preoperative level was similar in both groups. Conclusions Femoral component design itself would not significantly influence quadriceps recovery after TKA.
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Affiliation(s)
- Duk-Hyun Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dong-Kyoon Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dae-Kyung Bae
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
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18
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Jauregui JJ, Cherian JJ, Pierce TP, Beaver WB, Issa K, Mont MA. Long-Term Survivorship and Clinical Outcomes Following Total Knee Arthroplasty. J Arthroplasty 2015; 30:2164-6. [PMID: 26100473 DOI: 10.1016/j.arth.2015.05.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty (TKA) is one of the most successful commonly performed orthopedic procedures; as such, the purpose was to assess the long-term outcomes and survivorship of primary TKAs with a dual-radius prosthesis. We evaluated 125-patients (145-knees), with a mean age of 63 years (37-90 years) for a mean 11-year follow-up (10-13 years). Outcomes were assessed with KSS, UCLA, SF-36, satisfaction scores, and aseptic survivorship analysis. At 10-year follow-up, the UCLA (6-points), KSS objective (84-points) and functional (73-points), SF-36 physical (41-points) and mental (51-points), and patient satisfaction (14-points) scores were reported to be good to excellent. The 10-year Kaplan-Meier survivorship rate was 99%; one TKA demonstrated radiographic loosening. At a minimum 10-year follow-up, this device demonstrated satisfactory outcomes and outstanding aseptic-survivorship rates.
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Affiliation(s)
- Julio J Jauregui
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeffrey J Cherian
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Todd P Pierce
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Walter B Beaver
- OthoCarolina, Hip and Knee Center, Charlotte, North Carolina
| | - Kimona Issa
- Seton Hall University, Department of Orthopaedic Surgery, South Orange, New Jersey
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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