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Maciąg BM, Wilk B, Nawrocki M, Łapiński M, Świercz M, Maciąg G, Żarnovsky K, Adamska O, Stolarczyk A. Establishing femoral component rotation using a dynamic tensioner does not improve patellar position after total knee replacement with use of anatomic implants: A case-control study. Knee 2024; 48:217-225. [PMID: 38733872 DOI: 10.1016/j.knee.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/06/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Anterior knee pain (AKP) is one of the reasons for dissatisfaction after total knee replacement (TKR). It may result from patellofemoral joint dysfunction, caused by improper rotation of implant components. The aim of this study was to analyze patella positioning in patients after standard measured resection TKR and TKR with a use of a dynamic tensioner, and to assess the frequency of AKP, range of motion (ROM), and patient-reported outcome measures 6 weeks and 3 months postoperatively. METHODS The study consisted of 127 patients who underwent TKR. Eighty-nine of them treated with use of the dynamic tensioner FUZION formed the study group; the remainder formed the control group. All participants received cemented PERSONA MC without patella resurfacing. All patients had a standard anteroposterior, lateral weight-bearing, long-leg view X-ray and computed tomography examination in 30° of knee flexion following the procedure. RESULTS There were no significant differences between the study and the control groups regarding: posterior condylar axis (PCA)-patella angle, surgical transepicondylar axis (sTEA)-patella angle, PCA-sTEA angle, deviation from 90° in PCA-patella, sTEA-patella and PCA-sTEA angles. No significant difference was found in a ratio of obtaining PCA-patella angle deviation of more than 3°. Regarding clinical parameters, statistically and questionablly clinically significant difference in favor of the Study Group was found in Forgotten Joint Score 6 weeks and 3 months post-operativley and ROM 6 weeks post-operatively. However, such difference was not found by analyzing ROM 3 months post-operatively, AKP and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. CONCLUSION Compared with the standard 3° of femoral component external rotation, use of a dynamic tensioner does not allow for more accurate restoration of the patellar facet position with reference to the PCA.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Bartłomiej Wilk
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Nawrocki
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland.
| | - Maciej Świercz
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Olga Adamska
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
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Maciąg BM, Kordyaczny T, Żarnovsky K, Budzińska M, Jegierski D, Łapiński M, Maciąg GJ, Stolarczyk A. Curve-on-curve technique does not improve tibial coverage in total knee arthroplasty in comparison to tibial tuberosity technique with use of anatomical implants: randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:5901-5907. [PMID: 37000268 PMCID: PMC10064952 DOI: 10.1007/s00402-023-04857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION During the last years, main attention while performing total knee replacement was paid to femoral component alignment; however, there is still lack of studies concerning tibial baseplate rotational alignment, especially in terms of anatomical designs of knee prosthesis. Some recent studies proved that tibial baseplate malrotation might be a cause of knee pain and patients' dissatisfaction. The aim of this study was to compare tibial component rotation and its coverage on the tibial plateau achieved with curve-on-curve and tibial tuberosity techniques (t-t technique) with use of anatomic knee designs with asymmetric tibial baseplate. MATERIALS AND METHODS A total of 88 patients were randomly assigned in a 1:1 ratio to undergo total knee arthroplasty with use of the PERSONA PS (Zimmer Biomet) knee design with an asymmetric baseplate. The rotation of the tibial component was assessed and performed with two different techniques: curve-on-curve technique and tibial tuberosity technique. Tibial component rotation was measured on computed tomography (CT) scans using the method suggested by Benazzo et al. and designed for asymmetrical implants. For the measurement of the tibial bone coverage, the component surface area was outlined and measured on a proper CT section, then the tibial cut surface area was outlined and measured on a section just below the cement level. Pre- and post-operative range of motion was measured by another independent researcher 12 months post-operatively during follow-up visit. RESULTS There was a statistically significant difference between both groups in median value of tibial rotation angle: 7° (interquartile range (IQR) = 0-12) in curve-on-curve technique group vs 2° (IQR-1-7) in tibial tuberosity technique group, probability value (p) = 0.0041, with values above 0 meaning external rotation of the component. There was no statistically significant difference between both groups in terms of range of motion (ROM) with average values of 124.3° ± 13.0° for curve-on-curve technique and 125.6° ± 12.8° for t-t technique with p = 0.45. There was a statistically insignificant difference between both groups in terms of coverage percentage in slight favor for curve-on-curve technique (85.9 ± 4.2 vs 84.5 ± 4.8, p = 0.17). CONCLUSION In this study, no difference between the groups in terms of tibial bone coverage and range of motion was proved, even though both techniques differed significantly with values of tibial rotation. Future studies should be focused on influence of specific values of tibial rotation on patient-reported outcomes and survivorship of anatomic knee implants.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland.
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Martyna Budzińska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
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Maciąg BM, Kordyaczny T, Jegierski D, Łapiński M, Dorocińska M, Żarnovsky K, Maciąg GJ, Adamska O, Stolarczyk A. Differences in joint line level and posterior condylar offset during total knee replacement with use of gap-balancing and measured resection techniques-matched cohort study. BMC Musculoskelet Disord 2023; 24:610. [PMID: 37491199 PMCID: PMC10367383 DOI: 10.1186/s12891-023-06722-1] [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: 11/08/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Total knee replacement (TKR) is considered one of the most common elective orthopaedic procedures. The main focus of TKR is to offer patient's symptomatic relief from persistent knee pain. To achieve this it is crucial to restore joint biomechanics by performing proper bone cuts. Some surgeons favor the measured resection technique, others prefer gap balancing technique. The researchers of the presented study performed TKR using these two techniques. The aim of this study was to compare the postoperative change in joint line and posterior condylar offset after TKR with use of anatomic knee design implants between gap balancing and measured resection techniques. METHODS Two hundred twenty-five X-rays of patients who underwent TKR performed by a single surgeon between 2020 and 2021 were analyzed. The first group of patients (101) was operated with the use of gap balancing technique and the second group (124) was operated with the use of measured resection technique. Patients included in the study were > 50 years of age, had confirmed primary knee osteoarthritis, underwent primary TKR with a PS (posterior stabilized) knee implants without patella resurfacing and had at least 15 degree flexion contracture. T-student test and U Mann-Whitney test were used in statistical analysis of results, according to the normality of distribution examined with the Shapiro-Wilk test. Post-hoc analysis was performed using the Dwass-Steel-Crichtlow-Fligner test (DSCF). RESULTS The postoperative analysis showed a significantly elevated joint line level in the gap balancing group (-2.6 ± 4.1 vs -0.7 ± 4.8, p < 0.0005). In the gap balancing group significantly more patients had joint lines elevated > 2 mm comparing to measured resection technique. The difference between pre- and postoperative PCO (posterior condylar offset) and PCOR (posterior condylar offset ratio) results had no significant differences (100.8 ± 11.8 vs 101 ± 12.5, p > 0.05) between the groups. CONCLUSIONS The results of the study suggest that when it comes to restoring joint line level measured resection technique seems to be superior in comparison to the gap balancing technique. What is more, results indicate measured resection is equal in terms of restoring posterior condylar offset to the gap balancing technique. TRIAL REGISTRATION NCT04164147, date of registration: November 14, 2019.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland.
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Monika Dorocińska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Olga Adamska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
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Maciąg BM, Kordyaczny T, Maciąg GJ, Łapiński M, Jegierski D, Świderek J, Tsitko H, Dorocińska M, Żarnovsky K, Świercz M, Stępiński P, Adamska O, Stolarczyk A. Comparison of Femoral Component Rotation between Robotic-Assisted vs. Soft-Tissue Tensor Total Knee Arthroplasty with Anatomic Implants. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050880. [PMID: 37241112 DOI: 10.3390/medicina59050880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Total knee arthroplasty (TKA) is the most effective treatment method for end-stage osteoarthritis. One of the most important aspects of this surgery is adequate implant positioning, as it guarantees the desired outcome of restoring limb biomechanics. Surgical technique is being continuously improved along with hardware development. There are two novel devices designed to help establish proper femoral component rotation: soft-tissue tensor and robotic-assisted TKA (RATKA). This study compared the femoral component rotation achieved with the use of three methods: RATKA, soft tissue tensioner and the conventional measured-resection technique, all of them utilizing anatomical design prosthesis components. Materials and Methods: A total of 139 patients diagnosed with end-stage osteoarthritis underwent total knee arthroplasty between December 2020 and June 2021. After the surgery, they were divided into three groups depending on procedure technique and implant type: Persona (Zimmer Biomet) + Fuzion Balancer, RATKA + Journey II BCS or conventional TKA + Persona/Journey. Postoperatively, a computed tomography examination was performed in order to measure femoral component rotation. All three groups were compared independently during statistical analysis. Fisher's exact, Kruskal-Wallis and Dwass-Steel-Crichtlow-Fligner tests were used for particular calculations. Results: Statistically significant differences in femoral component rotation between groups were noticed. However, in terms of values other than 0° in external rotation, no significant variance was revealed. Conclusions: Additional total knee arthroplasty instruments seem to improve the outcomes of the surgery, providing better component positioning than in the conventional measured-resection technique based only on bone landmarks.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Jakub Świderek
- Faculty of Medicine, Medical University of Białystok, 15-089 Białystok, Podlaskie Voivodeship, Poland
| | - Hanna Tsitko
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Lubelskie Voivodeship, Poland
| | - Monika Dorocińska
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Maciej Świercz
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Piotr Stępiński
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Olga Adamska
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
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Zhang H, Cao C, Zhang H, Han S. Determining the rotational alignment of the tibial component referring to the tibial tubercle during total knee arthroplasty: the tibial tubercle-trochlear groove can be an aid. J Orthop Surg Res 2022; 17:253. [PMID: 35509006 PMCID: PMC9069815 DOI: 10.1186/s13018-022-03139-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background There is no consensus on anatomic landmarks or reference axes with which to accurately align rotational position of tibial component. Using the tibial tubercle, commonly referring to the Akagi line and the Insall line, for anatomic reference was widely accepted. However, it is unknown about the predictors that may affect the reliability of using the tibial tubercle for aligning tibial component rotation. The aims of our study were (1) to investigate the reproducibility and accuracy of using the tibial tubercle for aligning tibial component rotation and (2) to determine predictors resulting in discrepancies of the tibial component rotation when referring to the tibial tubercle. Method A total of 160 patients with osteoarthritis were recruited before total knee arthroplasty. The angle α formed by the tibial anteroposterior (AP) axis and the Akagi line and the angle β formed by the tibial AP axis and the Insall line were measured to quantify the discrepancies of the Akagi line and the Insall line. Independent variables, including the tibial tubercle-to-trochlear groove distance (TT-TG), tibial tubercle to posterior cruciate ligament (TT-PCL), and knee rotation angle (KRA), hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), and tibial bowing (TB), were measured. Pearson’s product moment correlation coefficients and multivariable linear regression analysis were calculated to assess relationships between independent variables and the two defined angles. Results All defined measurement were available for 140 patients. The Akagi line rotated internally with 1.03° ± 4.25° in regard to the tibial AP axis. The Insall line rotated externally in regard to the tibial AP axis with 7.93° ± 5.36°. Three variables, including TT-TG, TT-PCL, and KRA, tended to be positively correlated with the angle α and the angle β. In terms of a cutoff of TT-TG = 9 mm, 100% cases and 97% cases for using the Akagi line and Insall line, respectively, were located in the defined safe zone (− 5° to 10°). Conclusion The tibial tubercle (the Akagi line and Insall line) is found to be a useful and promising anatomic landmark for aligning the tibial component rotation. The TT-TG, with a cutoff value of 9 mm, is helpful to choose the Akagi line or Insall line, alternatively.
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Affiliation(s)
- He Zhang
- Handan Branch, Huabeiyiliao Jiankangjituan Fengfeng Zongyiyuan, Handan, 056000, Hebei, China
| | - Chengming Cao
- Handan Branch, Huabeiyiliao Jiankangjituan Fengfeng Zongyiyuan, Handan, 056000, Hebei, China
| | - Han Zhang
- Handan Branch, Huabeiyiliao Jiankangjituan Fengfeng Zongyiyuan, Handan, 056000, Hebei, China
| | - Shoujiang Han
- Department of Orthopaedic Surgery, Huabeiyiliao Jiankangjituan Fengfeng Zongyiyuan, Handan, 056000, Hebei, China.
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Rossi SMP, Ivone A, Ghiara M, Jannelli E, Sangaletti R, Perticarini L, Benazzo F. A ligament tensor-guided extramedullary alignment technique for distal femoral cut in total knee replacement: results at a minimum 3 years follow-up. Arch Orthop Trauma Surg 2021; 141:2295-2302. [PMID: 34386837 DOI: 10.1007/s00402-021-04115-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Femoral intramedullary canal referencing is used by most knee arthroplasty systems for distal femoral cut; to avoid the opening of the femoral canal different solutions have been presented such as navigation, patient-specific instruments (PSI) or the use of an extramedullary device. The FuZion® system is a tensor device, created to merge the two main techniques for performing a total knee arthroplasty: the ligament balancing and measured resection techniques. Our idea was to use the tensor as an extramedullary cutting guide for the distal femoral cut, based on a 90° tibial resection. METHODS A total of 110 patients were operated on with this technique. Patients were evaluated with weight-bearing long-standing X-rays, knee a-p and lateral views, validated PROMs (Oxford Knee Score, EQ-5D and EQ-VAS), the Knee Society Scoring System (KSS) and the Forgotten Joint Score (FJS). Minimum follow up was 3 years (range 38-50 months). RESULTS Complete results were available for 104 patients (5 were lost in follow up and 1 died). Significant improvements were registered for all the evaluated scores from pre-op to the final follow up. Pre-op long-standing X-rays showed 21 valgus knees (20%) with a mean HKA of 187.6° (± 3.2°), 70 varus knees (62%) with a mean 172.2° (± 3.7°) HKA and 19 neutrally aligned knees, with a mean HKA of 179.5° (0 ± 2°). The radiographic evaluation at 3 months post-op showed 20 valgus knees (mean HKA 183.7° ± 1.5°), 67 varus knees (mean HKA 176.1° ± 1.8°) and 23 neutrally aligned knees with a mean HKA of 179.3° (0 ± 2°). At final follow up the survival rate was 100% for revision of the implant as the endpoint. With any reoperation as the endpoint Kaplan-Meier survival estimate showed a survival rate of 95.1% at 3 years. CONCLUSIONS This technique for performing a ligament driven alignment in total knee arthroplasty showed encouraging clinical outcomes at mid-term follow up leaving a residual deformity on the coronal plane.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
| | - Alessandro Ivone
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy
| | - Matteo Ghiara
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy
| | - Eugenio Jannelli
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.,Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy.,Università degli Studi di Pavia, 27100, Pavia, Italy
| | - Loris Perticarini
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.,Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy.,Università degli Studi di Pavia, 27100, Pavia, Italy
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Gejo R, Mine H, Nogami M, Kawaguchi Y. Is it possible to predict the final component gap in flexion before femoral posterior condylar osteotomy in cruciate-retaining and posterior-stabilized total knee arthroplasty? Knee 2021; 28:89-96. [PMID: 33310670 DOI: 10.1016/j.knee.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/19/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total knee arthroplasty (TKA) with posterior condylar osteotomy using anatomical landmarks, predicting the final flexion gap is impossible, as it differs with the presence or absence of the posterior cruciate ligament. We compared the predicted flexion gap, based on pre-femoral posterior condylar osteotomy measurements, with the postsurgical final flexion gap in cruciate-retaining (CR) and posterior-stabilized (PS) TKA. METHODS One hundred knees of patients with osteoarthritis were included: 35 underwent CR, and 65 PS TKA. Distal femoral and proximal tibial osteotomy using the measured resection technique was performed. An anterior and posterior femoral osteotomy guide was set parallel to the surgical epicondylar axis, and the predicted flexion gap was measured using a seesaw tensor attached to the guide. After all procedures, the final component gap in flexion was measured using a similar seesaw tensor at the patella reduction position and was compared with the predicted gap. RESULTS The correlation coefficients for predicted vs. final component gap were 0.45 (P < 0.05) in CR and 0.82 (P < 0.001) in PS. The mean differences between predicted and final gaps were 1.8 mm for CR and 1.0 mm for PS. In 34.3% of CR cases, the gap difference was more than 2 mm. CONCLUSION It is possible to predict the final flexion gap before femoral posterior condylar osteotomy, with a strong correlation observed between predicted and final component gaps in PS TKA. However, in CR, more than 30% of the cases showed unexpectedly large final flexion gaps.
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Affiliation(s)
- Ryuichi Gejo
- Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan.
| | - Hayato Mine
- Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan
| | - Makiko Nogami
- Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan
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Watanabe S, Tomita T, Akagi R, Watanabe A, Yamazaki T, Enomoto T, Nakagawa R, Kimura S, Ohtori S, Sasho T. In vivo kinematics of cruciate-retaining total knee arthroplasty after a change of polyethylene insert configuration. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 24:1-8. [PMID: 33457208 PMCID: PMC7782324 DOI: 10.1016/j.asmart.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
Background To investigate in vivo kinematics of total knee arthroplasty (TKA) with the introduction of a mildly constrained (MC) type of polyethylene (PE). We compared the knee kinematics with a reported pattern after surgery using the same component with a conventionally constrained (CC) type of PE. Methods Finite element analysis (FEA) was performed to examine different peak stress distribution of both types of PE. For in vivo study, patients who underwent cruciate-retaining TKA using a total knee system with MC-PE were included. Fluoroscopic surveillance was used to measure the weight-bearing deep knee bend (squatting) using a two-dimensional/three-dimensional (2-D/3-D) registration technique. Results FEA analysis revealed the edge loading of the femoral component on PE in CC but not in MC. During the study period, 42 patients underwent TKA with MC-PE. Among them, 13 agreed to participate in the present study. In vivo kinematics analysis found that starting from an average external rotation of femur being 7.1° at 0° of flexion, the rotation slightly decreased to 6.8° at 10° of flexion, then increased with increasing knee flexion until it reached 10.8° at 80° of flexion, and finally decreased to 9.8° at 100° of knee flexion. The results indicate a modest medial pivot pattern. Although the overall pattern was similar for both MC-PE and CC-PE, a slight difference was observed. MC-PE showed a slight internal rotation of 0.3° from 0 to 10° of knee flexion, whereas CC-PE showed a gradual increase of external rotation in this range. Conclusions Change of configuration from CC to MC did not substantially affect in vivo kinematics of knees after TKA. Considering the theoretical wider range of allowance of rotation, MC-PE is easier for knee surgeons to use.
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Affiliation(s)
- Shotaro Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Tetsuya Tomita
- Department of Orthopedic Biomaterial Science, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama, 369-0293, Japan
| | - Takahiro Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Ryosuke Nakagawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Seiji Ohtori
- Department of Orthopedic Biomaterial Science, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
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Reddy G, Ul Islam S, Chandran P, Attar F. Can the Surgical Approach to Total Knee Arthroplasty Influence Early Postoperative Outcomes? - A Comparative Study between Trivector and Medial Parapatellar Approaches. Int J Appl Basic Med Res 2020; 10:25-29. [PMID: 32002382 PMCID: PMC6967342 DOI: 10.4103/ijabmr.ijabmr_176_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/01/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Trivector approach to total knee arthroplasty (TKA) is a quadriceps tendon sparing approach, whereas the medial parapatellar (MPP) approach involves making a longitudinal incision in quadriceps tendon. We postulated that quadriceps-sparing approach such as trivector should make postoperative rehabilitation easier and ultimately reduce the length of hospital stay. Objectives: The aim of the study is to compare the early postoperative outcomes of the TKA performed through the trivector and the MPP approaches. Methodology: We prospectively reviewed the results of 56 consecutive patients operated on by two knee surgeons: one routinely performs trivector and the other an MPP approach. Both the groups consisted of 28 patients each. We looked at operative times, the time taken to perform straight leg raise (SLR), range of movements achieved before discharge, and length of the hospital stay. Results: The mean time taken for performing the surgery through the MPP approach was 56 min, whereas, for the trivector approach, it was 54 min (P = 0.31). The mean time taken to perform SLR in the MPP approach group was 3.5 days, whereas in the trivector group, the meantime taken for SLR was 2.5 days (P = 0.003). The average extension at the time of discharge in the MPP group was 3.8°, and in the trivector group, it was 0.86° (P = 0.007). The average knee flexion at the time of discharge in the MPP group was 84.2°, whereas in the trivector group, it was 86.5° (P = 0.199). The average hospital stay in the MPP group was 5.96 days, whereas in the trivector group, it was 4.84 days (P = 0.11). Conclusions: The trivector approach patients took significantly less time to do SLR and achieved a better range of extension before discharge from the hospital. The patients with trivector approach were discharged early by one day, although it is not statistically significant, it is clinically significant.
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Affiliation(s)
- Gautam Reddy
- Department of Trauma and Orthopaedics, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, United Kingdom
| | - Saif Ul Islam
- Department of Trauma and Orthopaedics, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, United Kingdom
| | - Prakash Chandran
- Department of Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Fahad Attar
- Department of Trauma and Orthopaedics, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, United Kingdom
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Popescu R, Haritinian EG, Cristea S. Methods of intra- and post-operative determination of the position of the tibial component during total knee replacement. INTERNATIONAL ORTHOPAEDICS 2019; 44:119-128. [PMID: 31655885 DOI: 10.1007/s00264-019-04424-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
AIM OF THE STUDY To identify the most reliable anatomical landmarks and imaging techniques for assessing the rotation of the tibial component in total knee arthroplasty (TKA). METHODS An extensive literature review (from January 2016 to March 2019) was performed. We included studies about primary TKA with details concerning the anatomical landmarks used for implanting the tibial component and also imaging studies assessing tibial component rotation. The final selection comprises only thirty-five articles consistent with the inclusion criteria. RESULTS Extra-articular landmarks are not always reliable (even though the tibial tubercle is one of the most popular extra-articular landmarks used to assess the rotation of the tibial component), mainly because they vary and can lead to malrotation of the tibial component. Akagi's line (an intra-articular landmark) is considered to be the most reliable and easy to find during surgery and likewise is not affected by articular deformities. The anterior tibial cortex (intra-articular landmark) also proved to be accurate and reliable with the main advantage being that is palpable after tibial resection. Radiography provides a good and inexpensive option for imaging, but it is insufficient. Magnetic resonance imaging (MRI) is used in some cases but not routinely for assessing TKA components or their orientation. Computed tomography (CT), used together with a well-defined protocol (Berger's method being the preferred choice), remains the "gold standard" for evaluating the rotation of the tibial component after TKA. CONCLUSION Currently, the most accurate and reliable anatomical landmarks are represented by Akagi's line and the anterior cortex of the tibia. Post-operatively, through CT and well-established protocols, the rotation of the tibial component can be accurately determined.
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Affiliation(s)
- Roman Popescu
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania
| | - Emil G Haritinian
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania. .,Clinical Hospital of Orthopedics and Traumatology and Osteoarticular TB "Foișor", Ferdinand Blvd, no. 35-37, District 2, 021382, Bucharest, Romania.
| | - Stefan Cristea
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania. .,Department of Orthopaedics and Traumatology, Saint Pantelimon Emergency Hospital, Pantelimon Road, no. 340-342, District 2, 021659, Bucharest, Romania.
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The history of Italian Orthopaedics. INTERNATIONAL ORTHOPAEDICS 2018; 43:1-5. [PMID: 30578433 DOI: 10.1007/s00264-018-4276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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