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Bourdon CE, Broberg JS, McCalden RW, Naudie DD, MacDonald SJ, Lanting BA, Teeter MG. Comparison of long-term kinematics and wear of total knee arthroplasty implant designs. J Mech Behav Biomed Mater 2021; 124:104845. [PMID: 34555623 DOI: 10.1016/j.jmbbm.2021.104845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/23/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022]
Abstract
We sought to evaluate wear and kinematics in well-established implants of posterior stabilized (PS) and cruciate retaining (CR) designs. Ninety-one knees implanted for at least five years were examined. The implants were Genesis II PS (Smith & Nephew, Memphis, TN), Sigma PS (DePuy Synthes, Warsaw, IN), or Sigma CR. Radiostereometric analysis (RSA) images were acquired at multiple flexion angles and the 3D positions of the implant components were determined using model-based RSA software. The location of the center of the contact area between the femoral and polyethylene components was used to obtain contact kinematics, and the magnitude of the virtual intersection between the components indicated linear wear. All three groups had paradoxical anterior motion on both condyles, experienced similar net external rotation, and exhibited instances of internal rotation during flexion. The maximum observed wear rate was significantly greater for the Sigma PS than the Genesis II PS on the medial condyle (mean difference = 0.032 mm/year, p = 0.044), but not the lateral condyle, while there was no difference between the Sigma PS and Sigma CR for either condyle. Knees with lateral condylar separation had greater maximum wear rates on the medial condyle (mean difference = 0.033 mm/year, p = 0.001), while those with medial condylar separation had greater maximum wear rates on the lateral condyle (mean difference = 0.044 mm/year, p = 0.014). At long term follow-up in patients with well-functioning implants, there were differences in kinematics and wear resistance between implants. These results suggest that implant design affects long-term kinematics and wear in well-functioning implants and that condylar separation should be avoided to minimize wear.
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Affiliation(s)
- Caleigh E Bourdon
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Richard W McCalden
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Douglas D Naudie
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Steven J MacDonald
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada; Orthopaedics Program, Lawson Health Research Institute, Canada.
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Angerame MR, Eschen CL, Johnson RM, Jennings JM, Dennis DA. Ten-Year Follow-Up of High-Flexion Versus Conventional Total Knee Arthroplasty: A Matched-Control Study. J Arthroplasty 2021; 36:2795-2800. [PMID: 33810919 DOI: 10.1016/j.arth.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND High-flexion total knee arthroplasty (HF-TKA) prostheses were designed with hopes of improving knee function. Studies have suggested increased failure with HF-TKAs. The purpose is to compare clinical results of HF-TKA versus conventional TKA (C-TKA) from the same implant system with long-term follow-up. METHODS This review of prostheses implanted between 2004 and 2007 matched 145 of 179 possible HF-TKAs with 145 of 1347 possible C-TKAs. Mean follow-up was 121.5 ± 20.3 months. We were unable to match 12 HF-TKAs. HF-TKAs with less than 8-year follow-up were excluded. The primary outcome was failure requiring revision. Secondary outcomes included range of motion (ROM), Knee Society Scores (KSS), and radiolucent lines. RESULTS In the matched cohort, there were 15 HF-TKA reoperations, 8 of which involved component revisions. There were 12 reoperations in the C-TKA cohort but no component revisions (P = .001). The analysis of the unmatched cohorts revealed a higher revision rate for HF-TKAs (P = .039) (HF-TKA: 10/179 vs C-TKA: 27/1347). At final follow-up, HF-TKAs exhibited more prosthesis radiolucent lines without evidence of loosening. Particularly, HF-TKAs demonstrated more femoral zone IV radiolucencies (38.7%) at final follow-up compared with C-TKAs (13.8%) (P < .001). There were no differences found between cohorts in ROM or KSS. CONCLUSION This study found an increased incidence of failure requiring revision with the HF-TKA in the matched and unmatched analyses. Higher incidences of radiolucent lines were found with HF-TKA. With no observed differences in ROM or KSS and a higher rate of failure with HF-TKA, there appears to be no advantage for use of the HF-TKA.
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Affiliation(s)
- Marc R Angerame
- Illinois Bone & Joint Research and Education Institute, Des Plaines, IL
| | - Catie L Eschen
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO
| | | | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN
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Huang CH, Lu YC, Hsu LI, Liau JJ, Chang TK, Huang CH. Effect of material selection on tibial post stresses in posterior-stabilized knee prosthesis. Bone Joint Res 2020; 9:768-777. [PMID: 33135462 PMCID: PMC7649505 DOI: 10.1302/2046-3758.911.bjr-2020-0019.r2] [Citation(s) in RCA: 2] [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] [Indexed: 11/11/2022] Open
Abstract
Aims The material and design of knee components can have a considerable effect on the contact characteristics of the tibial post. This study aimed to analyze the stress distribution on the tibial post when using different grades of polyethylene for the tibial inserts. In addition, the contact properties of fixed-bearing and mobile-bearing inserts were evaluated. Methods Three different grades of polyethylene were compared in this study; conventional ultra high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (HXLPE), and vitamin E-stabilized polyethylene (VEPE). In addition, tibial baseplates with a fixed-bearing and a mobile-bearing insert were evaluated to understand differences in the contact properties. The inserts were implanted in neutral alignment and with a 10° internal malrotation. The contact stress, von Mises stress, and equivalent plastic strain (PEEQ) on the tibial posts were extracted for comparison. Results The stress and strain on the tibial post for the three polyethylenes greatly increased when the insert was placed in malrotation, showing a 38% to 56% increase in von Mises stress and a 335% to 434% increase in PEEQ. The VEPE insert had the lowest PEEQ among the three materials. The mobile-bearing design exhibited a lower increase in stress and strain around the tibial posts than the fixed-bearing design. Conclusion Using VEPE for the tibial component potentially eliminates the risk of material permanent deformation. The mobile-bearing insert can help to avoid a dramatic increase in plastic strain around the tibial post in cases of malrotation. The mobility allows the pressure to be distributed on the tibial post and demonstrated lower stresses with all three polyethylenes simulated. Cite this article: Bone Joint Res 2020;9(11):768–777.
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Affiliation(s)
- Chang-Hung Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Institute of Geriatric Welfare Technology and Science, MacKay Medical College, New Taipei City, Taiwan
| | - Yung-Chang Lu
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Lin-I Hsu
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Jiann-Jong Liau
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Ting-Kuo Chang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Hsiung Huang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Orthopaedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
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Abstract
BACKGROUND Revision of TKA as a result of polyethylene wear is decreasing, but long-term wear performance of polyethylene is still a topic of interest to surgeons and device manufacturers seeking to improve longevity. Measuring wear of modern, wear-resistant implants has been described using radiostereometric analysis (RSA). Performing in vivo measurements would establish whether implant retrieval studies are representative of wear in well-performing knees. QUESTIONS/PURPOSES For a single knee implant system, we sought to determine (1) the linear wear rate using RSA; (2) the association between demographic factors and wear rate; and (3) the association between limb alignment and wear rate. METHODS A total of 49 patients with a minimum followup of 10 years (median, 12 years; range, 10-20 years) were retrospectively selected. During the examined period, 4082 TKAs were performed of which 2085 were the implant examined in this study. There were 71 of these patients who met the criteria including an available full-leg radiograph postoperatively, and 34 of these patients returned for examination along with 15 additional from a separate RSA study that also met the criteria. All patients received a posterior-stabilized, cobalt-chromium-on-conventional polyethylene total knee implant from a single implant system, which was the most commonly used at our institution at the time. Patients underwent standing RSA examinations from 0° to 120° of flexion at a single time point without the use of marker beads. Linear wear rates (including creep) were measured based on intersections between the femoral component and tibial insert models. Associations between wear and patient age at surgery, sex, height, weight, body mass index, tibial insert size, and limb alignment were examined. RESULTS Using the maximum linear wear rate from any flexion angle, the lateral rate was 0.047 mm/year (interquartile range [IQR], 0.034-0.066 mm/year) and the medial rate was 0.052 mm/year (IQR, 0.040-0.069 mm/year). Using the median of the linear wear rates across all flexion angles, the lateral rate was 0.027 mm/year (IQR, 0.017-0.046 mm/year) and the medial rate was 0.038 mm/year (IQR, 0.022-0.054 mm/year). This rate for males was 0.049 mm/year medially (IQR, 0.042-0.077 mm/year) and 0.032 mm/year laterally (IQR, 0.026-0.059 mm/year), and for females was 0.027 mm/year medially (0.016-0.039 mm/year) and 0.020 mm/year laterally (IQR, 0.013-0.032 mm/year). The wear rate for males was greater medially (difference = 0.022 mm/year, p < 0.001) and laterally (difference = 0.012 mm/year, p = 0.008). There were associations between greater wear and increasing height (ρ = 0.48, p < 0.001 medially and ρ = 0.30, p = 0.04 laterally), decreasing body mass index (ρ = -0.31, p = 0.03 medially), and greater implant size (ρ = 0.34, p = 0.02 medially). Increasingly varus leg alignment was associated with greater medial wear (ρ = 0.33, p = 0.02). CONCLUSIONS Greater wear rates were associated with demographic factors and leg alignment. Further RSA wear studies of other modern implant systems would provide complementary information to retrieval studies and valuable data on wear resistance. CLINICAL RELEVANCE Good wear resistance was demonstrated by well-performing implants in patients at long-term followup with wear magnitudes in agreement with reported values from retrieval studies.
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Kim YH, Park JW, Kim JS. Do High-Flexion Total Knee Designs Increase the Risk of Femoral Component Loosening? J Arthroplasty 2017; 32:1862-1868. [PMID: 28238582 DOI: 10.1016/j.arth.2017.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of our prospective, randomized, long-term investigation is to compare the aseptic loosening rate of the femoral component of the total knee prosthesis and clinical and radiographic results of high-flexion posterior cruciate-substituting knee prosthesis or standard posterior cruciate-substituting knee prosthesis in the same patients. METHODS There were 960 patients (mean age 71.3 years). The mean follow-up period was 13.2 years (range 10-14). The patients were assessed clinically and radiographically with rating systems of the Knee Society. Furthermore, Western Ontario and McMaster Universities Osteoarthritis questionnaire and ranges of knee motion were determined in both groups. RESULTS In the high-flexion knee group, 2 knees (0.2%) had aseptic loosening of both femoral and tibial components. In the standard knee group, 2 knees (0.2%) had aseptic loosening of the femoral component only. The mean postoperative knee scores (97 vs 97 points), Western Ontario and McMaster Universities Osteoarthritis scores (19 vs 19 points), and range of knee motion (128° vs 129°) were not significantly different between the 2 groups. Two knees (0.2%) in the high-flexion knee group underwent a revision of both femoral and tibial components and 2 knees (0.2%) in the standard knee group had a revision of the femoral component only. CONCLUSION After a mean of 13.2 years of follow-up, this study did not show increased incidence of femoral component loosening in the high-flexion knee group. Furthermore, we found no significant differences between the 2 groups with regard to clinical or radiographic parameters or range of knee motion.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Ewha Womans University, SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
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Liao CD, Huang YC, Lin LF, Chiu YS, Tsai JC, Chen CL, Liou TH. Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:2578-86. [PMID: 26286622 DOI: 10.1007/s00167-015-3754-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE This study evaluated the effects of continuous passive motion (CPM) on accelerated flexion after total knee arthroplasty (TKA) and whether CPM application measures (i.e. initial angle and daily increment) are associated with functional outcomes. METHODS A retrospective investigation was conducted at the rehabilitation centre of a university-based teaching hospital. Patients who received CPM therapy immediately after TKA surgery were categorized into rapid-, normal-, and slow-progress groups according to their response to CPM during their acute inpatient stay. Knee pain, passive knee flexion, and knee function-measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-were assessed preoperatively at discharge and at 3- and 6-month outpatient follow-up visits. RESULTS A total of 354 patients were followed for 6 months after inpatient-stay discharge. The patients in the rapid-progress group (n = 119) exhibited significantly greater knee flexions than those in the slow-progress group did (n = 103) at the 3-month follow-up [mean difference (MD) = 10.3°, 95 % confidence interval (CI) 4.3°-16.3°, p < 0.001] and 6-month follow-up (MD = 10.9°, 95 % CI 6.3°-15.6°, p < 0.001). Significant WOMAC score differences between the rapid- and slow-progress groups were observed at the 3-month follow-up (MD = 7.2, 95 % CI 5.4-9.1, p < 0.001) and 6-month follow-up (MD = 16.1, 95 % CI 13.4-18.7, p < 0.001). CPM initial angles and rapid progress significantly predicted short- and long-term outcomes in knee flexion and WOMAC scores (p < 0.001). CONCLUSION When CPM is used, early application with initial high flexion and rapid progress benefits knee function up to 6 months after TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Chun-De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ching Huang
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Shuo Chiu
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jui-Chen Tsai
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Lung Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, Taiwan.
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Liao CD, Huang YC, Chiu YS, Liou TH. Effect of body mass index on knee function outcomes following continuous passive motion in patients with osteoarthritis after total knee replacement: a retrospective study. Physiotherapy 2016; 103:266-275. [PMID: 27647443 DOI: 10.1016/j.physio.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Obesity may influence postoperative rehabilitation outcomes after total knee replacement (TKR). The aim of this study was to evaluate the effects of body mass index (BMI) on the progression of inpatient rehabilitation using continuous passive motion (CPM) and its treatment outcomes. PARTICIPANTS AND SETTING A retrospective study was conducted in a rehabilitation centre. In total, 354 patients undergoing primary TKR were enrolled through medical chart review. INTERVENTION All patients commenced the CPM programme immediately after surgery and continued until hospital discharge. MAIN OUTCOME MEASURES Knee flexion, pain score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function score. DESIGN Patients were divided into five BMI groups: normal weight (n=59), overweight (n=95), Class I obesity (n=90), Class II obesity (n=82) and Class III obesity (n=28). All outcome measures were recorded at admission; daily during the inpatient stay; at discharge; and at 1-, 3- and 6-month follow-up assessments. RESULTS During CPM exercises, obese patients had a smaller initial flexion angle (P<0.001) and a smaller daily increment in the CPM motion arc (P<0.001) compared with patients of normal weight. Severe obesity was associated with poor knee flexion [adjusted odds ratio (aOR) 11.9, 95% confidence interval (CI) 3.49 to 40.94, P<0.001] and WOMAC physical function score (aOR 5.09, 95% CI 1.62 to 16.03, P=0.005) at 6-month follow-up. CONCLUSIONS Obesity had a negative effect on progress during the CPM protocol, which commenced immediately after surgery and continued until discharge. Obesity was also associated with poorer self-reported function at 6-month follow-up.
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Affiliation(s)
- C-D Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Y-C Huang
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Y-S Chiu
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - T-H Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Wang Z, Wei M, Zhang Q, Zhang Z, Cui Y. Comparison of High-Flexion and Conventional Implants in Total Knee Arthroplasty: A Meta-Analysis. Med Sci Monit 2015; 21:1679-86. [PMID: 26057659 PMCID: PMC4467602 DOI: 10.12659/msm.893112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The purpose of this study was to evaluate whether high-flexion prostheses are superior to conventional prostheses after total knee arthroplasty (TKA). Material/Methods We searched the PubMed and Embase databases for randomized trials and cohort studies comparing high-flexion with conventional knee implants. The heterogeneity across studies was examined by I2 and Cochran’s Q-tests. Then the overall weighted mean differences of range of motion (ROM) and knee functional scores were evaluated. Results A total of 16 trials involving 2643 knees met our inclusion criteria. The results revealed that high-flexion implants were superior to conventional implants in the improvement of range of motion (weighted mean difference, 2.92; 95% CI, 1.63–4.22; p<0.0001). The clear advantage of high-flex PS (posterior stabilized) as well as high-flex CR (cruciate retaining) implants was found in ROM when compared to PS implants (2.73; 95% CI, 1.27–4.20; p=0.0003) and CR implants (3.24; 95% CI, 0.28–6.20; p=0.003), respectively. However, there was no difference in Knee Society Scores (0.42; 95% CI, −0.60–1.43; p=0.42), Knee Society function (0.37; 95% CI, −1.48–2.22; p=0.70) and Hospital for Special Surgery scores (0.26; 95% CI, −0.47–1.00; p=0.48) between high-flexion and conventional groups. Conclusions The current meta-analysis revealed that high-flexion implants were superior to conventional implants in the improvement of ROM but not in functional outcome scores.
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Affiliation(s)
- Zhigang Wang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Min Wei
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Qiang Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Zhuo Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Yaofei Cui
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China (mainland)
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Li C, Shen B, Yang J, Zhou Z, Kang P, Pei F. Do patients really gain outcome benefits when using the high-flex knee prostheses in total knee arthroplasty? A meta-analysis of randomized controlled trials. J Arthroplasty 2015; 30:580-6. [PMID: 25550212 DOI: 10.1016/j.arth.2014.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/29/2014] [Accepted: 11/10/2014] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to undertake a meta-analysis to evaluate whether patients really gain outcome benefits when using the high-flex (HF) prostheses in total knee arthroplasty (TKA) compared with standard (STD) implants. Only randomized controlled trials were included in this meta-analysis. After searching PubMed, Embase, Wed of Science and Cochrane Library, 1042 papers were identified and 18 trials were finally eligible for meta-analysis including 2069 knees (1906 patients). We found no statistically significant difference between the two designs in terms of ROM, knee scores (KSS, HSS, WOMAC, and SF-36), patients' satisfaction and complications. Hence there is currently no evidence to confirm that the use of high-flex prostheses in short-term is superior to the standard prostheses after total knee arthroplasty.
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Affiliation(s)
- Canfeng Li
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Shen
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing Yang
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Pengde Kang
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
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Widmer KH, Zich A. Ligamentkontrollierte Positionierung der Knieprothesenkomponenten. DER ORTHOPADE 2015; 44:275-81. [DOI: 10.1007/s00132-015-3099-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sando T, McCalden RW, Bourne RB, MacDonald SJ, Somerville LE. Ten-year results comparing posterior cruciate-retaining versus posterior cruciate-substituting total knee arthroplasty. J Arthroplasty 2015; 30:210-5. [PMID: 25445852 DOI: 10.1016/j.arth.2014.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/04/2014] [Accepted: 09/08/2014] [Indexed: 02/01/2023] Open
Abstract
We compared the 10-year survival rates and clinical outcomes of posterior cruciate-retaining (CR) versus posterior cruciate-substituting (CS) total knee arthroplasty (TKA), using the Genesis II knee system (Smith and Nephew, Memphis, TN). Our institutional database identified patients undergoing a primary knee with the Genesis II system between 1995 and 2000. These patients were followed for an average of 12.3years (range 10.2-14.4years). There were 143 (34.5%) CR and 271 (65.5%) CS implants. No significant difference in 10-year survivorship was noted between the two cohorts. The postoperative clinical scores (KSCRS, WOMAC, SF-12) and knee ROM were significantly better for the CS cohort. In this large, long-term, single-implant prospective study, CS performed better than CR in terms of clinical scores and range of motion.
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Affiliation(s)
- Takashi Sando
- Division of Orthopaedic Surgery, London Health Science Centre, University Campus, London, Ontario, Canada; University Hospital, University of Western Ontario, London, Ontario, Canada
| | - Richard W McCalden
- Division of Orthopaedic Surgery, London Health Science Centre, University Campus, London, Ontario, Canada; University Hospital, University of Western Ontario, London, Ontario, Canada
| | - Robert B Bourne
- Division of Orthopaedic Surgery, London Health Science Centre, University Campus, London, Ontario, Canada; University Hospital, University of Western Ontario, London, Ontario, Canada
| | - Steven J MacDonald
- Division of Orthopaedic Surgery, London Health Science Centre, University Campus, London, Ontario, Canada; University Hospital, University of Western Ontario, London, Ontario, Canada
| | - Lyndsay E Somerville
- Division of Orthopaedic Surgery, London Health Science Centre, University Campus, London, Ontario, Canada; University Hospital, University of Western Ontario, London, Ontario, Canada
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Shi X, Zhou Z, Shen B, Yang J, Kang P, Pei F. Variations in morphological characteristics of prostheses for total knee arthroplasty leading to kinematic differences. Knee 2015; 22:18-23. [PMID: 25482346 DOI: 10.1016/j.knee.2014.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 10/10/2014] [Accepted: 10/30/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study is to compare kinematics during weight-bearing deep knee-bending motion in patients after bilateral total knee arthroplasty (TKA) of two types: 1) a conventional ScorpioFlex prosthesis and 2) a contemporary redesigned non-restrictive-geometry (NRG) prosthesis installed by the same surgeon. METHODS We enrolled 15 patients who underwent conventional ScorpioFlex posterior-stabilised TKA in one knee and contemporary NRG TKA on the contralateral side (the same surgeon). During fluoroscopic examination, each patient performed weight-bearing deep knee bending. Motions among all components were analysed using a two- to three-dimensional registration technique. RESULTS The mean maximum flexion was 108° (SD 8) and 120° (SD 9) after ScorpioFlex and NRG TKAs, respectively; there were statistically significant differences between the groups. From extension to maximal flexion, the medial condyle translated by 4.8mm (SD 1.2) and 5.4mm (SD 2.4) posteriorly after ScorpioFlex TKA and NRG TKA, respectively. The lateral femoral condyle moved 8.4mm (SD 1.5) and 12.2mm (SD 2.1) posteriorly after ScorpioFlex TKA and NRG TKA, respectively. There were no significant differences in medial condyle translation between the groups except for the lateral condyle. The total amount of tibial axial rotation during extension to flexion was 5.1° (SD 1.8) after ScorpioFlex and 13.2° (SD 3.4) after NRG TKAs; there were statistically significant differences between the groups. CONCLUSIONS NRG resulted in much better maximum flexion, lateral condyle movement and tibial internal rotation than did ScorpioFlex TKAs. The observed kinematic differences are most likely caused by variations in the morphological characteristics of the two implants.
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Affiliation(s)
- Xiaojun Shi
- Orthopaedic Department, West China Hospital, Sichuan University, 37 Guo-xue Lane, Wu-hou District, Chengdu, China
| | - Zongke Zhou
- Orthopaedic Department, West China Hospital, Sichuan University, 37 Guo-xue Lane, Wu-hou District, Chengdu, China
| | - Bin Shen
- Orthopaedic Department, West China Hospital, Sichuan University, 37 Guo-xue Lane, Wu-hou District, Chengdu, China
| | - Jing Yang
- Orthopaedic Department, West China Hospital, Sichuan University, 37 Guo-xue Lane, Wu-hou District, Chengdu, China
| | - Pengde Kang
- Orthopaedic Department, West China Hospital, Sichuan University, 37 Guo-xue Lane, Wu-hou District, Chengdu, China
| | - Fuxing Pei
- Orthopaedic Department, West China Hospital, Sichuan University, 37 Guo-xue Lane, Wu-hou District, Chengdu, China.
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Clinical evaluation of 292 Genesis II posterior stabilized high-flexion total knee arthroplasty: range of motion and predictors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:161-6. [PMID: 24908394 DOI: 10.1007/s00590-014-1467-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
Abstract
The primary aim of the study was to evaluate the range of motion and complications after Genesis II total knee arthroplasty with high-flexion tibia insert (TKA-HF). Furthermore, difference in knee flexion between high flexion and standard inserts was compared. The hypothesis was that knee flexion is better after high-flexion TKA. A total of 292 TKA-HF were retrospectively reviewed. Mean follow-up was 24.3 months. The range of motion was compared between TKA-HF (high-flexion group) and a comparable cohort of 86 Genesis II TKA with a standard tibia insert (control group). Surgeries were performed by one experienced knee orthopedic surgeon. Knee flexion in the high-flexion group increased from 114.8° preoperatively to 118.0° postoperatively (P < 0.01). Knee extension in the high-flexion group increased from -4.5° preoperatively to -0.4° after surgery (P < 0.01). Mean knee flexion was 5.52° (± 1.46°) better in the high-flexion group compared with the control group (P < 0.01). Preoperative range of motion, body mass index, diabetes mellitus and patellofemoral pain significantly influenced range of motion. Few complications occurred after TKA-HF. The Genesis II TKA-HF showed good short-term results with limited complications. Knee flexion after Genesis II TKA-HF was better compared with a standard tibia insert.
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Namba RS, Inacio MCS, Cafri G. Increased risk of revision for high flexion total knee replacement with thicker tibial liners. Bone Joint J 2014; 96-B:217-23. [PMID: 24493187 DOI: 10.1302/0301-620x.96b2.32625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The outcome of total knee replacement (TKR) using components designed to increase the range of flexion is not fully understood. The short- to mid-term risk of aseptic revision in high flexion TKR was evaluated. The endpoint of the study was aseptic revision and the following variables were investigated: implant design (high flexion vs non-high flexion), the thickness of the tibial insert (≤ 14 mm vs > 14 mm), cruciate ligament (posterior stabilised (PS) vs cruciate retaining), mobility (fixed vs rotating), and the manufacturer (Zimmer, Smith & Nephew and DePuy). Covariates included patient, implant, surgeon and hospital factors. Marginal Cox proportional hazard models were used. In a cohort of 64 000 TKRs, high flexion components were used in 8035 (12.5%). The high flexion knees with tibial liners of thickness > 14 mm had a density of revision of 1.45/100 years of observation, compared with 0.37/100 in non-high flexion TKR with liners ≤ 14 mm thick. Relative to a standard fixed PS TKR, the NexGen (Zimmer, Warsaw, Indiana) Gender Specific Female high flexion fixed PS TKR had an increased risk of revision (hazard ratio (HR) 2.27 (95% confidence interval (CI) 1.48 to 3.50)), an effect that was magnified when a thicker tibial insert was used (HR 8.10 (95% CI 4.41 to 14.89)). Surgeons should be cautious when choosing high flexion TKRs, particularly when thicker tibial liners might be required.
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Affiliation(s)
- R S Namba
- Kaiser Permanente, 6670 Alton Parkway, Irvine, California 92618, USA
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Sumino T, Rubash HE, Li G. Does cruciate-retaining total knee arthroplasty enhance knee flexion in Western and East Asian patient populations? A meta-analysis. Knee 2013; 20:376-83. [PMID: 23562350 DOI: 10.1016/j.knee.2013.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 02/27/2013] [Accepted: 03/02/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study analyzed the published data to examine if CR TKAs can enhance the flexion and functional outcomes of the knee in the Western and East Asian populations using a meta-analysis approach. MATERIALS AND METHODS A systematic review of literature published through Medline and EMBASE was conducted. The inclusion criteria were: primary TKA, follow up duration greater than one year, a fixed bearing CR prosthesis, and data for maximum pre- and post-operative flexion along with standard deviations or errors. We estimated the weighted mean differences between pre- and post-operative flexion, extension and knee scores (KSS and HSS) via a random effect model. RESULTS Seventeen articles were selected and reviewed among 1229 studies that included 1090 knees of the Western and 516 knees of the East Asian. No significant difference was noted in maximal knee flexion pre- and post-operatively, when all the studies were pooled together (-0.17°, p=0.93, post-operative<pre-operative). The mean difference in flexion was -1.87° (p=0.2) and 2.03° (p=0.17), respectively in the both populations. However, the extension angle was significantly improved by -5.49° and -13.05° (p<0.05), respectively. KSS scores were significantly improved by 46.39 and 51.63, and HSS scores by 36.65 and 30.67 (p<0.05), respectively in the both populations. CONCLUSION The meta-analysis indicated that contemporary CR TKAs have not been shown to enhance post-operative flexion capability in the Western and East Asian. The extension angles of the knee and the knee scores were significantly improved in both populations.
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Affiliation(s)
- Takanobu Sumino
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
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Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique. INTERNATIONAL ORTHOPAEDICS 2013; 38:531-7. [PMID: 24146174 DOI: 10.1007/s00264-013-2133-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to prove the hypothesis that soft tissues are well balanced using the gap technique with a navigation system in cruciate-retaining (CR) and posterior-stabilised (PS) total knee arthroplasty (TKA), leading to better clinical outcomes compared with the measured-resection technique. METHODS One hundred and thirty-five TKAs (90 CR and 45 PS) were performed in patients with varus-type osteoarthritis using the gap technique guided by the offset-type tensor and a navigation system. Soft-tissue balance (joint-component gap and ligament balance) were intraoperatively assessed with the tensor under 40 lb of joint-distraction force. The achievement in the equalised rectangular gap at extension and flexion was assessed and retrospectively compared with the previous series in which the measured-resection technique was used (20 CR and 100 PS TKAs). In addition, clinical outcomes, including range of motion and Knee Society Score were assessed at a minimum two year follow-up. RESULTS In achieving equalised rectangular gaps at extension and flexion, CR TKAs met criteria in more cases [66.7% (64/90) vs. 44.4% (20/45) of PS TKA] with the gap technique, which was superior to that with the measured-resection technique [50.0% (10/20) of CR TKA and 28.0% (28/100) of PS TKA]. However, clinical outcomes showed no significant differences among groups at minimum two year follow-up. CONCLUSIONS The superiority of CR TKA with the gap technique in achieving equalised rectangular gaps at extension and flexion does not directly reflect two year postoperative clinical outcomes.
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17
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Nieuwenhuijse MJ, van der Voort P, Kaptein BL, van der Linden-van der Zwaag HMJ, Valstar ER, Nelissen RGHH. Fixation of high-flexion total knee prostheses: five-year follow-up results of a four-arm randomized controlled clinical and roentgen stereophotogrammetric analysis study. J Bone Joint Surg Am 2013; 95:e1411-11. [PMID: 24088976 DOI: 10.2106/jbjs.l.01523] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High-flexion total knee arthroplasty was introduced to meet the demands of daily activity requiring increased knee flexion. However, concerns have been raised regarding the fixation of high-flexion total knee arthroplasty components and increased rates of loosening have been reported. To date, migration, and thus fixation, of high-flexion total knee arthroplasty components has not been analyzed and the preferential bearing type (mobile or fixed) is unknown. METHODS Of eighty-six consecutive eligible patients, seventy-four patients (seventy-eight knees) scheduled for total knee arthroplasty were randomized to one of four Legacy Posterior Stabilized (LPS) total knee prosthesis designs: (1) LPS-Flex mobile, (2) LPS-Flex fixed, (3) LPS mobile, and (4) LPS fixed. The primary outcome was component migration measured with use of Roentgen stereophotogrammetric analysis, and secondary outcomes were postoperative knee flexion and extension and Knee Society Score. Patients were evaluated postoperatively at six, twelve, twenty-six, and fifty-two weeks and annually thereafter. At the five-year follow-up, eight patients had died and two patients were lost to follow-up. Seventy-seven tibial and forty-two femoral components were suitable for migration measurements. RESULTS The overall five-year migration of the seventy-seven tibial components was not significantly different among the four total knee prosthesis designs (compared with the LPS fixed design, the range of overall mean differences for the other three designs was 0.02 to 0.25 mm) and migration was comparable at the two and five-year follow-up. Migration stabilized in all but three components (two LPS-Flex mobile and one LPS fixed); one of these components has already been revised and was aseptically loose. The overall five-year migration of the forty-two femoral components was comparable among the four designs (compared with the LPS fixed design, the range of overall mean differences for the other three designs was 0.01 to 0.18 mm) and was similar at two and five years postoperatively. One femoral component (LPS-Flex mobile) migrated excessively. In patients who had a mean postoperative flexion of ≥ 125° or a maximum flexion of ≥ 135° during the one to five-year follow-up period, migration of high-flexion components was comparable with that of conventional components and indicative of appropriate fixation. Postoperative flexion, extension, Knee Society Score, and Knee Society Score function were comparable during the five-year follow-up period and at the two and five-year follow-up. CONCLUSIONS The LPS-Flex total knee prosthesis with either a mobile or a fixed bearing had migration comparable that of with its conventional counterpart and is expected to have similar (excellent) long-term survival in these patients. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail address for M.J. Nieuwenhuijse:
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18
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Roach BL, Matheny JB, Spinelli M, Rusly RJ, Affatato S, DesJardins JD. Bi-unicondylar knee replacement laxity with changes to simulated soft tissue constraints. Proc Inst Mech Eng H 2013; 227:27-36. [PMID: 23516953 DOI: 10.1177/0954411912459420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unicondylar knee replacement systems have been shown to perform comparably to total knee replacements, while being much less surgically invasive. Proper ligament balancing, as well as knee laxity, has been shown to play an important role in optimizing kinematic behavior of these implant systems and improving long-term survival of the implant. This study investigates the effect of different simulated ligament laxity conditions of the anterior cruciate ligament and the posterior cruciate ligament on the resulting anteroposterior and mediolateral contact kinematics for medial and lateral pairs of UKR implants with flat and symmetric ultrahigh-molecular-weight polyethylene inserts during force-controlled ISO-14243-1 knee testing simulation. A novel method of capturing the tibiofemoral lowest point contact path was used to calculate the shear plane lowest point contact path kinematics in both the anteroposterior and the mediolateral directions. The results illustrated that multiple clinically relevant soft tissue configurations produce statistically different measured knee kinematics in unicondylar knee replacement systems than is seen in accepted "standard" knee simulator protocols with 95% confidence interval. The observed kinematic differences in anteroposterior and mediolateral movement from what was observed using standard wear testing protocols could aid in the development of unicondylar knee replacement design enhancements that are resistant to varying soft tissue deficiencies.
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Affiliation(s)
- Brendan L Roach
- Department of Enginieering, Clemson University, Clemson, SC 29634, USA
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19
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Daniilidis K, Skwara A, Vieth V, Fuchs-Winkelmann S, Heindel W, Stückmann V, Tibesku CO. Highly conforming polyethylene inlays reduce the in vivo variability of knee joint kinematics after total knee arthroplasty. Knee 2012; 19:260-5. [PMID: 21561778 DOI: 10.1016/j.knee.2011.04.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 03/29/2011] [Accepted: 04/01/2011] [Indexed: 02/02/2023]
Abstract
The use of highly conforming polyethylene inlays in total knee arthroplasty (TKA) provides improved anteroposterior stability. The aim of this fluoroscopic study was to investigate the in vivo kinematics during unloaded and loaded active extension with a highly conforming inlay and a flat inlay after cruciate retaining (CR) total knee arthroplasty (TKA). Thirty one patients (50 knees) received a fixed-bearing cruciate retaining total knee arthroplasty (Genesis II, Smith & Nephew, Schenefeld, Germany) for primary knee osteoarthritis. Twenty two of them received a flat polyethylene inlay (PE), nine a deep dished PE and 19 were in the control group (physiological knees). The mean age at the time of surgery was 62 years. Dynamic examination with fluoroscopy was performed to assess the "patella tendon angle" in relation to the knee flexion angle (measure of anteroposterior translation) and the "kinematic index" (measure of reproducibility). Fluoroscopy was performed under active extension and flexion, during unloaded movement, and under full weight bearing, simulated by step climbing. No significant difference was observed between both types of polyethylene inlay designs and the physiological knee during unloaded movement. Anteroposterior (AP) instability was found during weight-bearing movement. The deep-dish inlay resulted in lower AP translation and a non-physiological rollback. Neither inlay types could restore physiological kinematics of the knee. Despite the fact that deep dished inlays reduce the AP translation, centralisation of contact pressure results in non-physiological rollback. The influence of kinematic pattern variability on clinical results warrants further investigation.
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Affiliation(s)
- Kiriakos Daniilidis
- Department of Orthopaedics and Tumororthopaedics, University Hospital Muenster, Germany
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20
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Lateral laxity in flexion increases the postoperative flexion angle in cruciate-retaining total knee arthroplasty. J Arthroplasty 2012; 27:260-5. [PMID: 21752588 DOI: 10.1016/j.arth.2011.04.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 04/16/2011] [Indexed: 02/01/2023] Open
Abstract
Thirty-eight patients diagnosed with osteoarthritis underwent 41 cruciate-retaining total knee arthroplasties. In varus and valgus tests at flexion, subjects were seated on a table at 80° of knee flexion; 50 N was applied perpendicular to the lower leg. The factors affecting the postoperative flexion angle were investigated in a multiregression analysis. The mean joint angles of the flexion-valgus and flexion-varus tests were 3.4° ± 1.4° and 6.2° ± 2.5°, respectively. The flexion-varus angle was correlated with the postoperative flexion angle (P < .01). The mean postoperative flexion angles were 110.8° ± 9.6° and 118.1° ± 8.0° in the groups with the flexion-varus angle of 6° or less and more than 6°, respectively (P = .02). Slack lateral laxity in flexion had a significant effect during knee flexion in cruciate-retaining total knee arthroplasty.
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Bauman RD, Johnson DR, Menge TJ, Kim RH, Dennis DA. Can a high-flexion total knee arthroplasty relieve pain and restore function without premature failure? Clin Orthop Relat Res 2012; 470:150-8. [PMID: 22006196 PMCID: PMC3237972 DOI: 10.1007/s11999-011-2099-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High-flexion TKA prostheses are designed to improve flexion and clinical outcomes. Increased knee flexion can increase implant loads and fixation stresses, creating concerns of premature failure. Whether these goals can be achieved without premature failures is unclear. QUESTIONS/PURPOSES We assessed pain relief, knee motion, function, incidence of premature failure, and radiographic appearance in patients with a mobile-bearing high-flexion TKA and determined whether preoperative knee flexion affects postoperative knee flexion. PATIENTS AND METHODS We prospectively followed all 142 patients implanted with 154 mobile-bearing high-flexion TKAs between 2004 and 2007. We obtained Knee Society scores (KSS) and assessed radiographs for loosening. Minimum followup was 24 months (mean, 46 months; range, 24-79 months). RESULTS Average knee flexion improved from 123° to 129°. Patients with preoperative flexion of 100° to 120° had a greater postoperative flexion increase (mean, 13°; range, 114°-126°) than patients with preoperative flexion of greater than 120° (mean, 3.0°; range, 128°-131°). The mean KSS improved from 41 to 95 postoperatively. Patients with preoperative flexion of less than 120° had a greater improvement in KSS (62 versus 48). Posterior femoral radiolucent lines were observed in 43% without evidence of prosthetic loosening. CONCLUSIONS Our data were similar to those reported in patients implanted with traditional and other designs of high-flexion TKA. We found no increased incidence of premature failure, although a higher than expected incidence of posterior femoral radiolucent lines merit continued observation. Patients with less preoperative motion were more likely to benefit from a high-flexion TKA.
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Affiliation(s)
- Ryan D. Bauman
- Colorado Joint Replacement, 2535 S Downing Street, Number 100, Denver, 80210 CO USA
- Rocky Mountain Musculoskeletal Research Laboratory, Denver, CO USA
| | - Derek R. Johnson
- Colorado Joint Replacement, 2535 S Downing Street, Number 100, Denver, 80210 CO USA
- Rocky Mountain Musculoskeletal Research Laboratory, Denver, CO USA
| | - Travis J. Menge
- Colorado Joint Replacement, 2535 S Downing Street, Number 100, Denver, 80210 CO USA
- Rocky Mountain Musculoskeletal Research Laboratory, Denver, CO USA
| | - Raymond H. Kim
- Colorado Joint Replacement, 2535 S Downing Street, Number 100, Denver, 80210 CO USA
- Rocky Mountain Musculoskeletal Research Laboratory, Denver, CO USA
- Department of Bioengineering, University of Denver, Denver, CO USA
| | - Douglas A. Dennis
- Colorado Joint Replacement, 2535 S Downing Street, Number 100, Denver, 80210 CO USA
- Rocky Mountain Musculoskeletal Research Laboratory, Denver, CO USA
- Department of Bioengineering, University of Denver, Denver, CO USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN USA
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Bollars P, Luyckx JP, Innocenti B, Labey L, Victor J, Bellemans J. Femoral component loosening in high-flexion total knee replacement. ACTA ACUST UNITED AC 2011; 93:1355-61. [DOI: 10.1302/0301-620x.93b10.25436] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High-flexion total knee replacement (TKR) designs have been introduced to improve flexion after TKR. Although the early results of such designs were promising, recent literature has raised concerns about the incidence of early loosening of the femoral component. We compared the minimum force required to cause femoral component loosening for six high-flexion and six conventional TKR designs in a laboratory experiment. Each TKR design was implanted in a femoral bone model and placed in a loading frame in 135° of flexion. Loosening of the femoral component was induced by moving the tibial component at a constant rate of displacement while maintaining the same angle of flexion. A stereophotogrammetric system registered the relative movement between the femoral component and the underlying bone until loosening occurred. Compared with high-flexion designs, conventional TKR designs required a significantly higher force before loosening occurred (p < 0.001). High-flexion designs with closed box geometry required significantly higher loosening forces than high-flexion designs with open box geometry (p = 0.0478). The presence of pegs further contributed to the fixation strength of components. We conclude that high-flexion designs have a greater risk for femoral component loosening than conventional TKR designs. We believe this is attributable to the absence of femoral load sharing between the prosthetic component and the condylar bone during flexion.
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Affiliation(s)
- P. Bollars
- University Hospital Leuven, Department
of Orthopaedic Surgery, Weligerveld 1, 3212
Pellenberg, Belgium
| | - J.-P. Luyckx
- European Centre for Knee Research, Smith & Nephew Orthopaedics, Technologielaan 11 bis, 3001 Leuven, Belgium
| | - B. Innocenti
- European Centre for Knee Research, Smith & Nephew Orthopaedics, Technologielaan 11 bis, 3001 Leuven, Belgium
| | - L. Labey
- European Centre for Knee Research, Smith & Nephew Orthopaedics, Technologielaan 11 bis, 3001 Leuven, Belgium
| | - J. Victor
- AZ St Lucas, Sint-Lucaslaan
29, 8310 Brugge, Belgium
| | - J. Bellemans
- University Hospital Leuven, Department
of Orthopaedic Surgery, Weligerveld 1, 3212
Pellenberg, Belgium
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Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? A meta analysis. INTERNATIONAL ORTHOPAEDICS 2011; 35:1309-19. [PMID: 21409370 DOI: 10.1007/s00264-011-1228-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE This systematic literature review analysed the change in range of knee flexion from pre-operative values, following conventional posterior stabilised (PS) and high-flexion (H-F) PS total knee arthroplasty (TKA). METHODS We calculated the weighted mean differences of pre- and postoperative flexion using meta-analysis with random effect modelling. Eighteen studies met our inclusion criteria. These data included a total of 2,104 PS knees that received conventional implants and 518 knees that received H-F implants. RESULTS The pooled gain in flexion was 4.70° in the conventional group (p <0.0001) and 4.81° in the H-F group (p = 0.0008). In the subgroup analysis, the Western patient group showed significant difference in the gain of flexion with both implants. In contrast, no significant gain in flexion was observed in the Asian patient group. CONCLUSIONS These results suggest that improvement of preoperative flexion after TKA using current H-F PS prostheses is similar to that of conventional PS prostheses.
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Zhu Z, Ding H, Dang X, Tang J, Zhou Y, Wang G. In vitro kinematic measurements of the patellar tendon in two different types of posterior-stabilized total knee arthroplasties. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:3938-41. [PMID: 21097088 DOI: 10.1109/iembs.2010.5627702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Fixed-bearing posterior-stabilized (PS) total knee arthroplasty (TKA) has been used in Asian countries for several years, but few studies have investigated differences in the kinematic properties of the patellar tendon after standard PS TKA as compared to high-flex PS TKA. PURPOSE To quantify the in vitro three-dimensional (3D) kinematics of the patellar tendon during passive high flexion and full extension before and after two different types of PS TKAs. METHODS Six fresh-frozen cadaveric knees were tested under the following conditions: the unaltered state, status-post traditional PS prostheses (Simth-nephew GENESIS II) replacement, and status-post high-flexion PS prostheses replacement. The soft tissue around the knee and the quadriceps muscle were preserved, then tested under the load of a specific weight in an Oxford knee rig. We designed a specialized rigid body with four active markers fixed to each bone to track the 3D passive motion of the cadaveric knees. Flexion and extension was controlled by the knee rig and captured by an Optotrak Certus high precision optical tracking system. The attachment sites of the patellar tendon were registered as virtual markers to calculate the 3D kinematics. RESULTS The patellar tendon of the unaltered knee and both TKA knees showed similar deformation. We found the length of the patellar tendon changed significantly during a motion from full extension to 30°, but there was no significant change in length while undergoing a motion from 30° to full flexion. Both the sagittal plane and coronal plane angles of the patellar tendon decreased after PS TKAs. There was no significant difference in patellar tendon kinematics between the two types of PS TKAs. CONCLUSION We believe the changes observed in the sagittal plane and coronal plane angles of the patellar tendon after PS TKAs may influence the extensor mechanism and be an important cause of patella-femoral complications. These data may be used to assess patella-femoral complications after surgery so as to improve the design of high-flexion TKAs for Asians and achieve long-term stability.
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Affiliation(s)
- Zhonglin Zhu
- Department of Biomedical Engineering, Tsinghua University, 100084, China
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Nizard R. Évolution de la prise en charge des patients nécessitant une prothèse totale de genou. Presse Med 2010; 39:1189-93. [DOI: 10.1016/j.lpm.2010.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 01/20/2010] [Indexed: 10/19/2022] Open
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