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Langworthy M, Dasa V, Spitzer AI. Knee osteoarthritis: disease burden, available treatments, and emerging options. Ther Adv Musculoskelet Dis 2024; 16:1759720X241273009. [PMID: 39290780 PMCID: PMC11406648 DOI: 10.1177/1759720x241273009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/10/2024] [Indexed: 09/19/2024] Open
Abstract
Osteoarthritis (OA) is a prevalent condition that affects nearly 528 million people worldwide, including 23% of the global population aged ⩾40, and is characterized by progressive damage to articular cartilage, which often leads to substantial pain, stiffness, and reduced mobility for affected patients. Pain related to OA is a barrier to maintaining physical activity and a leading cause of disability, accounting for 2.4% of all years lived with disability globally, reducing the ability to work in 66% of US patients with OA and increasing absenteeism in 21% of US patients with OA. The joint most commonly involved in OA is the knee, which is affected in about 60%-85% of all OA cases. The aging population and longer life expectancy, coupled with earlier and younger diagnoses, translate into a growing cohort of symptomatic patients in need of alternatives to surgery. Despite the large number of patients with knee OA (OAK) worldwide, the high degree of variability in patient presentation can lead to challenges in diagnosis and treatment. Multiple society guidelines recommend therapies for OAK, but departures from guidelines by healthcare professionals in clinical settings reflect a discordance between evidence-based treatment algorithms and routine clinical practice. Furthermore, disease-modifying pharmacotherapies are limited, and treatment for OAK often focuses solely on symptom relief, rather than underlying causes. In this narrative review, we summarize the patient journey, analyze current disease burden and nonsurgical therapy recommendations for OAK, and highlight emerging and promising therapies-such as cryoneurolysis, long-acting corticosteroids, and gene therapies-for this debilitating condition.
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Affiliation(s)
- Michael Langworthy
- Southcoast Health, 300 A Faunce Corner Road, Dartmouth, MA 02720-3703, USA
- Menko Labs, Mattapoisett, MA, USA
| | - Vinod Dasa
- Louisiana State University School of Medicine, New Orleans, LA, USA
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2
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Luo Y. Toward Fully Automated Personalized Orthopedic Treatments: Innovations and Interdisciplinary Gaps. Bioengineering (Basel) 2024; 11:817. [PMID: 39199775 PMCID: PMC11351140 DOI: 10.3390/bioengineering11080817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/04/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024] Open
Abstract
Personalized orthopedic devices are increasingly favored for their potential to enhance long-term treatment success. Despite significant advancements across various disciplines, the seamless integration and full automation of personalized orthopedic treatments remain elusive. This paper identifies key interdisciplinary gaps in integrating and automating advanced technologies for personalized orthopedic treatment. It begins by outlining the standard clinical practices in orthopedic treatments and the extent of personalization achievable. The paper then explores recent innovations in artificial intelligence, biomaterials, genomic and proteomic analyses, lab-on-a-chip, medical imaging, image-based biomechanical finite element modeling, biomimicry, 3D printing and bioprinting, and implantable sensors, emphasizing their contributions to personalized treatments. Tentative strategies or solutions are proposed to address the interdisciplinary gaps by utilizing innovative technologies. The key findings highlight the need for the non-invasive quantitative assessment of bone quality, patient-specific biocompatibility, and device designs that address individual biological and mechanical conditions. This comprehensive review underscores the transformative potential of these technologies and the importance of multidisciplinary collaboration to integrate and automate them into a cohesive, intelligent system for personalized orthopedic treatments.
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Affiliation(s)
- Yunhua Luo
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
- Biomedical Engineering (Graduate Program), University of Manitoba, Winnipeg, MB R3T 2N2, Canada
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3
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Kahlenberg CA, Kheir MM, Selkridge IK, Quevedo Gonzalez FJ, Chiu YF, Wright TM, Chalmers BP, Sculco PK. Clinical and Biomechanical Evaluation of Mid-Level Constrained and Posterior-Stabilized Polyethylene Inserts in Primary Total Knee Arthroplasty: An Analysis of 12,674 Cases. J Arthroplasty 2024; 39:1518-1523. [PMID: 38103805 DOI: 10.1016/j.arth.2023.12.018] [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: 01/05/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Mid-level constraint polyethylene designs provide additional stability in total knee arthroplasty (TKA). The purposes of this study were to (1) compare the survivorship and reason for revision between mid-level inserts and posterior-stabilized (PS) used in primary TKA and (2) evaluate the biomechanical constraint characteristics of mid-level inserts. METHODS We reviewed all cases of primary TKA performed at our institution from 2016 to 2019 using either PS or mid-level constrained inserts from 1 of 6 manufacturers. Data elements included patient demographics, implants, reasons for revision, and whether a manipulation under anesthesia was performed. We performed finite element analyses to quantify the varus/valgus and axial-rotation constraint of each mid-level constrained insert. A one-to-one propensity score matching was conducted between the patients with mid-level and PS inserts to match for variables, which yielded 2 cohorts of 3,479 patients. RESULTS For 9,163 PS and 3,511 mid-level TKAs, survivorship free from all-cause revision was estimated up to 5 years and was lower for mid-level than PS inserts (92.7 versus 94.1%, respectively, P = .004). When comparing each company's mid-level insert to the same manufacturer's PS insert, we found no differences in all-cause revision rates (P ≥ .91) or revisions for mechanical problems (P ≥ .97). Using propensity score matching between mid-level and PS groups, no significant differences were found in rates of manipulation under anesthesia (P = .72), all-cause revision (P = .12), revision for aseptic loosening (P = .07), and revision for instability (P = .45). Finite element modeling demonstrated a range in varus/valgus constraint from ±1.1 to >5°, and a range in axial-rotation constraint from ±1.5 to ±11.5° among mid-level inserts. CONCLUSIONS Despite wide biomechanical variations in varus/valgus and axial-rotation constraint, we found minimal differences in early survivorship rates between PS and mid-level constrained knees.
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Affiliation(s)
- Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Michael M Kheir
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Isaiah K Selkridge
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Dutta S, Ambade R, Wankhade D, Agrawal P. Rehabilitation Techniques Before and After Total Knee Arthroplasty for a Better Quality of Life. Cureus 2024; 16:e54877. [PMID: 38533163 PMCID: PMC10965116 DOI: 10.7759/cureus.54877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
The most important gold standard treatment following advanced knee osteoarthritis is total knee arthroplasty. Following surgery of total knee replacement, the majority of patients report decreased pain and successful long-term results, but recovery is unpredictable, and most patients continue to exhibit muscle weakness in their lower limbs and functional limitations in comparison to similarly aged control individuals. The goal of this review article was to systematically review different articles containing controlled and randomized studies to find out the effectiveness of outpatient care postoperatively on short- and long-term functional recovery. The purpose of this review article is to investigate the possible advantages of pre- and postoperative rehabilitation as well as the value of exercise regimen recommendations following total knee replacement. The following interventions after total knee arthroplasty are discussed in this review article: preoperative education and exercises, continuous passive movement, strengthening interventions, aquatic therapy, balanced training, tourniquet exposure, use of alignment and implants, role of apps in phones and different wearable devices, influence of postoperative protocols, knee bracing, neuromuscular electrical stimulation, and clinical environment. Strengthening and intense functional exercises for patients above 45 years of age, in land or water programs like aquatic activities, with the increasing intensity of the exercises in accordance with the patient's progress, should be included in the best outpatient physical therapy protocols. Because these exercises are so precisely personalized, the best long-term effects after surgery may come from outpatient physiotherapy performed in a clinical setting under the supervision of a registered physiotherapist or medical professional. This review article also includes the change in the quality and well-being of a patient's life who has undergone total knee arthroplasty and practiced the rehabilitation techniques.
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Affiliation(s)
- Sushmita Dutta
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ratnakar Ambade
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Dhanashree Wankhade
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Palak Agrawal
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Barrie U, Montgomery EY, Ogwumike E, Pernik MN, Luu IY, Adeyemo EA, Christian ZK, Edukugho D, Johnson ZD, Hoes K, El Tecle N, Hall K, Aoun SG, Bagley CA. Household Income as a Predictor for Surgical Outcomes and Opioid Use After Spine Surgery in the United States. Global Spine J 2023; 13:2124-2134. [PMID: 35007170 PMCID: PMC10538313 DOI: 10.1177/21925682211070823] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-Sectional Study. OBJECTIVES Socioeconomic status (SES) is a fundamental root of health disparities, however, its effect on surgical outcomes is often difficult to capture in clinical research, especially in spine surgery. Here, we present a large single-center study assessing whether SES is associated with cause-specific surgical outcomes. METHODS Patients undergoing spine surgery between 2015 and 2019 were assigned income in accordance with the national distribution and divided into quartiles based on the ZIP code-level median household income. We performed univariate, chi-square, and Analysis of Variance (ANOVA) analysis assessing the independent association of SES, quantified by household income, to operative outcomes, and multiple metrics of opioid consumption. RESULTS 1199 patients were enrolled, and 1138 patients were included in the analysis. Low household income was associated with the greatest rates of 3-month opioid script renewal (OR:1.65, 95% CI:1.14-2.40). In addition, low-income was associated with higher rates of perioperative opioid consumption compared to higher income including increased mean total morphine milligram equivalent (MME) 252.25 (SD 901.32) vs 131.57 (SD 197.46) (P < .046), and inpatient IV patient-controlled analgesia (PCA) MME 121.11 (SD 142.14) vs 87.60 (SD 86.33) (P < .023). In addition, household income was independently associated with length of stay (LOS), and emergency room (ER) revisits with low-income patients demonstrating significantly longer postop LOS and increasing postoperative ER visits. CONCLUSIONS Considering the comparable surgical management provided by the single institution, the associated differences in postoperative outcomes as defined by increased morbidities and opioid consumption can potentially be attributed to health disparities caused by SES.
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Affiliation(s)
- Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Eric Y. Montgomery
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Erica Ogwumike
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Mark N. Pernik
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ivan Y. Luu
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Emmanuel A. Adeyemo
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Zachary K. Christian
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Derrek Edukugho
- Department of Neurological Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Zachary D. Johnson
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Kathryn Hoes
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Najib El Tecle
- Department of Neurological Surgery, Saint Louis University School of Medicine, St Louis, MI, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Salah G. Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Carlos A. Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
- Department of Orthopedic Surgery Dallas, University of Texas Southwestern Medical School, Texas, USA
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Cozzarelli NF, Khan IA, Imam N, Klein GR, Levine H, Seidenstein A, Zaid MB, Lonner JH. Robotic-Assisted Total Knee Arthroplasty Has Similar Rates of Prosthetic Noise Generation as Conventional Total Knee Arthroplasty. Arthroplast Today 2023; 23:101216. [PMID: 37753221 PMCID: PMC10518686 DOI: 10.1016/j.artd.2023.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
Background Noise has been reported to occur with relatively high frequency after conventional total knee arthroplasty (C-TKA), and this may impact the incidence of patient satisfaction and function. The purpose of this study was to compare the rate of patient-reported prosthetic noise generation after robotically-assisted TKA (RA-TKA) and C-TKA. Methods A retrospective study was conducted of unilateral primary RA-TKAs and C-TKAs performed between 2018 and 2021. Patients completed a survey consisting of 4 Likert scale questions related to prosthetic noise generation and Knee Injury and Osteoarthritis Score Joint Replacement and Forgotten Joint Score were assessed prospectively preoperatively and at a minimum of 1-year of clinical follow-up. Statistical analysis was done utilizing T-tests and chi-square tests, with statistical significance defined as a P-value < .05. Results One hundred sixty-two RA-TKAs and 320 C-TKAs with similar baseline characteristics and functions were included. There were no significant differences in hearing or feeling grinding, popping, clicking, or clunking (40.7% vs 38.1%; P = .647) between groups. Most RA-TKAs and C-TKAs were not dissatisfied regarding noise generation (70.4% vs 73.1%; P = .596). In both cohorts, patients who reported noise generation had lower average Forgotten Joint Scores (45.5 vs 66.1; P < .001) and lower postoperative Knee Injury and Osteoarthritis Score Joint Replacement scores (72.0 vs 81.4; P < .001) than those who did not experience noise generation. Conclusions While RA-TKA may facilitate soft tissue balancing, there were no differences in prosthetic noise generation between RA-TKA and C-TKA. However, those who experience implant-generated noise have lower functional outcome scores.
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Affiliation(s)
| | - Irfan A. Khan
- Division of Adult Reconstruction, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Nareena Imam
- Division of Adult Reconstruction, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Gregg R. Klein
- Division of Adult Reconstruction, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Harlan Levine
- Division of Adult Reconstruction, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Ari Seidenstein
- Division of Adult Reconstruction, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Musa B. Zaid
- Division of Adult Reconstruction, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jess H. Lonner
- Division of Adult Reconstruction, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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McNamara I, Pomeroy V, Clark AB, Creelman G, Whitehouse C, Wells J, Harry B, Smith TO, High J, Swart AM, Clarke C. Comparison of the Journey II bicruciate stabilised (JII-BCS) and GENESIS II total knee arthroplasty for functional ability and motor impairment: the CAPAbility, blinded, randomised controlled trial. BMJ Open 2023; 13:e061648. [PMID: 36599639 PMCID: PMC9815016 DOI: 10.1136/bmjopen-2022-061648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To determine if a newer design of total knee replacement (TKR) (Journey II BCS) produces superior patient-reported outcomes scores and biomechanical outcomes than the older, more established design (Genesis II). SETTING Patients were recruited from an NHS University Hospital between July 2018 and October 2019 with surgery at two sites. Biomechanical and functional capacity measurements were at a University Movement and Exercise Laboratory. PARTICIPANTS 80 participants undergoing single-stage TKR. INTERVENTIONS Patients were randomised to receive either the Journey II BCS (JII-BCS) or Genesis II TKR. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the Oxford Knee Score (OKS), at 6 months. Secondary outcomes were: OKS Activity and Participation Questionnaire, EQ-5D-5L and UCLA Activity scores, Timed Up and Go Test, 6 min walk test, lower limb kinematics and lower limb muscle activity during walking and balance. RESULTS This study found no difference in the OKS between groups. The OKS scores for the JII-BCS and Genesis II groups were mean (SD) 42.97 (5.21) and 43.13 (5.20) respectively, adjusted effect size 0.35 (-2.01,2.71) p=0.771In secondary outcome measures, the Genesis II group demonstrated a significantly greater walking range-of-movement (50.62 (7.33) vs 46.07 (7.71) degrees, adjusted effect size, 3.14 (0.61,5.68) p=0.02) and higher peak knee flexion angular velocity during walking (mean (SD) 307.69 (38.96) vs 330.38 (41.40) degrees/second, adjusted effect size was 21.75 (4.54,38.96), p=0.01) and better postural control (smaller resultant centre of path length) during quiet standing than the JII-BCS group (mean (SD) 158.14 (65.40) vs 235.48 (176.94) mm, adjusted effect size, 59.91 (-105.98, -13.85) p=0.01.). CONCLUSIONS In this study population, the findings do not support the hypothesis that the Journey II BCS produces a better outcome than the Genesis II for the primary outcome of the OKS at 6 months after surgery. TRIAL REGISTRATION NUMBER ISRCTN32315753.
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Affiliation(s)
- Iain McNamara
- Norfolk and Norwich University Hospital, Norwich, UK
- University of East Anglia, Norwich, UK
| | | | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - J Wells
- University of East Anglia, Norwich, UK
| | - B Harry
- Department of clinical neurosciences, University of Cambridge, Cambridge, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - Ann Marie Swart
- University of East Anglia, Norwich, UK
- Health Sciences, University of East Anglia, Norwich, UK
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Patient-reported impairment following TKA is reduced when a computationally simulated predicted ideal alignment is achieved. Knee Surg Sports Traumatol Arthrosc 2023; 31:1098-1105. [PMID: 36446908 PMCID: PMC9957835 DOI: 10.1007/s00167-022-07225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Joint dynamics following Total Knee Arthroplasty (TKA) may influence patient-reported outcome. Simulations allow many knee alignment approaches to a single patient to be considered prior to surgery. The simulated kinematics can be matched to patient-reported outcome to predict kinematic patterns most likely to give the best outcome. This study aims to validate one such previously developed algorithm based on a simulated deep knee bend (the Dynamic Knee Score, DKS). METHODS 1074 TKA patients with pre- and post-operative Computerised Tomography (CT) scans and 12-month post-operative Knee Injury and Osteoarthritis Outcomes (KOOS) Scores were identified from the 360 Med Care Joint Registry. Landmarking and registration of implant position was performed on all CT scans, and each of the achieved TKAs was computationally simulated and received a predictive outcome score from the DKS. In addition, a set of potential alternative surgical plans which might have been followed were simulated. Comparison of patient-reported issues and DKS score was evaluated in a counter-factual study design. RESULTS Patient-reported impairment with the knee catching and squatting was shown to be 30% lower (p = 0.005) and 22% lower (p = 0.026) in patients where the best possible DKS result was the one surgically achieved. Similar findings were found relating attainment of the best tibial slope and posterior femoral resection DKS plans to patient-reported difficulty straightening the knee (40% less likely, p < 0.001) and descending stairs (35% less likely, p = 0.006). CONCLUSION The DKS has been shown to correlate with presence of patient-reported impairments post-TKA and the resultant algorithm can be applied in a pre-operative planning setting. Outcome optimization in the future may come from patient-specific selection of an alignment strategy and simulations may be a technological enabler of this trend. LEVEL OF EVIDENCE III (Retrospective Cohort Study).
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Kokkotis C, Chalatsis G, Moustakidis S, Siouras A, Mitrousias V, Tsaopoulos D, Patikas D, Aggelousis N, Hantes M, Giakas G, Katsavelis D, Tsatalas T. Identifying Gait-Related Functional Outcomes in Post-Knee Surgery Patients Using Machine Learning: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:448. [PMID: 36612771 PMCID: PMC9819733 DOI: 10.3390/ijerph20010448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Modern lifestyles require new tools for determining a person's ability to return to daily activities after knee surgery. These quantitative instruments must feature high discrimination, be non-invasive, and be inexpensive. Machine learning is a revolutionary approach that has the potential to satisfy the aforementioned requirements and bridge the knowledge gap. The scope of this study is to summarize the results of a systematic literature review on the identification of gait-related changes and the determination of the functional recovery status of patients after knee surgery using advanced machine learning algorithms. The current systematic review was conducted using multiple databases in accordance with the PRISMA guidelines, including Scopus, PubMed, and Semantic Scholar. Six out of the 405 articles met our inclusion criteria and were directly related to the quantification of the recovery status using machine learning and gait data. The results were interpreted using appropriate metrics. The results demonstrated a recent increase in the use of sophisticated machine learning techniques that can provide robust decision-making support during personalized post-treatment interventions for knee-surgery patients.
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Affiliation(s)
- Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Georgios Chalatsis
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | | | - Athanasios Siouras
- AIDEAS OÜ, 10117 Tallinn, Estonia
- Department of Computer Science and Biomedical Informatics, School of Science, University of Thessaly, 35131 Lamia, Greece
| | - Vasileios Mitrousias
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Dimitrios Tsaopoulos
- Institute for Bio-Economy and Agri-Technology, Center for Research and Technology Hellas, 38333 Volos, Greece
| | - Dimitrios Patikas
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62110 Serres, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Michael Hantes
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Giannis Giakas
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
| | - Dimitrios Katsavelis
- Department of Exercise Science and Pre-Health Profession, Creighton University, Omaha, NE 68178, USA
| | - Themistoklis Tsatalas
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece
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10
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Kazarian GS, Haddad FS, Donaldson MJ, Wignadasan W, Nunley RM, Barrack RL. Implant Malalignment may be a Risk Factor for Poor Patient-Reported Outcomes Measures (PROMs) Following Total Knee Arthroplasty (TKA). J Arthroplasty 2022; 37:S129-S133. [PMID: 35248754 DOI: 10.1016/j.arth.2022.02.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Implant malalignment may be a risk factor for poor patient-reported outcomes measures (PROMs) following total knee arthroplasty (TKA). METHODS Postoperative surveys were administered to assess PROMs regarding satisfaction, pain, and function in 262 patients who underwent surgery at 4 centers in the U.S. and U.K (average age, 67.2) at a mean 5.5 years after primary TKA. Postoperative distal femoral angle (DFA), proximal tibial angle (PTA), and posterior tibial slope angle (PSA) were radiographically measured, and outliers were recorded. PROMs were compared between patients with aligned versus malaligned knees using univariate analysis. RESULTS Patients with DFA, PTA, and PSA outliers were more likely to experience similar or decreased activity levels postoperatively than patients with no alignment outliers, as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA, PTA, and PSA outliers were significantly more likely to be dissatisfied with their ability to perform activities of daily living (ADLs), as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA and PSA outliers were more likely to be dissatisfied with their degree of pain relief, as were patients with 2 outliers of any kind (P < .05). Finally, patients with DFA and PSA outliers, as well as those with 1 outlier of any kind, were more likely to be dissatisfied with their overall knee function (P < .05). CONCLUSION DFA, PTA, and PSA outliers represent a significant risk factor for decreased satisfaction with activities of daily living(ADLs), pain relief, and knee function, as well as decreased activity levels. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Fares S Haddad
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Matthew J Donaldson
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Warran Wignadasan
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
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Twiggs J, Miles B, Roe J, Fritsch B, Liu D, Parker D, Dickison D, Shimmin A, BarBo J, McMahon S, Solomon M, Boyle R, Walter L. Can TKA outcomes be predicted with computational simulation? Generation of a patient specific planning tool. Knee 2021; 33:38-48. [PMID: 34543991 DOI: 10.1016/j.knee.2021.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/21/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computer simulations of knee movement allow Total Knee Arthroplasty (TKA) dynamic outcomes to be studied. This study aims to build a model predicting patient reported outcome from a simulation of post-operative TKA joint dynamics. METHODS Landmark localisation was performed on 239 segmented pre-operative computerized tomography (CT) scans to capture patient specific soft tissue attachments. The pre-operative bones and 3D implant files were registered to post-operative CT scans following TKA. Each post-operative knee was simulated undergoing a deep knee bend with assumed ligament balancing of the extension space. The kinematic results from this simulation were used in a Multivariate Adaptive Regression Spline algorithm, predicting attainment of a Patient Acceptable Symptom State (PASS) score in captured 12 month post-operative Knee Injury and Osteoarthritis Outcome Scores (KOOS). An independent series of 250 patients was evaluated by the predictive model to assess how the predictive model behaved in a pre-operative planning context. RESULTS The generated predictive algorithm, called the Dynamic Knee Score (DKS) contained features, in order of significance, related to tibio-femoral force, patello-femoral motion and tibio-femoral motion. Area Under the Curve for predicting attainment of the PASS KOOS Score was 0.64. The predictive model produced a bimodal spread of predictions, reflecting a tendency to either strongly prefer one alignment plan over another or be ambivalent. CONCLUSION A predictive algorithm relating patient reported outcome to the outputs of a computational simulation of a deep knee bend has been derived (the DKS). Simulation outcomes related to tibio-femoral balance had the highest correlation with patient reported outcome.
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Affiliation(s)
| | | | - Justin Roe
- North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, North Sydney 2060, Australia
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute, Sydney 2067, Australia
| | - David Liu
- Gold Coast Centre for Bone and Joint Surgery, Gold Coast 4221, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney 2067, Australia
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MacLeod AR, Peckham N, Serrancolí G, Rombach I, Hourigan P, Mandalia VI, Toms AD, Fregly BJ, Gill HS. Personalised high tibial osteotomy has mechanical safety equivalent to generic device in a case-control in silico clinical trial. COMMUNICATIONS MEDICINE 2021; 1:6. [PMID: 35602226 PMCID: PMC9053187 DOI: 10.1038/s43856-021-00001-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
Background Despite favourable outcomes relatively few surgeons offer high tibial osteotomy (HTO) as a treatment option for early knee osteoarthritis, mainly due to the difficulty of achieving planned correction and reported soft tissue irritation around the plate used to stablise the osteotomy. To compare the mechanical safety of a new personalised 3D printed high tibial osteotomy (HTO) device, created to overcome these issues, with an existing generic device, a case-control in silico virtual clinical trial was conducted. Methods Twenty-eight knee osteoarthritis patients underwent computed tomography (CT) scanning to create a virtual cohort; the cohort was duplicated to form two arms, Generic and Personalised, on which virtual HTO was performed. Finite element analysis was performed to calculate the stresses in the plates arising from simulated physiological activities at three healing stages. The odds ratio indicative of the relative risk of fatigue failure of the HTO plates between the personalised and generic arms was obtained from a multi-level logistic model. Results Here we show, at 12 weeks post-surgery, the odds ratio indicative of the relative risk of fatigue failure was 0.14 (95%CI 0.01 to 2.73, p = 0.20). Conclusions This novel (to the best of our knowledge) in silico trial, comparing the mechanical safety of a new personalised 3D printed high tibial osteotomy device with an existing generic device, shows that there is no increased risk of failure for the new personalised design compared to the existing generic commonly used device. Personalised high tibial osteotomy can overcome the main technical barriers for this type of surgery, our findings support the case for using this technology for treating early knee osteoarthritis.
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Affiliation(s)
| | - Nicholas Peckham
- Oxford Clinical Trials Research Unit, NDORMS, University of Oxford, Oxford, UK
| | - Gil Serrancolí
- Department of Mechanical Engineering, Polytechnic University of Catalonia, Barcelona, Catalunya Spain
| | - Ines Rombach
- Oxford Clinical Trials Research Unit, NDORMS, University of Oxford, Oxford, UK
| | | | | | | | | | - Harinderjit S. Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK
- Centre for Therapeutic Innovation, University of Bath, Bath, UK
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Cochetti A, Ghirardelli S, Iannotti F, Giardini P, Risitano S, Indelli PF. Sensor-guided technology helps to reproduce medial pivot kinematics in total knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 28:2309499020966133. [PMID: 33146082 DOI: 10.1177/2309499020966133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
METHODS Two cohorts of 50 patients each were preoperatively matched to receive the same TKA, having a J-curve femoral design with an adapted "medially congruent" polyethylene insert; the second cohort (group B) underwent the intraoperative sensor-check. Intraoperative sensor data were recorded as tibiofemoral load at 10°, 45°, and 90°. We considered stable knees those with a pressure <50 lbs on the medial compartment, <35 lbs on the lateral, and a mediolateral inter-compartmental difference <15 lbs. Clinical outcomes were evaluated according to the Oxford Knee Score (OKS) and Knee Society Score (KSS). RESULTS All patients (group A: no sensor; group B: sensor) were available at 2-year minimum follow-up (FU; min. 24 months, max. 34 months); no preoperative statistical differences existed between groups in the average range of motion (ROM), OKS, KSS, and body mass index. There were no statistical differences at final FU between groups in the average OKS (group A: 41.1; group B: 41.5), in the average KSS (group A: 165.7; group B: 166.3), or in final ROM (group A: 123°; group B: 124°). One patient in each group required a manipulation under anesthesia. In the sensor group, an accessory soft tissue release/bone recut was necessary after sensor testing with trial components in 24% to obtain the desired loads; in the same group, the level of constraint in the final components was increased to posterior-stabilized in 12% because of an inter-compartmental difference >40 lbs. Surgical time was 8 min longer in the sensor group. CONCLUSION The use of this sensing technology did not improve the clinical outcome but supported multiple intraoperative decisions aimed to better reproduce the medial pivot kinematic of the normal knee.
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Affiliation(s)
- Andrea Cochetti
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA
| | | | | | - Piero Giardini
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA
| | | | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA.,Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA
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14
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No clinical differences at the 2-year follow-up between single radius and J-curve medial pivot total knee arthroplasty in the treatment of neutral or varus knees. Knee Surg Sports Traumatol Arthrosc 2020; 28:3949-3954. [PMID: 32055879 DOI: 10.1007/s00167-020-05854-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Modern total knee arthroplasty (TKA) systems are designed to reproduce the normal knee kinematics and improve patient outcome. The authors compared two different third-generation medial pivot TKA implants, having a single-radius or a J-curve design in their sagittal plane, hypothesizing no clinical differences. METHODS Two cohorts of 50 patients who underwent primary TKA were first preoperatively matched by sex, deformity, body mass index (BMI), Oxford Knee Score (OKS), Knee society score (KSS) and range of motion (ROM) and then statistically analyzed at a minimum follow-up (FU) of 2 years. An identical surgical technique, which aimed to reproduce a slightly tighter medial than lateral compartment, was used in all knees. RESULTS At a minimum follow-up of 2 years (range 24-34 months) there were no statistically significant differences in OKS and KSS between the two implant groups. The final ROM differed statistically between the two groups: the average maximum active flexion was 123° in the J-curve femoral design group with an adapted "medially-congruent" polyethylene insert, and 116° in the single radius femoral design with a medial "ball-in-socket" articulation. CONCLUSION No clinical and radiological differences were found when the two cohorts of patients were compared. This study showed that the implant design played a minor role in the final outcome as opposed to a precise surgical technique. LEVEL OF EVIDENCE Retrospective case-control study, Level III.
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15
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Omari A, Troelsen A, Husted H, Nielsen CS, Gromov K. Early clinical outcome and learning curve following unilateral primary total knee arthroplasty after introduction of a novel total knee arthroplasty system. World J Orthop 2020; 11:431-441. [PMID: 33134106 PMCID: PMC7582111 DOI: 10.5312/wjo.v11.i10.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND New implants for total knee arthroplasty (TKA) are continuously introduced with the proposed benefit of increased performance and improved outcome. Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation.
AIM To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system.
METHODS A novel TKA system was introduced at our institution on 30th November 2015. Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons (25 TKAs/surgeon) were identified as the Introduction Group. Moreover, the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group. A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period. Demographics, surgery-related factors and alignment data were recorded, and intergroup differences compared.
RESULTS Following introduction of the novel implant, Persona TKA was utilized in 69% (71%), 53% (54%), and 45% (75%) of primary TKA procedures by the three surgeons, respectively (Follow-up Group). Mean surgery time was increased by 28% (P < 0.0001) and mean intra-operative blood loss by 25% (P = 0.002) in the Introduction Group, while only the mean surgery time was increased in the Follow-up Group by 18% (P < 0.0001). Overall alignment was similar between the groups apart from femoral flexion (FF) and tibial slope (TS). The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group.
CONCLUSION Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction. These differences diminished one year after introduction of the new implant. Fewer outliers with respect to FF and TS were seen when using the novel TKA implant. Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.
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Affiliation(s)
- Adam Omari
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Copenhagen 2650, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen 2650, Denmark
| | - Henrik Husted
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen 2650, Denmark
| | | | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen 2650, Denmark
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Beringer DC. CORR Insights®: What Influences Patient Satisfaction after TKA? A Qualitative Investigation. Clin Orthop Relat Res 2020; 478:1867-1869. [PMID: 32732568 PMCID: PMC7371077 DOI: 10.1097/corr.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Don C Beringer
- D. C. Beringer, Surgery Department, Mercer University School of Medicine, Macon, GA, USA
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17
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Yi PH, Della Valle CJ, Fishman EK, Fritz J. Imaging of Periprosthetic Fractures of the Hip and Knee. Semin Roentgenol 2020; 56:90-105. [PMID: 33422187 DOI: 10.1053/j.ro.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paul H Yi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jan Fritz
- New York University Grossman School of Medicine, New York University, New York, NY..
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18
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Does Knee Prosthesis Survivorship Improve When Implant Designs Change? Findings from the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478:1156-1172. [PMID: 32324669 PMCID: PMC7319368 DOI: 10.1097/corr.0000000000001229] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND TKA generally has excellent long-term survivorship. When a new knee system supersedes a previous model, increased survivorship, improved functional performance, or both may be expected, because key areas of design modification are often targeted to address wear, stability, and the patellofemoral articulation. However, not all design changes are beneficial, and to our knowledge, knee arthroplasty has not been systematically evaluated in the context of design changes that occur during the development of new knee arthroplasty systems. QUESTIONS/PURPOSES Using the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) we performed multiple old-to-new comparisons of frequently used contemporary knee implants to ask: (1) does overall prosthesis survivorship free from revision increase when a new knee prosthesis system is introduced to replace a prior prosthesis system? (2) Has survivorship free from revision improved for the revision indications of wear, instability, and patellofemoral articulation issues, where development efforts have been concentrated? METHODS Data from the AOANJRR from September 1999 to December 2017 were used to compare the survivorship of prostheses free from revision at a maximum of 17 years in procedures where a new design model was introduced to replace a prior knee system from the same manufacturer. Only prosthesis systems used in a minimum of 2000 primary TKA procedures for osteoarthritis that had a minimum of 5 years of follow-up were included. Varus-valgus constrained and hinge TKA designs were excluded. Cruciate-retaining, posterior-stabilized, and medial pivot-design knees were considered separately. The new and old prosthesis systems were paired for analysis. Survivorship was calculated with Kaplan Meier estimates and comparisons were performed using the Cox proportional hazards method. Subanalyses according to the three main revision indications were performed, and where possible, analyses were performed based on polyethylene types (highly cross-linked polyethylene and ultra-high-molecular-weight polyethylene), combined and separated. Revision was defined as a reoperation of a previous knee arthroplasty in which one or more of the components was removed, replaced, or added. There were 323,955 TKA procedures and 11 new prosthesis system designs that were introduced to replace an earlier knee system from the same manufacturer. Of these prosthesis system pairs, six were cruciate-retaining prostheses, four were posterior-stabilized designs, and one was a medial pivot design. RESULTS Six of the 11 knee system pairs showed improved survivorship with the new design, three were no different, and in two, the newer prosthesis systems had a higher rate of revision than the old one did. When revision for wear was analyzed, five prosthesis systems showed improvement, five were no different, and one had a higher rate of revision than the previous system did. There was no improvement in the rate of revision for instability; seven new prosthesis systems showed no difference from the previous system and four new prosthesis systems had a higher rate of revision than the previous system did. A subanalysis of revision for patellofemoral complications showed improvement in two comparisons, no difference in six, and a higher revision rate in two; one could not be calculated because of an insufficient number of revisions for this reason. CONCLUSIONS It is difficult to predict whether a new system will demonstrate better survival than a previous one, and widespread uptake of a new design before a benefit is shown in robust clinical studies is unwise. Similarly, adoption of a new system for which there is no difference in survivorship from a previous model may be premature because a new device may have associated unknown and unintended consequences. Healthcare policy makers and therapeutic device regulators should similarly be guided by results and seek out peer-reviewed evidence before accepting change to established practice. Surgeons must be aware that implant changes may not translate into better survivorship and must seek compelling evidence of improvement in survival and/or function before changing systems. LEVEL OF EVIDENCE Level III, therapeutic study.
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Irmola T, Kangas J, Eskelinen A, Niemeläinen M, Huhtala H, Mattila VM, Moilanen T. Functional outcome of total knee replacement: a study protocol for a prospective, double-blinded, parallel-group randomized, clinical controlled trial of novel, personalized and conventional implants. BMC Musculoskelet Disord 2019; 20:443. [PMID: 31604440 PMCID: PMC6790022 DOI: 10.1186/s12891-019-2830-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 09/12/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The development of total knee replacement (TKR) implant designs aims to improve outcome regarding pain, function, joint stiffness, instability, patellar problems, and ultimately wear of the implant. Recently, two major orthopaedic implant manufacturers launched a new generation of TKR implants which, according to the manufacturers, provide improved functional outcome. However, the benefits of these new TKR designs claimed by the manufacturers in terms of improved functional outcome still lack scientific documentation. The present randomized controlled trial has been designed to compare three fixed bearing, cemented cruciate-retaining (CR) designs; one of the new personalized TKR design with two conventional TKR designs with the main emphasis being on functional outcome. METHODS The present study is a prospective, double-blinded, randomized, single-center intervention trial. A total of 240 patients will be recruited to participate in a parallel-group study at Coxa Hospital for Joint Replacement, Tampere, Finland. We will compare the short-term functional outcome of TKR performed with a novel personalized TKR design (Persona CR, Zimmer, Warsaw, IN, USA) against TKRs performed with two conventional designs (PFC CR, DePuy, Warsaw, IN, USA and Nexgen CR, Zimmer, Warsaw, IN, USA). In total, 80 patients will be randomized in each of the three study arms. The primary outcome in this study is the Oxford Knee Score (OKS), which is a validated patient-reported outcome measure (PROM). Secondary outcome measures include the Forgotten Joint Score, the 15D, the UCLA activity score, and the VAS pain scale. The results will be analyzed after 2-year follow-up. DISCUSSION This paper presents a prospective, randomized, single-center trial study protocol. It provides details of patient randomization, PROMs, follow-up, methods of analysis of the material, and publication plan. An important aspect that will be considered in the study will be the economic effects of the novel designs as they are substantially more expensive, and the benefits of the added costs remain unknown. In addition, it is especially important to carry out evaluative studies in independent centers that are not biased by the interests of the manufacturers. TRIAL REGISTRATION Retrospectively registered, November, 2017, ClinicalTrials.gov Identifier: NCT03339557 .
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Affiliation(s)
- T. Irmola
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - J. Kangas
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - A. Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | | | | | - V. M. Mattila
- Coxa Hospital for Joint Replacement, Tampere, Finland
- Department of Orthopaedics and Trauma, Tampere University Hospital, Tampere, Finland
| | - T. Moilanen
- Coxa Hospital for Joint Replacement, Tampere, Finland
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20
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Pineda A, Pabbruwe MB, Kop AM, Vlaskovsky P, Hurworth M. The effect of implant modification: the low contact stress experience. Bone Joint J 2019; 101-B:1248-1255. [PMID: 31564141 DOI: 10.1302/0301-620x.101b10.bjj-2019-0135.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to conduct the largest low contact stress (LCS) retrieval study to elucidate the failure mechanisms of the Porocoat and Duofix femoral component. The latter design was voluntarily recalled by the manufacturer. MATERIALS AND METHODS Uncemented LCS explants were divided into three groups: Duofix, Porocoat, and mixed. Demographics, polyethylene wear, tissue ingrowth, and metallurgical analyses were performed. RESULTS In 104 implants, a decrease in the odds of loosening and an increase in metallosis and tissue staining in the Duofix group relative to Porocoat group was detected (p = 0.028). There was an increased presence of embedded metallic debris in the Duofix group (p < 0.001). Decreased tissue ingrowth was associated with the Duofix surface (p < 0.001). The attached beads had reduced microhardness, indicative of adverse thermal processing, which resulted in bead shedding, particulate debris, and metallosis. CONCLUSION Hydroxyapatite coating of the LCS femoral component produced unexpected results and led to its recall. The root cause was likely a combination of retained alumina grit and a reduction in bead microhardness (mechanical strength) resulting in increased particle debris, metallosis, and early revision. The Duofix LCS femoral component was not equivalent to the Porocoat version despite its approval through the Food and Drug Administration (FDA) 510(k) equivalance approval process. Regulation of the introduction of modified existing devices needs to be improved and the Duofix LCS should have been considered to be a new device for which equivalence had not been demonstrated at the point of introduction. Cite this article: Bone Joint J 2019;101-B:1248-1255.
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Affiliation(s)
- Alfredo Pineda
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, Australia
| | - Moreica B Pabbruwe
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Alan M Kop
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
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Figueroa F, Wakelin E, Twiggs J, Fritsch B. Comparison between navigated reported position and postoperative computed tomography to evaluate accuracy in a robotic navigation system in total knee arthroplasty. Knee 2019; 26:869-875. [PMID: 31171424 DOI: 10.1016/j.knee.2019.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 04/04/2019] [Accepted: 05/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computer navigation increases reproducibility compared to non-navigated total knee arthroplasty (TKA). Robotics navigation is a branch of computer navigation technology that might further improve accuracy of implant placement. The aim of this study is to assess the accuracy achieved in TKA with a robotic navigation system. METHODS One hundred seventy three knees. System studied: Omni navigation System (OMNI, Raynham, MA). Navigated femoral and tibial cuts were compared to postoperative computed tomography (CT). Measurements reviewed: femoral coronal alignment (FCA), femoral sagittal alignment (FSA), femoral rotational alignment (FRA), tibial coronal alignment (TCA), tibial sagittal alignment (TSA) and hip-knee-ankle (HKA) angle. Statistical analysis was made using R. RESULTS The mean differences between the navigated reported and the CT positions were: FCA: 0.1 ± 1.2° more varus (P = 0.58), FSA: 1.5 ± 0.3° more flexed (P < 0.001), FRA: 0.0 ± 1.7° (P = 0.93), TCA: 0.7 ± 1.1° more varus (P < 0.001), TSA: -1.3 ± 1.5 more negative slope (P < 0.001), HKA angle: 0.4 ± 2.4 more varus (P < 0.049). The percentages of concordance inside a three degree difference were: FCA: 98% (169 knees), FSA: 100% (173 knees), FRA: 94% (162 knees), TCA: 99% (171 knees), TSA: 93% (161 knees) and HKA angle: 83% (144 knees). CONCLUSIONS The current study showed that the robotic navigation system studied is highly accurate regarding final implant positioning for FCA, FRA and TCA. It has less accuracy in FSA, TSA and the HKA angle.
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Affiliation(s)
- Francisco Figueroa
- Clínica Alemana-Universidad del Desarrollo, Chile; Hospital Sótero del Río, Chile.
| | | | | | - Brett Fritsch
- Sydney Orthopaedic Research Institute, Sydney, Australia
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Lützner C, Postler A, Beyer F, Kirschner S, Lützner J. Fulfillment of expectations influence patient satisfaction 5 years after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:2061-2070. [PMID: 30547305 DOI: 10.1007/s00167-018-5320-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 12/04/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE Constant efforts have been made to improve prosthesis design in total knee arthroplasty (TKA), but a significant number of patients remain dissatisfied postoperatively. Besides poor improvement in pain or function, poor fulfillment of patients expectations were identified as contributing factors. Purpose of the study was to assess fulfillment of patients' expectations and satisfaction with TKA 5 years after surgery. METHODS A total of 103 patients from a prospective randomised study of a high-flexion or standard TKA implant were investigated 5 years after surgery and patient-reported outcomes (PRO), fulfillment of expectations and satisfaction with the result of the surgery were obtained. RESULTS There were no differences in PROs, fulfillment of expectations and satisfaction between both implant designs. In total, the patients had high expectations preoperatively, mainly related to pain relief and functional abilities. A total of 89.4% of these expectations were fulfilled. No re-interventions (p < 0.001) and male gender (p = 0.017) were the most important predictors of higher fulfillment of expectations. Satisfaction scored highly at 8.2 out of 10 and most patients (93.2%) would undergo the surgery again. Higher Knee Score (p = 0.012) and fulfillment of expectations (p = 0.002) were correlated with higher satisfaction. CONCLUSION Five years after surgery fulfillment of expectations and satisfaction were high regardless of implant design and did significantly influence patient satisfaction. Surgeons should be aware of the importance of patients' expectations and their influence on satisfaction after TKA. Therefore, the probability of fulfillment should be discussed during shared decision making for TKA. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Cornelia Lützner
- Department for Orthopaedic and Trauma Surgery, University Medicine Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Anne Postler
- Department for Orthopaedic and Trauma Surgery, University Medicine Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- Department for Orthopaedic and Trauma Surgery, University Medicine Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Stephan Kirschner
- St. Vincentius-Kliniken, ViDia Christliche Kliniken Karlsruhe, Steinhäuserstraße 18, 76135, Karlsruhe, Germany
| | - Jörg Lützner
- Department for Orthopaedic and Trauma Surgery, University Medicine Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany.
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Kahlenberg CA, Lyman S, Joseph AD, Chiu YF, Padgett DE. Comparison of patient-reported outcomes based on implant brand in total knee arthroplasty. Bone Joint J 2019; 101-B:48-54. [DOI: 10.1302/0301-620x.101b7.bjj-2018-1382.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The outcomes of total knee arthroplasty (TKA) depend on many factors. The impact of implant design on patient-reported outcomes is unknown. Our goal was to evaluate the patient-reported outcomes and satisfaction after primary TKA in patients with osteoarthritis undergoing primary TKA using five different brands of posterior-stabilized implant. Patients and Methods Using our institutional registry, we identified 4135 patients who underwent TKA using one of the five most common brands of implant. These included Biomet Vanguard (Zimmer Biomet, Warsaw, Indiana) in 211 patients, DePuy/Johnson & Johnson Sigma (DePuy Synthes, Raynham, Massachusetts) in 222, Exactech Optetrak Logic (Exactech, Gainesville, Florida) in 1508, Smith & Nephew Genesis II (Smith & Nephew, London, United Kingdom) in 1415, and Zimmer NexGen (Zimmer Biomet) in 779 patients. Patients were evaluated preoperatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS), and 12-Item Short-Form Health Survey questionnaire (SF-12). Demographics including age, body mass index, Charlson Comorbidity Index, American Society of Anethesiologists status, sex, and smoking status were collected. Postoperatively, two-year KOOS, LEAS, SF-12, and satisfaction scores were compared between groups. Results Outcomes were available for 4069 patients (98%) at two years postoperatively. In multiple regression analysis, which separately compared each implant group with the aggregate of all others, there were no clinically significant differences in the change of KOOS score from baseline to two-year follow-up between any of the groups. More than 80% of patients in each group were satisfied at this time in all domains. In a multivariate regression model, patients in the NexGen group were the most likely to be satisfied (odds ratio (OR) 1.63; p = 0.006) and Optetrak Logic patients were the least likely to be satisfied (OR 0.60; p < 0.001). Conclusion TKA provides improvement in function and satisfaction regardless of the type of implant. We could not demonstrate superiority of one design above others across these groups of implants, and any price premium for one above the other systems may not be justified. Healthcare administrators may find these similarities in outcomes helpful when negotiating purchasing contracts. Cite this article: Bone Joint J 2019;101-B(7 Supple C):48–54
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Affiliation(s)
- C. A. Kahlenberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - S. Lyman
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - A. D. Joseph
- Arthroplasty, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Y-F. Chiu
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - D. E. Padgett
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA
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Molloy IB, Keeney BJ, Sparks MB, Paddock NG, Koenig KM, Moschetti WE, Jevsevar DS. Short term patient outcomes after total knee arthroplasty: Does the implant matter? Knee 2019; 26:687-699. [PMID: 30910627 PMCID: PMC6556140 DOI: 10.1016/j.knee.2019.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/20/2019] [Accepted: 01/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Newer implants for total knee arthroplasty (TKA) often gain market share at higher cost with little patient-reported and long-term clinical data. We compared outcomes after TKA using two different implants: DePuy PFC Sigma and Attune. METHODS Using a prospective data repository from an academic tertiary medical center, we analyzed 2116 TKAs (1603 Sigma and 513 Attune) from April 2011 through July 2016. Outcomes included length of surgery, length of stay, facility discharge, 90-day reoperation, range of motion (ROM) change, and patient-reported physical function (PCS). RESULTS There was no difference in length of surgery (Attune -2.87 min, P = 0.143). Implant type was not associated with extended LOS (>3 days) (OR 0.80, P = 0.439). There was no difference in facility discharge (OR 0.65, P = 0.103). Unadjusted 90-day reoperations were 0.3% for Sigma and 1.0% for Attune cohorts (P = 0.158). Sigma implants were associated with more ROM improvement in unadjusted analyses (+2.1 degree improvement P = 0.031). Fifty nine percent of the Sigma cohort and 49% of the Attune cohort achieved the minimal clinically important (MCID) change for PCS improvement, although there was no adjusted difference in achieving MCID (Attune OR 0.84, P = 0.435). There was no adjusted difference in absolute PCS improvement (Attune +0.12 score, P = 0.864). CONCLUSIONS Our data show no difference in physical function and most outcomes between Sigma and Attune. Attune implants had shorter absolute LOS, but there were no differences in extended LOS.
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Affiliation(s)
- Ilda B Molloy
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Benjamin J Keeney
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Berkley Medical Management Solutions, 10851 Mastin Street, Overland Park, KS 66210, USA; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Michael B Sparks
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Nicholas G Paddock
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Karl M Koenig
- Department of Surgery & Perioperative Care, Dell Medical School, University of Texas at Austin, 1701 Trinity St., Austin, TX 78712, USA.
| | - Wayne E Moschetti
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
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Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26:1811-1822. [PMID: 29185005 DOI: 10.1007/s00167-017-4817-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Due to the lack of comparative studies, a systematic review was conducted to determine revision rates of unicompartmental and total knee arthroplasty (UKA and TKA), and compare functional outcomes, range of motion and activity scores in patients less than 65 years of age. METHODS A literature search was performed using PubMed, Embase, and Cochrane systems since 2000. 27 UKA and 33 TKA studies were identified and included. Annual revision rate (ARR), functional outcomes, and return to activity were assessed for both types of arthroplasty using independent t tests. RESULTS Four level I studies, 12 level II, 16 level III, and 29 level IV were included, which reported on outcomes in 2224 UKAs and 4737 TKAs. UKA studies reported 183 revisions, yielding an ARR of 1.00 and extrapolated 10-year survivorship of 90.0%. TKA studies reported 324 TKA revisions, resulting in an ARR of 0.53 and extrapolated 10-year survivorship of 94.7%. Functional outcomes scores following UKA and TKA were equivalent, however, following UKA larger ROM (125° versus 114°, p = 0.004) and higher UCLA scores were observed compared to TKA (6.9 versus 6.0, n.s.). CONCLUSION These results show that good-to-excellent outcomes can be achieved following UKA and TKA in patients less than 65 years of age. A higher ARR was noted following UKA compared to TKA. However, improved functional outcomes, ROM and return to activity were found after UKA than TKA in this young population. Comparative studies are needed to confirm these findings and assess factors contributing to failure at the younger patient population. Outcomes of UKA and TKA in patients younger than 65 years are both satisfying, and therefore, both procedures are not contraindicated at younger age. UKA has several important advantages over TKA in this young and frequently more active population. LEVEL OF EVIDENCE IV.
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26
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Osmani FA, Bolz N, Odeh K, Bearison C, Schwarzkopf R, Iorio R. The ratio of patient body mass index to age: a cost-effective implant selection guideline for total knee arthroplasty. Arthroplast Today 2018; 4:94-98. [PMID: 29564376 PMCID: PMC5859741 DOI: 10.1016/j.artd.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 07/19/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022] Open
Abstract
Background We sought to develop an objective implant selection guideline based on the ratio of patient body mass index (BMI) to age in order to select implants preoperatively and reduce cost while maintaining quality. The BMI-to-age ratio can be used to distinguish patient demand and select those patients who may benefit from newer technology and higher cost implants and those who would do well with standard-demand implants. Methods A retrospective analysis investigated the types of implants received by patients undergoing total knee arthroplasty from January 2012 to August 2014. Patients with a BMI-to-age ratio >0.60 were categorized as high demand and were eligible for either a high-demand implant or a standard-demand implant. Patients with a BMI-to-age ratio ≤0.60 were recognized as standard demand and would be eligible for only standard-demand implants. The actual implant received was identified and compared with the implant as predicted by the BMI-to-age ratio and potential cost savings were identified. Results A total of 1507 operative knees were identified. The high-demand implant carries a 31% greater cost than that of a standard-demand implant. Thirty-eight of 1084 high-demand implants were placed in standard-demand knees. An additional 1.1% cost was realized with 38 standard-demand knees receiving high-demand implants and 28.6% if high-demand knees had been used in all standard-demand patients. Conclusions Limiting the use of high-demand implants to high-functional-demand patients based on the BMI-to-age ratio may guide the surgeon's choice in optimizing implant selection while providing value-based purchasing criteria to the selection of total knee arthroplasty implants.
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Affiliation(s)
- Feroz A Osmani
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | - Nicholas Bolz
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | - Khalid Odeh
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | | | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
| | - Richard Iorio
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Disease, New York, NY, USA
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27
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Canovas F, Dagneaux L. Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res 2018; 104:S41-S46. [PMID: 29183821 DOI: 10.1016/j.otsr.2017.04.017] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/14/2017] [Indexed: 02/02/2023]
Abstract
Total knee arthroplasty (TKA) results in a high degree of patient satisfaction, as it provides patients with considerable medium- and long-term benefits in terms of quality of life, pain relief and function. Nevertheless, the literature reports that up to 30% of patients are dissatisfied. This dissatisfaction is directly related to the patients' quality of life, which they deem insufficient. Their quality of life depends on many physical, behavioural, social and psychological factors that are not taken into account by functional outcome scores. After describing the principles of quality of life evaluation after TKA, we will assess the effects of patient-related factors, the surgical technique and postoperative program through an exhaustive review of the literature. Patient expectations after TKA will then be outlined, particularly return to work and return to sports.
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Affiliation(s)
- F Canovas
- Department of Orthopedic and Trauma Surgery, Upper limb and Spine Surgery Unit, Hôpital Lapeyronie, CHRU de Montpellier, 351, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France.
| | - L Dagneaux
- Department of Orthopedic and Trauma Surgery, Upper limb and Spine Surgery Unit, Hôpital Lapeyronie, CHRU de Montpellier, 351, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
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28
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Figueroa F, Parker D, Fritsch B, Oussedik S. New and evolving technologies for knee arthroplasty—computer navigation and robotics: state of the art. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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29
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Rutherford RW, Jennings JM, Dennis DA. Enhancing Recovery After Total Knee Arthroplasty. Orthop Clin North Am 2017; 48:391-400. [PMID: 28870300 DOI: 10.1016/j.ocl.2017.05.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There have been multiple successful efforts to improve and shorten the recovery period after elective total joint arthroplasty. The development of rapid recovery protocols through a multidisciplinary approach has occurred in recent years to improve patient satisfaction as well as outcomes. Bundled care payment programs and the practice of outpatient total joint arthroplasty have provided additional pressure and incentives for surgeons to provide high-quality care with low cost and complications. In this review, the evidence for modern practices are reviewed regarding patient selection and education, anesthetic techniques, perioperative pain management, intraoperative factors, blood management, and postoperative rehabilitation.
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Affiliation(s)
- Richard W Rutherford
- Colorado Joint Replacement, Porter Adventist Hospital, 2535 S. Downing Street, Denver, CO 80210, USA.
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, 2535 S. Downing Street, Denver, CO 80210, USA
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, 2535 S. Downing Street, Denver, CO 80210, USA; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
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30
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Dobbs MB, Gebhardt MC, Gioe TJ, Manner PA, Porcher R, Rimnac CM, Wongworawat MD, Leopold SS. Editorial: How Does CORR ® Evaluate Survey Studies? Clin Orthop Relat Res 2017; 475:2143-2145. [PMID: 28664262 PMCID: PMC5539049 DOI: 10.1007/s11999-017-5430-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Matthew B Dobbs
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Mark C Gebhardt
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Terence J Gioe
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Paul A Manner
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Raphaël Porcher
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Clare M Rimnac
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Montri D Wongworawat
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Seth S Leopold
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA.
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31
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Peersman G, Slane J, Dirckx M, Vandevyver A, Dworschak P, Heyse TJ, Scheys L. The influence of polyethylene bearing thickness on the tibiofemoral kinematics of a bicruciate retaining total knee arthroplasty. Knee 2017; 24:751-760. [PMID: 28433348 DOI: 10.1016/j.knee.2017.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/11/2017] [Accepted: 03/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The recently reintroduced bicruciate retaining Total Knee Arthroplasty (BCR TKA) is an effort to reproduce kinematics closer to the native knee. However, there is no data on appropriate balancing with this implant. Balancing is crucial and challenging as medial and lateral polyethylene (PE) inlays are modular, which allows for placement of different thicknesses in the medial and lateral compartments. This study aimed at providing a detailed kinematic view on balancing BCR TKA. METHODS Seven fresh frozen cadaver legs were mounted in a kinematic rig that applied squatting under application of physiologic quadriceps and hamstring forces. Additionally, specimen laxity was assessed using Lachman tests and varus/valgus stress tests. Following testing on the native knee, a BCR TKA was implanted in each specimen and all trials were repeated. Using one millimeter increments, five inlay thicknesses were tested to simulate optimal balancing, symmetric under-, and overstuffing, valgus constellation, and varus constellation. RESULTS Overall, knee kinematics following BCR TKA seem to be very close to the native knee. The changes as introduced to tibiofemoral kinematics through over- or understuffing the polyethylene inserts are affecting the system only to a minor degree and generally lack statistical significance. Reproduction of the tibial varus via PE-Inlays did not lead to kinematics much closer to the native knee. CONCLUSIONS The changes introduced to tibiofemoral kinematics by removal of the conforming meniscus and cartilage and replacement with a flat PE insert and femoral component are of more impact than different inlay sizes and their combinations for a BCR TKA.
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Affiliation(s)
- Geert Peersman
- ZNA Stuivenberg, Antwerp, Belgium; Institute for Orthopaedic Research and Training, KU Leuven/UZ Leuven, Campus Pellenberg, Leuven, Belgium.
| | - Josh Slane
- Institute for Orthopaedic Research and Training, KU Leuven/UZ Leuven, Campus Pellenberg, Leuven, Belgium
| | | | | | - Philipp Dworschak
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Germany
| | - Thomas J Heyse
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Germany
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training, KU Leuven/UZ Leuven, Campus Pellenberg, Leuven, Belgium
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Risitano S, Karamian B, Indelli PF. Intraoperative load-sensing drives the level of constraint in primary total knee arthroplasty: Surgical technique and review of the literature. J Clin Orthop Trauma 2017; 8:265-269. [PMID: 28951645 PMCID: PMC5605726 DOI: 10.1016/j.jcot.2017.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022] Open
Abstract
Total knee arthroplasty is a traditional surgical procedure aimed to restore function and relief pain in patients with severe knee osteoarthritis. Recently, many medial pivot knee systems were deigned to replicate the normal knee kinematic: a highly congruent medial compartment and a less conforming lateral tibial plateau characterize these devices. A slightly asymmetric soft tissue balancing is mandatory using medial pivot designs to obtain a correct and physiological knee biomechanics leading good outcomes and long survival rates. This article describes a new surgical technique using a modern third generation TKA design combined with wireless load-sensor tibial trials to improve the correct knee load balancing with a minimal conformity of the polyethylene insert. The use of wireless load-sensing tibial trials has several benefits: it is an intraoperative, objective and dynamic tool allowing surgeons to optimize in real time soft tissue balancing. The meaning of a "truly balanced knee" is still a controversial issue in the current literature.
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Affiliation(s)
| | | | - Pier Francesco Indelli
- Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA, USA
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33
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Strategies to Improve Total Knee Arthroplasty: A Multidisciplinary Research Conference. J Am Acad Orthop Surg 2017; 25 Suppl 1:S1-S3. [PMID: 27941416 DOI: 10.5435/jaaos-d-16-00633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Jones GG, Kotti M, Wiik AV, Collins R, Brevadt MJ, Strachan RK, Cobb JP. Gait comparison of unicompartmental and total knee arthroplasties with healthy controls. Bone Joint J 2017; 98-B:16-21. [PMID: 27694511 PMCID: PMC5047137 DOI: 10.1302/0301-620x.98b10.bjj.2016.0473.r1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/02/2022]
Abstract
Aims To compare the gait of unicompartmental knee arthroplasty (UKA)
and total knee arthroplasty (TKA) patients with healthy controls,
using a machine-learning approach. Patients and Methods 145 participants (121 healthy controls, 12 patients with cruciate-retaining
TKA, and 12 with mobile-bearing medial UKA) were recruited. The
TKA and UKA patients were a minimum of 12 months post-operative,
and matched for pattern and severity of arthrosis, age, and body
mass index. Participants walked on an instrumented treadmill until their
maximum walking speed was reached. Temporospatial gait parameters,
and vertical ground reaction force data, were captured at each speed.
Oxford knee scores (OKS) were also collected. An ensemble of trees
algorithm was used to analyse the data: 27 gait variables were used
to train classification trees for each speed, with a binary output
prediction of whether these variables were derived from a UKA or
TKA patient. Healthy control gait data was then tested by the decision
trees at each speed and a final classification (UKA or TKA) reached
for each subject in a majority voting manner over all gait cycles
and speeds. Top walking speed was also recorded. Results 92% of the healthy controls were classified by the decision tree
as a UKA, 5% as a TKA, and 3% were unclassified. There was no significant
difference in OKS between the UKA and TKA patients (p = 0.077).
Top walking speed in TKA patients (1.6 m/s; 1.3 to 2.1) was significantly
lower than that of both the UKA group (2.2 m/s; 1.8 to 2.7) and healthy
controls (2.2 m/s; 1.5 to 2.7; p < 0.001). Conclusion UKA results in a more physiological gait compared with TKA, and
a higher top walking speed. This difference in function was not
detected by the OKS. Cite this article: Bone Joint J 2016;98-B(10
Suppl B):16–21.
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Affiliation(s)
- G G Jones
- MSk Lab, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - M Kotti
- MSk Lab, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - A V Wiik
- MSk Lab, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - R Collins
- MSk Lab, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - M J Brevadt
- MSk Lab, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - R K Strachan
- Imperial College NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - J P Cobb
- MSk Lab, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
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Nam D, Barrack T, Nunley RM, Barrack RL. What Is the Frequency of Noise Generation in Modern Knee Arthroplasty and Is It Associated With Residual Symptoms? Clin Orthop Relat Res 2017; 475:83-90. [PMID: 26762299 PMCID: PMC5174019 DOI: 10.1007/s11999-016-4701-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prior investigations have recognized the presence of patient-perceived noise generation after total knee arthroplasty (TKA). However, questions remain regarding its overall frequency after both TKA and unicompartmental knee arthroplasty (UKA) as well as with respect to its association with demographic and prosthesis-related factors and its association with patient-reported outcomes. QUESTIONS/PURPOSES The purposes of this study were (1) to determine the frequency with which patients report noise coming from the knee after TKA or UKA; (2) to identify patient and prosthesis-related factors associated with noise generation; and (3) to ascertain whether noise coming from the knee is associated with residual symptoms after knee arthroplasty. METHODS A five-center survey study was designed to identify patient-perceived noise and to quantify the degree of residual symptoms and functional deficits in patients after TKA or UKA. Data were collected by an independent, third-party survey center, which administered questions about residual symptoms, function, and pre- and postoperative activity levels. Patients meeting prespecified inclusion criteria were specifically questioned regarding perceived noises from their knee within the last 30 days; those who reported hearing noises sometimes, often, or extremely often were categorized as positive. We retrospectively identified 2671 patients who underwent TKA and 744 patients who underwent UKA and who met inclusion criteria; the final survey population included 1580 patients who underwent TKA and 476 patients who underwent UKA (68% response rate). TKA implant types included cruciate-retaining (59%), posterior-stabilized (16%), rotating-platform (13%), gender-specific (7%), and high-flex (5%). Differences in baseline demographic variables were accounted for using multiple logistic regression statistical analyses. Chi square analyses were used to compare the frequency of residual symptoms in those patients with and without noise generation. RESULTS Overall, 27% (557 of 2056; 95% confidence interval [CI], 25-29) of all patients undergoing knee arthroplasty reported hearing grinding, popping, or clicking from their operative knee in the last 30 days. Men (odds ratio [OR], 1.3; 95% CI, 1.0-1.6; p = 0.02) and younger patients (χ2 [df = 7] = 67.3; p < 0.001) were more likely to report noise generation. After controlling for potential confounding variables, noise generation was more common after TKA (29%) than UKA (21%; OR, 1.5; 95% CI, 1.2-2.0; p < 0.001). Among TKA designs, the likelihood of noise generation was greater in posterior-stabilized (41%; OR, 2.5; 95% CI, 1.8-3.7; p < 0.001), rotating-platform (45%; OR, 2.8; 95% CI, 1.9-4.2; p < 0.001), and gender-specific (36%; OR, 2.0; 95% CI, 1.2-3.2; p = 0.007) designs than in cruciate-retaining (23%) knees. Patient-perceived noise generation was associated with residual symptoms, including difficulty getting in and out of a chair (38% versus 25%, p < 0.001), limp (39% versus 25%, p < 0.001), swelling (42% versus 24%, p < 0.001), and stiffness (40% versus 23%, p < 0.001) compared with those who did not report noise generation after TKA. CONCLUSIONS Patients frequently perceive noises coming from the knee after arthroplasty, more so in TKA than UKA. Patients reporting noises from the knee were more likely to report functional limitations and the presence of a limp, swelling, and stiffness. Surgeons should inform patients preoperatively of this possibility, because unmet patient expectations are known to negatively impact patient satisfaction after surgery. Subsequent investigations should focus on determining if there is a causal relationship between noise generation and residual symptoms after knee arthroplasty. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Denis Nam
- Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - Toby Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - Ryan M. Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
| | - Robert L. Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110 USA
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Nam D, Berend ME, Nunley RM, Della Valle CJ, Berend KR, Lombardi AV, Barrack RL. Residual Symptoms and Function After Unicompartmental and Total Knee Arthroplasty: Comparable to Normative Controls? J Arthroplasty 2016; 31:2161-6. [PMID: 27067170 DOI: 10.1016/j.arth.2016.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/23/2016] [Accepted: 02/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Whether patient-reported symptoms and function after total knee arthroplasty (TKA) and medial unicompartmental knee arthroplasty (UKA) compare favorably to similar individuals without a diagnosis of knee pathology has not been investigated. METHODS A retrospective, multicenter study was designed in which 4 centers contributed patients between ages 18 and 80 years undergoing knee arthroplasty. Data were collected by an independent, third-party survey center that administered a questionnaire assessing patient satisfaction and function. The survey center identified a "control" population of the same age range using a "random digit dial call method" with no prior knee interventions or major problems with their knees limiting their activity. Comparisons were performed using multivariate logistic regression analyses accounting for differences in demographic variables among the 3 cohorts. RESULTS Overall, 1456 TKAs, 476UKAs, and 409 controls were included for analysis. Controls reported a surprisingly high incidence of pain (30%), a limp (26%), stiffness (22%), and noise (21%) in their knee. However, the likelihood of reported noise (odds ratio [OR], 1.3), swelling (OR, 1.4), stiffness (OR, 1.8), and difficulty getting in and out of a chair (OR, 2.5) was increased after TKA vs controls (P < .001-.03). The likelihood of swelling (OR, 1.8), stiffness (OR, 1.5), and difficulty getting in and out of a chair (OR, 1.7) was increased after UKA vs controls (P = .002-.005). CONCLUSION When interviewed by an independent, third party, a substantial percentage of control patients reported the presence of knee symptoms, but to a lesser degree than patients after a knee arthroplasty.
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Affiliation(s)
- Denis Nam
- Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Michael E Berend
- The Center for Hip and Knee Surgery, St. Francis Hospital, Mooresville, Indiana
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | | | | | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
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Abstract
Total knee arthroplasty has been an effective treatment for advanced degenerative joint disease. Traditional knee designs and surgical approaches have resulted in consistently high performance, but some patients may remain dissatisfied after their surgery. Several surgical innovations, including accelerometer-based navigation, patient-specific instrumentation, and robotic-assisted total knee arthroplasty, have been developed to improve the accuracy and precision of total knee arthroplasty surgery, with anticipated secondary benefits of improved functional outcomes and implant survivorship. This article reviews the current status of these technologies as reported in contemporary orthopedic literature. [Orthopedics. 2016; 39(4):217-220.].
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A Comparison of 5 Models of Total Knee Arthroplasty in Young Patients. J Arthroplasty 2016; 31:994-9. [PMID: 26746570 DOI: 10.1016/j.arth.2015.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several different total knee implants were introduced in an attempt to potentially improve outcomes of total knee arthroplasty in young patients. The object of this study was to compare the clinical outcomes of 5 models of total knee implants. METHODS We compared 172 patients who received posterior substituting knee implants with an average 13.2-year follow-up, 182 patients who received high-flex knees with an average 11.8-year follow-up, 190 patients who received mobile-bearing knees with an average 13.9-year follow-up, 170 patients who received gender-specific knees with an average 10.8-year follow-up, and 192 patients who received oxidized zirconium knees with an average 13.5-year follow-up. There were 186 men and 720 women (mean age, 53.3 years; range, 40-60). The mean follow-up was 12.6 years. RESULTS We found similar postoperative Knee Society knee and function scores (P = .693 and P = .698, respectively), postoperative Western Ontario MacMaster Universities Osteoarthritis Index score (P = .523), University of California, Los Angeles activity score (P = .651) and range of knee motion (P = .417), radiographic results (P > .05), revision rates (P = .241), and survivorship (P = .981) of the implants. CONCLUSIONS Range of knee motion, prevalence of polyethylene wear, osteolysis, revision rates, and survivorship of 5 models of total knee arthroplasties were similar. We believe that good designs with a good quality of polyethylene and defined surgical techniques provided good clinical and radiographic outcomes of these 5 models of total knee arthroplasties at this length of follow-up.
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Thomsen MG, Latifi R, Kallemose T, Husted H, Troelsen A. Does knee awareness differ between different knee arthroplasty prostheses? A matched, case-control, cross-sectional study. BMC Musculoskelet Disord 2016; 17:141. [PMID: 27036995 PMCID: PMC4818449 DOI: 10.1186/s12891-016-1001-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 03/30/2016] [Indexed: 12/11/2022] Open
Abstract
Background Low knee awareness after Total Knee Arthroplasty (TKA) has become the ultimate goal in trying to achieve a natural feeling knee that meet patient expectations. To accommodate this manufacturers of TKAs have developed new prosthetic designs that potentially could give patients a more natural feeling knee during activities. The purpose af this study was to compare the Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) of patients treated with a previous generation standard Cruciate Retaining (CR) TKA to the scores obtained by patients treated with a newer generation CR TKA or a mobile bearing CR TKA. Methods We identified all patients receiving a new generation CR TKA or mobile bearing TKA at our institution between 2010 and 2012. These were matched to a population of patients receiving a standard CR TKA regarding age, gender, year of surgery, Kellgren-Lawrence (KL) grade and pre- and postoperative knee alignment. Patients were asked to complete the FJS and OKS questionnaires. Of the 316 patients completing the survey 64 standard CR TKAs to 35 new generation CR TKAs and 121 standard CR TKAs to 68 mobile bearing TKAs were matched. The FJS and OKS scores of the three TKA designs were compared. Results When comparing the new generation CR TKAs to the standard CR TKAs we found statistically significant higher OKS and FJS scores (6 (p = 0.04) and 16 (p = 0.03) points respectively) for the new generation CR TKAs. When comparing the mobile bearing TKAs to the standard CR TKAs we found a statistically significant higher OKS score (3 points, p = 0.04), and a higher but non-significant FJS score (4 points, p = 0.48) for the mobile bearing TKAs. Conclusions Patients receiving the new generation CR TKA obtained higher FJS and OKS scores when compared to patients receiving a standard CR TKA, indicating that the use of this newer prosthetic design facilitate less knee awareness and better function after TKA.
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Affiliation(s)
- Morten G Thomsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark.
| | - Roshan Latifi
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Henrik Husted
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
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