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Hirakawa M, Miyazaki M, Nagashima Y, Akase H, Matsuda S, Kaku N. Asymmetric Implant Design for Posterolateral Overhang of the Femoral Component in Total Knee Arthroplasty: A Retrospective Computed Tomography-Based Study. Cureus 2024; 16:e56862. [PMID: 38659568 PMCID: PMC11040276 DOI: 10.7759/cureus.56862] [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] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction During total knee arthroplasty (TKA), also referred to as total knee replacement (TKR), patients may experience pain in the posterolateral knee. One possible cause is the impingement between the popliteus tendon and the femoral components. The purpose of this study was to analyze the posterolateral overhang of the femoral component using 3D template software. Methods Preoperative CT scan images of 50 knees (11 males and 39 females) with osteoarthritis of grade 2 or lower according to the Kellgren-Lawrence classification were analyzed. The mean age of the subjects was 73.8±7.6 years (range 52-84 years). The Athena (Soft Cube Co., Ltd., Osaka, Japan) knee 3D image-matching software was used for the analysis. The positions of the two femoral components (symmetrical and asymmetrical) were simulated. In the coronal plane, the component overhang was measured between the resected lateral part of the posterior femur and its corresponding component size, and the two designs were compared in three zones (proximal, central, and distal). Results In the simulated femoral component, the asymmetric design had a significantly lower component overhang than the symmetric design in the proximal zone of the lateral posterior condyle (0.2±1.9 mm vs. 3.5±1.6 mm, p<0.01). In the proximal zone, significant overhang (>3 mm) was observed in 30 knees (60.0%) with the symmetric design, but only three knees (6.0%) had asymmetric designs (p<0.01). Conclusions The posterolateral overhang of the lateral posterior condyle occurs when a symmetrical prosthesis is used. The use of an asymmetric implant with a small, rounded proximal portion of the lateral posterior condyle improves this overhang and is expected to decrease problems such as impingement of the popliteus tendon and improve patient satisfaction.
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Affiliation(s)
| | | | - Yu Nagashima
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Hiroya Akase
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Shogo Matsuda
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
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2
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Connolly P, Coombs S, Schwarzkopf R. Mechanical complications after total knee arthroplasty. Expert Rev Med Devices 2023; 20:1105-1117. [PMID: 37950354 DOI: 10.1080/17434440.2023.2282744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION With the increasing demand for total knee arthroplasty (TKA) and the burden of revision TKA on the healthcare system, as well as the quality of life implications for patients, it is extremely important for surgeons to be able to anticipate and prevent TKA mechanical complications. Surgeons must be familiar with the different causes and mechanisms of TKA complications so that they can properly treat patients with failed TKAs and better avoid these complications. AREAS COVERED This review addresses TKA mechanical complications and provides context for the topic. A detailed review of surgical factors, implant factors, and patient factors that contribute to mechanical complications after TKA is provided. All of the literature cited in this review was gathered from the PubMed online database using different keywords based on the section of the manuscript. EXPERT OPINION As surgeons and engineers solve certain issues in TKA, new challenges will inevitably arise. We must continue to push forward and innovate from both a surgical technique and implant design perspective.
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Affiliation(s)
- Patrick Connolly
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Stefan Coombs
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Bolam SM, Tay ML, Zaidi F, Sidaginamale RP, Hanlon M, Munro JT, Monk AP. Introduction of ROSA robotic-arm system for total knee arthroplasty is associated with a minimal learning curve for operative time. J Exp Orthop 2022; 9:86. [PMID: 36042122 PMCID: PMC9427173 DOI: 10.1186/s40634-022-00524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The introduction of robotics for total knee arthroplasty (TKA) into the operating theatre is often associated with a learning curve and is potentially associated with additional complications. The purpose of this study was to determine the learning curve of robotic-assisted (RA) TKA within a multi-surgeon team. Methods This prospective cohort study included 83 consecutive conventional jig-based TKAs compared with 53 RA TKAs using the Robotic Surgical Assistant (ROSA) system (Zimmer Biomet, Warsaw, Indiana, USA) for knee osteoarthritis performed by three high-volume (> 100 TKA per year) orthopaedic surgeons. Baseline characteristics including age, BMI, sex and pre-operative Kellgren-Lawrence graded and Hip-Knee-Ankle Axis were well-matched between the conventional and RA TKA groups. Cumulative summation (CUSUM) analysis was used to assess learning curves for operative times for each surgeon. Peri-operative and delayed complications (infection, periprosthetic fracture, thromboembolism, and compromised wound healing) and revisions were reviewed. Results The CUSUM analysis for operative time demonstrated an inflexion point after 5, 6 and 15 cases for each of the three surgeons, or 8.7 cases on average. There were no significant differences (p = 0.53) in operative times between the RA TKA learning (before inflexion point) and proficiency (after inflexion point) phases. Similarly, the operative times of the RA TKA group did not differ significantly (p = 0.92) from the conventional TKA group. There was no discernible learning curve for the accuracy of component planning using the RA TKA system. The average length of post-operative follow-up was 21.3 ± 9.0 months. There was one revision for instability in the conventional TKA group and none in the RA TKA group. There were no significant difference (p > 0.99) in post-operative complication rates between the conventional TKA and RA TKA groups. Conclusions The introduction of the RA TKA system was associated with a learning curve for operative time of 8.7 cases. Operative times between the RA TKA and conventional TKA group were similar. The short learning curve implies this RA TKA system can be adopted relatively quickly into a surgical team with minimal risks to patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00524-5.
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Affiliation(s)
- Scott M Bolam
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand. .,Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Building 502 20185 Park Road, Grafton, 1023, Auckland, New Zealand.
| | - Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Building 502 20185 Park Road, Grafton, 1023, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Faseeh Zaidi
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Building 502 20185 Park Road, Grafton, 1023, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Michael Hanlon
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacob T Munro
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Building 502 20185 Park Road, Grafton, 1023, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Building 502 20185 Park Road, Grafton, 1023, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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4
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Tay ML, Carter M, Zeng N, Walker ML, Young SW. Robotic-arm assisted total knee arthroplasty has a learning curve of 16 cases and increased operative time of 12 min. ANZ J Surg 2022; 92:2974-2979. [PMID: 36398352 PMCID: PMC9804534 DOI: 10.1111/ans.17975] [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: 01/25/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Robotic-arm assisted systems are increasingly used for knee arthroplasty, however introduction of new systems can involve a learning curve. We aimed to define the learning curve in terms of operative time and component placement/sizing of a robotic system for total knee arthroplasty (TKA) in a team of experienced surgeons, and to investigate mid-term patient outcomes. METHODS A total of 101 consecutive patients underwent primary robotic-arm assisted TKA by three surgeons (mean 2 year follow-up). Operative times, component placement, implant sizing and reoperations were recorded. Cumulative Summation (CUSUM) was used to analyse learning curves. Patient outcomes were compared between learning and proficiency phases. RESULTS The learning curve was 16 cases, with a 12-min increase in operative time (P < 0.01). Once proficiency was achieved, the greatest time reductions were seen for navigation registration (P = 0.003) and bone preparation (P < 0.0001). A learning curve was found with polyethylene (PE) insert sizing (P = 0.01). No differences were found between learning and proficiency groups in terms of implant survival (100% and 97%, respectively, NS) or patient-reported outcome measures at 2 years (NS). CONCLUSION Introduction of a robotic-arm assisted system for TKA led to increased operative times for navigation registration and bone preparation, and a learning curve with PE insert sizing. No difference in patient outcomes between learning and proficiency groups at 2 years was found. These findings can inform surgeons' expectations when starting to use robotic-assisted systems.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS)University of AucklandAucklandNew Zealand,Department of Orthopaedic SurgeryNorth Shore Hospital, Waitematā DHBAucklandNew Zealand
| | | | - Nina Zeng
- Department of Orthopaedic SurgeryNorth Shore Hospital, Waitematā DHBAucklandNew Zealand
| | - Matthew L. Walker
- Department of Orthopaedic SurgeryNorth Shore Hospital, Waitematā DHBAucklandNew Zealand
| | - Simon W. Young
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS)University of AucklandAucklandNew Zealand,Department of Orthopaedic SurgeryNorth Shore Hospital, Waitematā DHBAucklandNew Zealand
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5
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Dupraz I, Thorwächter C, Grupp TM, Hammerschmid F, Woiczinski M, Jansson V, Müller PE, Steinbrück A. Impact of femoro-tibial size combinations and TKA design on kinematics. Arch Orthop Trauma Surg 2022; 142:1197-1212. [PMID: 34021794 DOI: 10.1007/s00402-021-03923-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The variability in patients' femoral and tibial anatomy requires to use different tibia component sizes with the same femoral component size. These size combinations are allowed by manufacturers, but the clinical impact remains unclear. Therefore, the goals of our study were to investigate whether combining different sizes has an impact on the kinematics for two well-established knee systems and to compare these systems' kinematics to the native kinematics. MATERIALS AND METHODS Six fresh frozen knee specimens were tested in a force controlled knee rig before and after implantation of a cruciate retaining (CR) and a posterior-stabilized (PS) implant. Femoro-tibial kinematics were recorded using a ultrasonic-based motion analysis system while performing a loaded squat from 30° to 130°. In each knee, the original best fit inlay was then replaced by different inlays simulating a smaller or bigger tibia component. The kinematics obtained with the simulated sizes were compared to the original inlay kinematics using descriptive statistics. RESULTS For all size combinations, the difference to the original kinematics reached an average of 1.3 ± 3.3 mm in translation and - 0.1 ± 1.2° in rotation with the CR implant. With the PS implant, the average differences reached 0.4 ± 2.7 mm and - 0.2 ± 0.8°. Among all knees, no size combination consistently resulted in significantly different kinematics. Each knee showed a singular kinematic pattern. For both knee systems, the rotation was smaller than in the native knee, but the direction of the rotation was preserved. The PS showed more rollback and the CR less rollback than the native knee. CONCLUSION TKA systems designed with a constant tibio-femoral congruency among size combinations should enable to combine different sizes without having substantial impact on the kinematics. The rotational pattern was preserved by both TKA systems, while the rollback could only be maintained by the PS design.
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Affiliation(s)
- Ingrid Dupraz
- Aesculap AG, Research and Development, Am Aesculap Platz 1, 78532, Tuttlingen, Germany.
| | - Christoph Thorwächter
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Thomas M Grupp
- Aesculap AG, Research and Development, Am Aesculap Platz 1, 78532, Tuttlingen, Germany
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Florian Hammerschmid
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Arnd Steinbrück
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
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Takahashi T, Matsumura T, Takeshita K. Total knee arthroplasty, following application of Taylor Spatial Frames to treat knee osteoarthritis with severe tibia extraarticular deformity due to fracture malunion: A case report. Trauma Case Rep 2022; 39:100640. [PMID: 35345780 PMCID: PMC8957042 DOI: 10.1016/j.tcr.2022.100640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 11/28/2022] Open
Abstract
Obtaining alignment during end-stage knee osteoarthritis with extraarticular deformities has always been challenging. Therefore, we report a case of total knee arthroplasty, following the application of Taylor Spatial Frame to treat knee osteoarthritis with severe tibia extraarticular deformity due to a proximal tibia fracture injury for more than 50 years ago. First, proximal tibial opening wedge osteotomy was conducted below the patellar tendon insertion from the anterior to the posterior direction to correct the deformity in multiple planes gradually. Then, osteotomy was done to restore both the varus and recurvatum deformities. Finally, Taylor Spatial Frame was used as a virtual hinge, with gradual adjustments to correct the deformity. Afterward, patient-specific instrumentation-assisted total knee arthroplasty was conducted after correcting the extraarticular deformity. During the two-year follow-up, no superficial and deep infection occurred, and his Oxford Knee Score had improved from 32 to 19 out of 48 at the time of the latest follow-up. Moreover, the patient walked using a one-hand clutch without protective limping. Hence, patient-specific instrumentation-assisted total knee arthroplasty, following proximal tibial osteotomy with Taylor Spatial Frame, should be considered a treatment option for patients with knee osteoarthritis having severe proximal tibia extraarticular deformity.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
- Corresponding author at: Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, 1-15-4 Shimokoyama, 329-0502, Japan.
| | - Tomohiro Matsumura
- Jichi Medical University Hospital Life Saving Emergency Center, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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7
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Tucker K, Günther KP, Kjaersgaard-Andersen P, Lützner J, Kretzer JP, Nelissen RGHH, Lange T, Zagra L. EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty. EFORT Open Rev 2021; 6:982-1005. [PMID: 34909220 PMCID: PMC8631244 DOI: 10.1302/2058-5241.6.210080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures.
Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080
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Affiliation(s)
- Keith Tucker
- Orthopaedic Data Evaluation Panel (ODEP), Norwich, UK
| | - Klaus-Peter Günther
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | | | - Jörg Lützner
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Toni Lange
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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8
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Jones CW, Jacobs H, Shumborski S, Talbot S, Redgment A, Brighton R, Walter WL. Sagittal Stability and Implant Design Affect Patient Reported Outcomes After Total Knee Arthroplasty. J Arthroplasty 2020; 35:747-751. [PMID: 31735490 DOI: 10.1016/j.arth.2019.10.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Joint stability is one of the goals of any joint replacement. The contribution of prosthesis design to sagittal stability in total knee arthroplasty (TKA) has emerged as an area of interest. The purpose of this study was to evaluate the sagittal stability of four prosthesis types and determine the effect on patient reported outcome measures (PROMs). METHODS A matched-cohort cross-sectional study was performed on 60 patients after TKA at 1-year follow-up. Three surgeons performed 10 medially stabilized (MS) TKA and 10 non-MS TKA. Sagittal stability was assessed by a blinded observer using a KT-1000 arthrometer, Lachman's test, and the anterior drawer test. PROMs (Oxford, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten joint score) and visual analog scale assessed function and satisfaction. RESULTS MS TKA had significantly decreased translation on KT-1000 and improved stability compared with non-MS TKA (P < .05). Increased PROMs were demonstrated in the MS TKA group compared with the non-MS TKA group (P < .05). When divided based on objective stability, regardless of the prosthesis type, patients with a stable knee had superior PROMs (P < .05), particularly in sport-related questions. CONCLUSION The MS TKA had significantly greater sagittal stability, improved PROMs, and satisfaction compared with non-MS TKA. Independent of prosthesis design, patients with greater sagittal stability demonstrated improved PROMs.
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Affiliation(s)
- Christopher W Jones
- Fiona Stanley Hospital Group & Orthopaedics WA, Perth, Australia; Curtin University, Perth, Australia; University of Sydney, Sydney, Australia
| | - Hans Jacobs
- Steve Biko Academic Hospital, The University of Pretoria, Pretoria, South Africa
| | | | - Simon Talbot
- Orthopaedic Department, Western Health, Melbourne, Australia
| | | | | | - William L Walter
- The University of Sydney & Northern Local Area Health District (Royal North Shore Hospital), Sydney, Australia
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9
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Odgaard A, Laursen MB, Gromov K, Troelsen A, Kristensen PW, Schrøder H, Madsen F, Overgaard S. Mismatch 'never events' in hip and knee arthroplasty: a cohort and intervention study. Bone Joint J 2019; 101-B:960-969. [PMID: 31362543 DOI: 10.1302/0301-620x.101b8.bjj-2018-1124.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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 give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. MATERIALS AND METHODS Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II). RESULTS A total of 26 524 arthroplasties were analyzed. From 12 307 procedures that were undertaken before implementation of the compatibility check, 21 class A incompatibilities were identified (real- or high-risk combinations; 0.17%; 95% confidence interval (CI) 0.11 to 0.26). From 5692 hip and 6615 knee procedures prior to implementation of the compatibility check, we found rates of class A-I incompatibility (real- or high-risk combinations unknowingly inserted) of 0.14% (95% CI 0.06 to 0.28) and 0.17% (95% CI 0.08 to 0.30), respectively. From 14 217 procedures after the introduction of compatibility checking (7187 hips and 7030 knees), eight class A incompatibilities (0.06%; 95% CI 0.02 to 0.11) were identified. This difference was statistically significant (p = 0.008). CONCLUSION Our data presents validated estimates of the baseline incidence of incompatibility events for hip and knee arthroplasty procedures and shows that a significant reduction in class A incompatibility events is possible using a web-based recording system. Cite this article: Bone Joint J 2019;101-B:960-969.
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Affiliation(s)
- A Odgaard
- Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - M B Laursen
- Aalborg University Hospital, Aalborg, Denmark
| | - K Gromov
- Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - A Troelsen
- Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | | | - F Madsen
- Aarhus University Hospital, Aarhus, Denmark
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Ishida K, Shibanuma N, Takayama K, Kurosaka M, Kuroda R, Matsumoto T. Posterior Reference Position Affects Intraoperative Kinematic and Soft Tissue Balance in Navigated Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2018; 33:2851-2857. [PMID: 29805103 DOI: 10.1016/j.arth.2018.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The importance of medial compartment stability is recognized in total knee arthroplasty (TKA). To manage the medial extension-flexion gap, the posterior reference position can be changed from conventional posterior center to posterior medial in measured resection techniques. This study aimed to compare the intraoperative soft tissue balance and rotational kinematics between the posterior medial and posterior center reference groups. METHODS We enrolled 57 consecutive patients with varus osteoarthritis undergoing posterior-stabilized (PS) TKA using an image-free navigation system. The detailed surgical plan in both groups and intraoperative kinematics were recorded using navigation, and soft tissue balance measured with an offset-type tensor was statistically compared between groups. RESULTS Patients were divided into the posterior center reference group (n = 32) and posterior medial reference group (n = 25). The posterior medial and posterior lateral condyles were significantly thicker in the posterior center reference group (P < .05). Although preoperative rotational kinematics were comparable between groups, the tibial rotational position was significantly more externally rotated in the posterior center reference group than in the posterior medial reference group at 45°, 60°, and 90° of flexion (P < .05). The varus angle and joint component gap were significantly smaller in the posterior medial reference group than in the posterior center reference group at 60° and 90° of flexion (P < .05). CONCLUSION The posterior reference position affects intraoperative kinematics and soft tissue balance in navigated PS TKA. Posterior medial reference PS TKA decreases the excessive tibial external rotation during midflexion and increases the flexion stability compared with conventional posterior center reference PS TKA.
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Affiliation(s)
- Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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11
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Song SJ, Park CH, Liang H, Kang SG, Park JJ, Bae DK. Comparison of Clinical Results and Injury Risk of Posterior Tibial Cortex Between Attune and Press Fit Condylar Sigma Knee Systems. J Arthroplasty 2018; 33:391-397. [PMID: 29066248 DOI: 10.1016/j.arth.2017.09.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/16/2017] [Accepted: 09/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We compared clinical and radiographic results after total knee arthroplasty (TKA) using Attune and Press Fit Condylar Sigma, and investigated whether use of the current prosthesis increased injury risk to the tibial cortex in Asian patients. We also assessed whether a preoperative posterior tibial slope angle (PSA) is associated with the injury when using the current prosthesis. METHODS The 300 TKAs with Attune (group A) were compared to the 300 TKAs with Press Fit Condylar Sigma (group B). Demographics were not different, except follow-up periods (24.8 vs 33.3 months, P < .001). The Western Ontario and McMaster Universities Index and range of motion were compared. A minimum distance between tibial component stem and posterior tibial cortex (mDSC) was compared. The correlation between preoperative PSA and mDSC was analyzed in group A. RESULTS The postoperative Western Ontario and McMaster Universities Index and range of motion of group A were better than those of group B (17.7 vs 18.8, P = .004; 131.4° vs 129.0°, P = .008). The mDSC was shorter in group A (6.3 vs 7.0 mm, P < .001), which made up a higher proportion of the high-risk group for posterior tibial cortical injury with an mDSC of <4 mm (20.0% vs 10.7%, P = .002). A negative correlation was found between the preoperative PSA and mDSC in group A (r = -0.205, P < .001). CONCLUSION The TKA using the current prosthesis provided more satisfactory results than the TKA using the previous prosthesis. However, the injury risk to the posterior tibial cortex increased in the knees with a large PSA when using the current prosthesis for Asian patients.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Hu Liang
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Se Gu Kang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jong Jun Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
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Murakami K, Hamai S, Okazaki K, Ikebe S, Nakahara H, Higaki H, Shimoto T, Mizu-Uchi H, Kuwashima U, Iwamoto Y. Kinematic analysis of stair climbing in rotating platform cruciate-retaining and posterior-stabilized mobile-bearing total knee arthroplasties. Arch Orthop Trauma Surg 2017; 137:701-711. [PMID: 28289890 DOI: 10.1007/s00402-017-2662-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of our study was to compare and contrast the effects of two types of mobile-bearing total knee arthroplasties (TKA), namely, the cruciate-retaining (CR) and posterior-stabilized (PS) TKAs, on clinical outcomes and in vivo kinematics during stair climbing. MATERIALS AND METHODS The Press-Fit Condylar Sigma rotating platform was used for both CR and PS TKAs. Patient-reported outcomes were assessed using the 2011 Knee Society Score. Quadriceps muscle strength was evaluated by isokinetic dynamometry. In vivo kinematics were evaluated using periodic sagittal plane radiographic images obtained during stair climbing to quantify anteroposterior (AP) tibiofemoral translation, implant flexion and axial rotation angles using image-matching techniques. Outcomes were evaluated in 20 TKAs, which had been undergone with clinical success, including ten knees with CR types and ten knees with PS types. RESULTS There were no significant differences between the CR and PS TKA groups (p > 0.05) in isometric extensor torque (1.0 ± 0.2 and 1.1 ± 0.6 N m/kg, respectively) or patient-reported score for stair climbing function (4.0 ± 0.5 and 3.8 ± 0.9, respectively). Both types of TKAs showed stable AP translation in the mid range of knee flexion and paradoxical translation in the low range of flexion, with limited rotation, during stair climbing. There were no significant differences between the CR and PS TKA groups (P > 0.05) in anterior translation from 80° to 40° of knee flexion (4.2 ± 1.2 and 3.5 ± 1.6 mm, respectively), posterior translation from 40° to 10° of knee flexion (2.3 ± 1.9 and 2.0 ± 1.5 mm, respectively), and total external rotation (2.8° ± 4.9° and 0.5° ± 5.0°, respectively). CONCLUSIONS Both CR and PS types of rotating platform mobile-bearing TKAs provided reproducible knee joint kinematics during stair climbing and equivalent clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Koji Murakami
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Katai Orthopaedic Hospital, 132-1 Okuma Kasuya-machi, Kasuya-gun, Fukuoka, 811-2302, Japan
| | - Satoru Ikebe
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Hiroyuki Nakahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Takeshi Shimoto
- Department of Information and Systems Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka, 811-0295, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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13
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Kim MS, Koh IJ, Choi YJ, Kim YD, In Y. Correcting Severe Varus Deformity Using Trial Components During Total Knee Arthroplasty. J Arthroplasty 2017; 32:1488-1495. [PMID: 28017574 DOI: 10.1016/j.arth.2016.11.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/20/2016] [Accepted: 11/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Extensive medial soft tissue release may be necessary to correct severe varus deformity during total knee arthroplasty (TKA). However, this procedure may result in instability. Here, we describe a novel soft tissue balancing technique, which can minimize medial release in severe varus deformity during TKA. METHODS Fifty knees (40 patients) with hip-knee-ankle angle of more than 20° of varus were corrected using this technique (group 1). After achieving flexion gap balancing by needle puncturing and spreading of the superficial medial collateral ligament, extension gap balancing was obtained by gradual extension with the trial components in place. After group 1 was set, a one-to-one patient-matched control group who had mild varus deformity was selected by propensity score matching (50 knees, 48 patients, group 2). At postoperative 1 year, mediolateral laxity was compared between the 2 groups using the stress radiographs. Clinical outcomes were also compared using the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index score. RESULTS There were no differences in mean medial and lateral laxities between groups 1 and 2 at 1 year after the operation (medial laxity: 2.3° ± 1.4° and 2.7° ± 1.3°, respectively, P = .310) (lateral laxity: 3.6° ± 1.7° and 3.2° ± 2.0°, respectively, P = .459). There were no significant differences in postoperative clinical scores and knee alignment. CONCLUSION Our technique of obtaining extension gap balancing using trial components led to safe and effective balancing by avoiding unnecessary extensive release in severe varus deformity during TKA.
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Affiliation(s)
- Man S Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In J Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young J Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong D Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Vertullo CJ, Lewis PL, Graves S, Kelly L, Lorimer M, Myers P. Twelve-Year Outcomes of an Oxinium Total Knee Replacement Compared with the Same Cobalt-Chromium Design: An Analysis of 17,577 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2017; 99:275-283. [PMID: 28196029 DOI: 10.2106/jbjs.16.00092] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Oxidized zirconium (Oxinium) was introduced as an alternative bearing surface to cobalt-chromium (CoCr) in an attempt to reduce polyethylene wear and decrease aseptic mechanical failure of total knee replacements. While noncomparative reports have been described as promising, we were aware of no short or long-term clinical studies showing the superiority of Oxinium on polyethylene as a bearing surface. Using data from a comprehensive national joint replacement registry, we compared the long-term outcomes after cruciate-retaining total knee arthroplasty (TKA) with an Oxinium femoral component and those with the same prosthetic design but with a CoCr femoral component. METHODS The cohorts consisted of 17,577 cemented Genesis-II cruciate-retaining total knee replacements using non-cross-linked polyethylene, which included 11,608 with CoCr femoral components and 5,969 with Oxinium femoral components. The cumulative percent revision and hazard ratio (HR) for revision risk were estimated for the cemented Genesis-II Oxinium and CoCr cruciate-retaining TKAs performed in Australia from September 1, 1999, to December 31, 2013. In addition, the revision diagnoses and the effects of age and patellar resurfacing were examined. RESULTS No difference in the HR for revision risk was found between the Oxinium and CoCr cohorts for any age category for all causes of revision (HR = 0.92 [95% confidence interval (CI), 0.92 to 1.29]; p = 0.329), loosening or lysis, or aseptic causes, except for loosening or lysis in the group of patients who were ≥75 years old (p = 0.033). In these patients, TKA with Oxinium femoral components had a higher rate of revision. Younger patients preferentially received Oxinium femoral components. The revision risk was not affected by patellar resurfacing or nonresurfacing. At 12 years, the cumulative percent revision was 4.8% (95% CI, 4.2% to 5.4%) for the CoCr Genesis-II prosthesis compared with 7.7% (95% CI, 6.2% to 9.5%) for the Oxinium Genesis-II prosthesis. CONCLUSIONS In this cohort study involving the same prosthetic design, Oxinium femoral components did not reduce revision rates for all causes, loosening or lysis, or when infection as a cause of revision was removed compared with the same CoCr femoral component across all age groups including patients who were <55 years old. The cumulative percent revision was greater for the Oxinium components than for the CoCr components. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher J Vertullo
- 1Knee Research Australia, Gold Coast, Queensland, Australia 2Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia 3Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia 4Brisbane Orthopaedic & Sports Medicine Centre, Brisbane, Queensland, Australia
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van der List JP, Chawla H, Joskowicz L, Pearle AD. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24:3482-3495. [PMID: 27600634 DOI: 10.1007/s00167-016-4305-9] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022]
Abstract
Recently, there is a growing interest in surgical variables that are intraoperatively controlled by orthopaedic surgeons, including lower leg alignment, component positioning and soft tissues balancing. Since more tight control over these factors is associated with improved outcomes of unicompartmental knee arthroplasty and total knee arthroplasty (TKA), several computer navigation and robotic-assisted systems have been developed. Although mechanical axis accuracy and component positioning have been shown to improve with computer navigation, no superiority in functional outcomes has yet been shown. This could be explained by the fact that many differences exist between the number and type of surgical variables these systems control. Most systems control lower leg alignment and component positioning, while some in addition control soft tissue balancing. Finally, robotic-assisted systems have the additional advantage of improving surgical precision. A systematic search in PubMed, Embase and Cochrane Library resulted in 40 comparative studies and three registries on computer navigation reporting outcomes of 474,197 patients, and 21 basic science and clinical studies on robotic-assisted knee arthroplasty. Twenty-eight of these comparative computer navigation studies reported Knee Society Total scores in 3504 patients. Stratifying by type of surgical variables, no significant differences were noted in outcomes between surgery with computer-navigated TKA controlling for alignment and component positioning versus conventional TKA (p = 0.63). However, significantly better outcomes were noted following computer-navigated TKA that also controlled for soft tissue balancing versus conventional TKA (mean difference 4.84, 95 % Confidence Interval 1.61, 8.07, p = 0.003). A literature review of robotic systems showed that these systems can, similarly to computer navigation, reliably improve lower leg alignment, component positioning and soft tissues balancing. Furthermore, two studies comparing robotic-assisted with computer-navigated surgery reported superiority of robotic-assisted surgery in controlling these factors. Manually controlling all these surgical variables can be difficult for the orthopaedic surgeon. Findings in this study suggest that computer navigation or robotic assistance may help managing these multiple variables and could improve outcomes. Future studies assessing the role of soft tissue balancing in knee arthroplasty and long-term follow-up studies assessing the role of computer-navigated and robotic-assisted knee arthroplasty are needed.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA.
| | - Harshvardhan Chawla
- Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
| | - Leo Joskowicz
- Computer Assisted Surgery and Medical Image Processing Laboratory, School of Engineering and Computer Science, Hebrew University, Jerusalem, Israel
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
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Effect of femoro-tibial component size mismatch on outcome in primary total knee replacement. Knee 2016; 23:532-4. [PMID: 27083320 DOI: 10.1016/j.knee.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/28/2016] [Accepted: 03/15/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Most total knee arthroplasty systems allow a degree of femoro-tibial component size mismatch. We aim to investigate the influence of size mismatch on outcome after primary total knee arthroplasty. METHODS We reviewed 332 patients with cruciate-retaining Genesis II total knee arthroplasty with regard to femoro-tibial component size mismatch and Oxford Knee Score (OKS). We evaluated effects of Body Mass Index, gender and patellar procedure. Minimum follow-up is five years. We divided patients into four groups (tibial component larger than femoral component, no mismatch, femoral component one size larger and femoral component two sizes larger than tibial component). RESULTS There was no statistically significant difference in OKS between the four groups. Size mismatch did not have a statistical significant effect on OKS in a multivariate analysis. Women had mismatched components in 66% of all cases and men in 40% of all cases. CONCLUSIONS Our study showed no statistically significant effect of femoro-tibial size mismatch on outcome after total knee replacement. Compared to men, women tend to have more component size mismatch. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Effects of Reduction Osteotomy on Gap Balancing During Total Knee Arthroplasty for Severe Varus Deformity. J Arthroplasty 2015; 30:2116-20. [PMID: 26239234 DOI: 10.1016/j.arth.2015.06.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 02/01/2023] Open
Abstract
This study aimed to assess the effects of down-sizing and lateralizing of the tibial component (reduction osteotomy) on gap balancing in TKA, and the clinical feasibility of an uncemented modular trabecular metal tibial tray in this technique. Reduction osteotomy was performed for 39 knees of 36 patients with knee OA with a mean tibiofemoral angle of 21° varus. In 20 knees, appropriate gap balance was achieved by release of the deep medial collateral ligament alone. Flexion gap imbalance could be reduced by approximately 1.7° and 2.8° for 4-mm osteotomy and 8-mm osteotomy, respectively. Within the first postoperative year, clinically-stable tibial component subsidence was observed in 9 knees, but it was not progressive, and the clinical results were excellent at a mean follow-up of 3.3 years.
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