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LaCour MT, Dessinger GM, Haas SB, Komistek RD. In Vivo Weight-Bearing Kinematics for Constrained Versus Traditional Bicruciate Stabilized Total Knee Arthroplasty Cohorts Compared to the Normal Knee. J Arthroplasty 2024; 39:1589-1594. [PMID: 38040066 DOI: 10.1016/j.arth.2023.11.033] [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: 03/27/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Constrained inserts in total knee arthroplasty (TKA) may offer additional stability, but can this insert type allow unrestricted movements or will the extra conformity cause kinematic conflict with the cam-post mechanism in deeper flexion? The objective of this study was to evaluate the weight-bearing kinematics of both traditional and constrained bicruciate stabilized (BCS) TKA inserts to determine if the rollback induced by the cam-post mechanism will work in unison with the constrained polyethylene insert. METHODS This study used previously published 3-dimensional model fitting techniques to compare weight-bearing flexion and femoro-tibial condylar motion patterns for 20 patients who had a traditional insert, 20 patients who had a constrained insert, and 10 previously published nonimplanted knees, all performing a deep knee bend activity while under fluoroscopic surveillance. RESULTS The results from this study indicate that subjects having a bicruciate stabilized TKA experienced similar postoperative kinematics for both constrained and unconstrained insert options, comparable to normal knees. CONCLUSIONS Subjects in this study having either a constrained or traditional insert experienced progressive rollback of both condyles, with the lateral condyle rolling more posterior than the medial condyle, leading to axial rotation. Although less in magnitude, these results were comparable to the normal knee in pattern, indicating that kinematic conflict did not occur for subjects having a constrained insert.
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Affiliation(s)
- Michael T LaCour
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
| | - Garett M Dessinger
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
| | - Steven B Haas
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
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2
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Sanz-Ruiz P, León-Román VE, Matas-Diez JA, Villanueva-Martínez M, Vaquero J. Long-term outcomes of one single-design varus valgus constrained versus one single-design rotating hinge in revision knee arthroplasty after over 10-year follow-up. J Orthop Surg Res 2022; 17:135. [PMID: 35246182 PMCID: PMC8896104 DOI: 10.1186/s13018-022-03026-3] [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: 01/10/2022] [Accepted: 02/18/2022] [Indexed: 08/30/2023] Open
Abstract
Background The appropriate degree of constraint in knee prosthetic revision is unknown, necessitating the use of the lowest possible constraint. This study aimed to compare the long-term clinical and survival results of revision with rotation hinge knee (RHK) VS constrained condylar constrained knee (CCK) implants. Methods Overall, 117 revision case were prospectively reviewed and dividing into two groups based on the degree of constraint used, using only one prosthetic model in each group (61 CCK vs 56 RHK). All implants were evaluated for a minimum of 10 years. Survival of both implants at the end of follow-up, free from revision for any cause, aseptic loosening, and septic cause was compared. Results Better results were seen with use of the RHK in joint ranges of (p = 0.023), KSCS (p = 0.015), KSFS (p = 0.043), and KOOS (p = 0.031). About 22.2% of the cases required repeat surgery (11.7% RHK vs 29.6% CCK, p = 0.023). Constrained condylar implants had a significantly lower survival rates than rotating hinge implants (p = 0.005), due to a higher aseptic loosening rate (p = 0.031). Conclusion Using a specific RHK design with less rotational constraint has better clinical and survival outcomes than implants with greater rotational constraint, such as one specific CCK.
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Affiliation(s)
- Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain. .,Faculty of Medicine, Complutense University of Madrid, Pza. Ramón y Cajal, Square, University City, 28040, Madrid, Spain.
| | - Víctor Estuardo León-Román
- Department of Traumatology and Orthopaedic Surgery, Villalba Hospital, Carretera de Alpedrete a Moralzarzal M-608 Km 41, 28400, Collado Villalba, Spain
| | - José Antonio Matas-Diez
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain
| | | | - Javier Vaquero
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Calle Doctor Esquerdo nº 46, 28007, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Pza. Ramón y Cajal, Square, University City, 28040, Madrid, Spain
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Kahlenberg CA, Baral EC, Lieberman LW, Huang RC, Wright TM, Padgett DE. Retrieval Analysis of Polyethylene Components in Rotating Hinge Knee Arthroplasty Implants. J Arthroplasty 2021; 36:2998-3003. [PMID: 33931282 DOI: 10.1016/j.arth.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study examined a cohort of retrieved rotating hinge (RH) total knee arthroplasty implants of four different designs with emphasis on the surface damage observed on the polyethylene components. Our purpose was to determine if differences in polyethylene damage existed among the designs, and if those differences could be explained by differences in design characteristics. MATERIALS AND METHODS Seventy-two RH implants from four manufacturers (DePuy LPS/SROM, Zimmer NexGen, Stryker Howmedica MRH, and Biomet Finn-OSS) removed at the time of revision performed between 2002 and 2017 were identified in our institutional retrieval registry. Damage to the surfaces of the polyethylene was assessed using a subjective grading system and evaluated in multiple zones. Design characteristics that were evaluated included the following: location of the dwell point on the polyethylene component, posterior position of the axle, and amount of hyperextension and rotation allowed by the implant. RESULTS There were no differences in total damage scores between the four implant groups (P = .45). The Stryker Howmedica MRH group showed the least backside wear of all implants but significantly more articular-sided wear compared with two of the other three groups. All implants except NexGen showed increased total damage scores in implants revised for mechanical (vs nonmechanical) reasons and in implants with a longer duration of implantation. CONCLUSION No single implant design emerged as superior in terms of minimizing polyethylene wear damage. Polyethylene damage existed in various locations but was not different in severity across designs, suggesting that there is no clear superior RH design that minimizes overall articular surface wear compared with other designs.
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Affiliation(s)
- Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Elexis C Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | | | - Ronald C Huang
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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Cinotti G, Perfetti F, Petitti P, Giannicola G. Primary complex total knee arthroplasty with severe varus deformity and large bone defects: mid-term results of a consecutive series treated with primary implants. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1045-1053. [PMID: 34240244 DOI: 10.1007/s00590-021-03074-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In recent years, the use of constrained implants in complex primary TKA has gained popularity since these implants may better and more easily address severe instability present in complex primary cases (CPC). However, the need for a constrained TKA in CPC is controversial. We hypothesized that a standard TKA may be successful in most of CPC and that an intraoperative switching to a constrained device is rarely need even in the presence of severe instability and bone loss. MATERIALS AND METHODS A consecutive series of 24 CPC (28 knees) were analysed retrospectively. Inclusion criteria were a femoro-tibial angle > 12° and bone defect of grade 2-3 (group 1). Forty-eight patients (52 knees) were analysed as controls (group 2). Patients were followed up clinically and radiographically up to a minimum of 5 years. RESULTS In group 1, a PS was used in 24 knees and a CR in 4. In no patient, a CCK or RHK was implanted. Bone defect was treated with bone cement plus cortical screws in 15 knees (53.5%), a medial wedge in 8 (28.5%), a medial wedge plus bone grafting with cancellous screws in 5 (17.8%). Metaphyseal sleeve or cone was not used. At the last follow-up, no significant difference was found in the clinical scores between the 2 groups. CONCLUSION In CPC with marked varus deformity, instability and bone loss, the use of primary TKA is associated with a clinical outcome comparable to standard cases. Ligamentous balancing may be addressed using primary implants and simple cost-effective techniques may be used to manage an extensive bone loss. In most CPC, an intraoperative switching to a constrained device is not necessary.
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Affiliation(s)
- Gianluca Cinotti
- Department of Anatomical, Histological, Medico Legal and Orthopaedic Sciences, University La Sapienza, Rome, Italy.
| | - Fabiano Perfetti
- Department of Anatomical, Histological, Medico Legal and Orthopaedic Sciences, University La Sapienza, Rome, Italy
| | - Paolo Petitti
- Department of Anatomical, Histological, Medico Legal and Orthopaedic Sciences, University La Sapienza, Rome, Italy
| | - Giuseppe Giannicola
- Department of Anatomical, Histological, Medico Legal and Orthopaedic Sciences, University La Sapienza, Rome, Italy
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Zhang JY, Tian DM, Ren ZP, Hu YC, Yu XC. Influence of Congruency Design on the Contact Stress of a Novel Hinged Knee Prosthesis Using Finite Element Analysis. Orthop Surg 2020; 12:631-638. [PMID: 32159285 PMCID: PMC7189048 DOI: 10.1111/os.12640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives To investigate the contact stress and the contact area o tibial inserts and bushings with respect to different congruency designs in a spherical center axis and rotating bearing hinge knee prosthesis under gait cycle loading conditions using finite element analysis. Methods Nine prostheses with different congruency (different degrees of tibiofemoral conformity and different distances between the spherical center and the bushing) designs were developed with the same femoral and tibial components. The models were transferred to finite element software. The peak contact stresses and contact areas on tibial inserts and bushings under the gait cycle loading conditions were investigated and compared. Results For tibial insert, the peak contact stress was the highest in the low conformity‐long group (61.4486 MPa), and it was 1.88 times higher than that in the group with the lowest stress (moderate conformity‐short group, 32.754 MPa). The contact area was the largest in the low conformity‐long group (420.485 mm2), and it was 1.19 times larger than that in the group with the smallest area (moderate conformity‐middle group, 352.332 mm2). For bushing, the peak contact stress was the highest in the high conformity‐long group (72.8093 MPa), and it was 3.21 times higher than that in the group with the lowest stress (high conformity‐short group, 22.6928 MPa). The contact area was the largest in the low conformity‐short group (2.41 mm2), and it was 2.27 times larger than that in the group with the smallest area (high conformity‐middle group, 1.063 mm2). Conclusion The results of our study showed that the congruency of the tibiofemoral surface and bushing surface should be considered carefully in the design of the spherical center axis and rotating bearing hinge knee prosthesis. Different levels of contact performance were observed with different congruency designs. In addition, the influence of contact stress and contact area on the polyethylene wear of rotating hinge knee prostheses should be confirmed with additional laboratory tests.
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Affiliation(s)
- Jing-Yu Zhang
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China.,Department of Hand Surgery, Second Hospital of Tangshan, Tangshan, China
| | - Dong-Mu Tian
- Beijing Weigao Yahua Artificial Joint Development Company, Beijing, China
| | - Zhi-Peng Ren
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China
| | - Yong-Cheng Hu
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistice Support Force, Jinan, China
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Mou P, Zeng Y, Pei F, Zhou Z, Shen B, Kang P, Yang J. Medial femoral epicondyle upsliding osteotomy with posterior stabilized arthroplasty provided good clinical outcomes such as constrained arthroplasty in primary total knee arthroplasty with severe valgus deformity. Knee Surg Sports Traumatol Arthrosc 2019; 27:2266-2275. [PMID: 30430221 DOI: 10.1007/s00167-018-5292-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/09/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE A modified technique referred to as a medial femoral epicondyle upsliding osteotomy was proposed to address severe valgus deformity with unconstrained posterior stabilized (PS) arthroplasty. The study compared the effectiveness of the technique and PS arthroplasty with constrained arthroplasty during primary total knee arthroplasty (TKA). METHODS Fifty-three patients presenting with valgus knees with a mean valgus angle (VA) greater than 30° were prospectively randomized and divided into two groups, and both groups received primary TKA. Upsliding osteotomy with PS arthroplasty was performed on the knees of 27 patients (group A), while the remaining 26 patients (group B) received a constrained arthroplasty. The Knee Society function score (KSF), Hospital for Special Surgery knee score (HSS), range of motion (ROM), mediolateral stability and hospitalization expenses were recorded. The hip-knee-ankle angle (HKA), femorotibial angle (FTA) and VA were analysed. Complications were also recorded. RESULTS The patients received follow-up care for more than 50 months. The postoperative KSF, HSS and ROM showed marked improvement in both groups (p < 0.05). Radiological assessments showed that HKA, FTA and VA for group A were restored to (179.9 ± 3.0)°, (173.0 ± 2.4)° and (7.0 ± 2.4)°, respectively. For group B, the HKA, FTA and VA were restored to (181.5 ± 2.3)°, (172.5 ± 2.3)° and (7.5 ± 2.3)°, respectively. Only two patients from group A demonstrated mild medial laxity in their knees, and the remaining patients from both groups were stable medially and laterally. However, the total hospitalization expenses and material expenses of group A were less than those of group B because of the more expensive constrained prosthesis and stems. No late-onset loosening or recurrent valgus deformity was displayed. CONCLUSIONS Both medial femoral epicondyle upsliding osteotomy with PS arthroplasty and constrained arthroplasty showed good outcomes for the restoration of neutral limb alignment and soft tissue balance, which are demonstrated to be safe and effective techniques for correcting severely valgus knees. Therefore, the clinically important finding of this study is that medial femoral epicondyle upsliding osteotomy with PS arthroplasty can be an alternative method for correcting severe valgus knees. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ping Mou
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Zeng
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Pengde Kang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jing Yang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Yoon JR, Cheong JY, Im JT, Park PS, Park JO, Shin YS. Rotating hinge knee versus constrained condylar knee in revision total knee arthroplasty: A meta-analysis. PLoS One 2019; 14:e0214279. [PMID: 30908538 PMCID: PMC6433230 DOI: 10.1371/journal.pone.0214279] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 03/11/2019] [Indexed: 12/25/2022] Open
Abstract
There is debate in the literature whether rotating hinge knee (RHK) or constrained condylar knee (CCK) prostheses lead to better clinical outcomes and survival rates in patients undergoing revision total knee arthroplasty (RTKA). The purpose of this meta-analysis is to compare the survivorship and clinical outcomes of RHK and CCK prostheses. In this meta-analysis, we reviewed studies that evaluated pain and function scores, range of motion (ROM), complications, and survival rates in patients treated with RHK or CCK with short-term (<5 years) or midterm (5-10 years) follow-up. The survivorship was considered as the time to additional surgical intervention such as removal or revision of the components. A total of 12 studies (one randomized study and 11 non-randomized studies) met the inclusion criteria and were analyzed in detail. The proportion of the knees in which short-term (<5 years) survival rates (RHK, 83/95; CCK, 111/148; odds ratio [OR] 0.52; 95% CI, 0.24-1.11; P = 0.09) and midterm (5-10 years) survival rates (RHK, 104/128; CCK, 196/234; OR 1.05; 95% CI, 0.56-1.97; P = 0.88) were evaluated did not differ significantly between RHK and CCK prostheses. In addition, there were no significant differences in ROM (95% CI: -0.40 to 9.93; P = 0.07) and complication rates (95% CI: 0.66 to 2.49; P = 0.46). In contrast, CCK groups reported significantly better pain score (95% CI: 0.50 to 2.73; P = 0.005) and function score (95% CI: 0.01 to 2.00; P = 0.05) than RHK groups. This meta-analysis revealed that 87.4% of RHK and 75.0% of CCK prostheses survive at short-term (<5 years), while 81.3% of RHK and 83.8% of CCK prostheses survive at midterm (5-10 years). The differences in standardized mean pain and function scores we detected were likely to be imperceptible to patients and almost certainly below the minimum clinically important level, despite a significant difference in both groups. Based on the findings of the current meta-analysis, RHK prostheses continue to be an option in complex RTKA with reasonable midterm survivorship.
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Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Ji-Young Cheong
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jung-Taek Im
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Phil-Sun Park
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jae-Ok Park
- Medical Library, Veterans Health Service Medical Center, Seoul, South Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, South Korea
- * E-mail:
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Tashjian RZ, Chalmers PN. Future Frontiers in Shoulder Arthroplasty and the Management of Shoulder Osteoarthritis. Clin Sports Med 2018; 37:609-630. [DOI: 10.1016/j.csm.2018.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Mou P, Zeng Y, Yang J, Zhong H, Yin SJ, Li RB. The Effectiveness of Medial Femoral Epicondyle Up-Sliding Osteotomy to Correct Severe Valgus Deformity in Primary Total Knee Arthroplasty. J Arthroplasty 2018; 33:2868-2874. [PMID: 29805102 DOI: 10.1016/j.arth.2018.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND While many surgical techniques can achieve neutral limb alignment and soft tissue balance in severe valgus deformity during total knee arthroplasty (TKA), few published reports concern medial femoral epicondyle up-sliding osteotomy. METHODS A prospective investigation was conducted of patients with severe valgus deformities who underwent medial femoral epicondyle up-sliding osteotomy. Clinical measurements, radiological evaluation, and complication data were recorded. RESULTS Using posterior-stabilized prostheses, 26 patients underwent 28 TKAs performed by the same surgeon using medial femoral epicondyle up-sliding osteotomy to balance the soft tissue. On average, the follow-up was 54 ± 18 months, and the patient age was 63 ± 11 years. All knees were type II according to Krackow's classification. Varus-valgus knee motion was prohibited with the protection of long-leg knee brace for 3 months. At the last follow-up, the Knee Society function score, Hospital for Special Surgery knee-rating scale, and range of motion were 94 ± 6, 91 ± 4, and 116° ± 8°, respectively. All knees were stable laterally, whereas 2 knees had mild medial laxity and the others were stable. The hip-knee-ankle angle, femorotibial angle, condylar-hip angle, plateau-ankle angle, and valgus angle were 179.9° ± 3.4°, 172.9° ± 3.6°, 89.8° ± 2.5°, 90.2° ± 1.1°, and 7.3° ± 3.5°, respectively. CONCLUSION Medial femoral epicondyle up-sliding osteotomy during TKA in patients with severe valgus deformities facilitates the restoration of lower limb alignment, soft tissue balance, and knee stability.
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Affiliation(s)
- Ping Mou
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yi Zeng
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jing Yang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hang Zhong
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shi-Jiu Yin
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Rui-Bo Li
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Czekaj J, Fary C, Gaillard T, Lustig S. Does low-constraint mobile bearing knee prosthesis give satisfactory results for severe coronal deformities? A five to twelve year follow up study. INTERNATIONAL ORTHOPAEDICS 2017; 41:1369-1377. [PMID: 28396931 DOI: 10.1007/s00264-017-3452-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Severe varus and valgus knee deformities traditionally are replaced with constrained implants, with a number of disadvantages. We present our results in this challenging group using a low constraint deep-dish mobile bearing implant design. METHODS One hundred fifty-four patients (170 arthroplasties) who underwent primary TKA using a deep-dish, mobile bearing posterior-stabilized implant for severe varus (HKA < 170°) or valgus (HKA > 190°) deformity between 2004 and 2009 were evaluated at a mean of 6.6 years post-operatively (minimum of 5 years). RESULTS Alignment improved from a pre-operative mean (±SD) varus deformity of 167.4° (±2.6°) and a mean (±SD) valgus deformity of 194.1° (±4.0°) to an overall mean (±SD) post-operative mechanical alignment of 178.6° (±3.2°). Twenty-three patients had post-operative varus alignment, five patients had post-operative valgus alignment and 134 knees were in neutral alignment (within 3° spread). Clinical scores at final follow-up were excellent (IKS score 93.8 (±7.4) and function score 82.4 (±20.2)). Three patients were re-operated upon: one deep infection, one periprosthetic fracture and one revision at 144 months for aseptic loosening of the femoral component. No patient was revised for instability or implant failure. The survival rate at five years was 99.4% and at ten years 98.6%. CONCLUSIONS Satisfactory outcomes can be achieved in patients with substantial varus or valgus deformities using low constraint deep-dish mobile bearing implant, standard approach and appropriate soft tissue releases.
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Affiliation(s)
- Jaroslaw Czekaj
- Albert TRILLAT Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Camdon Fary
- Western Hospital and Epworth Musculoskeletal Institute, Melbourne, Australia
| | - Thierry Gaillard
- Centre de Chirurgie Orthopédique du Beaujolais, 120, Ancienne Route de Beaujeu, 69653, Villefranche-sur-Sâone, France
| | - Sebastien Lustig
- Albert TRILLAT Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
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Analysis of Carbon Fiber Reinforced PEEK Hinge Mechanism Articulation Components in a Rotating Hinge Knee Design: A Comparison of In Vitro and Retrieval Findings. BIOMED RESEARCH INTERNATIONAL 2017; 2016:7032830. [PMID: 28101512 PMCID: PMC5213741 DOI: 10.1155/2016/7032830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/05/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022]
Abstract
Carbon fiber reinforced poly-ether-ether-ketone (CFR-PEEK) represents a promising alternative material for bushings in total knee replacements, after early clinical failures of polyethylene in this application. The objective of the present study was to evaluate the damage modes and the extent of damage observed on CFR-PEEK hinge mechanism articulation components after in vivo service in a rotating hinge knee (RHK) system and to compare the results with corresponding components subjected to in vitro wear tests. Key question was if there were any similarities or differences between in vivo and in vitro damage characteristics. Twelve retrieved RHK systems after an average of 34.9 months in vivo underwent wear damage analysis with focus on the four integrated CFR-PEEK components and distinction between different damage modes and classification with a scoring system. The analysis included visual examination, scanning electron microscopy, and energy dispersive X-ray spectroscopy, as well as surface roughness and profile measurements. The main wear damage modes were comparable between retrieved and in vitro specimens (n = 3), whereby the size of affected area on the retrieved components showed a higher variation. Overall, the retrieved specimens seemed to be slightly heavier damaged which was probably attributable to the more complex loading and kinematic conditions in vivo.
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