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Cretu B, Costache M, Cursaru A, Serban B, Spiridonica R, Popa M, Cirstoiu C, Iordache S. Restoring Anatomical Features in Primary Total Knee Arthroplasty. Cureus 2023; 15:e40616. [PMID: 37342300 PMCID: PMC10278159 DOI: 10.7759/cureus.40616] [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: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
Today, the number of people affected by gonarthrosis symptoms is increasing proportionally. Total knee arthroplasty (TKA) is a successful intervention that aims to reduce pain and restore knee function. However, studies have shown that active young patients still have limitations in performing activities such as skiing, golfing, surfing, and dancing. Over the last few years, total knee arthroplasty has undergone significant changes. Most of the modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological pattern with greater compliance in the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side. Unfortunately, functional outcomes are compromised in approximately half of TKA patients. This loss may be caused by the abnormal kinematics and inherent instability of many contemporary implants. The proper alignment of the femoral component during TKA is a crucial step that influences postoperative results. The position of the femoral component in the axial plane is responsible for flexion stability, knee joint kinematics, flexion alignment, and patellar tracking. The main goal when choosing a type of prosthesis is to achieve an adequate recovery that leads to an improvement in mobility and an increase in the efficiency of the quadriceps.
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Affiliation(s)
- Bogdan Cretu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
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Amin OA, Alzahrani KH, Basaqr AA, Tayeb MM. Nonabsorbable Suture of a PCL Allograft Resulting in a Squeaking Knee After PCL Reconstruction: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00068. [PMID: 35294406 DOI: 10.2106/jbjs.cc.21.00684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE This case report describes the occurrence of a squeaking knee joint on active flexion-extension in a 35-year-old man who had previously undergone posterior cruciate ligament (PCL) reconstruction surgery. The patient suffered from psychosocial distress because of the noise and complained of persistent left knee pain. After nonsurgical treatment failed to resolve the noise, arthroscopic surgery was performed to debride the interposed nonabsorbable suture located on the intra-articular surface, resulting in squeaking sound elimination. CONCLUSION Surgery was necessary to alleviate a squeaking knee joint caused by interposed nonabsorbable sutures after PCL reconstruction in this patient.
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Affiliation(s)
- Omar A Amin
- Department of Orthopedic Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Khalid H Alzahrani
- Department of Orthopedic Surgery, Security Force Hospital, Makkah, Saudi Arabia
| | - Abdulaziz A Basaqr
- Department of Orthopedic Surgery, Security Force Hospital, Makkah, Saudi Arabia
| | - Mazen M Tayeb
- Department of Orthopedic Surgery, Security Force Hospital, Makkah, Saudi Arabia
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Taniguchi H, Itoh M, Yoshimoto N, Itou J, Kuwashima U, Okazaki K. Noise after total knee arthroplasty has limited effect on joint awareness and patient-reported clinical outcomes: retrospective study. BMC Musculoskelet Disord 2020; 21:115. [PMID: 32085760 PMCID: PMC7035734 DOI: 10.1186/s12891-020-3134-7] [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: 12/05/2019] [Accepted: 02/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Some patients complain of noise after total knee arthroplasty (TKA). Controversy still exists on how the noise affects the clinical outcomes, including joint awareness, after TKA. The Forgotten Joint Score—12 (FJS-12) measures the clinical outcomes focusing on joint awareness after surgery. The Knee Society Scoring System—2011 (KSS-2011) includes questionnaires for satisfaction, expectation, and functional activities. The aim of this study is to clarify the relationship among FJS-12, KSS-2011, and the noise. Furthermore, the relationship between FJS-12 and KSS-2011 was validated. Methods Using FJS-12 and KSS-2011, 295 knees from 225 patients who underwent TKA were retrospectively evaluated. Noise perception was evaluated by a questionnaire with five grades, a method that follows the questionnaire form of FJS-12 (“Are you aware of the noise of your artificial joint?”; never, almost never, seldom, sometimes, mostly). Correlations among FJS-12, KSS-2011, and noise were analyzed. The patients were divided into four groups based on the mechanism of their implant [cruciate retaining, posterior stabilized, cruciate sacrificed, and bicruciate stabilized (BCS)]. FJS-12, KSS-2011, and noise were compared among the groups. Results A strong correlation was found between FJS-12 and total score of KSS-2011 (0.70; P < 0.001). FJS-12 correlated with KSS-2011 subcategories of “symptoms,” “satisfaction,” and “standard activities,” with correlation coefficients at approximately 0.60. Noise had weak correlations with FJS-12 (0.28; P < 0.001) and KSS-2011 (0.20 P < 0.001). In comparing the TKA mechanisms, BCS had remarkably better KSS-2011 and greater movement range but worse noise scores. Conclusions Noise perception after TKA had limited effect on joint awareness and clinical outcomes. FJS-12 correlated strongly with KSS-2011 and associated with satisfaction, residual symptoms, and daily activities, as assessed by KSS-2011 subscores. Trial registration This study was approved by the Medical Ethical Committee of the Tokyo Women’s Medical University (approval number: 4681 on March 2, 2018).
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Affiliation(s)
- Hiroto Taniguchi
- Department of Orthopaedic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Nobuyuki Yoshimoto
- Department of Orthopaedic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan.
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The minimum clinically important difference for the Japanese version of the new Knee Society Score (2011KSS) after total knee arthroplasty. J Orthop Sci 2019; 24:1053-1057. [PMID: 31543424 DOI: 10.1016/j.jos.2019.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The new Knee Society Score (2011KSS) has been used to evaluate post-operative outcomes after total knee arthroplasty (TKA). However, there is no minimum clinically important difference (MCID) for 2011KSS. The purpose of this study is to define MCID of 2011KSS after TKA. METHODS Patients who underwent primary TKA for primary knee osteoarthritis between April 2012 and December 2016 were included in the study. The Japanese version of 2011KSS and original Knee Society Score (OKSS) were recorded preoperatively and at one-year postoperatively. With improvement in pain score of OKSS as an anchor, an anchor-based approach was used to identify the MCID of 2011KSS. The improvement in pain of OKSS was classified into 5 categories. The MCID was determined using a linear regression analysis of delta 2011KSS against improvement in the category of pain in OKSS. The MCID for 2011KSS expectation was not calculated because the items of pre- and post-operative questionnaires were different. RESULTS Five hundred and twenty-two cases were enrolled (age: 74.8 ± 7.3 years, female: 80.0%). After 1-year follow-up, 344 TKAs were finally included (age: 74.6 ± 7.1 years, female: 77.9%). Linear regression analyses showed that MCID for 2011KSS was 1.9 (95% confidential interval (CI): 1.3-2.5) in symptom, 2.2 (95%CI: 1.4-2.9) in satisfaction, and 4.1 (95%CI: 2.5-5.7) in functional activities. CONCLUSIONS MCID for 2011KSS was successfully calculated. These MCID values make the 2011KSS a more efficient tool for evaluating the physical activities of the populations of patients undergoing TKA. These MCID values can also be used to calculate sample size to evaluate the power of a study in designing clinical studies.
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Gu S, Kuriyama S, Nakamura S, Nishitani K, Ito H, Matsuda S. Underhang of the tibial component increases tibial bone resorption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1270-1279. [PMID: 30470851 DOI: 10.1007/s00167-018-5309-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE One of the causes of aseptic loosening is marked tibial bone resorption (TR) at the tibial bone-component interface after total knee arthroplasty (TKA). It was hypothesized that insufficient coverage of the tibial component and improper cementing technique would cause increased TR after cemented TKA. METHODS One hundred thirty-four primary TKAs in 107 patients with varus osteoarthritis were included in this study. The relationships between the TRs at 2 years after TKA and the tibial component underhang (TUH), the thickness of the cement mantle around the keel, and clinical parameters were evaluated. RESULTS The widths of TRs on anteroposterior radiographs were significantly larger on the medial side than on the lateral side (p = 0.001), whereas the difference between the anterior and posterior sides on lateral radiographs was relatively small. Multiple regression analyses showed that medial TR was positively related to medial TUH (p = 0.006), and lateral TR was positively related to a thicker distal cement mantle (p = 0.027). On the lateral view, stepwise selection indicated that postoperative knee flexion angle was the most significant risk factor (p = 0.005) for anterior TR, and posterior TUH was the strongest predictor (p = 0.001) of posterior TR. CONCLUSIONS To avert postoperative progressive TR, surgeons should perfectly fit a suitably sized tibial component to the medial edge of the tibia. Also, care should be taken to avoid an excessive cement mantle at the distal portion of the keel during TKA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- ShiZhong Gu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Orthopaedic Surgery, Sports Medicine and Joint Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Tsukiyama H, Kuriyama S, Kobayashi M, Nakamura S, Furu M, Ito H, Matsuda S. Medial rather than lateral knee instability correlates with inferior patient satisfaction and knee function after total knee arthroplasty. Knee 2017; 24:1478-1484. [PMID: 28970125 DOI: 10.1016/j.knee.2017.09.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/16/2017] [Accepted: 09/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is commonly thought that balanced medial and lateral tibiofemoral joint gaps are essential, but the effect of joint laxity on clinical outcome after total knee arthroplasty (TKA) is unclear. It was hypothesised that medial joint laxity correlates with inferior patient satisfaction and knee function, although lateral joint laxity is allowed to a certain degree in TKA. METHODS This study included 50 knees that underwent primary TKA. Knee laxity was measured with postoperative stress radiographs in flexion and extension, and patient satisfaction and knee function were evaluated by the 2011 Knee Society Knee Scoring System. RESULTS In a comparison of medially tight and medially loose knees in flexion, the scores for satisfaction, symptoms, standard activity, and advanced activity were significantly better in medially tight than in medially loose knees (satisfaction: 29.8, 22.2; symptoms: 20.3, 15.9; standard activities: 24.2, 19.1; and advanced activities: 15.3, 8.7, in the tight and loose knees, respectively). Neither lateral joint laxity during knee flexion nor medial joint laxity during knee extension was associated with a poor postoperative clinical outcome, whereas lateral joint laxity and the standard activity score in extension had a moderate positive correlation. CONCLUSIONS Knees with medial joint laxity during flexion resulted in an inferior postoperative outcome, and lateral joint laxity did not influence patient satisfaction or function. Care should be taken to maintain medial joint stability during the TKA procedure.
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Affiliation(s)
- Hiroyuki Tsukiyama
- Department of Orthopaedic Surgery, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masahiko Kobayashi
- Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Moritoshi Furu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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