1
|
Kahlenberg CA, Kheir MM, Selkridge IK, Quevedo Gonzalez FJ, Chiu YF, Wright TM, Chalmers BP, Sculco PK. Clinical and Biomechanical Evaluation of Mid-Level Constrained and Posterior-Stabilized Polyethylene Inserts in Primary Total Knee Arthroplasty: An Analysis of 12,674 Cases. J Arthroplasty 2024; 39:1518-1523. [PMID: 38103805 DOI: 10.1016/j.arth.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Mid-level constraint polyethylene designs provide additional stability in total knee arthroplasty (TKA). The purposes of this study were to (1) compare the survivorship and reason for revision between mid-level inserts and posterior-stabilized (PS) used in primary TKA and (2) evaluate the biomechanical constraint characteristics of mid-level inserts. METHODS We reviewed all cases of primary TKA performed at our institution from 2016 to 2019 using either PS or mid-level constrained inserts from 1 of 6 manufacturers. Data elements included patient demographics, implants, reasons for revision, and whether a manipulation under anesthesia was performed. We performed finite element analyses to quantify the varus/valgus and axial-rotation constraint of each mid-level constrained insert. A one-to-one propensity score matching was conducted between the patients with mid-level and PS inserts to match for variables, which yielded 2 cohorts of 3,479 patients. RESULTS For 9,163 PS and 3,511 mid-level TKAs, survivorship free from all-cause revision was estimated up to 5 years and was lower for mid-level than PS inserts (92.7 versus 94.1%, respectively, P = .004). When comparing each company's mid-level insert to the same manufacturer's PS insert, we found no differences in all-cause revision rates (P ≥ .91) or revisions for mechanical problems (P ≥ .97). Using propensity score matching between mid-level and PS groups, no significant differences were found in rates of manipulation under anesthesia (P = .72), all-cause revision (P = .12), revision for aseptic loosening (P = .07), and revision for instability (P = .45). Finite element modeling demonstrated a range in varus/valgus constraint from ±1.1 to >5°, and a range in axial-rotation constraint from ±1.5 to ±11.5° among mid-level inserts. CONCLUSIONS Despite wide biomechanical variations in varus/valgus and axial-rotation constraint, we found minimal differences in early survivorship rates between PS and mid-level constrained knees.
Collapse
Affiliation(s)
- Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Michael M Kheir
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Isaiah K Selkridge
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| |
Collapse
|
2
|
Jhurani A, Agarwal P, Sahni H, Ardawatia G, Srivastava M. Role and Results of Constrained Insert in Computer-Assisted Primary Total Knee Arthroplasty: A Propensity-Matched Study. Arthroplast Today 2024; 27:101423. [PMID: 38946924 PMCID: PMC11214376 DOI: 10.1016/j.artd.2024.101423] [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: 01/27/2024] [Revised: 03/16/2024] [Accepted: 04/29/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Mild ligament imbalance is often encountered in the mediolateral plane during complex primary total knee arthroplasty. A constrained (CP) polyethylene insert compatible with the primary femur is useful to manage these cases without the need to fall back on revision implants. The aim of the study was to define the correct indications of the use of a CP insert based on objective data from computer assisted surgery and to compare the early results of a CP insert with a standard posterior stabilized (PS) insert through one-to-one propensity score matching. Methods This is a retrospective case study from a prospectively collected database. One-to-one matching without replacement was used with a caliper width of 0.2 to match the scores between CP (N = 64) and PS groups (N = 1624), resulting in equal covariate matching of PS (N = 64) and CP (N = 64) cohorts. Patients were assessed radiographically and functionally at a minimum follow-up of 3 years. Result Average coronal and sagittal plane deformities were similar in both the group CP (varus 13.1 ± 5.2 valgus 13 ± 7.9) and the group PS (varus 13.4 ± 4.6 valgus 10.9 ± 8.6). The average residual medial lateral gap difference was significantly higher in group CP (3.8 ± 1.8) in comparison to group PS (1.3 ± 1) (P < .05). A CP insert was chosen where mild ligament imbalance of 3-5 mm persisted after medial soft tissue releases in a varus knee and in cases with residual medial collateral ligament laxity in valgus knees. Conclusions Constrained insert used with the primary femoral component is a valuable option to handle mild ligamentous instability in complex primary total knee arthroplasty after mechanical alignment is achieved with computer navigation. Level of Evidence III.
Collapse
Affiliation(s)
- Anoop Jhurani
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Piyush Agarwal
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Hardik Sahni
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Gaurav Ardawatia
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Mudit Srivastava
- Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| |
Collapse
|
3
|
Aberman Z, Germano J, Scuderi GR. Intraoperative Medial Instability During Total Knee Arthroplasty. Orthop Clin North Am 2024; 55:61-71. [PMID: 37980104 DOI: 10.1016/j.ocl.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
A review article summarizes the existing literature on intraoperative injury to medial collateral ligament (MCL) during total knee arthroplasty (TKA), methods of fixation, repair, and the outcomes after these injuries. The options for increasing implant constraint and repair of the MCL injury are discussed with the potential indications for each. There is also a review of risk factors for MCL injury during TKA to help anticipate potential issues preoperatively. The proper use of retractors during total knee replacement is also discussed with a focus on careful protection of the MCL during surgery.
Collapse
Affiliation(s)
| | - James Germano
- Long Island Valley Stream Hospital Northwell Health, Valley Stream, NY, USA
| | - Giles R Scuderi
- Department of Orthopaedic Surgery, Lenox Hill, New York, NY, USA.
| |
Collapse
|
4
|
Movassaghi K, Patel A, Ghulam-Jelani Z, Levine BR. Modern Total Knee Arthroplasty Bearing Designs and the Role of the Posterior Cruciate Ligament. Arthroplast Today 2023; 21:101130. [PMID: 37151403 PMCID: PMC10160699 DOI: 10.1016/j.artd.2023.101130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/04/2023] [Accepted: 03/08/2023] [Indexed: 05/09/2023] Open
Abstract
The role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) surgery continues to be a source of debate among the adult reconstruction community. In native knee flexion, the PCL is comprised of an anterolateral and posteromedial bundle that work together to limit posterior tibial translation and allow adequate femoral rollback for deep flexion. In the arthritic knee, the PCL can often become dysfunctional and attenuated, which led to the development of posterior stabilized (PS) TKA bearing options. PS TKAs implement a cam-post construct to functionally replace a resected PCL. While PS designs may facilitate balancing knees with significant deformity, they are associated with complications such as postfracture, increased wear, and patellar clunk/crepitus. In recent years, newer designs have been popularized with greater degrees of congruency and incorporation of medial and lateral pivoting to better recreate native knee kinematics. The American Joint Registry has confirmed the recent predilection for ultra-congruent and cruciate-retaining TKA inserts over PS TKAs during the last decade. Studies have failed to identify an overall clinical superiority between the cruciate substituting and sacrificing designs. The literature has also failed to identify clinical consequences from PCL resection with modern, more conforming TKA designs. In this article, we review modern PCL sacrificing designs and discuss the impact of each on the kinematics after TKA. We also will delineate the role of the PCL in modern TKA in the hopes to better understand the recent surge in sacrificing but not substituting knee implants.
Collapse
Affiliation(s)
- Kamran Movassaghi
- Department of Orthopaedic Surgery, University of California, San Francisco Fresno, Fresno, CA, USA
- Corresponding author. University of California, San Francisco Fresno, 2823 Fresno Street, Fresno, CA 93721, USA. Tel.: +1 818 640 5244.
| | - Arpan Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Zohal Ghulam-Jelani
- Department of Orthopaedic Surgery, University of California, San Francisco Fresno, Fresno, CA, USA
| | - Brett R. Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
5
|
Kahlenberg CA, Chalmers B, Sun HJ, Mayman DJ, Westrich GH, Haas SB, Sculco PK. Polyethylene Components in Primary Total Knee Arthroplasty: A Comprehensive Overview of Fixed Bearing Design Options. J Knee Surg 2022; 35:1401-1408. [PMID: 33618396 DOI: 10.1055/s-0041-1723981] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The articular design of a polyethylene insert influences the kinematics and overall function of a total knee arthroplasty (TKA). Standard symmetric posterior-stabilized and cruciate-retaining polyethylene designs have a long track record of high patient satisfaction and longevity in TKA. However, the number and variety of polyethylene inserts and articulations have continued to evolve in an attempt to better replicate native knee kinematics or provide additional constraint. Ultracongruent polyethylene designs have been touted as increasing stability while maintaining the benefits of cruciate-retaining knees. Medial pivot and lateral/dual pivot polyethylene designs were introduced to mimic more normal knee kinematics with regard to femoral rollback. Further, with increasing recognition of knee instability as a cause for persistent symptoms and revision TKA, the utilization of midlevel constraint polyethylene inserts has been increasing, with multiple implant companies offering an insert design with increased constraint for use with a primary femoral component. In this rapidly evolving arena in with a myriad of options available, surgeons should be knowledgeable about the design concepts and their applicable uses for specific patient scenarios. Future research is needed to better understand whether a particular type or design of polyethylene insert and articulation leads to improved patient reported outcomes, improved replication of knee kinematics, and long-term durable implant survivorship.
Collapse
Affiliation(s)
- Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Brian Chalmers
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Hyung Jin Sun
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Steven B Haas
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| |
Collapse
|
6
|
Rosso F, Rossi R, Benazzo F, Ghiara M, Bonasia DE, Rossi SMP. Primary TKA in patients with major deformities and ligament laxities: promising results of an intermediate constrained implant at mid-term follow-up. Arch Orthop Trauma Surg 2022; 143:2675-2681. [PMID: 35819516 DOI: 10.1007/s00402-022-04527-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/16/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) in major deformities with ligament insufficiency may require a higher constraint, with bone sacrifice and concerns about long-term survivorship. Mid-level constraint liners have been recently introduced, but few studies described their outcomes. The aim of this study is to evaluate the short to mid-term outcomes of a constrained postero-stabilized (CPS) insert for primary TKA in moderate to severe deformities. METHODS All patients who underwent TKA using a CPS liner in two centers between 2015 and 2017 were included in the study. The indications were: (1) valgus deformity type 2-3 partially correctable; (2) severe varus deformity with varus thrust; (3) post-traumatic deformity with major ligamentous insufficiency and any case of intra-operative ligament insufficiency. Patients were evaluated according to the Knee Society Scoring System (KSS), the Hospital for Special Surgery score (HSS), the Western Ontario and Mc Master University (WOMAC) and the Oxford Knee score (OKS). X-rays were evaluated according to the Knee Society Roentgenographic Evaluation System. RESULTS Forty-seven TKA were included, with an average age of 66.1 ± 10.3 years and an average follow-up of 68.4 ± 6 months. All patients demonstrated a moderate to severe pre-operative mediolateral instability. All the scores significantly improved (p < 0.0001). In 71.4% of cases, the outcomes were excellent or very good. There were no failures due to aseptic loosening but one failure due to a traumatic ligament rupture. The cumulative survivorship was 97.9% ± 2.1% at 84 months. CONCLUSIONS This mid-range constraint total knee replacement demonstrated promising outcomes and survival at mid-term follow-up. LEVEL OF EVIDENCE IV (case series).
Collapse
Affiliation(s)
- Federica Rosso
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy
| | - Roberto Rossi
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy.,Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Via Po 8, 10100, Turin, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy.,IUSS, Istituto Universitario di Studi Superiori, Pavia, Italy
| | - Matteo Ghiara
- Clinica Ortopedica e Traumatologia, Università degli Studi di Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Davide Edoardo Bonasia
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy.
| |
Collapse
|
7
|
Elmasry SS, Kahlenberg CA, Mayman DJ, Wright TM, Westrich GH, Cross MB, Imhauser CW, Sculco PK, Chalmers BP. A Mid-Level Constrained Insert Reduces Coupled Axial Rotation but Not Coronal Mid-Flexion Laxity Induced by Joint Line Elevation in Posterior-Stabilized Total Knee Arthroplasty: A Computational Study. J Arthroplasty 2022; 37:S364-S370.e1. [PMID: 35240279 DOI: 10.1016/j.arth.2022.02.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Surgeons may resect additional distal femur during primary posterior-stabilized (PS) total knee arthroplasty (TKA) to correct a flexion contracture. However, the resultant joint line elevation (JLE) increases mid-flexion laxity. We determined whether a mid-level constraint (MLC) insert reduced mid-flexion laxity after JLE. METHODS Six computational knee models were developed using computed tomography scans and average soft tissue properties yielding balanced extension gaps but with a 10° flexion contracture. Distal femoral resections of +2 and +4 mm were simulated with PS and MLC inserts. Varus-valgus ±10 Nm moments were applied at 30°, 45°, and 60° of flexion. Coronal laxity (the sum of varus-valgus angulation) and coupled axial rotation (the sum of internal/external rotation) were measured and compared between insert models. RESULTS At 30° of flexion, coronal laxities with the PS insert at the +2 and +4 mm resections averaged 7.9° ± 0.6° and 11.3° ± 0.6°, respectively, and decreased by 0.8° (P = .06) and 1.0° (P = .07), respectively, with the MLC insert. PS rotational laxities at the +2 and +4 mm resections averaged 11.1° ± 3.9° and 12.5° ± 4.6°, respectively, and decreased by 5.6° (P = .01) and 7.1° (P = .02), respectively, with the MLC insert. Similar patterns were observed at 45° and 60° of flexion. CONCLUSION With additional distal femoral resections to alleviate a flexion contracture, utilizing an MLC insert substantially reduced coupled axial rotation but had a minimal impact on coronal laxity compared to a PS insert. Efforts should be taken to avoid JLE in primary total knee arthroplasty as even MLC inserts may not mitigate coronal laxity.
Collapse
Affiliation(s)
- Shady S Elmasry
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Cynthia A Kahlenberg
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - David J Mayman
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | | | - Michael B Cross
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| |
Collapse
|
8
|
Yohe N, Vanderbrook DJ, Sherman AE, Papas PV, Scuderi GR. Stability with a Constrained Posterior Stabilized Primary Total Knee Arthroplasty Does Not Compromise Durability. J Knee Surg 2022. [PMID: 35240717 DOI: 10.1055/s-0042-1743230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total knee arthroplasty (TKA) in cases of complex deformity (e.g., ligamentous laxity, posttraumatic arthritis) may require prostheses with inherent varus-valgus stability greater than that of traditional posterior stabilized or cruciate-retaining implants. Here, we investigate the clinical and radiographic outcomes of TKA using a midlevel constraint (MLC) prosthesis. A retrospective review of 53 patients (62 knees) who underwent primary TKA with an MLC implant was performed. Short tibial stem extensions were utilized in 49 knees, and 13 knees received no stem extension. Mean follow-up time was 31.6 months (standard deviation [SD] = 10.0, range = 24-53). Preoperative and postoperative range of motion (ROM) were assessed. Plain radiographs were reviewed for alignment, radiolucent lines, component loosening, and osteolysis. Patients who developed postoperative arthrofibrosis underwent manipulation under anesthesia (MUA). Failure was defined as instability, component loosening, or need for revision surgery. Mean ROM significantly improved from 114.1 degrees (SD = 19.7 degrees) preoperatively to 123.5 degrees (SD = 12.2 degrees) at final follow-up (t = -3.43, p = 0.001). Thirty-seven knees initially presented with varus deformity (mean = 7.5 degrees, SD = 4.8 degrees), whereas 23 had valgus deformity (mean = 10.6 degrees, SD = 6.5 degrees), and 2 knees had neutral alignment. Following surgery, mean alignment was 4.3 degrees valgus (SD = 1.7 degrees, range = 0-8 degrees), representing a statistically significant improvement (t = 5.29, p < 0.001). Six patients (9.7%) developed arthrofibrosis requiring MUA, which was irrespective of baseline ROM (p = 0.92) and consistent with 12% incidence reported in the literature. There were no significant differences in postoperative ROM (t = 0.38, p = 0.71), alignment (t = -0.22, p = 0.83), or incidence of arthrofibrosis (χ2 = 0.07, p = 0.79) between short-stemmed and nonstemmed implants. There was no radiographic evidence of radiolucent lines, component loosening, or osteolysis in any patients. No patients required revision surgery. Use of an MLC prosthesis with primary femoral component in TKA resulted in satisfactory clinical and radiographic results with no evidence of component loosening, osteolysis, instability, or need for revision at minimum 2-year follow-up.
Collapse
Affiliation(s)
- Nicholas Yohe
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York
| | | | - Alain E Sherman
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York
| | | | - Giles R Scuderi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York
| |
Collapse
|
9
|
Seidenstein A, Omari AM, Levine HB, Klein GR. Femoral Condyle Insufficiency Fracture After Total Knee Arthroplasty Using a Stemless Femoral Component With a Midlevel Constraint Articular Surface. Arthroplast Today 2022; 13:82-88. [PMID: 35257022 PMCID: PMC8897186 DOI: 10.1016/j.artd.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ari Seidenstein
- Rothman Orthopaedic Institute, Montvale, NJ, USA
- Hackensack Meridian School of Medicine, Department of Orthopaedic Surgery, Nutley, NJ, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Ali M. Omari
- Rothman Orthopaedic Institute, Montvale, NJ, USA
- Corresponding author. Rothman Orthopaedic Institute, 50 Craig Road, Montvale, NJ 07670, USA. Tel.: +1 248 909 9340.
| | - Harlan B. Levine
- Rothman Orthopaedic Institute, Montvale, NJ, USA
- Hackensack Meridian School of Medicine, Department of Orthopaedic Surgery, Nutley, NJ, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Gregg R. Klein
- Rothman Orthopaedic Institute, Montvale, NJ, USA
- Hackensack Meridian School of Medicine, Department of Orthopaedic Surgery, Nutley, NJ, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
| |
Collapse
|
10
|
PIRES E ALBUQUERQUE RODRIGOSATTAMINI, SOUSA FILHO PEDROGUILMETEIXEIRADE, MORAES RUIFELIPEPACHEDE, FRANCO FILHO DALTONROBERTODEMELO, MOZELLA ALLAN, COBRA HUGO, GAMEIRO VINICIUSSCHOTT. STUDY BETWEEN SEMI-CONSTRAINED TOTAL KNEE ARTHROPLASTY WITH OR WITHOUT INTRAMEDULLARY STEM. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e250492. [PMID: 36092171 PMCID: PMC9425980 DOI: 10.1590/1413-785220223004e250492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: This research sought to carry out a comparative study observing the clinical and radiographic analysis of primary prostheses of the type TC3 Depuy Johnson® with or without a stem during a short-term follow-up. Methods: The sample was divided into three groups: Group 1 (with stem), Group 2 (without stem) and Group 3 (mixed). Patients were evaluated to assess whether the implants were loosening and a clinical analysis was performed. Results: Preoperative deformities were predominantly considered severe. The total range of motion in the postoperative period was above 96.7° in the three groups. In the postoperative period, the femoral-tibial angle oscillated on average between 5 to 6° valgus. There was no record of implant loosening for cases treated with stem, and the incidence of loosening was 14.3% for the group without stem and 16.7% among cases in the mixed group. Conclusion: In general, preoperative deformities were considered severe. In the postoperative period, the total range of motion was above 96.7°. The postoperative femoral-tibial angle obtained an average of 5 to 6° valgus. There is no significant difference in implants loosening in the three groups. Level of Evidence III, Retrospective Comparative Study.
Collapse
Affiliation(s)
| | | | - RUI FELIPE PACHE DE MORAES
- National Institute of Orthopedics and Traumatology Instituto Nacional de Traumatologia e Ortopedia, Brazil
| | | | - ALLAN MOZELLA
- National Institute of Orthopedics and Traumatology Instituto Nacional de Traumatologia e Ortopedia, Brazil
| | - HUGO COBRA
- National Institute of Orthopedics and Traumatology Instituto Nacional de Traumatologia e Ortopedia, Brazil
| | | |
Collapse
|
11
|
Limberg AK, Wyles CC, Taunton MJ, Hanssen AD, Pagnano MW, Abdel MP. Varus-valgus constrained insert with posterior-stabilized femoral components in complex primary total knee arthroplasties. Bone Jt Open 2021; 2:921-925. [PMID: 34751585 PMCID: PMC8636289 DOI: 10.1302/2633-1462.211.bjo-2021-0134.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims Varus-valgus constrained (VVC) devices are typically used in revision settings, often with stems to mitigate the risk of aseptic loosening. However, in at least one system, the VVC insert is compatible with the primary posterior-stabilized (PS) femoral component, which may be an option in complex primary situations. We sought to determine the implant survivorship, radiological and clinical outcomes, and complications when this VVC insert was coupled with a PS femur without stems in complex primary total knee arthroplasties (TKAs). Methods Through our institution’s total joint registry, we identified 113 primary TKAs (103 patients) performed between 2007 and 2017 in which a VVC insert was coupled with a standard cemented PS femur without stems. Mean age was 68 years (SD 10), mean BMI was 32 kg/m2 (SD 7), and 59 patients (50%) were male. Mean follow-up was four years (2 to 10). Results The five-year survivorship free from aseptic loosening was 100%. The five-year survivorship free from any revision was 99%, with the only revision performed for infection. The five-year survivorship free from reoperation was 93%. The most common reoperation was treatment for infection (n = 4; 4%), followed by manipulation under anaesthesia (MUA; n = 2; 2%). Survivorship free from any complication at five years was 90%, with superficial wound infection as the most frequent (n = 4; 4%). At most recent follow-up, two TKAs had non-progressive radiolucent lines about both the tibial and femoral components. Knee Society Scores improved from 53 preoperatively to 88 at latest follow-up (p < 0.001). Conclusion For complex primary TKA in occasional situations, coupling a VVC insert with a standard PS femur without stems proved reliable and durable at five years. Longer-term follow-up is required before recommending this technique more broadly. Cite this article: Bone Jt Open 2021;2(11):921–925.
Collapse
Affiliation(s)
- Afton K Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
12
|
Mancino F, De Martino I, Burrofato A, De Ieso C, Saccomanno MF, Maccauro G, De Santis V. Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up. J Orthop Traumatol 2020; 21:22. [PMID: 33263831 PMCID: PMC7710834 DOI: 10.1186/s10195-020-00561-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/18/2020] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of this study was to evaluate (1) the reoperation rates and survivorship for septic and aseptic causes, (2) radiographic outcomes, and (3) clinical outcomes of condylar-constrained knee (CCK) implants used in primary total knee arthroplasty (TKA) with severe coronal deformity and/or intraoperative instability. Materials and methods A consecutive series of CCK implants in primary TKA was retrospectively evaluated in patients with severe coronal deformities. Forty-nine patients (54 knees) were included with a mean follow-up of 9 years (range 6–12). All patients were treated with a single-design, second-generation CCK implant. The primary diagnosis was osteoarthritis in 36 knees, post-traumatic arthritis in 7 knees, and rheumatoid arthritis in 4 knees. Preoperatively, standing femorotibial alignment was varus in 22 knees and valgus in 20 knees. Results At a mean follow-up of 9 years, overall survivorship was 93.6%. Two knees (4.3%) required revision for periprosthetic joint infection. One knee (2.1%) required subsequent arthroscopy due to patellar clunk syndrome. At final follow-up, no evidence of loosening or migration of any implant was reported, and the mean Knee Society knee scores improved from 43 to 86 points (p < 0.001). The mean Knee Society function scores improved to 59 points (p < 0.001). The average flexion contracture improved from 7° preoperatively to 2° postoperatively and the average flexion from 98° to 110°. No knees reported varus–valgus instability in flexion or extension. Conclusion CCK implants in primary TKA with major coronal deformities and/or intraoperative instability provide good midterm survivorship, comparable with less constrained implants. In specific cases, CCK implants can be considered a viable option with good clinical and radiographic outcomes. However, a higher degree of constraint should be used cautiously, leaving the first choice to less constrained implants. Level of evidence Therapeutic study, level IV.
Collapse
Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Aaron Burrofato
- Department of Orthopaedics, Children's Hospital "Bambino Gesù", Rome, Italy
| | - Carmine De Ieso
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
| | - Maristella F Saccomanno
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Vincenzo De Santis
- Department of Orthopaedics and Traumatology, Mater Olbia Hospital, Olbia, Italy
| |
Collapse
|
13
|
Hampton CB, Berliner ZP, Nguyen JT, Mendez L, Smith SS, Joseph AD, Padgett DE, Rodriguez JA. Aseptic Loosening at the Tibia in Total Knee Arthroplasty: A Function of Cement Mantle Quality? J Arthroplasty 2020; 35:S190-S196. [PMID: 32171492 DOI: 10.1016/j.arth.2020.02.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/22/2020] [Accepted: 02/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Aseptic loosening remains one of the leading causes for failure of total knee arthroplasty (TKA). We sought to identify early radiographic measures that may associate with aseptic tibial component loosening, emphasizing systematic evaluation of the cement mantle. METHODS All TKA revisions from 2007 to 2015 with the primary indication of tibial aseptic loosening were identified using in an institutional implant retrieval database. After exclusion criteria, 61 TKAs comprised the study group. A matched control group of 59 TKAs that had not failed at a minimum of 3 years was identified for comparison. Radiographic analysis on all 6-week postoperative radiographs included angulation of components, cement penetration depth, and presence of radiolucency at the implant-cement and bone-cement interfaces. Groups were compared with Student's t-test, chi-squared test, and Mann-Whitney U-test. A final multivariable logistic regression model was formed for the outcome of aseptic loosening. RESULTS On multivariable analysis, failure was associated with a greater number of zones with cement penetration <2 mm (5.6 vs 3.4 zones, odds ratio [OR] 1.89, P < .001), increasing percent involvement of radiolucency at the implant-cement interface (8.7% vs 3.1%, OR = 1.15, P = .001), and increased varus alignment of the tibial component (1.5° vs 0°, OR = 1.35, P = .014). A greater number of zones with a radiolucent line at the bone-cement interface did not significantly associate (1.1 vs 0.3, P = .091). CONCLUSION Our results suggest that radiographic indicators of poor cement mantle quality associate with later aseptic loosening. This emphasizes the need for surgeons to perform careful cement technique in order to reduce the risk of TKA failure. LEVEL OF EVIDENCE III (Case-control).
Collapse
Affiliation(s)
- Chadwick B Hampton
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Zachary P Berliner
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Joseph T Nguyen
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Logan Mendez
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Sarah S Smith
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Amethia D Joseph
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - José A Rodriguez
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| |
Collapse
|
14
|
Ten-Year Minimum Outcomes and Survivorship With a High Flexion Knee System. J Arthroplasty 2019; 34:1975-1979. [PMID: 31104836 DOI: 10.1016/j.arth.2019.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The purpose of this study is to report the long-term outcomes and survivorship of a high flexion knee system. METHODS We identified 1312 patients (1664 knees) who underwent primary total knee arthroplasty with the Vanguard Complete Knee System with 10-year minimum follow-up. Preoperative and postoperative range of motion, Knee Society scores, complications, and reoperations were evaluated. RESULTS At an average of 11.9 years of follow-up, 88 knees were revised (5.3%). The deep infection rate was 1.4%. There was an average range of motion improvement of 3.9°, pain level decreased by 35.8, Knee Society clinical scores improved by 48, and Knee Society functional scores improved by 15.1 (all P < .001). Survival was 96.4% at 10 years for aseptic causes and 95.5% for all causes. CONCLUSION At a 10-year minimum follow-up, this high flexion knee system demonstrates excellent survivorship.
Collapse
|
15
|
Rossi R, Cottino U, Bruzzone M, Dettoni F, Bonasia DE, Rosso F. Total knee arthroplasty in the varus knee: tips and tricks. INTERNATIONAL ORTHOPAEDICS 2018; 43:151-158. [PMID: 30141140 DOI: 10.1007/s00264-018-4116-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023]
Abstract
Varus knee deformity is very common, and it can be classified according to the severity and reducibility of the deformity. Pre-operative planning is mandatory to obtain a good result. Both clinical and radiological planning should be carefully performed, particularly focused on collateral ligament deficiency. In most of the cases, a postero-stabilized implant is necessary, but in the presence of a varus thrust, a midlevel constrained (MLC) implant may be necessary. Rarely, if a severe extra-articular deformity is present, a femoral osteotomy and a high constrain implant may be necessary. In most of the cases, a standard midline approach can be performed. Soft tissue balancing is crucial, avoiding excessive releases of the medial collateral ligament (MCL). In the presence of severe deformity, more aggressive procedure such as tibial reduction osteotomy or sliding medial epicondyle osteotomy can be performed. In literature, good outcomes are reported for total knee arthroplasty (TKA) in varus deformity. In this manuscript, the available literature on TKA in varus deformity is analyzed, and the preferred surgical techniques of the authors are described.
Collapse
Affiliation(s)
- Roberto Rossi
- AO Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128, Turin, Italy.,University of Study of Turin, Via Po 8, 10100, Turin, Italy
| | - Umberto Cottino
- AO Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128, Turin, Italy
| | - Matteo Bruzzone
- AO Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128, Turin, Italy
| | - Federico Dettoni
- AO Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128, Turin, Italy
| | - Davide Edoardo Bonasia
- AO Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128, Turin, Italy
| | - Federica Rosso
- AO Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128, Turin, Italy.
| |
Collapse
|