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Borsinger TM, Quevedo Gonzalez FJ, Pagan CA, Karasavvidis T, Sculco PK, Wright TM, Kahlenberg CA, Lipman JD, Debbi EM, Vigdorchik JM, Mayman DJ. Is Tibial Bone Mineral Density Related to Sex, Age, Preoperative Alignment, or Fixation Method in Primary Total Knee Arthroplasty? J Arthroplasty 2024:S0883-5403(24)00272-9. [PMID: 38548236 DOI: 10.1016/j.arth.2024.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) has regained interest for its potential for long-term biologic fixation. The density of the bone is related to its ability to resist static and cyclic loading and can affect long-term implant fixation; however, little is known about the density distribution of periarticular bone in TKA patients. Thus, we sought to characterize the bone mineral density (BMD) of the proximal tibia in TKA patients. METHODS We included 42 women and 50 men (mean age 63 years, range: 50 to 87; mean body mass index 31.6, range: 20.5 to 49.1) who underwent robotic-assisted TKA and had preoperative computed tomography scans with a BMD calibration phantom. Using the robotic surgical plan, we computed the BMD distribution at 1 mm-spaced cross-sections parallel to the tibial cut from 2 mm above the cut to 10 mm below. The BMD was analyzed with respect to patient sex, age, preoperative alignment, and type of fixation. RESULTS The BMD decreased from proximal to distal. The greatest changes occurred within ± 2 mm of the tibial cut. Age did not affect BMD for men; however, women between 60 and 70 years had higher BMD than women ≥ 70 years for the total cut (P = .03) and the medial half of the cut (P = .03). Cemented implants were used in 1 86-year-old man and 18 women (seven < 60 years, seven 60 to 70 years, and four ≥ 70 year old). We found only BMD differences between cemented or cementless fixation for women < 60 years. CONCLUSIONS To our knowledge, this is the first study to characterize the preoperative BMD distribution in TKA patients relative to the intraoperative tibial cut. Our results indicate that while sex and age may be useful surrogates of BMD, the clinically relevant thresholds for cementless knees remain unclear, offering an area for future studies.
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Affiliation(s)
- Tracy M Borsinger
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | | - Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Theofilos Karasavvidis
- 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
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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O'Brien DF, Sullivan TC, Lambert BS, Brown TS, Incavo SJ, Park KJ. Patient Perceptions of Same-Day Discharge Versus Overnight Stay After Total Joint Arthroplasty: Results of a Survey. HSS J 2024; 20:96-101. [PMID: 38356758 PMCID: PMC10863581 DOI: 10.1177/15563316231218249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 02/16/2024]
Abstract
Background In the COVID-19 era, there has been increasing interest in same-day discharge (SDD) after total joint arthroplasty (TJA). However, patient perception of SDD is not well reported. Purpose We sought to understand patients' perceptions and preferences of postoperative care by surveying patients who have completed both an overnight stay (ONS) and an SDD after TJA. Methods We emailed survey links to 67 patients who previously underwent either 2 total hip arthroplasties (THAs) or 2 total knee arthroplasties (TKAs). Results Fifty-two patients (78%) responded to the survey. Thirty-four (65%) patients underwent staged, bilateral TKAs, and 18 (35%) patients underwent staged, bilateral THAs. Overall, 63% of patients preferred their SDD, 12% had no preference, and 25% preferred their ONS, with no difference in preference between TKA and THA groups. Those who preferred their SDD reported being more comfortable at home. Those who preferred their ONS felt their pain and concerns were better addressed. No differences were found in comfort, sleep quality, appetite, burden on family, return to function, feelings of being discharged too soon, overall experience, 30-day emergency department (ED) visits, or readmissions within 30 days between patients' SDD and ONS. There was a small statistically significant difference between patients' perception of safety between SDD and ONS. Conclusion Our survey found that most patients reported a preference for SDD after TJA over ONS. Although there was a small difference in patient perception of safety, there were no differences in return to the ED or readmissions after SDD and ONS.
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Affiliation(s)
- Daniel F O'Brien
- Houston Methodist Hospital, Department of Orthopedics and Sports Medicine, Houston, TX, USA
| | - Thomas C Sullivan
- Houston Methodist Hospital, Department of Orthopedics and Sports Medicine, Houston, TX, USA
| | - Bradley S Lambert
- Houston Methodist Hospital, Department of Orthopedics and Sports Medicine, Houston, TX, USA
| | - Timothy S Brown
- Houston Methodist Hospital, Department of Orthopedics and Sports Medicine, Houston, TX, USA
| | - Stephen J Incavo
- Houston Methodist Hospital, Department of Orthopedics and Sports Medicine, Houston, TX, USA
| | - Kwan J Park
- Houston Methodist Hospital, Department of Orthopedics and Sports Medicine, Houston, TX, USA
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Matassi F, Pettinari F, Frasconà F, Innocenti M, Civinini R. Coronal alignment in total knee arthroplasty: a review. J Orthop Traumatol 2023; 24:24. [PMID: 37217767 DOI: 10.1186/s10195-023-00702-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
Total knee arthroplasty (TKA) alignment has recently become a hot topic in the orthopedics arthroplasty literature. Coronal plane alignment especially has gained increasing attention since it is considered a cornerstone for improved clinical outcomes. Various alignment techniques have been described, but none proved to be optimal and there is a lack of general consensus on which alignment provides best results. The aim of this narrative review is to describe the different types of coronal alignments in TKA, correctly defining the main principles and terms.
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Affiliation(s)
- F Matassi
- Orthopedic Clinic, AOU Careggi, University of Florence, Florence, Italy
| | - F Pettinari
- Orthopedic Clinic, AOU Careggi, University of Florence, Florence, Italy.
| | - F Frasconà
- Orthopedic Clinic, AOU Careggi, University of Florence, Florence, Italy
| | - M Innocenti
- Orthopedic Clinic, AOU Careggi, University of Florence, Florence, Italy
| | - R Civinini
- Orthopedic Clinic, AOU Careggi, University of Florence, Florence, Italy
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Vale J, Pinto LV, Barros B, Diniz S, Rodrigues F, Marques M, Belinha J, Vilaça A. Total knee arthroplasty coronal alignment and tibial base stress-a new numerical evaluation. Porto Biomed J 2023; 8:e208. [PMID: 37152633 PMCID: PMC10158898 DOI: 10.1097/j.pbj.0000000000000208] [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: 11/28/2022] [Accepted: 02/07/2023] [Indexed: 05/09/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures. The correct positioning and alignment of the components significantly affects prosthesis survival. Considering the current controversy regarding the target of postoperative alignment of TKA, this study evaluated the tension at tibial component interface using two numerical methods. Methods The stress of the prosthesis/bone interface of the proximal tibial component was evaluated using two numerical methods: the finite element method (FEM) and the new meshless method: natural neighbor radial point interpolation method (NNRPIM). The construction of the model was based on Zimmers NexGen LPS-Flex Mobile® prosthesis and simulated the forces by using a free-body diagram. Results Tibiofemoral mechanical axis (TFMA) for which a higher number of nodes are under optimal mechanical tension is between 1° valgus 2° varus. For values outside the interval, there are regions under the tibial plate at risk of bone absorption. At the extremities of the tibial plate of the prosthesis, both medial and lateral, independent of the alignment, are under a low stress. In all nodes evaluated for all TFMA, the values of the effective stresses were higher in the NNRPIM when compared with the FEM. Conclusion Through this study, we can corroborate that the optimal postoperative alignment is within the values that are currently considered of 0 ± 3° varus. It was verified that the meshless methods obtain smoother and more conservative results, which may make them safer when transposed to the clinical practice.
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Affiliation(s)
- João Vale
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
- Corresponding author: Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal. E-mail address: (João Vale)
| | - Luisa V. Pinto
- Department of Physical and Medicine Rehabilitation, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Bianca Barros
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
| | - Sara Diniz
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
| | - Filipe Rodrigues
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
| | - Marco Marques
- Institute of Science and Innovation in Mechanical and Industrial Engineering, INEGI, Porto, Portugal
| | - Jorge Belinha
- Department of Mechanical Engineering, School of Engineering, Polytechnic of Porto, ISEP, Porto, Portugal
| | - Adélio Vilaça
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
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Jack RA, Lambert BS, Hedt CA, Delgado D, Goble H, McCulloch PC. Blood Flow Restriction Therapy Preserves Lower Extremity Bone and Muscle Mass After ACL Reconstruction. Sports Health 2022; 15:361-371. [PMID: 35762124 PMCID: PMC10170230 DOI: 10.1177/19417381221101006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Muscle atrophy is common after an injury to the knee and anterior cruciate ligament reconstruction (ACLR). Blood flow restriction therapy (BFR) combined with low-load resistance exercise may help mitigate muscle loss and improve the overall condition of the lower extremity (LE). PURPOSE To determine whether BFR decreases the loss of LE lean mass (LM), bone mass, and bone mineral density (BMD) while improving function compared with standard rehabilitation after ACLR. STUDY DESIGN Randomized controlled clinical trial. METHODS A total of 32 patients undergoing ACLR with bone-patellar tendon-bone autograft were randomized into 2 groups (CONTROL: N = 15 [male = 7, female = 8; age = 24.1 ± 7.2 years; body mass index [BMI] = 26.9 ± 5.3 kg/m2] and BFR: N = 17 [male = 12, female = 5; age = 28.1 ± 7.4 years; BMI = 25.2 ± 2.8 kg/m2]) and performed 12 weeks of postsurgery rehabilitation with an average follow-up of 2.3 ± 1.0 years. Both groups performed the same rehabilitation protocol. During select exercises, the BFR group exercised under 80% arterial occlusion of the postoperative limb (Delfi tourniquet system). BMD, bone mass, and LM were measured using DEXA (iDXA, GE) at presurgery, week 6, and week 12 of rehabilitation. Functional measures were recorded at week 8 and week 12. Return to sport (RTS) was defined as the timepoint at which ACLR-specific objective functional testing was passed at physical therapy. A group-by-time analysis of covariance followed by a Tukey's post hoc test were used to detect within- and between-group changes. Type I error; α = 0.05. RESULTS Compared with presurgery, only the CONTROL group experienced decreases in LE-LM at week 6 (-0.61 ± 0.19 kg, -6.64 ± 1.86%; P < 0.01) and week 12 (-0.39 ± 0.15 kg, -4.67 ± 1.58%; P = 0.01) of rehabilitation. LE bone mass was decreased only in the CONTROL group at week 6 (-12.87 ± 3.02 g, -2.11 ± 0.47%; P < 0.01) and week 12 (-16.95 ± 4.32 g,-2.58 ± 0.64%; P < 0.01). Overall, loss of site-specific BMD was greater in the CONTROL group (P < 0.05). Only the CONTROL group experienced reductions in proximal tibia (-8.00 ± 1.10%; P < 0.01) and proximal fibula (-15.0±2.50%,P < 0.01) at week 12 compared with presurgery measures. There were no complications. Functional measures were similar between groups. RTS time was reduced in the BFR group (6.4 ± 0.3 months) compared with the CONTROL group (8.3 ± 0.5 months; P = 0.01). CONCLUSION After ACLR, BFR may decrease muscle and bone loss for up to 12 weeks postoperatively and may improve time to RTS with functional outcomes comparable with those of standard rehabilitation.
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Affiliation(s)
- Robert A Jack
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Bradley S Lambert
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Corbin A Hedt
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Domenica Delgado
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Haley Goble
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Patrick C McCulloch
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
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Minoda Y, Ikebuchi M, Kobayashi A, Sugama R, Ohta Y, Takemura S, Yamamoto N, Nakamura H. Medial peg position of cementless porous tantalum tibial component affects bone mineral density around the prosthesis after total knee arthroplasty: 2-year follow-up study. Knee 2022; 34:55-61. [PMID: 34875497 DOI: 10.1016/j.knee.2021.11.005] [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: 02/23/2021] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Use of a porous tantalum tibial component for total knee arthroplasty (TKA) was reported to have beneficial effects on periprosthetic bone mineral density (BMD). In some cases, hexagonal peg is placed close to or in contact with the tibial cortex, which may result in stress-shielding around the peg. However, no studies have analyzed the relationship between peg position and BMD. The aim of this study was to compare the peg position and BMD around the peg in a porous tantalum tibial component after TKA. METHODS Twenty-seven patients (27 knees) who underwent primary TKA with a cementless porous tantalum tibial component were investigated. BMD was measured by dual-energy X-ray absorptiometry for 2 years after the operation. The distance between the peg and the tibial cortex (peg distance) was measured on the medial and lateral sides. RESULTS BMD was decreased in the medial region after the operation (p < 0.01). Relative change in BMD was lower in the medial region than in the central and lateral regions (p < 0.01). Multiple regression analysis showed that medial peg distance was negatively correlated with relative change of BMD in the medial part of the tibia (p = 0.04, R = 0.402). CONCLUSIONS The medial peg position affected the postoperative relative change of BMD in the medial part of the tibia, but did not affect the longevity of the implant. As the tibial medial peg became closer to the medial tibial cortex, the BMD loss became larger in the medial part of the tibia at 2 years postoperatively.
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Affiliation(s)
- Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan.
| | - Mitsuhiko Ikebuchi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan
| | - Susumu Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan
| | - Nobuo Yamamoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan
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Tallard JC, Hedt C, Lambert BS, McCulloch PC. The Role of Fatigue in Return to Sport Testing Following Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther 2021; 16:1043-1051. [PMID: 34386283 PMCID: PMC8329315 DOI: 10.26603/001c.25687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Fatigue may play a role in anterior cruciate ligament (ACL) injury, but has not been incorporated into objective test batteries for return to sport decisions following ACL reconstruction (ACLR) surgery. The effect of fatigue on muscle function and performance following surgery and rehabilitation has been poorly studied. PURPOSE/HYPOTHESIS The purpose of this study was to assess the effect of fatigue on performance of various hop tests used in clinical rehabilitation settings by examining LSI scores. The authors hypothesized that participants will have worse limb symmetry index scores following the fatigue protocol and that the operative limb (ACLR) will have a greater decline in function than the non-operative limb (CON). STUDY DESIGN Cross-Sectional Study. METHODS Participants (n=21 [Male = 15, Female = 6]; AGE = 24.6 ± 9.3) were at least six months post ACLR and in rehabilitation. Testing was performed over two separate sessions in either a non-fatigued (NFS) or fatigued state (FS). In the FS, individuals performed a series of exercises to exhaust muscular endurance, strength, and power systems, after which they performed as battery of seven hop tests (single hop for distance, triple hop for distance, crossover hop for distance, 6-meter timed hop, lateral rotation hop for distance, medial rotation hop for distance, and vertical jump for height). A 2(limb) x 2(time) ANOVA was used to compare limbs between each state. RESULTS Differences between limbs (CON vs ACLR) were observed for all hop tests in the NFS whereby the ACLR limb was observed to have reduced performance (↓5.4-9.1%, p <0.05). When tested in the FS, significant differences in performance between limbs remained for only the crossover (↓4.9%), medial rotation (↓7.1%), lateral rotation (↓5.5%), and vertical hop (↓10.0%)(p<0.05). When comparing the NFS and FS states, only the CON limb was observed to have significant decreases in performance of the Triple Hop (↓7.4%), Crossover (↓8.7%), and Lateral Rotation (↓5.2%)(p<0.05). CONCLUSIONS Following ACL reconstruction, there appears to be a greater loss in jump performance in the CON limb in the FS. These findings suggest it may be crucial to consider and assess the endurance of both limbs rather than just the ACLR limb when determining readiness for return to play. LEVEL OF EVIDENCE Level 3.
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