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Mancino F, Fontalis A, Haddad FS. Beyond the scalpel. Bone Joint J 2024; 106-B:760-763. [PMID: 39084644 DOI: 10.1302/0301-620x.106b8.bjj-2024-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
- The Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
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Karasavvidis T, Pagan CA, Debbi EM, Mayman DJ, Jerabek SA, Vigdorchik JM. No Difference in Limb Alignment Between Kinematic and Mechanical Alignment Robotic-Assisted Total Knee Arthroplasty. J Arthroplasty 2024; 39:S200-S205. [PMID: 38548234 DOI: 10.1016/j.arth.2024.03.050] [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: 11/20/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Individualized alignment techniques have gained major interest in an effort to increase satisfaction among total knee arthroplasty patients. This study aimed to compare postoperative alignment between kinematic alignment (KA) and mechanical alignment (MA) and assess whether KA significantly deviates from the principle of aligning the limb as close to neutral alignment as possible. METHODS There were 234 patients who underwent robotic-assisted total knee arthroplasty using an unrestricted KA and a strict MA technique (KA: 145, MA: 89). The lateral distal femoral angle, medial proximal tibia angle, and the resultant arithmetic hip-knee-ankle angle (aHKA) were measured. The aHKA < 0 indicated varus alignment, while the aHKA > 0 indicated valgus knee alignment. The primary outcome was the frequency of cases that resulted in an aHKA of ± 4° of neutral (0°), as assessed on full-leg standing radiographs obtained at 6 weeks postoperatively. The secondary outcome was the change in coronal plane alignment of the knee classification type from preoperative to postoperative between the MA and KA groups. RESULTS The mean preoperative aHKA was similar between the 2 groups (P = .19). The KA group had a mean postoperative aHKA of -1.4 ± 2.4°, while the MA group had a mean postoperative aHKA of -0.5 ± 2.1°. No significant difference in limb alignment was identified between KA and MA cases that resulted in hip-knee-ankle angle of ± 4° being neutral (91.7 versus 96.6%, P = .14). There were 97.2% of cases in the KA group that fell within the ± 5° range. The MA group was associated with a significantly higher rate of coronal plane alignment of the knee classification type change from preoperatively to postoperatively (P < .001). CONCLUSIONS Kinematic alignment achieved similar postoperative aHKA compared to MA, and thus did not significantly deviate from the principle of aligning the limb as close to neutral alignment as possible. Surgeons should feel comfortable starting to introduce individualized alignment techniques. Without being restricted by boundaries, postoperative alignment will be within 5 degrees of neutral 97% of the time.
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Affiliation(s)
- Theofilos Karasavvidis
- 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
| | - Eytan M Debbi
- 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
| | - Seth A Jerabek
- 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
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Song S, Liu Z, Zhang Q. Application of virtual reality technology in postoperative rehabilitation following total knee arthroplasty: A scoping review. Int J Orthop Trauma Nurs 2024; 54:101124. [PMID: 39096627 DOI: 10.1016/j.ijotn.2024.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/05/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND With the advent of an ageing era, the number of elderly patients undergoing knee joint replacement is increasing. Postoperative long-term standardized functional exercise is a focal point and difficulty in the recovery of joint function for patients after knee replacement. Virtual reality (VR) is increasingly considered a potentially effective option that can provide patients with a relaxed and enjoyable exercise method. OBJECTIVE The primary objective of the scoping review to systematically evaluates the impact of virtual reality (VR) technology the movement and functional recovery, psychological state, pain levels, and quality of life of patients after total knee arthroplasty (TKA). It summarises and synthesises VR's effects and feasibility in TKA rehabilitation training, offering a scientific basis and reference for the professional advancement of orthopaedic practice nurses and future research in this domain. METHODS We employed the Joanna Briggs Institute's scoping review guidelines as our methodological framework. The literature search spanned from January 2018 to December 31, 2023, encompassing databases such as PubMed, Web of Science, The Cochrane Library, Embase, CNKI, Wanfang, CQVIP, and the China Biomedical Literature Database. RESULTS An initial search yielded 2708 articles, with 17 studies meeting the inclusion criteria after stringent screening. The findings indicate that VR equipment primarily comprises VR goggles, handheld controllers, and sensor technology. Interventions typically occurred 3 to 5 times weekly, lasting 20-30 min per session. The principal assessment metrics included pain levels, psychological state, joint function, and quality of life. CONCLUSION VR technology proves feasible in the rehabilitation of TKA patients, effectively alleviating pain, enhancing psychological states, and improving joint function and quality of life. However, discrepancies exist regarding VR's effect on bolstering lower limb muscle strength. Future research should focus on evidence-based medical practices, optimising VR intervention strategies, developing customised plans tailored to individual patient differences, and potentially extending intervention durations to amplify VR technology's application effects in TKA patient rehabilitation.
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Affiliation(s)
- Shiyu Song
- The First Clinical College of Xinxiang Medical College, China.
| | - Zhixia Liu
- The First Clinical College of Xinxiang Medical College, China
| | - Quanying Zhang
- The First Affiliated Hospital of Xinxiang Medical University, China.
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Pagan C, Karasavvidis T, Cohen-Rosenblum A, Hannon CP, Lombardi AV, Vigdorchik J. Technology in Total Knee Arthroplasty in 2023. J Arthroplasty 2024:S0883-5403(24)00751-4. [PMID: 39053667 DOI: 10.1016/j.arth.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
Over the past few decades, instrumentation and techniques for total knee arthroplasty (TKA) have evolved from conventional manual tools to a wide range of technologies, including calibrated guides for accurate bone cuts and alignment, smart tools, dynamic intraoperative sensors for soft-tissue balancing, patient-specific guides, computer navigation, and robotics. This review is intended to provide an overview of the latest advancements in TKA technology, address potential challenges and solutions related to the application of these technologies, and explore their limitations.
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Affiliation(s)
- Cale Pagan
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Charles P Hannon
- Deparment of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jonathan Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Franceschetti E, Campi S, Giurazza G, Tanzilli A, Gregori P, Laudisio A, Hirschmann MT, Samuelsson K, Papalia R. Mechanically aligned total knee arthroplasty does not yield uniform outcomes across all coronal plane alignment of the knee (CPAK) phenotypes. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38984905 DOI: 10.1002/ksa.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Patient dissatisfaction rates following total knee arthroplasty (TKA) reported in the literature reach 20%. The optimal coronal alignment is still under debate. The aim of this retrospective study was to compare clinical outcomes in different coronal plane alignment of the knee (CPAK) phenotypes undergoing mechanically aligned (MA) TKA. The hypothesis was that knees with preoperative varus arithmetic hip-knee-ankle angle (aHKA) would achieve inferior clinical outcomes after surgery compared to other aHKA categories. Additionally, another objective was to assess CPAK phenotypes distribution in the study population. METHODS A retrospective selection was made of 180 patients who underwent MA TKA from April 2021 to December 2022, with a 1-year follow-up. Coronal knee alignment was classified according to the CPAK classification. Clinical outcome evaluations were measured using the Knee Society Score (KSS), Oxford Knee Score (OKS), Short Form Survey 12 and Forgotten Joint Score (FJS). Differences in clinical outcomes were considered statistically significant with a p value <0 .05. RESULTS Patients with varus aHKA achieved significantly inferior outcomes at final follow-up compared to other aHKA categories in KSS pt. 1 (79.7 ± 17.2 vs. 85.6 ± 14.7; p = 0.028), OKS (39.2 ± 9.2 vs. 42.2 ± 7.2; p = 0.019) and FJS (75.4 ± 31.0 vs. 87.4 ± 22.9; p =0 .003). The most common aHKA category was the varus category (39%). The most common CPAK phenotypes were apex distal Types I (23.9%), II (22.8%) and III (13.3%). CONCLUSION MA TKA does not yield uniform outcomes across all CPAK phenotypes. Varus aHKA category shows significantly inferior results at final follow-up. The most prevalent CPAK categories are varus aHKA and apex distal JLO, with phenotypes I, II and III being the most common. However, their gender distribution varies significantly. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Giancarlo Giurazza
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Andrea Tanzilli
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Pietro Gregori
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Alice Laudisio
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Copp EH, Gale TH, Byrapogu VKC, Urish KL, Anderst WJ. Unicompartmental knee arthroplasty approximates healthy knee kinematics more closely than total knee arthroplasty. J Orthop Res 2024. [PMID: 38956422 DOI: 10.1002/jor.25926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/03/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are effective surgeries to treat end-stage knee osteoarthritis. Clinicians assume that TKA alters knee kinematics while UKA preserves native knee kinematics; however, few studies of in vivo kinematics have evaluated this assumption. This study used biplane radiography to compare side-to-side tibiofemoral kinematics during chair rise, stair ascent, and walking in 16 patients who received either TKA or UKA. We hypothesized that TKA knees would have significant kinematic changes and increased asymmetry with the contralateral knee, while UKA knee kinematics would not change after surgery and preoperative knee symmetry would be maintained. Native bone and implant motion were tracked using a volumetric model-based tracking technique. Six degrees of freedom kinematics were calculated throughout each motion. Kinematics were compared between the operated and contralateral knees pre- and post-surgery using a linear mixed-effects model. TKA knees became less varus with the tibia more medial, posterior, and distal relative to the femur. UKA knees became less varus with the tibia less lateral on average. Postoperative TKA knees were in less varus than UKA knees on average and at low flexion angles, with an internally rotated tibia during chair rise and stair ascent. At high flexion angles, the tibia was more medial and posterior after TKA than UKA. Side-to-side kinematic symmetry worsened after TKA but was maintained or improved after UKA. Greater understanding of kinematic differences between operated and contralateral knees after surgery may help surgeons understand why some patients remain unsatisfied with their new knees.
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Affiliation(s)
- Elizabeth H Copp
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tom H Gale
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Kenneth L Urish
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William J Anderst
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Sauder N, Brinkman N, Sayegh GE, Moore MG, Koenig KM, Bozic KJ, Patel JJ, Jayakumar P. Preoperative Symptoms of Depression are Associated With Worse Capability 6-weeks and 6-months After Total Hip Arthroplasty for Osteoarthritis. J Arthroplasty 2024; 39:1777-1782. [PMID: 38642851 DOI: 10.1016/j.arth.2024.04.044] [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: 09/16/2023] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Symptoms of depression have been associated with greater incapability following total hip arthroplasty (THA). A brief, 2-question, measure of symptoms of depression - the Patient Health Questionnaire-2 (PHQ-2) - may be sufficient to measure associations with the magnitude of incapability during recovery from THA. This study investigated whether preoperative symptoms of depression (measured with the PHQ-2) correlated with levels of incapability 6 weeks and 6 months after THA, accounting for demographic and clinical factors. METHODS We performed a prospective cohort study across 5 centers and recruited 101 patients undergoing THA, of whom 90 (89%) completed follow-up. Patients completed demographics, a preoperative 2-item (PHQ-2) measure of symptoms of depression, and the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) at 6-weeks and 6-months postoperatively. Negative binomial regression models determined factors associated with HOOS JR at 6 weeks and 6 months, accounting for potential confounders. RESULTS Accounting for potential confounding factors, we found that higher preoperative PHQ-2 scores (reflecting greater symptoms of depression) were associated with lower HOOS JR scores (reflecting a greater level of hip disability) at both 6 weeks (regression coefficient = -0.67, P < .001) and 6 months (regression coefficient = -1.9, P < .001) after THA. CONCLUSIONS Symptoms of depression on a 2-question preoperative questionnaire are common, and greater symptoms of depression are associated with reduced capability within the first year following THA. These findings support the prioritization of routine mental health assessments before THA. Measuring mindset using relatively brief instruments will be important considering the current shift toward implementing self-reported measures of health status in clinical practice and incorporating them within alternative payment models.
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Affiliation(s)
- Nicholas Sauder
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Niels Brinkman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - George E Sayegh
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Meredith G Moore
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Karl M Koenig
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Jay J Patel
- Hoag Orthopaedic Institute, Orange, Orange, California
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
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Khan Z, Leica A, Sava M, Hirschmann MT. No difference in postoperative patient satisfaction rates between mechanical and kinematic alignment total knee arthroplasty: A systematic review. J Exp Orthop 2024; 11:e12101. [PMID: 39050592 PMCID: PMC11267171 DOI: 10.1002/jeo2.12101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/21/2024] [Accepted: 05/24/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose The purpose of this systematic review was to compare patient satisfaction patient-reported outcomes (PROMs) levels after mechanically aligned (MA) and kinematically aligned (KA) total knee arthroplasty (TKA). Methods A systematic literature search following PRISMA guidelines was conducted on PubMed, Embase, Medline and Scopus to identify potentially relevant articles for this review, published from the beginning of March 2013 until the end of October 2023. Only articles reporting satisfaction after KA TKA, MA TKA or both were included, which use valid and reliable tools for the evaluation and reporting of satisfaction after TKA. Title, authors, year of publication, study design, level of evidence, follow-up period, patients' demographic data, sample size, type of satisfaction score, postoperative satisfaction score, postoperative alignment, statistical significance, as well as other variables, were extracted for analysis. An Agency for Healthcare Research and Quality's (AHRQ) design-specific scale was used for assessing randomized control trials (RCTs). The nonrandomized control trials were evaluated by using the Joanna Briggs Institute's (JBI) Critical Appraisal Tool. The Newcastle-Ottawa Scale (NOS) was also used to assess cohort studies, while case series were evaluated using the NIH Quality Assessment Tool for Case Series Studies. Results The initial search identified 316 studies, of which 178 were considered for screening. Eleven studies completely fulfilled the inclusion criteria, including one RCT, five nonrandomized control trials/quasi-experiments, three case series, and two cohort studies. The total number of patients recruited for MA TKA was 1740. Conversely, 497 patients were enrolled for KA TKA. Five studies used the visual analogue scale (VAS) for assessing postoperative patient satisfaction, four used the Knee Society Score (KSS) 2011 version and two Likert-based types of scores. Overall, the highest mean satisfaction score of KSS 2011 was 31.5 ± 6.6 in the MA group, and 29.8 ± 80 in the KA group in four studies. All of them showed high postoperative patient satisfaction rates for both MA and KA TKA, but with no statistically significant difference between them (p > 0.05). Conclusion Both mechanically aligned total knee arthroplasty, as well as kinematically aligned total knee arthroplasty led to high rates of postoperative patient satisfaction, with no statistically significant differences between them. Level of Evidence Level III, systematic review.
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Affiliation(s)
- Zainab‐Aqeel Khan
- Department of Orthopaedic Surgery and TraumatologyKantonsspital Baselland (Bruderholz, Liestal, Laufen)BruderholzSwitzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & BiomechanicsUniversity of BaselBaselSwitzerland
- Department of ResearchAO HospitalKarachiPakistan
- Department of Molecular Medicine and SurgeryStockholm Sports Trauma Research Center, Karolinska InstitutetStockholmSweden
| | - Alexandra Leica
- Department of Orthopaedic Surgery and TraumatologyKantonsspital Baselland (Bruderholz, Liestal, Laufen)BruderholzSwitzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & BiomechanicsUniversity of BaselBaselSwitzerland
| | - Manuel‐Paul Sava
- Department of Orthopaedic Surgery and TraumatologyKantonsspital Baselland (Bruderholz, Liestal, Laufen)BruderholzSwitzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & BiomechanicsUniversity of BaselBaselSwitzerland
| | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and TraumatologyKantonsspital Baselland (Bruderholz, Liestal, Laufen)BruderholzSwitzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & BiomechanicsUniversity of BaselBaselSwitzerland
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Tsao AK, Scuderi GR, Mont MA. The Utility of Preoperative Screening for Depression in Total Hip Arthroplasty: A Commentary. J Arthroplasty 2024; 39:1635-1636. [PMID: 38583683 DOI: 10.1016/j.arth.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Affiliation(s)
- Audrey K Tsao
- Mid-Atlantic Permanente Medical Group, Kensington, Maryland
| | - Giles R Scuderi
- Northwell Health Physician Partners Orthopaedic Institute at Lennox Hill, New York, New York
| | - Michael A Mont
- The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Campbell TM. CORR Insights®: Human Infrapatellar Fat Pad Mesenchymal Stem Cell-derived Extracellular Vesicles Purified by Anion Exchange Chromatography Suppress Osteoarthritis Progression in a Mouse Model. Clin Orthop Relat Res 2024; 482:1263-1266. [PMID: 38843517 PMCID: PMC11219161 DOI: 10.1097/corr.0000000000003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 07/04/2024]
Affiliation(s)
- T Mark Campbell
- Clinician Investigator, Physical Medicine and Rehabilitation Department, Élisabeth Bruyère Hospital, Ottawa, Ontario, Canada
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11
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Su Q, Shao Y, Bao Y, Kan Y, Wu B, Ye F. A qualitative study on the perioperative experiences and demands of haemophilic arthropathy patients undergoing total joint replacement. Haemophilia 2024; 30:1050-1058. [PMID: 38923219 DOI: 10.1111/hae.15073] [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] [Received: 01/24/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Total joint replacement is the optimal treatment option for patients with severe haemophilic arthritis. Current research emphasizes patient-reported outcomes as a vital measure for evaluating surgical outcomes and patient satisfaction. Nevertheless, very limited information about the subjective experience of perioperative haemophiliacs in the literature, highlighting the need for exploration in this area. AIM To investigate the psychological experiences and health demands of haemophilic arthropathy patients during the perioperative period of total joint replacement. DESIGN Qualitative descriptive research with semistructured individual interviews. METHODS From June to September 2023, nine patients with severe haemophilic arthropathy who underwent total joint replacement at a Haemophilia Diagnosis and Treatment Centre in China were interviewed for average 37 min per person. Data were analysed using the traditional content analysis method and reported following the consolidated criteria for reporting qualitative research. The study is reported according to the COREQ checklist. RESULTS Interviews described two main themes: (1) emotional decline which involves preoperative overoptimism, early postoperative anxiety and disease uncertainty during the early independent rehabilitation. (2) wellness aspiration which includes rehabilitation support and spiritual healing. CONCLUSION This study reveals the patients' significant psychological changes and their well-being aspiration, particularly out-of-hospital rehabilitation needs. Strengthening communication between multidisciplinary teams and patients, enhancing the involvement of nurses, broadening the scope of functions at primary Haemophilia Treatment Centres, and developing telerehabilitation, these concerted efforts may improve the overall treatment experience for patients.
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Affiliation(s)
- Qian Su
- Zhejiang Chinese Medical University, School of Nursing, Hangzhou, China
| | - Yashuang Shao
- Zhejiang Chinese Medical University, School of Nursing, Hangzhou, China
| | - Yunchun Bao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yanan Kan
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Bainv Wu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Fuying Ye
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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12
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Sattler LN, Walker AT, Kan AJ, Hing WA, Vertullo CJ. Stratification of Outpatient Physical Therapy Following Total Knee Arthroplasty: Knee Arthroplasty Physical Therapy Pathways (KAPPA) Nonrandomized Controlled Trial. J Arthroplasty 2024; 39:1685-1691. [PMID: 38331361 DOI: 10.1016/j.arth.2024.02.002] [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: 11/17/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Outpatient physical therapy following total knee arthroplasty (TKA) is often considered crucial for an effective recovery. However, recent evidence suggests that a self-directed pathway may yield similar benefits to supervised care. Despite this, there appear to be no established criteria to determine who can successfully self-direct their rehabilitation versus those who would benefit from outpatient physical therapy. This study aimed to determine if early postoperative criteria can stratify TKA patients into a self-directed or supervised physical therapy pathway without compromising outcomes. METHODS Overall, 60 TKA patients were initially allocated to a self-directed, unsupervised protocol for their postoperative rehabilitation. Baseline demographics, along with functional and self-reported outcomes, were assessed preoperatively and at 2 weeks, 6 weeks, and 4 months following surgery. Patients were referred to supervised outpatient physical therapy if they met any of the following Knee Arthroplasty Physical Therapy Pathways (KAPPA) criteria: (1) knee flexion range of motion <90 degrees; (2) knee extension range of motion lacking >10 degrees; or (3) dissatisfaction with the progress of their rehabilitation. RESULTS At 2 weeks post-TKA, 28 participants met the KAPPA criteria for supervised physical therapy for reasons of knee flexion <90 degrees (61%), a lack of knee extension >10 degrees (36%), or not being satisfied with the progress of their recovery (3%). The remaining 32 participants continued with a self-directed rehabilitation pathway. All outcomes assessed favored the self-directed group at 2 weeks, however, after an average of 4 supervised physical therapy sessions at 4 months there were no longer any differences between the 2 groups. CONCLUSIONS Over half of the included participants could self-direct their rehabilitation following TKA without supervised physical therapy while also maintaining excellent clinical outcomes. For those who met KAPPA criteria at 2 weeks post-TKA, 4 supervised physical therapy sessions appeared to be beneficial when outcomes were reassessed at 4 months.
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Affiliation(s)
- Larissa N Sattler
- Faculty Health Sciences and Medicine, Bond University Institute of Health and Sport, Robina, QLD, Australia
| | - Adam T Walker
- Faculty Health Sciences and Medicine, Bond University Institute of Health and Sport, Robina, QLD, Australia; Gold Coast Knee Group, Robina, QLD, Australia
| | - Adrian J Kan
- Faculty Health Sciences and Medicine, Bond University Institute of Health and Sport, Robina, QLD, Australia; Gold Coast Knee Group, Robina, QLD, Australia
| | - Wayne A Hing
- Faculty Health Sciences and Medicine, Bond University Institute of Health and Sport, Robina, QLD, Australia
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Palanisamy Y, Prasad AR, Seetharaman K, Elango H, Rajan DV, Meena N. Analgesic eluting bone cement: A novel approach for targeted pain management in total knee arthroplasty - An in-vitro study. Knee 2024; 49:135-146. [PMID: 38943788 DOI: 10.1016/j.knee.2024.05.012] [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: 01/16/2024] [Revised: 04/08/2024] [Accepted: 05/28/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND The average rate of patient dissatisfaction following total knee arthroplasty (TKA) is 10%. Multi-modal analgesia is the present standard of pain management after TKA. Studies show that with multi-modal analgesia, approximately 60% of patients experience severe knee pain following surgery, while around 30% experience moderate pain. To date, there is no literature available on targeted pain management using bone cement. OBJECTIVES To investigate the feasibility of incorporating anti-inflammatory medications and identify the analgesic with the best release pharmacokinetics from bone cement for application in pain management. METHODS In an in-vitro study, 100 mg of five drugs (aceclofenac, diclofenac, naproxen, paracetamol and methyl prednisolone) were incorporated into bone cement (Palacos). Cement cubes holding each drug were made and allowed to harden for 30 min. Each drug-containing cube was placed in a beaker with saline for 72 h. Fractions of 10 ml were collected at 0, 6, 24, 48 and 72 h and analysed using high-pressure liquid chromatography to measure the percentage release of the drug from bone cement. RESULTS Naproxen showed superior elution from bone cement, with 10.9% at 24 h and 9.08% at 72 h. Paracetamol showed 4.9% at 24 h and 3.78% at 72 h, aceclofenac 0.2% at 24 h and 0.4% at 72 h, diclofenac 3.03% at 24 h and 1.99% at 72 h, and methylprednisolone 0.26% at 24 h and 0.32% at 72 h. CONCLUSIONS Polymethylmethacrylate bone cement can elute analgesics in vitro. Among the five drugs studied, naproxen had the best release kinematics from polymethylmethacrylate bone cement. Analgesic eluting bone cement is a novel approach for targeted postoperative pain management in TKA.
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Affiliation(s)
| | - Arjun R Prasad
- Ortho-one Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu, India.
| | | | - Hemnath Elango
- Drug Testing Laboratory, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
| | - David V Rajan
- Ortho-one Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu, India
| | - Meena N
- RVS dental college and hospital, Coimbatore, Tamil Nadu, India
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14
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Vogel N, Kaelin R, Arnold MP. Custom total knee arthroplasty with personalised alignment showed better 2-year functional outcome compared to off-the-shelf arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38881354 DOI: 10.1002/ksa.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Customised individually made (CIM) total knee arthroplasty (TKA) with personalised alignment is relatively new and evidence is limited. The aim of this study was to compare patient-reported outcome measures between CIM and off-the-shelf (OTS) TKA patients in a matched-pair analysis with a 2-year follow-up. METHODS In this single-centre, prospective cohort study, propensity score matching was performed on 51 CIM and 51 OTS TKA. Data were measured at baseline, at 4 months, 1 and 2 years and included the Forgotten Joint Score (FJS-12), the High Activity Arthroplasty Score (HAAS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the EQ-5D-3L, the EQ-Visual Analogue Scale, satisfaction, overall knee improvement, willingness to undergo the surgery again and the Knee Society Score. RESULTS At 2 years follow-up, the FJS-12 (77 vs. 67, p = .058), HAAS (13 vs. 11, p < .001), KOOS daily living (92 vs. 86, p = .029), KOOS sport (76 vs. 65, p = .019), KOOS quality of life (81 vs. 71, p = .028) and the EQ-5D (.95 vs. .90, p = .030) were higher for CIM TKA compared to OTS TKA. Satisfaction rate was 92% for CIM TKA and 84% for OTS TKA (p = .357). Most patients reported an improvement in the overall knee state (94% CIM and 90% OTS, p = .487) and almost all patients would undergo the surgery again (96% CIM and 98% OTS, p = .999). CONCLUSION The current study found that CIM TKA patients had better functional outcomes at 2 years. Patient satisfaction was high and not statistically significantly different from OTS TKA patients. LEVEL OF EVIDENCE Level II prospective cohort study.
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Affiliation(s)
- Nicole Vogel
- Practice MEIN KNIE, Hirslanden Klinik Birshof, Münchenstein, Switzerland
- Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Kaelin
- Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Markus P Arnold
- Practice MEIN KNIE, Hirslanden Klinik Birshof, Münchenstein, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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15
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Selph TJ, Suleiman LI, Pagadala MS, Bergman R, Franklin PD, Edelstein AI. Agreement of the American Academy of Orthopaedic Surgeons Appropriate Use Criteria With Treatment Recommendations From Arthroplasty Surgeons. Arthroplast Today 2024; 27:101386. [PMID: 38812476 PMCID: PMC11134556 DOI: 10.1016/j.artd.2024.101386] [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: 01/03/2024] [Revised: 03/02/2024] [Accepted: 03/24/2024] [Indexed: 05/31/2024] Open
Abstract
Background The American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC) for Surgical Management of Osteoarthritis of the Knee (2016) and Management of Osteoarthritis of the Hip (2017) are intended to provide treatment recommendations for osteoarthritis (OA). This study examined the agreement of AUC appropriateness classifications with arthroplasty surgeon recommendations for total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods The cohort included 558 OA patients (397 knee, 161 hip) referred to a specialty arthroplasty clinic. Surgeons completed the online AAOS AUC patient profiles to generate appropriateness ratings. Surgeons' recommendations for treatment were recorded. We performed univariate and bivariate analyses to evaluate relationships between AUC appropriateness and surgeon recommendations. Results The knee OA AUC classified TKA as "appropriate" for 309 (77.8%) of the 397 knee OA patients. Surgeons recommended TKA for 123 (31.0%), resulting in 46.8% (n = 186) higher rate of "appropriate" classification by AUC than TKA recommendation by surgeons. Weighted Cohen's κ demonstrated slight agreement (κ = 0.06, 95% confidence interval: 0.04, 0.09) between AUC appropriateness and surgeon TKA recommendation. The hip OA AUC classified THA as "appropriate" for 98 (60.9%) of the 161 hip OA patients. Surgeons recommended THA for 76 (47.2%), resulting in 13.7% (n = 22) higher rate of "appropriate" classification by AUC than THA recommendation by surgeons. Weighted Cohen's κ demonstrated moderate agreement (κ = 0.47, 95% confidence interval: 0.37, 0.57) between the AUC appropriateness classification and the surgeon's THA recommendation. Conclusions AAOS AUC guidelines indicated surgical appropriateness significantly more than arthroplasty surgeons. AUC agreed slightly with surgeons for TKA and moderately for THA.
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Affiliation(s)
- T. Jacob Selph
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda I. Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rachel Bergman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patricia D. Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Adam I. Edelstein
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Kim CH, Park YB, Baek SH. Clinical and Radiological Outcomes of Computer-Assisted Navigation in Primary Total Knee Arthroplasty for Patients with Extra-articular Deformity: Systematic Review and Meta-Analysis. Clin Orthop Surg 2024; 16:430-440. [PMID: 38827763 PMCID: PMC11130617 DOI: 10.4055/cios23261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 06/05/2024] Open
Abstract
Background Computer-assisted navigation surgery (CAS) during primary total knee arthroplasty (TKA) may help improve outcomes for patients with extra-articular deformity (EAD); however, this has not been extensively studied. Therefore, we aimed to investigate the clinical and radiological outcomes following primary TKA using CAS in patients with EAD. Methods We searched Medline, Embase, and the Cochrane Library up to March 3, 2023 for studies investigating surgical outcomes of using the navigation system for TKA to treat patients with EAD. From 14 studies, 539 knees with EAD that underwent navigation TKA were enrolled. We investigated the knee range of motion (ROM), outcome scores at final follow-up (Knee Society Score [KSS] and Knee Functional Score [KFS]), and pre- and postoperative mechanical hip-knee-ankle (mHKA) angle using lower extremity scanogram. The meta-analysis was based on the single-arm method, and all data were pooled using a random-effects model. Results Following our meta-analyses, the mean knee ROM changed from 87.0° (95% confidence interval [CI], 75.9°-98.1°) preoperatively to 109.4° (95% CI, 97.9°-120.8°) postoperatively. The adjusted KSS was 93.45 points (95% CI, 88.36-98.54 points), and the adjusted KFS was 91.57 points (95% CI, 86.80-96.33 points) in knees with EAD that underwent CAS-TKA. As a radiological outcome, the mHKA angle changed from 169.53° (95% CI, 166.90°-172.16°) preoperatively to 178.81° (95% CI, 178.31°-179.30°) postoperatively. Conclusions CAS-TKA yielded positive clinical results and demonstrated a satisfactory alignment of the lower limb's mechanical axis. CAS-TKA showed promise for primary TKA procedures, demonstrating favorable clinical and radiological outcomes even in complex cases involving EAD.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Suk Ho Baek
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
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17
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Strahl A, Delsmann MM, Simon A, Ries C, Rolvien T, Beil FT. A clinical risk score enables early prediction of dissatisfaction 1 year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38796721 DOI: 10.1002/ksa.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE Dissatisfaction after total knee arthroplasty (TKA) is a prevalent and clinically relevant problem that affects approximately 10%-20% of patients. The aim of this study is to identify factors associated with dissatisfaction 1 year after TKA. METHODS A total of 236 patients undergoing TKA were included in this prospective cohort study. Demographic data, preoperative clinical parameters (e.g., axial alignment, osteoarthritis severity) and patient-reported outcome measures (PROMs) were collected preoperatively, at 1 month and 1 year after TKA, encompassing the Knee Society Score (KSS) and Knee injury and Osteoarthritis Outcome Score (KOOS). The primary outcome was dissatisfaction 1 year after TKA, defined as ≤20 points on the KSS satisfaction scale. A risk score based on multiple regression and area under the curve (AUC) analyses was calculated to predict dissatisfaction. RESULTS One year after TKA, 16% of the patients were dissatisfied. Dissatisfied patients were significantly younger (p = 0.023) and had a higher body mass index (BMI) (p = 0.007). No differences were observed in preoperative objective (p = 0.903) and functional KSS (p = 0.346), pain (p = 0.306), osteoarthritis severity (p = 0.358), axial knee alignment (p = 0.984) or psychological distress (p = 0.138). The likelihood of dissatisfaction at 1 year was 3.0, 4.0, 7.4, 4.3 and 2.8 times higher amongst patients aged <63.5 years, with a BMI > 30.1 kg/m2, a KOOSPain < 50%, a KSSFunction < 42 points and a KSSExpectation < 9 points (all at 1 month), respectively. Using these variables, a risk score with a maximum of 7 points was developed, demonstrating a high predictive value for dissatisfaction (AUC: 0.792 [95% confidence interval: 0.700-0.884], p < 0.001). CONCLUSION Dissatisfaction 1 year after TKA can be predicted by a weighted risk score that includes patient age, BMI, pain, subjective functionality and unmet expectation 1 month postoperatively. Using the risk score, early detection of dissatisfaction has the potential to enable targeted interventions and improve patients' quality of life. LEVEL OF EVIDENCE Level II, Prognostic study.
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Affiliation(s)
- André Strahl
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian M Delsmann
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Simon
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ries
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Latijnhouwers DAJM, van Gils JA, Vliet Vlieland TPM, van Steenbergen LN, Marang-van de Mheen PJ, Cannegieter SC, Verdegaal SHM, Nelissen RGHH, Gademan MGJ. Multiple Joint Arthroplasty in Hip and Knee Osteoarthritis Patients: A National Longitudinal Cohort Study. J Arthroplasty 2024:S0883-5403(24)00532-1. [PMID: 38797445 DOI: 10.1016/j.arth.2024.05.060] [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: 01/16/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Many patients suffer from osteoarthritis (OA) in multiple joints, possibly resulting in multiple joint arthroplasties (MJAs). Primarily, we determined the cumulative incidence (Cin) of MJA in hip and knee joints up to 10 years. Secondly, we calculated the mean time between the first and subsequent joint arthroplasty, and evaluated the different MJA trajectories. Lastly, we compared patient characteristics and outcomes (functionality and pain) after surgery between MJA patients and single hip arthroplasty or knee arthroplasty (HA and KA) patients. METHODS Primary index (first) HA or KA for OA were extracted from the Dutch Arthroplasty Register. The 1, 2, 5, and 10-year Cin (including competing risk death) of MJA, mean time intervals, and MJA-trajectories were calculated and stratified for primary index HA or KA. Sex, preoperative age, and body mass index were compared using ordinal logistic regression. Outcomes, measured preoperatively, 3, 6, and 12 months postoperatively (function: Hip Disability or Knee Injury and OA Outcome Score; Pain: Numerical Rating Scale), were compared using linear regression. RESULTS A total of 140,406 HA-patients and 140,268 KA-patients were included. One, 2, 5, and 10-year Cin for a second arthroplasty were respectively 8.9% [95% confidence interval (CI): 8.7 to 9.0], 14.3% [95% CI: 14.1 to 14.5], 24.0% [95% CI: 23.7 to 24.2], and 32.7% [95% CI: 32.2 to 33.1] after index HA, and 9.5% [95% CI: 9.4 to 9.7], 16.0% [95% CI: 15.9 to 16.2], 26.4% [95% CI: 26.1 to 26.6], and 35.8% [95% CI: 35.4 to 36.3] after index KA. The 10-year Cin for > 2 arthroplasties were small in both the index HA and KA groups. Time-intervals from first to second, third, and fourth arthroplasty were 26 [95% CI: 26.1 to 26.7], 47 [95% CI: 46.4 to 48.4], and 58 [95% CI: 55.4 to 61.1] months after index HA, and 26 [95% CI: 25.9 to 26.3], 52 [95% CI: 50.8 to 52.7], and 61 [95% CI: 58.3 to 63.4] months after index KA. There were 83% of the second arthroplasties placed in the contralateral cognate joint (ie, knee or hip). Differences in postoperative functionality and pain between MJAs and single HAs and KAs were small. CONCLUSIONS The 10-year Cin showed that about one-third of patients received a second arthroplasty after approximately 2 years, with the majority in the contralateral cognate joint. Few patients received > 2 arthroplasties within 10 years. Being a women, having a higher body mass index, and being younger increased the odds of MJA. Postoperative outcomes were slightly negatively affected by MJA.
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Affiliation(s)
| | - Jip A van Gils
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Perla J Marang-van de Mheen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Safety & Security Science, Faculty of Technology, Policy & Management, Delft University of Technology, Delft, the Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzan H M Verdegaal
- Safety & Security Science, Faculty of Technology, Policy & Management, Delft University of Technology, Delft, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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19
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Manner PA. Editor's Spotlight/Take 5: High Expectations Among Patients Who Have Undergone TKA Do Not Correlate With Satisfaction. Clin Orthop Relat Res 2024; 482:753-755. [PMID: 38546833 PMCID: PMC11008617 DOI: 10.1097/corr.0000000000003066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Paul A Manner
- Senior Editor, Clinical Orthopaedics and Related Research ®, Park Ridge, IL, USA
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20
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Khatri C, Ahmed I, Dhaif F, Rodrigues J, Underwood M, Davis ET, Mitchell P, Metcalfe A. What's important for recovery after a total knee replacement? A systematic review of mixed methods studies. Arch Orthop Trauma Surg 2024; 144:2213-2221. [PMID: 38070014 PMCID: PMC11093842 DOI: 10.1007/s00402-023-05136-x] [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: 09/16/2023] [Accepted: 11/11/2023] [Indexed: 04/21/2024]
Abstract
BACKGROUND Understanding how patients perceive and prioritise various aspects of recovery following total knee replacement, including pain, function and return to activity, will help clinicians in pre-operative consultations by ensuring they effectively address patient concerns and managing their expectations. AIMS The aim of this study is to identify aspects of recovery that are important to people after a total knee replacement. METHODS Studies were identified from Medline, Embase, PsycInfo, Cochrane Library and Web of Science. This mixed methods review included all original study types (quantitative, qualitative, discrete choice experiments and mixed methods design). Reviews and non-peer-reviewed publications were excluded. Studies with participants (age ≥ 18 years) who had a primary TKR for osteoarthritis were included. Studies of people with unicompartmental knee, patella-femoral or revision knee replacement were excluded. Recovery attributes were extracted from individual papers and grouped into recovery themes. RESULTS A total of 23 studies with 8404 participants and 18 recovery themes were developed. The most frequently identified overarching theme was pain, followed by activities of daily living, mobility (walking), recreational activities, specific functional movements of the knee, use of walking aids, sexual activity and range of motion of the knee. Medical complications were an infrequently reported theme, however, was deemed to be high importance. CONCLUSIONS Reducing pain, returning of activities and daily living and mobility are the three most frequently reported recovery domains for people after TKR. Clinicians should be aware of recovery themes, to ensure they are explored sufficiently when consenting for a TKR. Future research should aim to determine the relative importance of these attributes compared to each other. Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021253699.
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Affiliation(s)
- Chetan Khatri
- Clinical Trials Unit, University of Warwick, Coventry, UK.
- Clinical Sciences Research Laboratories, University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Imran Ahmed
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Fatema Dhaif
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | | | - Edward T Davis
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Paul Mitchell
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK
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21
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Heijbel S, W-Dahl A, E-Naili J, Hedström M. Patient-Reported Anxiety or Depression Increased the Risk of Dissatisfaction Despite Improvement in Pain or Function Following Total Knee Arthroplasty: A Swedish Register-Based Observational Study of 8,745 Patients. J Arthroplasty 2024:S0883-5403(24)00419-4. [PMID: 38697320 DOI: 10.1016/j.arth.2024.04.071] [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: 09/01/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Remaining pain and functional limitations may cause dissatisfaction in patients after total knee arthroplasty (TKA). Furthermore, anxiety and depression are associated with remaining postoperative symptoms and dissatisfaction. We investigated if patient-reported anxiety or depression increased the risk of dissatisfaction 1 year after TKA in patients who improved in pain or function. METHODS Data on primary TKAs due to osteoarthritis between 2017 and 2019 were obtained from the Swedish Knee Arthroplasty Register. Out of 14,120 patients, 9,911 completed the Knee injury and Osteoarthritis Outcome Score and satisfaction rate with the result of the surgery. According to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria patients were classified as responders (improved in pain or function) or nonresponders. Anxiety and depression were assessed through EuroQol-5 Dimension 3 levels. Log-linear regression models estimated the risk ratios (RRs) for dissatisfaction in all patients and stratified by age groups (< 65, 65 to 74, and > 74 years). There were 8,745 patients who were classified as responders whereas 11% were defined as dissatisfied. The proportion of patients who reported anxiety or depression was 35% preoperatively and 17% postoperatively. RESULTS Anxiety or depression increased the risk of dissatisfaction preoperatively (RR 1.23, 95% confidence interval = 1.09 to 1.40) and postoperatively (RR 2.65, confidence interval 2.33 to 3.00). Patients younger than 65 years reported preoperative anxiety or depression to a greater extent but did not have an increased risk of dissatisfaction. CONCLUSIONS Patient-reported anxiety or depression preoperatively and postoperatively are important and potentially treatable factors to consider, as they were found to increase the risk of dissatisfaction after TKA despite improvements in pain or function.
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Affiliation(s)
- Siri Heijbel
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden, Huddinge, Sweden; Medical Research Internship, Karolinska University Hospital, Stockholm, Sweden
| | - Annette W-Dahl
- Department of Clinical Science Lund, Lund University, Lund, Sweden; The Swedish Arthroplasty Register, Göteborg, Sweden
| | - Josefine E-Naili
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Motion Analysis Lab, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden, Huddinge, Sweden; Trauma and Reparative Medicine Theme (TRM), Karolinska University Hospital, Stockholm, Sweden
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22
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De Groot JD, Brokelman RBG, Lammers PG, Van Stralen GMJ, Kooijman CM, Hokwerda ST. Performance of medial pivot, posterior stabilized and rotating platform total knee arthroplasty based on anteroposterior stability and patient-reported outcome measures; a multicentre double-blinded randomized controlled trial of 210 knees. Arch Orthop Trauma Surg 2024; 144:2327-2335. [PMID: 38653837 DOI: 10.1007/s00402-024-05340-3] [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: 12/20/2023] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Despite advancements in total knee arthroplasty (TKA), 10-20% of patients remain dissatisfied after surgery. Improved anteroposterior (AP) stability provided by medial pivot (MP) implants may theoretically lead to higher patient satisfaction. METHODS AP stability and patient-reported outcome measures (PROMs) at one-year postsurgery were compared between patients who underwent TKA with MP- (n = 121), posterior stabilized (PS; n = 53) and rotating platform (RP; n = 57) implants in a double-blind multicentre randomized controlled trial (Dutch Trial Register: NL6856, 21-02-2018). AP stability was assessed at 30°, 60° and 90° of knee flexion using a KT-2000 arthrometer. PROMs were measured preoperative and one-year postsurgery. RESULTS MP-TKA provided significant better AP stability at early flexion (30°) compared to PS- and RP-TKA (median [IQR]; 1.79 [1.14-2.77] mm vs. 3.31 [2.51-4.08] mm vs. 2.82 [1.80-4.03] mm, p < 0.001). Additionally, MP-TKA provided significant better AP stability at mid-flexion (60°) compared to PS-TKA (1.75 [1.23-2.36] mm vs. 2.14 [1.49-2.83] mm, p = 0.014). PROM improvements were comparable between implant designs. AP laxity of ≥ 4 mm at early flexion was independently of implant design associated with significantly worse Kujala scores. The incidence of ≥ 4 mm AP laxity at any knee angle was however not significantly different between implant designs. CONCLUSION MP-, PS- and RP-TKA all provide excellent and comparable results. Although MP-TKA provided better AP stability at early flexion compared to PS- and RP-TKA, this was found to be unrelated to improved PROMs in favour of MP-TKA. More studies focusing on early and mid-flexion performance based differences between MP and other TKA designs are required to confirm our findings. Other non-implant related factors may play a more important role in the performance of TKA and are potentially worthwhile examining.
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Affiliation(s)
- J D De Groot
- Department of Orthopaedic Surgery, OCON, Geerdinksweg 141, Hengelo, 7555 DL, The Netherlands.
| | - R B G Brokelman
- Department of Orthopaedic Surgery, OCON, Geerdinksweg 141, Hengelo, 7555 DL, The Netherlands
| | - P G Lammers
- Department of Orthopaedic Surgery, St. Jansdal, Wethouder Jansenlaan 90, Harderwijk, 3844 DG, The Netherlands
| | - G M J Van Stralen
- Department of Orthopaedic Surgery, Nij Smellinghe, Compagnonsplein 1, Drachten, 9202 NN, The Netherlands
| | - C M Kooijman
- Department of Orthopaedic Surgery, Nij Smellinghe, Compagnonsplein 1, Drachten, 9202 NN, The Netherlands
| | - S T Hokwerda
- Department of Orthopaedic Surgery, Antonius, Bolwarderbaan 1, Sneek, 8601 ZK, The Netherlands
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23
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Riddle DL, Henderson N. Six-month pain and function outcome expectations were established for total knee arthroplasty using the smallest worthwhile effect. PLoS One 2024; 19:e0300439. [PMID: 38687733 PMCID: PMC11060529 DOI: 10.1371/journal.pone.0300439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Interpretations of patient-reported outcome measures following knee arthroplasty lack context and typically do not account for costs, risks and benefits compared to an alternative treatment. The primary purpose of our paper is to estimate expectations patients have for pain and function destination outcome, six-months following surgery relative to the outcome expected if knee arthroplasty was not done. Secondary purposes were to determine if statistically significant changes in the smallest worthwhile six-month outcome occurred following an interactive discussion and to assess the construct validity of the expected six-month outcome obtained at baseline. METHODS This was a secondary analysis of a prospective longitudinal cohort study of 121 patients undergoing knee arthroplasty. Smallest worthwhile effect estimates were determined and expected six-month KOOS Pain and Function, daily activity measures were established during a pre-operative visit. RESULTS The average six-month expected (the destination of interest) KOOS Pain score was 75 (IQR = 64 to 86) and the average KOOS Function, daily activity score was 74 (IQR = 59 to 86). The smallest worthwhile effect discussion led to significant changes in expected destination scores. For example, KOOS Pain expected outcome changed from 87.7 (9.8) to 75.0 (13.6), a statistically significant reduction in expected outcome (t(119) = 16.942, p < 0.001. CONCLUSION Six-month expected KOOS outcomes following knee arthroplasty were established and approximate the average six-month outcomes reported in the literature. Validity of these estimates was established. These data can be used to aid shared decision-making discussions regarding patient expectations of knee arthroplasty outcomes during a patient encounter.
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Affiliation(s)
- Daniel L. Riddle
- Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, Virginia, United Stated of America
| | - Nancy Henderson
- Department of Rehabilitation Sciences, Georgia Southern University- Armstrong Campus, Savannah, Georgia, United Stated of America
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24
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Muffly BT, Ayeni AM, Bonsu JM, Heo K, Premkumar A, Guild GN. Early Versus Late Periprosthetic Joint Infection After Total Knee Arthroplasty: Do Patient Differences Exist? J Arthroplasty 2024:S0883-5403(24)00384-X. [PMID: 38677341 DOI: 10.1016/j.arth.2024.04.061] [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: 06/25/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Little evidence exists comparing those with early versus late PJI. The purpose of the study was to determine comorbidity profile differences between patients developing early and late PJI. METHODS There were 72,659 patients undergoing primary TKA from 2009 to 2021, who were identified from a commercial claims and encounters database. Subjects diagnosed with PJI were categorized as either 'early' (within 90 days of index procedure) or 'late' (> 2 years after index arthroplasty). Non-infected patients within these periods served as control groups following 4:1 propensity score matching on other extraneous variables. Logistic regression analyses were performed comparing comorbidities between groups. RESULTS Patients were significantly younger in the late compared to the early infection group (58.1 versus 62.4 years, P < .001). When compared to those with early PJI, patients who had chronic kidney disease (13.3 versus 4.1%; OR [odds ratio] 5.17, P = .002), malignancy (20.4 versus 10.5%; OR 2.53, P = .009), uncomplicated diabetes (40.8 versus 30.6%; OR 2.00, P = .01), rheumatoid arthritis (9.2 versus 3.3%; OR 2.66, P = .046), and hypertension (88.8 versus 81.6%; OR 2.17, P = .04), were all significant predictors of developing a late PJI. CONCLUSIONS When compared to patients diagnosed with early PJI following primary TKA, the presence of chronic kidney disease, malignancy, uncomplicated diabetes, rheumatoid arthritis, and hypertension, were independent risk factors for the development of late PJI. Younger patients who have these comorbidities may be targets for preoperative optimization interventions that minimize the risk of PJI.
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Affiliation(s)
- Brian T Muffly
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ayomide M Ayeni
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Janice M Bonsu
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Kevin Heo
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - George N Guild
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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25
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Ma J, Zhang K, Ma X, Wang H, Ma C, Zhang Y, Liu R. Clinical phenotypes of comorbidities in end-stage knee osteoarthritis: a cluster analysis. BMC Musculoskelet Disord 2024; 25:299. [PMID: 38627663 PMCID: PMC11022443 DOI: 10.1186/s12891-024-07394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES Comorbidities, as components of these heterogeneous features, often coexist with knee osteoarthritis, and are particularly prevalent in end-stage knee osteoarthritis. Here, we attempted to identify the different clinical phenotypes of comorbidities in patients with end-stage knee osteoarthritis by cluster analysis. METHODS A total of 421 inpatients diagnosed with end-stage knee osteoarthritis who underwent inpatient surgery were included in this cross-sectional study. 23 demographic, comorbidity, inflammatory immune and evaluation scale variables were collected. Systematic clustering after factor analysis and separate two-step cluster analysis were performed for individual comorbidity variables and all variables, respectively, to objectively identify the different clinical phenotypes of the study patients. RESULTS Four clusters were finally identified. Cluster 1 had the largest proportion of obese patients (93.8%) and hypertension was common (71.2%). Almost all patients in cluster 2 were depressed (95.8%) and anxiety disorders (94.7%). Cluster 3 combined patients with isolated end-stage knee osteoarthritis and a few comorbidities. Cluster 4 had the highest proportion of patients with rheumatoid arthritis (58.8%). CONCLUSIONS Patients with end-stage knee osteoarthritis may be classified into four different clinical phenotypes: "isolated end-stage knee osteoarthritis"; "obesity + hypertension"; "depression + anxiety"; and "rheumatoid arthritis", which may help guide individualized patient care and treatment strategies.
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Affiliation(s)
- Jun Ma
- Department of Orthopedics, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kai Zhang
- Ningxia Medical University Third Clinical Medical School, Yinchuan City, Ningxia, China
| | - Xilong Ma
- Ningxia Medical University Third Clinical Medical School, Yinchuan City, Ningxia, China
| | - Hao Wang
- Ningxia Medical University Third Clinical Medical School, Yinchuan City, Ningxia, China
| | - Chao Ma
- Department of Orthopaedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan City, Ningxia, China
| | - Yahui Zhang
- Ningxia Medical University Third Clinical Medical School, Yinchuan City, Ningxia, China
| | - Ruiyu Liu
- Department of Orthopedics, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Vaishya R, Mahajan RP, Sibal A. Prehabilitation: A proactive approach to enhancing outcomes in joint replacement surgery. J Clin Orthop Trauma 2024; 51:102398. [PMID: 38585383 PMCID: PMC10998185 DOI: 10.1016/j.jcot.2024.102398] [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: 01/28/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024] Open
Abstract
Prehabilitation is an emerging proactive and preventive approach to healthcare that focuses on preparing individuals for upcoming medical interventions or procedures. It aims to optimize physical and mental health before the planned medical and surgical interventions. By integrating exercise, psychological support, and lifestyle modifications, prehabilitation empowers individuals to face medical interventions with increased resilience and a higher likelihood of successful outcomes. Prehabilitation helps patients build strength and endurance, which can enhance their ability to withstand the physical stress of surgery and contribute to faster recovery. It plays a crucial role in optimizing outcomes for patients undergoing joint replacement surgery, by enhancing postoperative recovery, reducing complications, and improving the overall quality of life for patients. As the field of orthopaedics continues to evolve, the integration of prehabilitation into standard care protocols has the potential to redefine the landscape of joint replacement surgeries, ultimately improving patient outcomes, and hence more research is required from diverse population groups from developed and developing countries to collate required data and formulate evidence-based clinical guidelines.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
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27
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Scuderi GR, Delanois R, Mont MA. Challenging the Tenets of Mechanical Alignment in Total Knee Arthroplasty: A New Wave of Thought? J Arthroplasty 2024; 39:855-856. [PMID: 38360284 DOI: 10.1016/j.arth.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
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28
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Zalikha AK. Letter to the Editor in Response to "Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature". J Arthroplasty 2024; 39:e27-e28. [PMID: 38479947 DOI: 10.1016/j.arth.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/05/2023] [Accepted: 12/04/2023] [Indexed: 07/23/2024] Open
Affiliation(s)
- Abdul K Zalikha
- Department of Orthopaedic Surgery, Detroit Medical Center/Wayne State University, Detroit, Michigan
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29
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Sass JO, Johnson K, Darques JB, Buerstenbinder L, Soodmand I, Bader R, Kebbach M. Influence of posterior cruciate ligament tension on tibiofemoral and patellofemoral joint contact mechanics in cruciate-retaining total knee replacement: a combined musculoskeletal multibody and finite-element simulation. Comput Methods Biomech Biomed Engin 2024:1-13. [PMID: 38511844 DOI: 10.1080/10255842.2024.2329946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
The influence of posterior cruciate ligament (PCL) tension on the clinical outcome of cruciate-retaining total knee replacement (CR-TKR) remains controversial. Various numerical approaches have been used to study this influence systematically, but the models used are limited by certain assumptions and simplifications. Therefore, the objective of this computational study was to develop a combined musculoskeletal multibody and finite-element simulation during a squat motion to 90° knee flexion with a CR-TKR design to overcome previous limitations regarding model inputs. In addition, different PCL tensions (tight, lax, resected) were modeled and the influence on tibiofemoral and resurfaced patellofemoral joint dynamics and contact stresses was evaluated. The effect of the PCL on knee joint dynamics and contact stresses was more pronounced at higher flexion angles. Tibiofemoral joint dynamics were influenced and a tight PCL induced increased posterior femoral translation during flexion. The maximum contact stress in the tibial insert increased from 20.6 MPa to 22.5 MPa for the resected and tightest PCL at 90° knee flexion. Patellofemoral joint dynamics were only slightly affected by PCL tension. However, the maximum contact stress in the patellar component decreased from 58.0 MPa to 53.7 MPa for the resected and tightest PCL at 90° knee flexion. The combination of musculoskeletal multibody and finite-element simulation is a sufficient method to comprehensively investigate knee joint dynamics and contact stresses in CR-TKR. The PCL tension after CR-TKR affects joint dynamics and contact stresses at the articulating implant surfaces.
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Affiliation(s)
- Jan-Oliver Sass
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Kurt Johnson
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Jean-Baptiste Darques
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
- Polytech Marseille, école d'ingénieurs d'Aix Marseille Université, Marseille, France
| | - Lucas Buerstenbinder
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Iman Soodmand
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Maeruan Kebbach
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
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30
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Mosher ZA, Bolognesi MP, Malkani AL, Meneghini RM, Oni JK, Fricka KB. Cementless Total Knee Arthroplasty: A Resurgence - Who, When, Where, and How? J Arthroplasty 2024:S0883-5403(24)00198-0. [PMID: 38458333 DOI: 10.1016/j.arth.2024.02.078] [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: 12/13/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most common procedures in orthopaedics, but there is still debate over the optimal fixation method for long-term durability: cement versus cementless bone ingrowth. Recent improvements in implant materials and technology have offered the possibility of cementless TKA to change clinical practice with durable, stable biological fixation of the implants, improved operative efficiency, and optimal long-term results, particularly in younger and more active patients. METHODS This symposium evaluated the history of cementless TKA, the recent resurgence, and appropriate patient selection, as well as the historical and modern-generation outcomes of each implant (tibia, femur, and patella). Additionally, surgical technique pearls to assist in reliable, reproducible outcomes were detailed. RESULTS Historically, cemented fixation has been the gold standard for TKA. However, cementless fixation is increasing in prevalence in the United States and globally, with equivalent or improved results demonstrated in appropriately selected patients. CONCLUSION Cementless TKA provides durable biologic fixation and successful long-term results with improved operating room efficiency. Cementless TKA may be broadly utilized in appropriately selected patients, with intraoperative care taken to perform meticulous bone cuts to promote appropriate bony contact and biologic fixation.
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Affiliation(s)
- Zachary A Mosher
- Anderson Orthopaedic Research Institute (AORI), Alexandria, VA, USA; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA, USA
| | | | - Arthur L Malkani
- University of Louisville Department of Orthopaedic Surgery, Louisville, KY, USA
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, IN, USA; Indiana University Department of Orthopaedic Surgery, Indianapolis, IN, USA
| | - Julius K Oni
- The Johns Hopkins University Department of Orthopaedic Surgery, Baltimore, MD, USA
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute (AORI), Alexandria, VA, USA; Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA, USA.
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31
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Zhou Y, Patten L, Spelman T, Bunzli S, Choong PFM, Dowsey MM, Schilling C. Predictive Tool Use and Willingness for Surgery in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240890. [PMID: 38457182 PMCID: PMC10924247 DOI: 10.1001/jamanetworkopen.2024.0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
Importance Despite the increasing number of tools available to predict the outcomes of total knee arthroplasty (TKA), the effect of these predictive tools on patient decision-making remains uncertain. Objective To assess the effect of an online predictive tool on patient-reported willingness to undergo TKA. Design, Setting, and Participants This parallel, double-masked, 2-arm randomized clinical trial compared predictive tool use with treatment as usual (TAU). The study was conducted between June 30, 2022, and July 31, 2023. Participants were followed up for 6 months after enrollment. Participants were recruited from a major Australian private health insurance company and from the surgical waiting list for publicly funded TKA at a tertiary hospital. Eligible participants had unilateral knee osteoarthritis, were contemplating TKA, and had previously tried nonsurgical interventions, such as lifestyle modifications, physiotherapy, and pain medications. Intervention The intervention group was provided access to an online predictive tool at the beginning of the study. This tool offered information regarding the likelihood of improvement in quality of life if patients chose to undergo TKA. The predictions were based on the patient's age, sex, and baseline symptoms. Conversely, the control group received TAU without access to the predictive tool. Main Outcomes and Measures The primary outcome measure was the reduction in participants' willingness to undergo surgery at 6 months after tool use as measured by binomial logistic regression. Secondary outcome measures included participant treatment preference and the quality of their decision-making process as measured by the Knee Decision Quality Instrument. Results Of 211 randomized participants (mean [SD] age, 65.8 [8.3] years; 118 female [55.9%]), 105 were allocated to the predictive tool group and 106 to the TAU group. After adjusting for baseline differences in willingness for surgery, the predictive tool did not significantly reduce the primary outcome of willingness for surgery at 6 months (adjusted odds ratio, 0.85; 95% CI, 0.42-1.71; P = .64). Conclusions and Relevance Despite the absence of treatment effect on willingness for TKA, predictive tools might still enhance health outcomes of patients with knee osteoarthritis. Additional research is needed to optimize the design and implementation of predictive tools, address limitations, and fully understand their effect on the decision-making process in TKA. Trial Registration ANZCTR.org.au Identifier: ACTRN12622000072718.
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Lauren Patten
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Peter F. M. Choong
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M. Dowsey
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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32
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Te Molder MEM, Verhoef LM, Smolders JMH, Heesterbeek PJC, van den Ende CHM. Prioritization of Adverse Consequences After Total Knee Arthroplasty Contributing to a Poor Response: A Best-Worst Scaling Exercise Among Total Knee Arthroplasty Patients and Knee Specialists. J Arthroplasty 2024; 39:651-657.e1. [PMID: 37611678 DOI: 10.1016/j.arth.2023.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) can have a number of adverse consequences for patients that might contribute to a poor outcome. This study aimed to prioritize these consequences, from the perspective of patients and knee specialists. METHODS There were 95 TKA patients and 63 knee specialists who prioritized a set of 29 adverse consequences, based on a previous qualitative study, using a Maximum Difference Scaling method. A hierarchical Bayesian analysis was used to calculate relative importance scores. Differences and agreements between patients versus knee specialists and satisfied versus dissatisfied patients were analyzed using Mann-Whitney-U tests and Kendall's coefficients of concordance. RESULTS There were 4 out of 5 items in the top-5 of both patients and knee specialists that were similar, however, the ranking was different. The highest-ranked consequence for patients was: "Inability to do normal activities such as walking, cycling, swimming and heavy household chores", while knee specialists ranked: "No improvement in pain during the day" as the highest. "No improvement in walking" was in the patients' top-5, but was not ranked in the top-5 of knee specialists. For satisfied and dissatisfied patients, the top-5 of consequences was similar. CONCLUSION Comparable perspectives were found for patients versus knee specialists and satisfied versus dissatisfied patients on the importance of adverse consequences after TKA. However, when looking in more detail, differences in ranking of specific subitems suggest that patients place slightly more importance on the inability to perform valued activities, while knee specialists prioritize lack of pain relief to a higher degree.
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Affiliation(s)
- Malou E M Te Molder
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Lise M Verhoef
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - José M H Smolders
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Cornelia H M van den Ende
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Sangaletti R, Meschini C, Capece G, Montagna A, Andriollo L, Benazzo F, Rossi SMP. A morphometric medial compartment-specific unicompartmental knee system: 5 years follow up results from a pilot center. Knee 2024; 47:179-185. [PMID: 38401342 DOI: 10.1016/j.knee.2024.02.005] [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: 08/20/2023] [Revised: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Unicompartmental Knee Arthroplasty (UKA) is a valuable solution for the treatment of medial osteoarthritis of the knee. New implants feature designs for the elective substitution of a specific compartment. Aim of this study was to assess the survivorship and functional outcomes at minimum 4 years of the first 60 implanted patients in a pilot center of a new medial UKA as the evolution of a well performing long lasting fixed bearing implant. METHODS Between June 2017 and the end of 2018, 60 medial UKA were implanted in 58 patients. All patients were available for the last follow up and were analyzed prospectively. 37 were females and 21 were males with a mean age of 67 years (SD 10,71) and a mean of BMI 27.16 (SD 3.94) for the male population and of 26.73 (SD 4.05) for the female population. RESULTS At final follow up the mean Oxford Knee Score (OKS) was 44,02 (SD 3,1) and the mean Forgotten Joint Score (FJS) 78,6 (SD 7,9). The Knee Society Score (KSS) score was 95,2 for the "knee" score and 89.8 for the "function" score. No patients were revised. Kaplan-Meyer survival estimate showed a 100% survivorship at final follow up. No progressive radiolucent lines were found and no direct or indirect signs of polyethylene wear were registered on the final radiographs. CONCLUSIONS This new implant demonstrated promising clinical results with an excellent survival rate at short to midterm follow- up. Further follow up is needed to confirm this trend at longer term.
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Affiliation(s)
- Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy
| | - Cesare Meschini
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Capece
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alice Montagna
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; Università degli studi di Pavia, Pavia, Italy
| | - Luca Andriollo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy; IUSS Istituto Universitario di Studi Superiori, Pavia, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy.
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Baba R, Ohkoshi Y, Maeda T, Suzuki K, Iwadate A, Iwasaki K, Onodera T, Kondo E, Iwasaki N. The Influence of Patello-Femoral Overstuffing After Modular Unlinked Bicompartmental Knee Arthroplasty (BiKA) for Medial Tibio-Femoral and Patello-Femoral Osteoarthritis of the Knee. J Arthroplasty 2024; 39:638-644. [PMID: 37633506 DOI: 10.1016/j.arth.2023.08.069] [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: 04/26/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The factors affecting results after bicompartmental knee arthroplasty (BiKA) have not been fully elucidated. This major ligament-preserving procedure may be more susceptible to overstuffing of the patello-femoral (PF) joint than the major ligament-sacrificing total knee arthroplasty. Currently, we investigated the effect of PF overstuffing after BiKA on its clinical outcome. METHODS There were 71 patients (74 knees) who underwent modular unlinked BiKA at our clinic who had a follow-up of 5 to 9 years. Final follow-up results were assessed by evaluating knee range of motion, the 2011 Knee Society Score (2011KSS), Japanese Knee Osteoarthritis Measure, and radiological findings. The degree of postoperative PF overstuffing was evaluated by computed tomography and magnetic resonance images for 55 knees, and the correlation between the degree of overstuffing and postoperative clinical results were examined. RESULTS Overall clinical results improved significantly after surgery without any revision cases. The X-ray measurements showed the improved coronal alignments and the appropriate implant installation angles. Higher degree of postoperative PF overstuffing caused by insufficient amount of osteotomy on the anterior surface of the femur correlated with worse postoperative total 2011KSS at 2 years after surgery (Spearman's rank correlation coefficient (rs) = -0.387, P = .004), as opposed to no correlation at the time of the final follow-up (Spearman's rank correlation coefficient = 0.068, P = .623). CONCLUSION Modular unlinked BiKA provided patients with a high level of satisfaction and functional improvement over 5 to 9 years postoperatively. However, because PF overstuffing affects initial patient satisfaction, the amount of osteotomy should be determined carefully during the surgery.
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Affiliation(s)
- Rikiya Baba
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Ko Suzuki
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Akane Iwadate
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Koji Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Wan D, Wang R, Wei J, Zan Q, Shang L, Ma J, Yao S, Xu C. Bibliometric and visual analysis of research on analgesia and total knee arthroplasty from 1990 to 2022. Heliyon 2024; 10:e25153. [PMID: 38322956 PMCID: PMC10844279 DOI: 10.1016/j.heliyon.2024.e25153] [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: 07/01/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
Background In recent decades, there have been notable advancements in the field of analgesia and total knee arthroplasty (TKA). This study aims to employ bibliometric analysis to elucidate the prevailing research focal points and trends within analgesia and TKA from 1990 to 2022. Material and methods Relevant publications were retrieved from the Web of Science Core Collection. CiteSpace, VOSviewer, and Scimago Graphica were used for visualization and bibliometric analysis of countries, institutions, authors, journals, references, and keywords. Results A total of 2776 publications on analgesia and TKA were identified, with the United States having the highest number of publications. The University of Copenhagen was the most productive institution, and Kehlet, Henrik was the most prolific author. The Journal of Arthroplasty had the most publications and citations. The most common keywords were "TKA," "pain management," "postoperative pain," "Total hip arthroplasty (THA)," and "postoperative management." Keyword burst detection demonstrated that adductor canal block (ACB) was a recent research hotspot. Conclusion Our study revealed a sharp increase in global publications on analgesia and TKA, and this trend is expected to continue. Further research is necessary to determine the optimal regimen for multimodal analgesia, the ideal location and volume of ACB, and their clinical significance.
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Affiliation(s)
- Dongping Wan
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Rui Wang
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jie Wei
- State Key Laboratory of Cancer Biology, Department of Pathology, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, China
| | - Qiang Zan
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Lei Shang
- Department of Health Statistics, Faculty of Preventive Medicine, The Air Force Military Medical University, Xi’an, China
| | - Jianbing Ma
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Shuxin Yao
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Health Statistics, Faculty of Preventive Medicine, The Air Force Military Medical University, Xi’an, China
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Castellarin G, Bori E, Barbieux E, Grandjean VP, Jost G, Innocenti B. Is Total Knee Arthroplasty Surgical Performance Enhanced Using Augmented Reality? A Single-Center Study on 76 Consecutive Patients. J Arthroplasty 2024; 39:332-335. [PMID: 37572726 DOI: 10.1016/j.arth.2023.08.013] [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: 03/01/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Augmented reality (AR) is a powerful multipurpose tool. With a dedicated visor, AR allows the visualization of a series of information and/or images superimposed on the user's field of vision. For this reason, it was recently introduced as a surgical assistant tool. This single-center study aimed to evaluate the intraoperative outcomes of total knee arthroplasties performed with AR assistance in terms of time required and the difference between preplanned and achieved implant positioning (in terms of tibial cut varus and slope angles). METHODS A total of 76 consecutive patients was selected. Preplanning was performed according to the AR protocol, and the target varus and slope angles were defined to instruct the device, which subsequently guided the tibial cuts intraoperatively. Surgeries were performed starting from the tibial cut, and the time required to perform the calibration, registration, and fixation of the resection block was recorded. The varus and slope angles achieved were recorded to compare with the preplanned ones to determine the means and SDs of the differences. RESULTS The mean usage time of the AR tool was 5 ± 1 minutes. Results showed a mean difference of 0.59 ± 0.55° for varus angles and 0.70 ± 0.75° for the slope. For varus angles, the differences were <1° for 96% of the cases. Concerning the slope, 89% of the cases were <1°. CONCLUSION The results showed excellent accuracy of the surgical cuts and a limited increase in surgery duration. Therefore, these outcomes highlighted the potential of this new technology as a valid option for surgical assistance.
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Affiliation(s)
| | - Edoardo Bori
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Elodie Barbieux
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Grace Jost
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
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Sebastia-Forcada E, Ruiz-Lozano M, Perez-Aznar A, Miralles-Muñoz FA, Gonzalez-Navarro B, Lizaur-Utrilla A. Functional Outcome Change Over 10 Years After Primary Total Knee Arthroplasty. A Prospective Longitudinal Cohort Study. J Arthroplasty 2024; 39:374-378. [PMID: 37598778 DOI: 10.1016/j.arth.2023.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND To assess any clinically important difference in functional outcome over 10 years after primary total knee arthroplasty (TKA). METHODS A prospective registry-based observational cohort study including 309 patients older than 60 years who underwent primary TKA. Patients were assessed at 1, 3, 5, 7 and 10 postoperative years with the Knee Society scores (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Clinically important improvement was defined according to the minimal clinically important difference (MCID). Patients were also categorized as type A (unilateral knee osteoarthritis), type B (bilateral knee osteoarthritis) or type C (various sites of osteoarthritis). RESULTS The mean age at the TKA surgery was 69.2 (SD 7.3) years, 197 (63.7%) were women.Maximum postoperative improvements in functional scores occurred at 3 postoperative years, remained relatively stable up to 5-year. There were significant decreases in all KSS and WOMAC scores at 7-year follow-up (P = .001), remained stable up to 10-year. At 10-year, functional scores were significantly higher than preoperatively (P = .001). Differences between maximum scores at 3-year and those at 10-year were significantly lesser than MCID in all scores (P = .001). In multivariate analysis, type-C patient at TKA surgery was the only significant predictor of unsuccessful KSS score and dissatisfaction at 10-year follow-up. CONCLUSION Primary TKA provides clinically important improvements in functional and quality of life outcomes over 10-year follow-up compared to preoperatively. Although there were statistically significant declines in KSS and WOMAC scores from 3 to 10 years, the differences were lesser than the MCID.
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Affiliation(s)
| | - Matias Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | - Adolfo Perez-Aznar
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | | | | | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
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Roberts DW. Why Does My Knee Still Hurt After My Knee Replacement?: Commentary on an article by Man Soo Kim, MD, PhD, et al.: "Central Sensitization and Neuropathic Pain Cumulatively Affect Patients Reporting Inferior Outcomes Following Total Knee Arthroplasty". J Bone Joint Surg Am 2024; 106:e2. [PMID: 38231195 DOI: 10.2106/jbjs.23.01128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Donald W Roberts
- Northwest Surgical Specialists Research Foundation, Vancouver, Washington
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39
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Pijls BG. Technology assistance in primary total knee replacement: hype or hope? Expert Rev Med Devices 2024; 21:11-14. [PMID: 37992036 DOI: 10.1080/17434440.2023.2287576] [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] [Received: 08/18/2023] [Accepted: 11/21/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Total knee replacement (TKR) reduces pain, it increases quality of life and it generally lasts a long time with revision rates of less than 5% at 10 years. Some authors have suggested that outcomes may be further improved by technology assistance. AREAS COVERED Technology assistance in primary TKR includes technologies such as navigated TKR, patient specific instrumentation TKR and robotic TKR. EXPERT OPINION In general, technology assistance results in higher accuracy of component positioning and alignment, but this is likely not clinically relevant as no clinically important difference in clinical outcomes, quality of life and complications such as revisions has been demonstrated in meta-analyses of randomized controlled trials. As technology assistance in primary TKR is increasingly used to capture patient and surgeon data, surgeons have an increasingly important role in protecting their patients' data and their own data. Real world evidence of implant registries has shown that TKR without technologically assistance can achieve perfectly acceptable outcomes. Although there is a genuine hope that technology-assisted TKR may further improve these outcomes, this hope is based on promises rather than solid evidence. At the same time, technology assisted TKR is heavily promoted including direct patient marketing, which are aspects of a hype.
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Affiliation(s)
- Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Kono K, Yamazaki T, Tamaki M, Ishibashi T, Tanaka S, Tomita T. Effect of single-radius design on in vivo kinematics during stair activities after total knee arthroplasty. J Orthop Surg (Hong Kong) 2024; 32:10225536241246326. [PMID: 38652873 DOI: 10.1177/10225536241246326] [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] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The single-radius design is one of the major total knee arthroplasty (TKA) designs and widely used all over the world. The objective of this study was to compare in vivo kinematics between the anteroposterior (AP) single-radius design with mediolateral (ML) single-radius (Non Restricted Geometry; NRG) and ML dual-radius (Triathlon) during stair activities. METHODS A total of 21 knees in 18 patients (NRG group: 10 knees in 7 patients, Triathlon group: 11 knees in 11 patients) with a clinically successful posterior stabilized TKA were examined. Under fluoroscopic surveillance, each patient performed stair ascending and descending motions. In vivo kinematics were analyzed using 2D/3D registration technique. The knee flexion angle, rotation angle, varus-valgus angle, AP translation of the femorotibial contact point for both the medial and lateral sides of the knee, and post-cam engagement were evaluated. RESULTS There were no significant differences between the two groups in rotation angle and AP translation at each flexion angle. Examining the varus-valgus angle, the NRG group showed varus position at an early flexion angle during both stair activities.Post-cam engagement was observed in both groups during both stair activities. The mean flexion angle of engagement in the NRG group, the post of which was located anterior to the Triathlon, was larger than that in the Triathlon group during both stair activities. CONCLUSION Despite the same AP single-radius TKA, ML single-radius might affect varus motion at an early flexion angle.
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Affiliation(s)
- Kenichi Kono
- Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, Fukaya, Japan
| | - Masashi Tamaki
- Department of Orthopedic Biomaterial Science, Osaka UniversityGraduate School of Medicine, Suita, Japan
| | - Teruya Ishibashi
- Department of Orthopedic Biomaterial Science, Osaka UniversityGraduate School of Medicine, Suita, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Tetsuya Tomita
- Department of Orthopedic Biomaterial Science, Osaka UniversityGraduate School of Medicine, Suita, Japan
- Department of Health Science, Graduate School of Health Science, Morinomiya University of Medical Sciences, Suminoe, Japan
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Xu C, Yao S, Wei W, Zhang H, Ma J, Shang L. Cross-cultural adaptation and validation for central sensitization inventory: based on Chinese patients undergoing total knee arthroplasty for knee osteoarthritis. J Orthop Surg Res 2023; 18:960. [PMID: 38093300 PMCID: PMC10717624 DOI: 10.1186/s13018-023-04375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This study was conducted to develop a simplified Chinese version of the central sensitization inventory (CSI-CV) and to evaluate its reliability and validity. METHODS The CSI-CV was developed through a process involving the translation and back translation of the original CSI. Subsequently, experts reviewed and revised the content of the items to ensure their appropriateness. A total of 325 patients with knee osteoarthritis (KOA), who were scheduled to undergo total knee arthroplasty (TKA), completed the CSI-CV at a prominent orthopedic center in Xi'an, China. Afterward, a random selection of 100 participants was chosen for retesting after one week. The reliability and validity of the inventory were evaluated through exploratory factor analysis, correlation coefficient calculation and other methods. RESULTS The CSI-CV consists of 25 items in five dimensions (emotional distress, headache and jaw symptoms, physical symptoms, urological symptoms, and fatigue and sleep problems). The cumulative variance contribution rate was 75.3%, the Cronbach's α coefficient was 0.83, the Guttman split-half reliability coefficient was 0.88 and the intraclass correlation coefficient was 0.965. The CSI-CV scores correlated moderately with the total scores of the brief pain inventory (r = 0.506), Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.466) and EuroQoL Group's five-dimension questionnaire (r = 0.576). CONCLUSIONS The findings demonstrate that the CSI was successfully trans-culturally adapted into a simplified Chinese version (CSI-CV) that was reliable and valid for Chinese-speaking patients who awaiting TKA for KOA.
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Affiliation(s)
- Chao Xu
- Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, No.169. Changle West Rd, Xi'an, Shaanxi, China
- Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Rd, Xi'an, Shaanxi, China
| | - Shuxin Yao
- Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Rd, Xi'an, Shaanxi, China
| | - Wei Wei
- Department of Orthopedics, 989th Hospital of PLA, No. 2 Huaxia West Rd, Luoyang, Henan, China
| | - Haiyue Zhang
- Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, No.169. Changle West Rd, Xi'an, Shaanxi, China
| | - Jianbing Ma
- Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Rd, Xi'an, Shaanxi, China.
| | - Lei Shang
- Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, No.169. Changle West Rd, Xi'an, Shaanxi, China.
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Clement ND, Scott CEH. Editorial: factors influencing the outcome of total hip and knee arthroplasty. ARTHROPLASTY 2023; 5:64. [PMID: 38053213 DOI: 10.1186/s42836-023-00219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Total hip and knee arthroplasty for end stage arthritis are among the most cost-effective interventions available in all of medicine. Success of hip and knee arthroplasties is not universal and approximately one in ten patients are not satisfied with their arthroplasty and 10 to 34% of patients have an unfavourable long term pain outcome. The aim of this edition of Arthroplasty was to identify factors associated with: (1) poor joint specific outcome, (2) poor health related quality of life outcome and (3) dissatisfaction following total hip and knee arthroplasty. METHODS The scope was deliberately broad to identify factors (known and unknown) that influence outcome of total hip and knee arthroplasty, and of 40 submissions, eight were selected for this special edition after peer review. RESULTS Many of the included studies reported subjective patient reported outcome measures as their key outcomes but other objective measures such as muscle mass, timed Up-and-Go test, kneeling ability and postoperative pain are also featured. Some studies involved a focus on early rehabilitation after surgery (ERAS) principles and how to optimise pre-rehabilitation and reduce length of hospital stay readmission and reoperation. The effect of metal allergy and drain usage on outcomes is also explored. A variety of methodologies have been used including one randomised control trial, some machine learning and three systematic reviews investigating the effect of metal allergy on outcomes, associations with postoperative pain and the effect of patella resurfacing. CONCLUSION This special edition has advanced our knowledge of factors influencing to the outcome of hip and knee arthroplasty but has also identified several areas of research that need to be addressed to improve the outcomes of our patients.
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Affiliation(s)
- Nicholas D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK.
- Department of Orthopaedics, University of Edinburgh, Little France, Edinburgh, UK.
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
- Department of Orthopaedics, University of Edinburgh, Little France, Edinburgh, UK
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Rehman Y, Korsvold AM, Lerdal A, Aamodt A. No difference in patient-reported outcomes with cruciate-retaining, anterior-stabilized, and posterior-stabilized total knee arthroplasty designs. Bone Joint J 2023; 105-B:1271-1278. [PMID: 38037687 DOI: 10.1302/0301-620x.105b12.bjj-2023-0064.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims This study compared patient-reported outcomes of three total knee arthroplasty (TKA) designs from one manufacturer: one cruciate-retaining (CR) design, and two cruciate-sacrificing designs, anterior-stabilized (AS) and posterior-stabilized (PS). Methods Patients scheduled for primary TKA were included in a single-centre, prospective, three-armed, blinded randomized trial (n = 216; 72 per group). After intraoperative confirmation of posterior cruciate ligament (PCL) integrity, patients were randomly allocated to receive a CR, AS, or PS design from the same TKA system. Insertion of an AS or PS design required PCL resection. The primary outcome was the mean score of all five subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) at two-year follow-up. Secondary outcomes included all KOOS subscales, Oxford Knee Score, EuroQol five-dimension health questionnaire, EuroQol visual analogue scale, range of motion (ROM), and willingness to undergo the operation again. Patient satisfaction was also assessed. Results Patients reported similar levels of pain, function, satisfaction, and general health regardless of the prosthetic design they received. Mean maximal flexion (129° (95% confidence interval (CI) 127° to 131°) was greater in the PS group than in the CR (120° (95% CI 121° to 124°)) and AS groups (122° (95% CI 120° to 124°)). Conclusion Despite differences in design and constraint, CR, AS, and PS designs from a single TKA system resulted in no differences in patient-reported outcomes at two-year follow-up. PS patients had statistically better ROM, but the clinical significance of this finding is unclear.
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Affiliation(s)
- Yasser Rehman
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ann M Korsvold
- Department of Physiotherapy, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Research and Development, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
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Desai KB, Mulpur P, Jayakumar T, Suhas Masilamani A, Ranjan A, Gurava Reddy A. Adoption of robotics in arthroplasty- a survey of perceptions, utilization and challenges with technology amongst Indian surgeons. J Orthop 2023; 46:51-57. [PMID: 37942218 PMCID: PMC10630109 DOI: 10.1016/j.jor.2023.10.019] [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: 08/04/2023] [Revised: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Total joint replacement surgeries are standard procedures for managing end-stage hip or knee arthritis. Despite advances in technology, some patients experience dissatisfaction after total knee arthroplasty (TKA). Robotic technology has evolved significantly and has shown promise in improving component positioning, alignment, and surgical outcomes. However, the widespread adoption of robotics in arthroplasty faces challenges such as high costs, a steep learning curve, and limited evidence on long-term outcomes. Methods This cross-sectional observational study used a structured self-administered online survey to assess the perceptions of Indian arthroplasty surgeons regarding robotic technology. The survey included questions about the surgeon's background, experience, perceptions of robotic joint replacement, and limiting factors for robotic usage. A total of 417 responses were collected from practising arthroplasty surgeons. Results Most participants(78.1 %) expressed a willingness to adopt robotics in their arthroplasty practice if the cost of installation was reduced. Robotic users were more convinced about the benefits of robotics, including improved alignment, reduced pain, faster rehabilitation, and better outcomes. High-volume robotic surgeons demonstrated a greater belief in the broader potential of robotics beyond implant positioning and alignment. The major barriers to adoption were the high cost of installation and limited insurance coverage for robotic-assisted procedures. Lack of formal robotic training opportunities, resistance from corporate management, patient acceptance issues, and limited published literature supporting robotic advantages were also cited as limiting factors. Conclusion Robotic technology is increasingly being adopted in India for TKA. The main obstacle to widespread adoption is the high cost of installation. As technology costs decrease, we can expect a rise in the number of installations across the country. Advocacy from national orthopaedic organizations may be needed to address insurance reimbursement challenges. Overall, this study provides valuable insights into the perceptions and challenges associated with the adoption of robotic technology in arthroplasty in India.
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Affiliation(s)
- Keyur B. Desai
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Praharsha Mulpur
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Tarun Jayakumar
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | | | - Abhishek Ranjan
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - A.V. Gurava Reddy
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
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Anderson AM, McHugh GA, Comer C, Joseph J, Smith TO, Yardley L, Redmond AC. Supporting patients to prepare for total knee replacement: Evidence-, theory- and person-based development of a 'Virtual Knee School' digital intervention. Health Expect 2023; 26:2549-2570. [PMID: 37606150 PMCID: PMC10632615 DOI: 10.1111/hex.13855] [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] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Digital delivery of pre-operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre- and post-operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks. OBJECTIVE To develop a pre-operative TKR education and prehabilitation digital intervention, the 'Virtual Knee School' (VKS). METHODS The VKS was developed using an evidence-, theory- and person-based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think-aloud interviews with nine patients who were awaiting/had undergone TKR. Meta-inferences were generated by integrating findings from all the phases. ISRCTN registration of the overall project was obtained on 24 April 2020 (ISRCTN11759773). RESULTS Most participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype's digital format or content did not meet their individual needs. Participants' feedback was used to refine the prototype's information architecture, design and content. Two meta-inferences were generated and recommend: 1. Comprehensive pre-operative TKR education and prehabilitation support should be rapidly accessible in digital and non-digital formats. 2. Pre-operative TKR digital interventions should employ computer- and self-tailoring to account for patients' individual needs and preferences. CONCLUSIONS Integrating evidence, theory and stakeholders' perspectives enabled the development of a promising VKS digital intervention for patients awaiting TKR. The findings suggest future research evaluating the VKS is warranted and provide recommendations for optimising pre-operative TKR care. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement (PPI) was central throughout the project. For example, PPI representatives contributed to the project planning, were valued members of the Project Advisory Group, had key roles in developing the VKS prototype and helped disseminate the project findings.
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Affiliation(s)
- Anna M. Anderson
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
- Present address:
Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | | | - Christine Comer
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- Musculoskeletal and Rehabilitation ServicesLeeds Community Healthcare NHS TrustLeedsUK
| | - Judith Joseph
- Centre for Clinical and Community Applications of Health PsychologyUniversity of SouthamptonSouthamptonUK
| | - Toby O. Smith
- School of Health SciencesUniversity of East AngliaNorwichUK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
- Present address:
Warwick Medical SchoolUniversity of WarwickWarwickUK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health PsychologyUniversity of SouthamptonSouthamptonUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Anthony C. Redmond
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
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Sajan M, Moussa MK, Lefèvre N, Payan C, Valentin E, Meyer A, Bohu Y, Khalaf Z, Grimaud O, Gerometta A, Hardy A, Khiami F. Customized-individually-made origin® implants in total knee arthroplasty allow a reliable solution for accurate reproduction of planned implant positioning. J Exp Orthop 2023; 10:123. [PMID: 38015319 PMCID: PMC10684845 DOI: 10.1186/s40634-023-00706-9] [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: 09/06/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To evaluate the accuracy and reproducibility of a patient-specific, customized individually made (CIM) total knee replacement (TKR) using the ORIGIN® prosthesis. METHODS This was a prospective study conducted at a University Hospital from January 15, 2019, to April 30, 2021. The study included patients planned for an ORIGIN® CIM TKR procedure. Exclusion criteria included revision surgery, severe deformity, stiffness, or laxity. Evaluations were carried out using computed tomography scans performed 8 weeks preoperatively and 6 weeks postoperatively. The primary outcome measurements were the preoperative, planned, and postoperative CT scan alignment measurements including the Hip-Knee-Ankle (HKA) angle, mechanical Medial Distal Femoral articular surface Angle (mMDFA, distal alpha angle), Posterior Distal femoral articular surface angle (PDFA, posterior alpha angle), mechanical Medial Proximal Tibial articular surface Angle (mMPTA, beta angle) and posterior proximal tibial angle (PPTA). Secondary outcomes included the accuracy of implant positioning with percentage of outliers at 2° and 3° RESULTS: The study encompassed 51 knees from 50 patients with mean age of 68.1 (SD = 8.89). The overall HKA angle deviated by -0.93° [95% CI: -1.45; -0.43], and the PDFA angle by -0.61° [95% CI: -1.07; -0.15], while the mMPTA exceeded planned values by 1.00° [95% CI: 0.57; 1.43]. The 3° outliers rate ranged from 3.9% for the mMPTA to 7.8% for the HKA alignment, with no outliers in mMDFA and PPTA. Similarly, the 2° outliers rate ranged from 15.7% for both the PDFA angle and mMPTA to 19.6% for the HKA alignment. The Bland-Altman plots further emphasized the precision of planned and post-operative angles across all measurements. CONCLUSION The CIM TKR showed high accuracy and reproducibility, closely matching preoperative planning. The weakest accuracy at 3°-outliers is in the reproduction of the HKA alignment at 92.2% (range for all angle: 92.2-100%). Similarly, the weakest accuracy at 2°-outliers is in the reproduction of the HKA alignment at 80.4% (range for all angles: 80.4-92.2%).
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Affiliation(s)
- Martin Sajan
- Hôpital de la Pitié Salpêtrière-AP-HP, 75013, Paris, France
| | - Mohamad K Moussa
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France.
| | - Nicolas Lefèvre
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | | | - Eugénie Valentin
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | - Alain Meyer
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | - Yoann Bohu
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | - Zeinab Khalaf
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | - Olivier Grimaud
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | | | - Alexandre Hardy
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | - Frédéric Khiami
- Clinique du sport, 36 Boulevard Saint-Marcel, 75005, Paris, France
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Karasavvidis T, Pagan Moldenhauer CA, Lustig S, Vigdorchik JM, Hirschmann MT. Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) - there is no winner yet. J Exp Orthop 2023; 10:120. [PMID: 37991599 PMCID: PMC10665290 DOI: 10.1186/s40634-023-00697-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Dissatisfaction following total knee arthroplasty (TKA) has been extensively documented and it was attributed to numerous factors. In recent years, significant focus has been directed towards implant alignment and stability as potential causes and solutions to this issue. Surgeons are now exploring a more personalized approach to TKA, recognizing the importance of thoroughly understanding each individual patient's anatomy and functional morphology. A more comprehensive preoperative analysis of alignment and knee morphology is essential to address the unresolved questions in knee arthroplasty effectively. The crucial task of determining the most appropriate alignment strategy for each patient arises, given the substantial variability in bone resection resulting from the interplay of phenotype and the alignment strategy chosen. This review aims to comprehensively present the definitions of different alignment techniques in all planes and discuss the consequences dependent on knee phenotypes.Level of evidence V.
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Affiliation(s)
- Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Cale A Pagan Moldenhauer
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Sébastien Lustig
- Department of Orthopaedic Surgery and Sports Medicine, Croix-Rousse Hospital, Lyon, 69004, France
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, CH-4101, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, CH-4001, Switzerland
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Migliorini F, Feierabend M, Hofmann UK. Fostering Excellence in Knee Arthroplasty: Developing Optimal Patient Care Pathways and Inspiring Knowledge Transfer of Advanced Surgical Techniques. J Healthc Leadersh 2023; 15:327-338. [PMID: 38020721 PMCID: PMC10676205 DOI: 10.2147/jhl.s383916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Osteoarthritis of the knee is common. Early sports trauma or cartilage defects are risk factors for osteoarthritis. If conservative treatment fails, partial or total joint replacement is often performed. A joint replacement aims to restore physiological biomechanics and the quality of life of affected patients. Total knee arthroplasty is one of the most performed surgeries in musculoskeletal medicine. Several developments have taken place over the last decades that have truly altered the way we look at knee arthroplasty today. Some of the fascinating aspects will be presented and discussed in the present narrative review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100 Bolzano, Italy
| | - Martina Feierabend
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
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Jung Jung H, Kang MW, Lee JH, Lee JK, Kim JI. Preoperative patellar bone marrow lesions with full thickness cartilage defects correlate with residual anterior knee pain in total knee arthroplasty without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2023; 31:5048-5056. [PMID: 37695390 DOI: 10.1007/s00167-023-07551-4] [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: 05/17/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Residual anterior knee pain is one of the most common problems after total knee arthroplasty (TKA). However, the contributing factors affecting postoperative anterior knee pain (AKP) remain poorly understood. This study aimed to evaluate the effect of preoperative patellar bone marrow lesions (BMLs) and patellar cartilage defects on postoperative AKP after patellar non-resurfacing TKA. METHODS This retrospective study included 336 patients who underwent unilateral TKA without patella resurfacing. All patients underwent preoperative magnetic resonance imaging (MRI) to assess the presence of BMLs and the degree of cartilage defects in the patella. Patients were categorized into four groups according to the presence of BMLs (with or without BMLs) and the degree of cartilage defects (with or without full thickness cartilage defects). The Kujala Anterior Knee Pain Scale (AKPS) and the Hospital for Special Surgery Knee Rating Scale (HSS) scores at 2 years after TKA were compared among the groups. RESULTS Preoperative BMLs in the patella were found in 132 (39.3%) of 336 cases. Among the four groups, the group with both BMLs and full-thickness cartilage defects demonstrated significantly lower AKPS compared to the other groups at 2 years after TKA (p < 0.01), but no significant difference was shown in the HSS scores, between these groups. There were no significant differences in either AKPS or HSS scores among the other three patient groups. CONCLUSIONS The presence of preoperative BMLs with full-thickness cartilage defects in the patella was associated with worse postoperative AKP after TKA without patella resurfacing. Patella resurfacing should be considered in this patient group to minimize the risk of developing residual AKP after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ho Jung Jung
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Min Wook Kang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Hwa Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
- Department of Orthopedic Surgery, Hallym University Hospital, 1 Singilo, Yeongdeungpo-gu, Seoul, 07441, Korea.
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Nam HS, Yoo HJ, Ho JPY, Kim YB, Lee YS. Preoperative education on realistic expectations improves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized-controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:4705-4715. [PMID: 37355528 DOI: 10.1007/s00167-023-07487-9] [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: 04/01/2023] [Accepted: 06/08/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to investigate whether an additional module on realistic expectations following total knee arthroplasty (TKA) would lead to a higher proportion of satisfied patients compared to existing preoperative education. METHODS This was a single-center, randomized-controlled trial. A total of 172 patients who were scheduled for TKA between September 2020 and October 2021 were enrolled. Patients were randomized to receive either only standard preoperative education, or an additional module on realistic expectations following TKA. The primary outcome was patient satisfaction. Secondary outcomes were Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, crepitus score, and range of motion. Subgroup analysis was performed based on central sensitization inventory (CSI) score stratification. Assessment was performed at the 3-month, 6-month, and > 1-year follow-up. RESULTS At more than 1 year, 65/78 (83.3%) patients in the intervention group and 52/80 (65.0%) patients in the control group were satisfied (P = 0.03). The mean satisfaction score was measured as 4.2 ± 0.9 in the intervention and 3.9 ± 0.9 in the control at > 1 year (P = 0.01). There were significant differences in Short Form-36 physical and mental component summary scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores at 6 months (P = 0.02, P = 0.02, P = 0.04, P = 0.04). The frequency of satisfaction and mean satisfaction score in the top 25 percentile CSI group were 15/16 (93.8%) and 4.6 ± 0.6 in those who received intervention and 12/19 (63.2%) and 3.8 ± 0.8 in those who did not (P = 0.01, P = 0.01). CONCLUSIONS Thorough preoperative education on realistic expectations following TKA showed effects on WOMAC pain and satisfaction at > 1 year after surgery. It was more prominent in the group with a higher CSI score at > 1-year follow-up. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Hyun Jin Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, South Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Yong Beom Kim
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine,, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
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