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Campbell B, Weinberg M, Bischoff J, Scuderi GR. An Evaluation of Anatomic Referencing for Femoral Component Sizing Using Computed Tomography-Based Computer Modeling. J Knee Surg 2024; 37:638-641. [PMID: 38191007 DOI: 10.1055/a-2240-3566] [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: 01/10/2024]
Abstract
One of the critical steps in total knee arthroplasty is femoral component positioning and sizing. Historically, there was wider variability between femoral component sizes, necessitating the concepts of anterior referencing (AR) and posterior referencing (PR). With the introduction of smaller increments between sizes, the concept of anatomic referencing has been introduced to replace AR and PR. The intent of this study was to validate the concept of anatomic referencing and show that with 2 mm increments in femoral sizes, the femoral component can be placed flush to the anterior cortex while maintaining posterior condylar offset (PCO). Digital surface models were created using 515 femurs from an established computed tomography database. Virtual bone resections, component sizing and placement were performed assuming neutral mechanical axis and a cartilage thickness of 2 mm. The appropriately sized femoral component, which had 2 mm incremental sizes, was placed flush with the anterior cortex with restoration of the PCO. The anterior-posterior distance from the posterior surface of the component to the medial and lateral surfaces of the posterior condylar cartilage were measured. The medial condyle was the limiting condyle in the majority of cases (73%). The average medial gap after appropriate femoral component matching was 0.6 mm (0.39-1.41 mm) across all sizes. The overall average condylar gap was 1.02 mm. The most common femoral component was a size 7 (57.2 mm) and the average femoral AP width was 55.9 mm. Anatomic referencing with an implant system that has 2-mm increments in femoral component sizing provides an alternative to AR and PR without compromise. Anatomic referencing allows for perfect alignment of the anterior flange of the femoral component to the anterior cortex of the femur while restoring the native PCO to within 1 mm. This avoids having to choose between AR or PR when in between femoral sizes.
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Affiliation(s)
- Brett Campbell
- Department of Orthopedic Surgery, Penn State Health, St. Joe's Medical Center, Reading, Pennsylvania
| | - Max Weinberg
- Department of Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Garden City, New York
| | | | - Giles R Scuderi
- Department of Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Garden City, New York
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Jin Z, Wang Z, Xu K, Chu J, Xiang S, Tang Y, Wang R, Hua H, Zhang Z, Tong P, Lv S. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study. Open Med (Wars) 2024; 19:20240932. [PMID: 38633220 PMCID: PMC11022038 DOI: 10.1515/med-2024-0932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose To explore the effect of AFN on knee function and complications in patients after TKA. Methods We evaluated 150 patients undergoing unilateral TKA, specifically including 102 patients with varying degrees of AFN after selection. They were divided into four groups based on AFN grade. About 48 patients did not produce AFN, 63 patients were grade I, 29 patients were grade II, and 10 patients were grade III. All patients were followed up for 24 months, and knee function, pain, complications, and other indicators were compared between the four groups. Correlation analysis and regression analysis were used to study the relationship between AFN and other indicators. Results Two cases of periprosthetic fractures (PPF) occurred in our study, with an incidence of 1.35%, which did not show a significant association with AFN. The changes in knee social score (ΔKSS), Western Ontario and McMaster Universities Osteoarthritis Index (ΔWOMAC), and postoperative anterior knee pain visual analog scale (VAS) score were higher in patients with AFN than in those without. Particularly, grades II and III AFN demonstrated superior efficacy. Pearson's correlation analysis showed that AFN grade is positively correlated with both ΔKSS and ΔWOMAC (r = 0.44, P < 0.001), and AFN grade had a negative correlation with the anterior knee pain VAS (r = -0.250, P < 0.05). In linear regression analysis, AFN grade was positively correlated with both ΔKSS (β = 5.974, 95% CI: 3.968-7.981, P < 0.001) and ΔWOMAC (β = 6.356, 95% CI: 4.223-8.490, P < 0.001). Besides that, there was a negative correlation between AFN grade and anterior knee pain (β = 5.974, 95% CI: 3.968-7.981, P < 0.05). Conclusion Patients with grade II and III AFN who underwent TKA exhibited better knee function and lower levels of anterior knee pain post-surgery.
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Affiliation(s)
- Zhaokai Jin
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Zhengming Wang
- Orthopedic Department, Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kuangying Xu
- Orthopedic Department, The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
| | - Jiahao Chu
- Orthopedic Department, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Sicheng Xiang
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Yi Tang
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Rui Wang
- Orthopedic Department, Guanghua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine, Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai200052, China
| | - Haotian Hua
- Orthopedic Department, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhongyi Zhang
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Peijian Tong
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Shuaijie Lv
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
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Chávez-Valladares S, Trigueros-Larrea JM, Pais-Ortega S, González-Bedia MA, Caballero-García A, Córdova A, Noriega-González D. Clinical and Radiological Outcomes of Computer-Assisted versus Conventional Total Knee Arthroplasty at 5-Year Follow-Up: Is There Any Benefit? J Pers Med 2023; 13:1365. [PMID: 37763133 PMCID: PMC10533044 DOI: 10.3390/jpm13091365] [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: 08/18/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Computer-assisted total knee arthroplasty (CAS) remains controversial. Some authors defend that its improvement in knee alignment and positioning positively impacts arthroplasty survival rates, while others have stated that there is minimal or no difference compared to the conventional technique (cTKA). This paper features a retrospective, single-center, single-surgeon study, evaluating CAS surgery vs. regular cTKA in patients who consecutively underwent surgery between 2015 and 2017 (60 CAS patients vs. 59 cTKA). Data collection includes surgery duration, length of stay, blood loss and both preoperative and postoperative clinical outcome evaluation using WOMAC, SF-12, Forgotten Joint Score and VAS. Radiograph evaluation includes the tibiofemoral angle, posterior condylar offset and its ratio, and notching frequency and measurement. A total of 119 patients were included: 60 in the CAS group and 59 in the cTKA. Mean follow-up was 5.61 years (Max 7.83-Min 5.02 years). No clinically relevant preoperative differences were observed between the groups. Postoperatively, both groups showed similar functional results (WOMAC, SF-12, FJS, KSS, and VAS) with similar complication rates. The CAS group had an increased surgery time by a mean of 12 min (107.02 ± 15.22 vs. 95.32 + 13.87; p = 0.00) as well as a higher notching frequency and size (40% vs. 13.60%; p = 0.013; 1.239 mm ± 1.7604 vs. 0.501 mm ± 1.4179; p = 0.031). CAS obtained similar functional, radiological, and complication rates to cTKA at the expense of increasing surgery time and notching frequency and size.
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Affiliation(s)
- Sergio Chávez-Valladares
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47003 Valladolid, Spain; (J.M.T.-L.); (S.P.-O.); (M.A.G.-B.)
| | - Jose Maria Trigueros-Larrea
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47003 Valladolid, Spain; (J.M.T.-L.); (S.P.-O.); (M.A.G.-B.)
| | - Sergio Pais-Ortega
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47003 Valladolid, Spain; (J.M.T.-L.); (S.P.-O.); (M.A.G.-B.)
| | - Maria Antonia González-Bedia
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47003 Valladolid, Spain; (J.M.T.-L.); (S.P.-O.); (M.A.G.-B.)
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, Campus Universitario “Los Pajaritos”, University of Valladolid, 42004 Soria, Spain;
| | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, Campus Universitario “Los Pajaritos”, University of Valladolid, 42004 Soria, Spain
| | - David Noriega-González
- Orthopaedics and Traumatology Surgery, Hospital Clínico Universitario de Valladolid (HCUV), 47003 Valladolid, Spain; (J.M.T.-L.); (S.P.-O.); (M.A.G.-B.)
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Bhor P, pawar S, Kutumbe D, Vatkar A, kale S, Jagtap R. Does preoperative 3D CT planning helps in predicting the component size determination and alignment in automatic robotic total knee arthroplasty (RA-TKA). J Orthop 2023; 43:25-29. [PMID: 37555200 PMCID: PMC10405159 DOI: 10.1016/j.jor.2023.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE Image-based Robotic Total knee Arthroplasty (RA-TKA)was developed with the purpose of enhancing the accuracy in determining the component sizes preoperatively and helping surgeons in minimizing errors and improve patient outcomes. The research aims to find the reliability of robotic-assisted TKR based on images in determining the correct component sizes using preoperative three-dimensional (3D) computer tomography. METHOD After ethical approval, we conducted a prospective study from March 2022 to December 2022. A total of 100 knees underwent image-based RA-TKA having grade 4 Osteoarthritis knee (Kellegren Lawrence classification). A single senior surgeon performed on all patients. Postoperative implant sizes and fit were assessed by five radiographic markers by an independent observer. RESULTS In our study, we found the mean age was (64.96 ± 7.3) years, with female to male ratio of 43:22. The preoperative 3D CT accuracy is 100% for femoral component sizing and 97% for the tibial component. There was a statistically significant improvement in varus deformity from preoperative 7.370 ± 3.70° to 1.24 0 ± 0.910° after surgery., p = 0.001. Improvement in flexion deformity correction was from preoperative 6.50 ± 6.30 to postoperative 1.640 ± 1.770, p = 0.001. CONCLUSION Our study concludes that the use of pre-operative 3D CT helps in predicting the component sizes, minimizes surgical time, and enhances implant position accuracy, as well as improves postoperative limb alignment in the coronal and sagittal planes.
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Affiliation(s)
- Pramod Bhor
- Fortis Hiranandani Hospitals, Mini Sea Shore Road, Juhu Nagar, Sector 10A, Vashi, Navi Mumbai, Maharashtra, 400703, India
| | - Sawankumar pawar
- Fortis Hiranandani Hospitals, Mini Sea Shore Road, Juhu Nagar, Sector 10A, Vashi, Navi Mumbai, Maharashtra, 400703, India
| | - Dnyanada Kutumbe
- Fortis Hiranandani Hospitals, Mini Sea Shore Road, Juhu Nagar, Sector 10A, Vashi, Navi Mumbai, Maharashtra, 400703, India
| | - Arvind Vatkar
- Fortis Hiranandani Hospitals, Mini Sea Shore Road, Juhu Nagar, Sector 10A, Vashi, Navi Mumbai, Maharashtra, 400703, India
| | - Sachin kale
- Fortis Hiranandani Hospitals, Mini Sea Shore Road, Juhu Nagar, Sector 10A, Vashi, Navi Mumbai, Maharashtra, 400703, India
| | - Rahul Jagtap
- Fortis Hiranandani Hospitals, Mini Sea Shore Road, Juhu Nagar, Sector 10A, Vashi, Navi Mumbai, Maharashtra, 400703, India
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Ali M, Ferguson C, Singh I, Phillips D, Sadhwani S, Kahan M, Kamson AO, Angerett N, Hallock RH, Dahl R, King SG. Arthrofibrosis in Robotic Total Knee Arthroplasty: An Investigation Into How Robotic Assistance May Contribute to a Tight Knee. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00005. [PMID: 37141487 PMCID: PMC10155891 DOI: 10.5435/jaaosglobal-d-23-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Arthrofibrosis after total knee arthroplasty (TKA) can lead to pain and restricted range of motion. Matching native knee kinematics is crucial in avoiding arthrofibrosis postoperatively. However, manual jig-based instruments have demonstrated variability and inaccuracy during primary TKA. Robotic-arm-assisted surgery was developed to increase the precision and accuracy of bone cuts and component alignment. In the literature, limited information on arthrofibrosis after robotic-assisted TKA (RATKA) exists. The purpose of this study was to compare the incidence of arthrofibrosis after manual TKA (mTKA) with RATKA by examining the need for manipulation under anesthesia (MUA) postoperatively and evaluating preoperative and postoperative radiographic parameters. METHODS A retrospective analysis of patients who underwent primary TKA from 2019 to 2021 was conducted. Rates of MUA were evaluated and perioperative radiographs were analyzed to determine posterior condylar offset ratio, Insall-Salvati Index, and posterior tibial slope (PTS) in patients who underwent mTKA versus RATKA. Range of motion was recorded for patients who required MUA. RESULTS A total of 1234 patients were included, of which 644 underwent mTKA, and 590 underwent RATKA. Thirty-seven RATKA patients compared with 12 mTKA patients required MUA postoperatively (P < 0.0001). A significant decrease in PTS postoperatively was seen in the RATKA (7.10° ± 2.4° preoperatively versus 2.46° ± 1.2° postoperatively), with a mean decrease of the tibial slope of -4.6° ± 2.5° (P < 0.0001). In patients requiring MUA, a larger decrease was seen in the RATKA group when compared with the mTKA group (mean -5.5 ± 2.0 versus -5.3 ± 0.78, P = 0.6585). No significant difference was seen in the posterior condylar offset ratio and Insall-Salvati Index in both groups. DISCUSSION When conducting RATKA, it is important to match PTS close to the native tibial slope to decrease the incidence of arthrofibrosis postoperatively, as a decrease in PTS can lead to decreased postoperative knee flexion and poor functional outcomes.
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Affiliation(s)
- Muzaffar Ali
- From UPMC Pinnacle, Harrisburg, PA (Dr. Ali, Dr. Ferguson, Dr. Phillips, Dr. Singh, Dr. Sadhwani, Dr. Kahan, Dr. Kamson, Dr. Angerett, Dr. Hallock, Dr. Dahl, and Dr. King); the Rubin Institute for Advanced Orthopedics, Baltimore, MD (Dr. Kahan and Dr. Angerett); the University of Maryland Medical Center, Baltimore, MD (Dr. Kahan and Dr. Angerett); the Orthopedic Institute of Pennsylvania, Camp Hill, PA (Dr. Hallock and Dr. Dahl); and the UPMC Arlington Orthopedics, Harrisburg, PA (Dr. King)
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Custom TKA combined with personalised coronal alignment yield improvements that exceed KSS substantial clinical benefits. Knee Surg Sports Traumatol Arthrosc 2022; 30:2958-2965. [PMID: 35182169 DOI: 10.1007/s00167-022-06867-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to report Knee Society Scores (KSS) at 12-month follow-up in a series of 266 knees that received custom TKA. The hypothesis was that custom TKA combined with personalised alignment would yield improvements greater than substantial clinical benefits (SCB) of KSS Knee and Function. METHODS From a consecutive series of 905 patients (918 knees) that received primary TKAs, 261 (29%) patients (266 knees) received computed tomography (CT)-based posterior-stabilised cemented custom TKA. Knees were aligned aiming to preserve or restore constitutional alignment within predetermined limits of 85°-95° for femoral mechanical angle (FMA) and tibial mechanical angle (TMA), and 175°-183° for hip knee ankle (HKA) angle. The KSS Knee and Function were collected preoperatively and 12 months postoperatively, to determine if patients achieved SCB. Uni- and multivariable analyses were performed to determine associations between KSS scores (Knee and Function) and patient demographics as well as pre- and postoperative radiographic alignments. RESULTS Of the initial cohort of 261 patients, 4 (1.8%) were reoperated for patellar resurfacing, 1 (0.4%) for lavage to treat infection, and 1 (0.4%) had arthroscopy to treat a stiff knee with < 90° range of motion. Complete clinical records were available for 227 patients (232 knees, 87%) that comprised 102 men (5 bilateral) and 125 women. At 12-month follow-up, mean improvements in KSS Knee and Function scores were, respectively, 61.0 ± 13.0 and 42.7 ± 16.7, which exceeded the SCB of KSS. Comparison of knees inside versus outside the target zone revealed no differences in KSS Knee (94.1 ± 9.1 versus 94.3 ± 9.0, n.s.) and Function (96.1 ± 9.2 versus 96.3 ± 8.9, n.s.). Multivariable analysis revealed worse KSS Knee in knees with preoperative FMA > 95° (β = - 6.21; p = 0.023), but no association between KSS Function and patient demographics or pre- and postoperative radiographic alignments. CONCLUSIONS Custom TKA combined with personalised alignment yielded improvements that exceeded substantial clinical benefits of KSS Knee and Function scores. These findings demonstrate the feasibility of custom TKA with 'personalised alignment' and encourage further investigations using comparative studies at longer follow-up. LEVEL OF EVIDENCE IV, case series.
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Zhang JC, Zhang LS, Zhou H, Chen W, Hu ZH, Chen XY, Feng S. Stress distribution patterns during the gait cycle in patients with anterior femoral notching following total knee replacement. BMC Musculoskelet Disord 2022; 23:718. [PMID: 35902856 PMCID: PMC9330681 DOI: 10.1186/s12891-022-05643-9] [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: 03/08/2022] [Accepted: 07/11/2022] [Indexed: 12/05/2022] Open
Abstract
Background Anterior femoral notching (AFN) is a severe complication of total knee replacement (TKR), which in a percentage of patients may lead to fractures after surgery. The purpose of this study was to investigate the stress distribution in patients with AFN and the safety depth of AFN during the gait cycle. Methods We performed a finite element (FE) analysis to analyse the mechanics around the femur during the gait cycle in patients with AFN. An adult volunteer was selected as the basis of the model. The TKR models were established in the 3D reconstruction software to simulate the AFN model during the TKR process, and the 1 mm, 2 mm, 3 mm, 4 mm, and 5 mm AFN models were established, after which the prosthesis was assembled. Three key points of the gait cycle (0°, 22°, and 48°) were selected for the analysis. Results The stress on each osteotomy surface was stable in the 0° phase. In the 22° phase, the maximum equivalent stress at 3 mm was observed. In the 48° phase, with the increase in notch depth, each osteotomy surface showed an overall increasing trend, the stress range was more extended, and the stress was more concentrated. Moreover, the maximum equivalent force value (158.3 MPa) exceeded the yield strength (115.1 MPa) of the femur when the depth of the notch was ≥ 3 mm. Conclusions During the gait cycle, if there is an anterior femoral cortical notch ≥ 3 mm, the stress will be significantly increased, especially at 22° and 48°. The maximum equivalent stress exceeded the femoral yield strength and may increase the risk of periprosthetic fractures.
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Affiliation(s)
- Jin-Cheng Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, 221002, Xuzhou, Jiangsu, China
| | - Le-Shu Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, 221002, Xuzhou, Jiangsu, China
| | - Hang Zhou
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, 221002, Xuzhou, Jiangsu, China
| | - Wang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, 221002, Xuzhou, Jiangsu, China
| | - Zheng-Hao Hu
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, 221002, Xuzhou, Jiangsu, China
| | - Xiang-Yang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, 221002, Xuzhou, Jiangsu, China.
| | - Shuo Feng
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, 221002, Xuzhou, Jiangsu, China.
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Zhang J, Feng S, Zhang L, Zhou H, Chen X. [Research progress of anterior femoral notching in total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1499-1504. [PMID: 34779180 DOI: 10.7507/1002-1892.202105026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress of the causes and prevention methods of anterior femoral notching in total knee arthroplasty (TKA). Methods The related literature at home and abroad about the causes and prevention methods of the anterior femoral notching in TKA was extensively reviewed and summarized. Results The reasons for the occurrence of anterior femoral notching can be summarized as follows: the application of the posterior reference technique, the increase of the posterior condylar angle, the variant anatomical shape of anterior femoral cortex, the selective reduction of the femoral prosthesis size, backward movement of the entrance point, and the application of computer-assisted navigation technology or patient-specific instrumentation. To prevent the occurrence of anterior femoral notching, programs such as flex the femoral prosthesis, robot-assisted technology, and anterior and posterior reference techniques combination can be used. Conclusion Anterior femoral notching is a common surgical complication of TKA. A complete preoperative plan, assessment of the patient's knee joint condition, and development of a reasonable surgical plan can effectively reduce the occurrence of anterior femoral notching.
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Affiliation(s)
- Jincheng Zhang
- Department of Joint Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221006, P.R.China
| | - Shuo Feng
- Department of Joint Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221006, P.R.China
| | - Leshu Zhang
- Department of Joint Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221006, P.R.China
| | - Hang Zhou
- Department of Joint Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221006, P.R.China
| | - Xiangyang Chen
- Department of Joint Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221006, P.R.China
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Müller JH, Liebensteiner M, Kort N, Stirling P, Pilot P, Demey G. No significant difference in early clinical outcomes of custom versus off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 31:1230-1246. [PMID: 34432095 DOI: 10.1007/s00167-021-06678-6] [Citation(s) in RCA: 3] [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: 05/10/2021] [Accepted: 07/18/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to collect, synthesise and critically appraise findings of clinical studies that report outcomes of custom total knee arthroplasty (TKA). The hypothesis was that, compared to off-the-shelf (OTS) TKA, custom TKA would yield better surgical, clinical and radiographic outcomes. METHODS This systematic review and meta-analysis was performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). On 8 February 2021, two authors independently searched and screened articles using MEDLINE®, Embase® and the Cochrane Library without restriction on date of publication. Findings from eligible articles were narratively synthesised and tabulated, and when ≥ 3 comparative studies reported the same outcome, results were pooled and summarised in forest plots. Quality assessments of the studies were done according to the guidelines of the Joanna Briggs Institute (JBI) Checklists. RESULTS A total of 15 articles were eligible for data extraction, of which 9 were case-control studies reporting on 929 custom versus 998 OTS TKA, 5 were case series reporting on results of 587 custom TKA, and 1 was a cross-sectional study reporting on results of 44 custom versus 132 OTS TKA. Five studies that compared early revision rates found the overall effect in favour of OTS TKA (odds ratio (OR), 0.4; p = n.s.) but the result did not reach statistical significance. Four studies found no statistically significant difference in KSS knee (standardised mean difference (SMD), - 0.10; p = n.s.) and function (SMD, 0.03; p = n.s.), and five studies found no statistically significant difference in range of motion (SMD, 0.02; p = n.s.). One study that compared bone-implant fit between custom and three OTS tibial components found no overhang but revealed under-coverage of up to 18% in knees with custom tibial baseplates. CONCLUSION Custom TKA demonstrated no significant benefits compared to OTS TKA in terms of pooled clinical outcomes, but had considerably higher early revision rates. The findings of the present systematic review and meta-analysis suggest the need for studies with better comparable groups and standardisation of reporting outcomes amongst studies, that could increase the quality of evidence and enable pooling of results in future meta-analyses. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Michael Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Nanne Kort
- CortoClinics, Schijndel, The Netherlands
| | | | | | - Guillaume Demey
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Ramsay Santé, 29 Avenue des Sources, 69009, Lyon, France
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Stamiris D, Gkekas NK, Asteriadis K, Stamiris S, Anagnostis P, Poultsides L, Sarris I, Potoupnis M, Kenanidis E, Tsiridis E. Anterior femoral notching ≥ 3 mm is associated with increased risk for supracondylar periprosthetic femoral fracture after total knee arthroplasty: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:383-393. [PMID: 33900452 DOI: 10.1007/s00590-021-02989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Anterior femoral notching (AFN) may be associated with a higher risk for supracondylar periprosthetic fracture (sPPF) after total knee arthroplasty (TKA), although studies have yielded inconclusive results. We aimed to systematically investigate and meta-analyze the best available evidence regarding the association between AFN and the risk of sPPF after TKA. METHODS A comprehensive search of PubMed, Scopus, Mendeley, Google Scholar and Cochrane databases was performed, from conception to February 29, 2020. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). I2-index was employed for heterogeneity. Newcastle-Ottawa scale was implemented for quality assessment of the included studies. RESULTS Nine studies fulfilled the eligibility criteria, including a total of 3264 patients subjected to TKA. Among them, there were 150 patients who sustained a sPPF. Overall, patients exposed to AFN (AFN group) demonstrated an increased risk for sPPF compared to those not exposed (control group) (OR 3.91, 95% CI 1.22-12.58, p = 0.02; I2 68.52%). Subgroup analysis based on AFN depth with a cut-off value of 3 mm further clarified this association. Patients with AFN ≥ 3mm were at higher risk for sPPF compared to patients with AFN < 3 mm and control group (OR 4.85, 95% CI 2.08-11.33, p = 0.00; I2 0.0%). On the contrary, fracture risk was not significant for patients with AFN < 3 mm compared to the control group (OR 5.0, 95% CI 0.44-56.82, p = 0.19; I2 42.99%). CONCLUSION Patients, exposed to AFN ≥ 3 mm in depth, are at higher risk for sustaining a sPPF.
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Affiliation(s)
- Dimitrios Stamiris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece. .,Department of Orthopedics, 424 General Military Hospital of Thessaloniki, 56429, Thessaloniki, Greece. .,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Nifon K Gkekas
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Asteriadis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Stamiris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Department of Orthopedics, 424 General Military Hospital of Thessaloniki, 56429, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.,Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lazaros Poultsides
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Sarris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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