1
|
Piovan G, Bori E, Padalino M, Pianigiani S, Innocenti B. Biomechanical analysis of patient specific cone vs conventional stem in revision total knee arthroplasty. J Orthop Surg Res 2024; 19:439. [PMID: 39068461 PMCID: PMC11282788 DOI: 10.1186/s13018-024-04936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND In revision total knee arthroplasty, addressing significant bone loss often involves the use of cemented or press-fit stems to ensure implant stability and long-term fixation. A possible alternative to stem was recently introduced utilizing custom-made porous metaphyseal cones, designed to reconstruct the missing tibial and femoral geometries. Early clinical and radiological assessments have shown promising results. The objective of this research was to biomechanically evaluate the performances of these custom-made cones. METHODS The biomechanical study was conducted using a validated finite element model. The bone geometries of a patient (selected for their history of four knee revisions due to infection and periprosthetic fractures, followed by a successful treatment with custom-made 3D-printed metaphyseal cones) were employed for the study. On these bone models, different revision scenarios were simulated and examined biomechanically: (A) custom-made cementless metaphyseal cones; (B) cemented stems; (C) press-fit stems; (D) distal femoral reconstruction with press-fit stem. All the models were analyzed at 0 °and 90 °of flexion, under physiological load conditions simulating daily activities; stress distribution, average Von-Mises stresses and risk of fracture were then analyzed and compared among configurations. RESULTS The use of custom-made 3D-printed cones exhibited the most favorable stress distribution in both femoral and tibial bones. Tibial bone stress was evenly distributed in custom-made cone configurations, while stress concentration was observed in distal regions for the other scenarios. Additionally, custom-made cones displayed overall homogeneity and lower stress levels, potentially contributing to limit pain. Symmetrical stress distribution was observed between the lateral and medial proximal tibia in custom-made cone models, whereas other scenarios exhibited uneven stress, particularly in the anterior tibial bone. CONCLUSIONS The biomechanical analysis of porous custom-made metaphyseal cones in re-revision arthroplasties is in agreement with the positive clinical and radiological outcomes. These findings provide valuable insights into the potential benefits of using custom-made cones, which offer more uniform stress distribution and may contribute to improve patient outcomes in revision TKA procedures. Further studies in this direction are warranted to validate these biomechanical findings.
Collapse
Affiliation(s)
- Gianluca Piovan
- Department of Orthopaedic and Traumatology, S. Cuore-Don Calabria Hospital, Negrar, Italy
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, Brussels, 1050, Belgium
- Département ECAM, Haute Ecole ICHEC-ECAM-ISFSC, Woluwe-Saint-Lambert, Belgium
| | - Marika Padalino
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, Brussels, 1050, Belgium
| | - Silvia Pianigiani
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, Brussels, 1050, Belgium
- Adler Ortho, Cormano, Milan, 20032, Italy
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, Brussels, 1050, Belgium.
| |
Collapse
|
2
|
Fiedler B, Bieganowski T, Singh V, Marwin S, Rozell JC, Schwarzkopf R. Clinical Outcomes of Offset Stem Couplers with or without Cone Augmentation in Revision Total Knee Arthroplasty. J Knee Surg 2024; 37:297-302. [PMID: 37142239 DOI: 10.1055/a-2086-4820] [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: 05/06/2023]
Abstract
Intramedullary stems are often required in patients undergoing revision total knee arthroplasty (rTKA) to achieve stable fixation. Significant bone loss may require the addition of a metal cone to maximize fixation and osteointegration. The purpose of this study was to investigate clinical outcomes in rTKA using different fixation techniques. We conducted a single-institution retrospective review of all patients who received a tibial and femoral stem during rTKA between August 2011 and July 2021. Patients were separated into three cohorts based on fixation construct: press-fit stem with an offset coupler (OS), fully cemented straight (CS) stem, and press-fit straight (PFS) stem. A subanalysis of patients who received tibial cone augmentation was also conducted. A total of 358 patients who underwent rTKA were included in this study, of which 102 (28.5%) had a minimum 2-year follow-up and 25 (7.0%) had a minimum 5-year follow-up. In the primary analysis, 194 patients were included in the OS cohort, 72 in the CS cohort, and 92 in the PFS cohort. When stem type alone was considered, there was no significant difference in rerevision rate (p = 0.431) between cohorts. Subanalysis of patients who received augmentation with a tibial cone demonstrated that OS implants led to significantly higher rates of rerevision compared with the other two stem types (OS: 18.2% vs. CS: 2.1% vs. PFS: 11.1%; p = 0.037). The findings of the present analysis demonstrate that CS and cones in rTKA may provide more reliable long-term outcomes compared with press-fit stems with OS. LEVEL III EVIDENCE: Retrospective Cohort Study.
Collapse
Affiliation(s)
- Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Scott Marwin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| |
Collapse
|
3
|
Salman LA, Khatkar H, Al-Ani A, Alzobi OZ, Abudalou A, Hatnouly AT, Ahmed G, Hameed S, AlAteeq Aldosari M. Reliability of artificial intelligence in predicting total knee arthroplasty component sizes: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:747-756. [PMID: 38010443 PMCID: PMC10858112 DOI: 10.1007/s00590-023-03784-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE This systematic review aimed to investigate the reliability of AI predictive models of intraoperative implant sizing in total knee arthroplasty (TKA). METHODS Four databases were searched from inception till July 2023 for original studies that studied the reliability of AI prediction in TKA. The primary outcome was the accuracy ± 1 size. This review was conducted per PRISMA guidelines, and the risk of bias was assessed using the MINORS criteria. RESULTS A total of four observational studies comprised of at least 34,547 patients were included in this review. A mean MINORS score of 11 out of 16 was assigned to the review. All included studies were published between 2021 and 2022, with a total of nine different AI algorithms reported. Among these AI models, the accuracy of TKA femoral component sizing prediction ranged from 88.3 to 99.7% within a deviation of one size, while tibial component sizing exhibited an accuracy ranging from 90 to 99.9% ± 1 size. CONCLUSION This study demonstrated the potential of AI as a valuable complement for planning TKA, exhibiting a satisfactory level of reliability in predicting TKA implant sizes. This predictive accuracy is comparable to that of the manual and digital templating techniques currently documented in the literature. However, future research is imperative to assess the impact of AI on patient care and cost-effectiveness. LEVEL OF EVIDENCE III PROSPERO registration number: CRD42023446868.
Collapse
Affiliation(s)
- Loay A Salman
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | | | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Osama Z Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Abedallah Abudalou
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ashraf T Hatnouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Shamsi Hameed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Mohamed AlAteeq Aldosari
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| |
Collapse
|
4
|
Karnuta JM, Shaikh HJF, Murphy MP, Brown NM, Pearle AD, Nawabi DH, Chen AF, Ramkumar PN. Artificial Intelligence for Automated Implant Identification in Knee Arthroplasty: A Multicenter External Validation Study Exceeding 3.5 Million Plain Radiographs. J Arthroplasty 2023; 38:2004-2008. [PMID: 36940755 DOI: 10.1016/j.arth.2023.03.039] [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: 11/14/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Surgical management of complications following knee arthroplasty demands accurate and timely identification of implant manufacturer and model. Automated image processing using deep machine learning has been previously developed and internally validated; however, external validation is essential prior to scaling clinical implementation for generalizability. METHODS We trained, validated, and externally tested a deep learning system to classify knee arthroplasty systems as one of the 9 models from 4 manufacturers derived from 4,724 original, retrospectively collected anteroposterior plain knee radiographs across 3 academic referral centers. From these radiographs, 3,568 were used for training, 412 for validation, and 744 for external testing. Augmentation was applied to the training set (n = 3,568,000) to increase model robustness. Performance was determined by the area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy. Implant identification processing speed was calculated. The training and testing sets were drawn from statistically different populations of implants (P < .001). RESULTS After 1,000 training epochs by the deep learning system, the system discriminated 9 implant models with a mean area under the receiver operating characteristic curve of 0.989, accuracy of 97.4%, sensitivity of 89.2%, and specificity of 99.0% in the external testing dataset of 744 anteroposterior radiographs. The software classified implants at a mean speed of 0.02 seconds per image. CONCLUSION An artificial intelligence-based software for identifying knee arthroplasty implants demonstrated excellent internal and external validation. Although continued surveillance is necessary with implant library expansion, this software represents a responsible and meaningful clinical application of artificial intelligence with immediate potential to globally scale and assist in preoperative planning prior to revision knee arthroplasty.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Prem N Ramkumar
- Hospital for Special Surgery, New York, New York; Long Beach Orthopaedic Institute, Long Beach, California
| |
Collapse
|
5
|
Cohen D, Greenberg A, Maliarov A, Seligman D, Backstein D. Long-term outcomes of the Nexgen © posterior stabilized knee: minimum 15 year follow-safe and effective. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2943-2949. [PMID: 36912950 PMCID: PMC10009351 DOI: 10.1007/s00590-023-03514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Studying long-term survivorship and functional outcomes for specific prostheses is critical for elucidating areas in need of design improvement. This study reports the long-term of the NexGen Posterior Stabilized (PS) Total Knee implant (TKA) (Zimmer Biomet, Warsaw IN) Performed by a single surgeon. METHODS Data from patients treated with the NexGen PS TKA between January 2003 and December 2005 with a minimal follow-up of 15 years was collected from a prospectively collected database. Survivorship rates and Oxford Knee Scores (OKS) were obtained for those patients available for follow-up. RESULTS Ninety-five patients met the inclusion criteria during the study period. OKS was available for 44 (46%) patients. Ten patients required revision surgery (10.52%). Implant-specific survivorship of all cases that were reviewed was 98%. Survivorship of implants in patients that we were able to reach, or deceased patients was 93%. The average Oxford Knee Score was 39.1 (14-48. SD ± 7.70) with 48 being the maximal score. CONCLUSION Despite some concerns about durability of this implant, good longevity and function was demonstrated. At a minimum of 15 years follow-up in this cohort. Given these results design features of this system should be considered for future generations of implants.
Collapse
Affiliation(s)
- Daniel Cohen
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - Arieh Greenberg
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - Anton Maliarov
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - David Seligman
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - David Backstein
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| |
Collapse
|
6
|
Bieganowski T, Buchalter DB, Singh V, Mercuri JJ, Aggarwal VK, Rozell JC, Schwarzkopf R. Bone loss in aseptic revision total knee arthroplasty: management and outcomes. Knee Surg Relat Res 2022; 34:30. [PMID: 35725586 PMCID: PMC9208118 DOI: 10.1186/s43019-022-00158-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Although several techniques and implants have been developed to address bone loss in revision total knee arthroplasty (rTKA), management of these defects remains challenging. This review article discusses the indications and management options of bone loss following total knee arthroplasty based on preoperative workup and intraoperative findings. Main text Various imaging modalities are available that can be augmented with intraoperative examination to provide a clear classification of a bony defect. For this reason, the Anderson Orthopaedic Research Institute (AORI) classification is frequently used to guide treatment. The AORI provides a reliable system by which surgeons can classify lesions based on their size and involvement of surrounding structures. AORI type I defects are managed with cement with or without screws as well as impaction bone grafting. For AORI type IIA lesions, wedge or block augmentation is available. For large defects encompassing AORI type IIB and type III defects, bulk allografts, cones, sleeves, and megaprostheses can be used in conjunction with intramedullary stems. Conclusions Treatment of bone loss in rTKA continues to evolve as different techniques and approaches have been validated through short- and mid-term follow-up. Extensive preoperative planning with imaging, accurate intraoperative evaluation of the bone loss, and comprehensive understanding of all the implant options available for the bone loss are paramount to success.
Collapse
|
7
|
Collins DP, Elsouri KN, Demory Beckler M. Osteoarthritis: Can We Do Better? Cureus 2022; 14:e31505. [DOI: 10.7759/cureus.31505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
|
8
|
Dossa F, Simpson AN, Sutradhar R, Urbach DR, Tomlinson G, Detsky AS, Baxter NN. Sex-Based Disparities in the Hourly Earnings of Surgeons in the Fee-for-Service System in Ontario, Canada. JAMA Surg 2020; 154:1134-1142. [PMID: 31577348 DOI: 10.1001/jamasurg.2019.3769] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Sex-based income disparities are well documented in medicine and most pronounced in surgery. These disparities are commonly attributed to differences in hours worked. One proposed solution to close the earnings gap is a fee-for-service payment system, which is theoretically free of bias. However, it is unclear whether a sex-based earnings gap persists in a fee-for-service system when earnings are measured on the basis of hours worked. Objective To determine whether male and female surgeons have similar earnings for each hour spent operating in a fee-for-service system. Design, Setting, and Participants This cross-sectional, population-based study used administrative databases from a fee-for-service, single-payer health system in Ontario, Canada. Surgeons who submitted claims for surgical procedures performed between January 1, 2014, and December 31, 2016, were included. Data analysis took place from February 2018 to December 2018. Exposures Surgeon sex. Main Outcomes and Measures This study compared earnings per hour spent operating between male and female surgeons and earnings stratified by surgical specialty in a matched analysis. We explored factors potentially associated with earnings disparities, including differences in procedure duration and type between male and female surgeons and hourly earnings for procedures performed primarily on male vs female patients. Results We identified 1 508 471 surgical procedures claimed by 3275 surgeons. Female surgeons had practiced fewer years than male surgeons (median [interquartile range], 8.4 [2.9-16.6] vs 14.7 [5.9-25.7] years; P < .001), and the largest proportion of female surgeons practiced gynecology (400 of 819 female surgeons [48.8%]). Hourly earnings for female surgeons were 24% lower than for male surgeons (relative rate, 0.76 [95% CI, 0.74-0.79]; P < .001). This disparity persisted after adjusting for specialty and in matched analysis stratified by specialty, with the largest mean differences in cardiothoracic surgery (in US dollars: $59.64/hour) and orthopedic surgery ($55.45/hour). There were no differences in time taken by male and female surgeons to perform common procedures; however, female surgeons more commonly performed procedures with the lowest hourly earnings. Conclusions and Relevance Even within a fee-for-service system, male and female surgeons do not have equal earnings for equal hours spent working, suggesting that the opportunity to perform the most lucrative surgical procedures is greater for men than women. These findings call for a comprehensive analysis of drivers of sex-based earning disparities, including referral patterns, and highlight the need for systems-level solutions.
Collapse
Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Minimally Invasive Gynecologic Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - David R Urbach
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Epidemiology and Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan S Detsky
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Saeidi M, Ramezani M, Kelly P, Neitzert T, Kumar P. Preliminary study on a novel minimally invasive extra-articular implant for unicompartmental knee osteoarthritis. Med Eng Phys 2019; 67:96-101. [PMID: 30852111 DOI: 10.1016/j.medengphy.2019.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this research was to study the efficacy of a novel implant for osteoarthritic knees. This implant is designed to eliminate excessive loads through the knee and to provide suitable conditions for possible tibiofemoral cartilage repair. The implant was designed for the medial side of the knee joint. Finite Element Analysis (FEA) was performed for an extended knee position of the knee joint. Von Mises stress and contact pressure distributions on the medial and lateral compartments were investigated as well as stress distributions throughout the implant's plates. Comparison of FEA results with and without the implant showed that the maximum von Mises stress and contact pressure experienced by the femoral cartilage were reduced by 40% and 35%, respectively, after introducing the implant. Furthermore, after attaching the implant, the femur was slightly abducted and more stress and pressure were perceived in the lateral compartment compared to the model without implant. The maximum von Mises stress in the implant (96 MPa) was far lower than the yield strength of Ti-6Al-4V (∼900 MPa), the selected material for manufacturing the implant. According to the above points, this initial study shows promise for the new prosthesis.
Collapse
Affiliation(s)
- Mehdi Saeidi
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Maziar Ramezani
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Piaras Kelly
- Department of Engineering Science, University of Auckland, Auckland, New Zealand.
| | - Thomas Neitzert
- Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Pranesh Kumar
- Department of Orthopaedic Surgery, Whanganui Hospital, Whanganui, New Zealand
| |
Collapse
|
10
|
Does the tibia component design affect the need for offset stems in revision total knee arthroplasty? Arch Orthop Trauma Surg 2017; 137:853-860. [PMID: 28331989 DOI: 10.1007/s00402-017-2677-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The stem/keel location varies between anatomic and symmetric revision tibial baseplates. The current study investigates the impact of an anatomic versus symmetric stem location on the need for offset couplers in revision total knee arthroplasty. MATERIALS AND METHODS Hip to ankle standing radiographs and lateral radiographs of 75 patients were analyzed using digital templating software. The offset in the anterior-posterior as well as medial-lateral plane between the center of the tibial diaphysis and the stem of the tibial baseplate were determined for an anatomic and symmetric tibial baseplate, respectively. Measurements were repeated for 4 resection levels: tip of fibular head (0), 10 mm (1), 15 mm (2) and 20 mm (3) below the tip of the fibula head. RESULTS Anatomic tibial baseplates require less offset for resection levels up to the tip of the fibula: total offset 2.28 versus 5.44 mm (p < 0.001). However, for defects that result in resection levels below the tip of the fibula symmetric tibial baseplates require less offset: resection level 1: 3.18 versus 2.4 mm (p = 0.008), 2: 4.81 versus 1.67 mm (p < 0.001) and resection level 3: 5.66 versus 1.52 mm (P < 0.001). CONCLUSION The current study suggests that while asymmetric anatomic tibial baseplates have benefits for revisions with minimal bone loss, symmetric tibial baseplates require less offset when larger bone defects are encountered.
Collapse
|