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Xu H, Chen AF, Shoji MM, Fitz W, Lange JK. Are There More Radiolucent Lines in Patients Who Underwent Total Knee Arthroplasty With or Without a Tourniquet During Cementation at 5 to 8 Years After Surgery? J Arthroplasty 2023; 38:1052-1056. [PMID: 36858126 DOI: 10.1016/j.arth.2023.02.057] [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: 09/25/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND This study investigated the presence and progression of radiolucent lines (RLLs) after cemented total knee arthroplasty (TKA) with or without tourniquet use. METHODS There were 369 consecutive primary cemented TKAs with 5 to 8 years of follow-up. A tourniquet was used during component cementation in patients who underwent surgery from January 3, 2006, to March 31, 2010. No tourniquet was used from August 14, 2009, to October 14, 2014. There were 192 patients in the tourniquet group (TQ) and 177 patients in the no tourniquet group (NQ). Patient demographics, reoperations, and complications were recorded. RLLs were identified on anteroposterior, lateral, and skyline x-rays at 1, 2, and 5 to 8 years postoperatively using the modern knee society radiographic evaluation system. Demographics, reoperations, complications, and RLLs were compared. Age, sex, and body mass index were similar between groups. Mean tourniquet time in TQ was 11 minutes (range, 8 to 25). RESULTS The presence of RLLs differed between groups, with 65% of TQ knees having RLLs under any part of the prostheses versus 46% of NQ knees (P < .001). The progression of RLL >2 mm occurred in 26.0% of knees in TQ and 16.7% of knees in NQ (P = .028). There were 13 TKAs that underwent subsequent revision surgery. There was no statistically or clinically significant difference in revision rate between groups (7 revisions in TQ, 6 in NQ, P = .66). CONCLUSION Less RLLs were identified in NQ versus TQ. There were no statistically or clinically significant differences in revision rates between the NQ and TQ groups at 5 to 8 years.
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Affiliation(s)
- Haijun Xu
- Department of Orthopaedic Surgery, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica M Shoji
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wolfgang Fitz
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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2
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Liu X, Liu Y, Li B, Wang L, Wang Y, Liu J. Comparison of the clinical and patient-reported outcomes between medial stabilized and posterior stabilized total knee arthroplasty: A systematic review and meta-analysis. Knee 2022; 36:9-19. [PMID: 35405624 DOI: 10.1016/j.knee.2022.03.010] [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: 06/12/2021] [Revised: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is effective in relieving pain and improving function in patients with end-stage knee osteoarthritis. Both medial stabilized total knee arthroplasty (MS-TKA) and posterior stabilized total knee arthroplasty (PS-TKA) can achieve satisfactory clinical results, but comparisons between MS-TKA and PS-TKA have yielded contradictory conclusions. This systematic review and meta-analysis were performed to investigate the differences in clinical and patient-reported outcomes (PROMs) between MS-TKA and PS-TKA. METHODS In December 2020, systematic searches of the following databases were undertaken: Pubmed, Embase, Cochrane Library, Clinical Trials.gov. Studies with PROMs comparing MS-TKA to PS-TKA were included. Meta-analysis was conducted for range of motion (ROM), Knee Society Score (KSS), Knee Society Functional Score (KFS), Forgotten Joint Score (FJS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Oxford Knee Score (OKS). RESULTS There were 17 studies included in this review, 13 studies used for quantitative analysis, and 4 studies used for qualitative synthesis. Meta-analysis concluded that the WOMAC mean difference (MD) for MS-TKA was 1.55 higher than for PS-TKA (MD = -1.55; 95 %CI = -2.45 to -0.64, P = 0.0008); however, this difference was less than the minimum clinically important difference (MCID) value of 15. Assessment using the OKS determined that the MD for PS-TKA was 0.58 higher than for MS-TKA (MD = 0.58; 95 %CI = 0.25 to 0.91, P = 0.0006); again, this MD was less than the MCID value of 5. There were no significant differences between MS-TKA and PS-TKA when assessed by ROM (P = 0.23), KSS (P = 0.13), KFS (P = 0.61), or FJS (P = 0.22). CONCLUSION Derived from numerous sources, utilizing a multitude of validated functional and patient-reported outcome assessment tools, there was no clinically evident advantage of MS-TKA compared to PS-TKA. REGISTRATION The registration number on PROSPERO is CRD42021228555.
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Affiliation(s)
- Xiaolong Liu
- Tianjin Medical University, No. 22 Qixiangtai Rd, Heping District, Tianjin 300041 China.
| | - Yang Liu
- Tianjin Medical University, No. 22 Qixiangtai Rd, Heping District, Tianjin 300041 China.
| | - Bing Li
- Tianjin Hospital, No. 406 Jiefang South Rd, Hexi District, Tianjin 300211, China.
| | - Lei Wang
- Tianjin Hospital, No. 406 Jiefang South Rd, Hexi District, Tianjin 300211, China.
| | - Yuanlin Wang
- Tianjin Medical University, No. 22 Qixiangtai Rd, Heping District, Tianjin 300041 China.
| | - Jun Liu
- Tianjin Hospital, No. 406 Jiefang South Rd, Hexi District, Tianjin 300211, China.
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Comparison of Existing and New Total Knee Arthroplasty Implant Systems From the Same Manufacturer: A Prospective, Multicenter Study. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00010. [PMID: 34908561 PMCID: PMC8678005 DOI: 10.5435/jaaosglobal-d-21-00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022]
Abstract
This study evaluated total knee arthroplasty (TKA) outcomes for an Existing-TKA versus New-TKA from the same manufacturer.
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A Prospective Randomized Controlled Trial Comparing Medial-Pivot versus Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2021; 36:1584-1589.e1. [PMID: 33531176 DOI: 10.1016/j.arth.2021.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/20/2020] [Accepted: 01/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The medial-pivot (MP) design for total knee arthroplasty (TKA) aims to restore more natural "ball-and-socket" knee kinematics compared to the traditional posterior-stabilized (PS) implants for TKA. The objective of this study is to determine if there was any difference in functional outcomes between patients undergoing MP-TKA vs PS-TKA. METHODS This prospective randomized controlled trial consisted of 43 patients undergoing MP-TKA vs 45 patients receiving a single-radius PS-TKA design. The primary outcome was postoperative range of motion (ROM). Secondary outcomes included the Western Ontario and McMaster Universities Arthritis Index, Oxford Knee Score, Knee Society Score (KSS), and radiological outcomes. All study patients were followed-up for 2 years after surgery. RESULTS Patients undergoing MP-TKA had comparable ROM at 1 year (114.6° ± 16.3° vs 111.3° ± 17.8° respectively, P = .88) and 2 years after surgery (114.9° ± 15.5° vs 114.9° ± 16.4° respectively, P = .92) compared to PS-TKA. There were also no differences in Western Ontario and McMaster Universities Arthritis Index (26.8 ± 19.84 vs 22.0 ± 12.03 respectively, P = .14), Oxford Knee Score (42.7 ± 8.1 vs 42.3 ± 6.7 respectively, P = .18), KSS clinical scores (82.9 ± 16.96 vs 81.42 ± 10.45 respectively, P = .12) and KSS functional scores (76.2 ± 18.81 vs 73.93 ± 8.53 respectively, P = .62) at 2-year follow-up. There was no difference in postoperative limb alignment or complications. CONCLUSION This study demonstrated excellent results in both the single-radius PS-TKA design and MP-TKA design. No differences were identified at 2-year follow-up with respect to postoperative ROM and patient-reported outcome measures.
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Frye BM, Patton C, Kinney JA, Murphy TR, Klein AE, Dietz MJ. A Medial Congruent Polyethylene Offers Satisfactory Early Outcomes and Patient Satisfaction in Total Knee Arthroplasty. Arthroplast Today 2021; 7:243-249.e0. [PMID: 33786348 PMCID: PMC7987930 DOI: 10.1016/j.artd.2020.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
Background Although a successful operation, almost 20% of patients are dissatisfied with total knee arthroplasty (TKA). The purpose of this retrospective cohort study was to see if a medial congruent (MC) polyethylene would offer satisfactory early outcomes and patient satisfaction after TKA. Methods We reviewed prospectively collected data on 327 TKAs using multiple bearings within the same implant system. Ninety-six received an MC bearing, 70 received a cruciate-retaining (CR) bearing, and 161 received a posterior-stabilized (PS) bearing. We evaluated the visual analog scale pain scores and range of motion (ROM) at 2 weeks, 6 weeks, 3 months, and 1 year; Patient-Reported Outcomes Measurement Information System (PROMIS-10) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 3 months and 1 year; and Forgotten Joint Score (FJS-12) at 1 year. Results All groups had similar KOOS and PROMIS-10 scores. MC knees had lower visual analog scale scores than PS knees at all time points (P < .05) and a higher ROM than PS at 2 weeks (98.6 vs 93.7, P = .002). MC knees had a significantly higher FJS-12 than CR knees (71.6 vs 58.7, P = .02). More MC knees were “very satisfied” than CR (92.6% vs 81.5%, P = .04). Fewer MC knees were “not at all satisfied” than CR (1.2% vs 9.2%, P = .04). There were similar satisfaction ratings with MC and PS. Conclusions An MC bearing provided similar or improved early pain, ROM, KOOS, PROMIS-10, FJS-12, and patient satisfaction as compared with standard bearings in TKA.
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Affiliation(s)
- Benjamin M Frye
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Caitlyn Patton
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Jason A Kinney
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - T Ryan Murphy
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Adam E Klein
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Matthew J Dietz
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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Does Patellar Resurfacing Matter? Midterm Follow-Up of MRK Total Knee Replacement. Indian J Orthop 2020; 55:56-61. [PMID: 34122755 PMCID: PMC8149519 DOI: 10.1007/s43465-020-00258-5] [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: 07/10/2020] [Accepted: 09/07/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many designs of TKR have been developed to optimize the kinematics and improve satisfaction, including the 'medial rotating' philosophy. The purpose of this study is to report the mid-term clinical outcome of MRK knees and evaluate whether resurfacing the patella makes any difference in outcome. METHODS A retrospective analysis was done of 104 MRK total knee replacement done between 2008 and 2017. Patients were called for a review for evaluation of OKS, Baldini and Feller scores. Demographics of the patients, clinical outcome, complications were assessed. RESULTS 62 had patellar resurfacing. Mean follow-up was 74.45 months in non- resurfaced and 54.93 months in resurfaced group. Mean flexion range in both groups at final follow-up was 101.45. Median OKS at follow-up was 36 (12-47) in non-resurfaced and 37 (9-48) in resurfaced group. Patella scores were better in resurfaced group-Baldini score median (range) was 90 (25-100) in non-resurfaced v/s 100 (30-100) in resurfaced, Feller score median (range) was 25 (12-30) in non-resurfaced v/s 28 (10-30) (p 0.042) in resurfaced. The patellofemoral component of the OKS (Q5 + Q7 + Q12) median showed an improvement from 3 (1-11) to 6.5 (3-11) in non-resurfaced and from 3 (0-12) to 8 (2-12) (p 0.039) in resurfaced group. There were five complications overall (4.8%). CONCLUSION These results show a satisfactory outcome at mid-term follow-up. We found a statistically significant difference in Feller score and in the patellofemoral component of OKS between the groups of MRK knee suggesting specific benefits of patellar resurfacing with this implant.
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Samy DA, Wolfstadt JI, Vaidee I, Backstein DJ. A Retrospective Comparison of a Medial Pivot and Posterior-Stabilized Total Knee Arthroplasty With Respect to Patient-Reported and Radiographic Outcomes. J Arthroplasty 2018; 33:1379-1383. [PMID: 29276117 DOI: 10.1016/j.arth.2017.11.049] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/13/2017] [Accepted: 11/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Medial pivot (MP) type total knee arthroplasty (TKA) implants are designed with a highly congruent medial tibiofemoral articulation. Compared with the cam-and-post design of the posterior-stabilized (PS) TKA, the MP-TKA design has been hypothesized to better replicate the natural kinematics of the knee. We compared the MP-TKA and PS-TKA designs, with our primary outcome measures being range of motion (ROM) and patient-reported satisfaction. METHODS This study was a retrospective comparison between the 2 groups (76 MP-TKA vs 88 PS-TKA). ROM was collected preoperatively, 6 weeks, 6 months, and 1 year postoperatively. The Forgotten Joint Score-12 (FJS-12) scores were collected at a minimum of 1 year postoperatively. RESULTS There was no statistically significant difference in age, gender, or body mass index between the groups. We found a statistical difference in preoperative ROM (MP = 120.3°, PS = 112.8°, P = .002). There was no difference in ΔROM at 6 weeks (MP = -12.36, PS = -3.79, P = .066), 6 months (MP = -4.23, PS = 2.73, P = .182), or 1 year (MP = .17, PS = 3.31, P = .499). Patients who underwent the MP-TKA scored significantly better than the PS-TKA on the FJS-12 score (MP = 59.72, PS = 44.77, P = .007). CONCLUSION We found that patients who underwent the MP-TKA scored better on the FJS than those who underwent the PS-TKA; particularly with regard to deep knee flexion and stability of the prosthesis. The MP-TKA design may offer improved patient outcomes because of its highly congruent medial tibiofemoral articulation.
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Affiliation(s)
- David A Samy
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada; University of Aberdeen, School of Medicine, Aberdeen, United Kingdom
| | - Jesse I Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Iman Vaidee
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - David J Backstein
- Granovsky Gluskin Division of Orthopaedics, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
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Karachalios T, Varitimidis S, Bargiotas K, Hantes M, Roidis N, Malizos KN. An 11- to 15-year clinical outcome study of the Advance Medial Pivot total knee arthroplasty. Bone Joint J 2016; 98-B:1050-5. [DOI: 10.1302/0301-620x.98b8.36208] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/01/2016] [Indexed: 11/05/2022]
Abstract
Aims The Advance Medial-Pivot total knee arthroplasty (TKA) was designed to reflect contemporary data regarding the kinematics of the knee. We wished to examine the long-term results obtained with this prosthesis by extending a previous evaluation. Patients and Methods We retrospectively evaluated prospectively collected data from 225 consecutive patients (41 men and 184 women; mean age at surgery 71 years, 52 to 84) who underwent 284 TKAs with a mean follow-up of 13.4 years (11 to 15). Implant failure, complication rate, clinical (both subjective and objective) and radiological outcome were assessed. Pre- and post-operative clinical and radiographic data were available at regular intervals for all patients. A total of ten patients (4.4%; ten TKAs) were lost to follow-up. Results Survival analysis at 15 years showed a cumulative success rate of 97.3% (95% confidence interval (CI) 96.7 to 97.9) for revision for any reason, of 96.4% (95% CI 95.2 to 97.6) for all operations, and 98.8% (95% CI 98.2 to 99.4) for aseptic loosening as an end point. Three TKAs (1.06%) were revised due to aseptic loosening, two (0.7%) due to infection, one (0.35%) due to instability and one (0.35%) due to a traumatic dislocation. All patients showed a statistically significant improvement on the Knee Society Score (p = 0.001), Western Ontario and McMaster University Osteoarthritis Index (p = 0.001), Short Form-12 (p = 0.01), and Oxford Knee Score (p = 0.01). A total of 207 patients (92%) were able to perform age appropriate activities with a mean flexion of the knee of 117° (85° to 135°) at final follow-up. Conclusion This study demonstrates satisfactory functional and radiographic long-term results for this implant. Cite this article: Bone Joint J 2016;98-B:1050–5.
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Affiliation(s)
- Th. Karachalios
- University of Thessalia, School
of Health Sciences, Faculty of Medicine, University
General Hospital, Biopolis, Larissa
41110, Greece
| | - S. Varitimidis
- University of Thessalia, School
of Health Sciences, Faculty of Medicine, University
General Hospital, Biopolis, Larissa
41110, Greece
| | - K. Bargiotas
- University of Thessalia, School
of Health Sciences, Faculty of Medicine, University
General Hospital, Biopolis, Larissa
41110, Greece
| | - M. Hantes
- University of Thessalia, School
of Health Sciences, Faculty of Medicine, University
General Hospital, Biopolis, Larissa
41110, Greece
| | - N. Roidis
- KAT General Hospital, Athens
41110, Greece
| | - K. N. Malizos
- University of Thessalia, School
of Health Sciences, Faculty of Medicine, University
General Hospital, Biopolis, Larissa
41110, Greece
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Bae DK, Cho SD, Im SK, Song SJ. Comparison of Midterm Clinical and Radiographic Results Between Total Knee Arthroplasties Using Medial Pivot and Posterior-Stabilized Prosthesis-A Matched Pair Analysis. J Arthroplasty 2016; 31:419-24. [PMID: 26482685 DOI: 10.1016/j.arth.2015.09.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/31/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the theoretical advantage of a knee design that can more reliably replicate the medial pivot (MP) of the natural knee, only a few clinical studies have compared the clinical results between the MP prosthesis and another design of prosthesis. We compared the midterm results of total knee arthroplasty (TKA) using an MP prosthesis vs a posterior-stabilized prosthesis via a matched-pair analysis; we included results related to patellofemoral joint symptoms. METHODS The midterm clinical and radiographic results of 125 consecutive patients (150 knees) who underwent a TKA with the ADVANCE MP prosthesis were compared with those of a control group who had undergone a primary TKA with a posterior-stabilized prosthesis. RESULTS Values of the Knee Society's Knee Scoring System, Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala and Feller scoring systems, as well as the range of motion after TKA, did not significantly differ between the 2 groups. No differences in femorotibial angle and component position, including the patella component, were observed between the 2 groups. No significant differences in the change of patella tilt angle and the postoperative patellar translation were observed between the 2 groups. CONCLUSION Patients with the MP prosthesis experienced satisfactory pain relief and a functional recovery, providing results similar to those of the posterior-stabilized prosthesis, including the resolution of patellofemoral joint symptoms.
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Affiliation(s)
- Dae Kyung Bae
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Do Cho
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Kyu Im
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Fang CH, Chang CM, Lai YS, Chen WC, Song DY, McClean CJ, Kao HY, Qu TB, Cheng CK. Is the posterior cruciate ligament necessary for medial pivot knee prostheses with regard to postoperative kinematics? Knee Surg Sports Traumatol Arthrosc 2015; 23:3375-82. [PMID: 25155052 DOI: 10.1007/s00167-014-3249-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 08/15/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Excellent clinical and kinematical performance is commonly reported after medial pivot knee arthroplasty. However, there is conflicting evidence as to whether the posterior cruciate ligament should be retained. This study simulated how the posterior cruciate ligament, post-cam mechanism and medial tibial insert morphology may affect postoperative kinematics. METHODS After the computational intact knee model was validated according to the motion of a normal knee, four TKA models were built based on a medial pivot prosthesis; PS type, modified PS type, CR type with PCL retained and CR type with PCL sacrificed. Anteroposterior translation and axial rotation of femoral condyles on the tibia during 0°-135° knee flexion were analyzed. RESULTS There was no significant difference in kinematics between the intact knee model and reported data for a normal knee. In all TKA models, normal motion was almost fully restored, except for the CR type with PCL sacrificed. Sacrificing the PCL produced paradoxical anterior femoral translation and tibial external rotation during full flexion. CONCLUSION Either the posterior cruciate ligament or post-cam mechanism is necessary for medial pivot prostheses to regain normal kinematics after total knee arthroplasty. The morphology of medial tibial insert was also shown to produce a small but noticeable effect on knee kinematics. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Chao-Hua Fang
- Department of Joint Surgery, The 6th Hospital of Ningbo, Ningbo, Zhejiang, China
| | - Chia-Ming Chang
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Yu-Shu Lai
- Orthopaedic Device Research Center, National Yang Ming University, Taipei, Taiwan
| | - Wen-Chuan Chen
- Orthopaedic Device Research Center, National Yang Ming University, Taipei, Taiwan
| | - Da-Yong Song
- Naton Institute of Medical Technology, Beijing, China
| | - Colin J McClean
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Hao-Yuan Kao
- School of Biological Science and Medical Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China
| | - Tie-Bing Qu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Affiliated Hospital of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Cheng-Kung Cheng
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan. .,Orthopaedic Device Research Center, National Yang Ming University, Taipei, Taiwan. .,Naton Institute of Medical Technology, Beijing, China. .,School of Biological Science and Medical Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China. .,Institute of Biomedical Engineering, National Yang Ming University, No. 155, Sec. 2, Li-Nong St., Beitou Dist., Taipei, 112, Taiwan.
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11
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Jonas SC, Argyropoulos M, Al-Hadithy N, Korycki M, Lotz B, Deo SD, Satish V. Knee arthroplasty with a medial rotating total knee replacement. Midterm clinical findings: a district general experience of 38 cases. Knee 2015; 22:122-5. [PMID: 25533210 DOI: 10.1016/j.knee.2014.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 11/11/2014] [Accepted: 11/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Medial Rotating Knee replacement (MRK) was first used in 1994, reporting high rates of satisfaction. It is designed to replicate natural knee kinematics and improve stability and function. There are limited studies on the mid-term clinical outcomes, in particular in a district general hospital (DGH) environment. This is the first study that we are aware of that evaluates the learning curve of the implementation of this knee system in this environment. PATIENTS/METHOD Between 2007 and 2009 we performed 38 consecutive MRK replacements (MAT ORTHO, UK) in 36 patients. The mean follow-up was four years. Patients were evaluated clinically, using OKS and patient questionnaire and radiographically (good/acceptable/poor) to assess outcome. RESULTS Mean age was 73.0 years. Mean pre-operative OKS was 17.7 (range 8-29), which rose to 38.1 (range 23-48) at latest follow up (p<0.005). Overall 71% of the patients were either satisfied (29%) or very satisfied (42%). 81% felt an improvement of the ability to go up or down stairs and 92% felt stable. All poor radiographic and the majority of acceptable outcomes were experienced in the first 50% of cases. CONCLUSION The MRK can be successfully implanted in a DGH environment. It improves pain and function comparably to standard TKRs, however, subjective improvement may be higher. Radiographic evaluation shows an acceptable learning curve. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Sam C Jonas
- Great Western Hospital, Marlborough Road, Swindon SN3 6BB, United Kingdom.
| | | | - Nawfal Al-Hadithy
- Great Western Hospital, Marlborough Road, Swindon SN3 6BB, United Kingdom
| | - Marius Korycki
- Great Western Hospital, Marlborough Road, Swindon SN3 6BB, United Kingdom
| | - Benedict Lotz
- Great Western Hospital, Marlborough Road, Swindon SN3 6BB, United Kingdom
| | - Sunny D Deo
- Great Western Hospital, Marlborough Road, Swindon SN3 6BB, United Kingdom
| | - Venkat Satish
- Great Western Hospital, Marlborough Road, Swindon SN3 6BB, United Kingdom
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Ahn JH, Jeong SH, Lee SH. The effect of multiple drilling on a sclerotic proximal tibia during total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2014; 39:1077-83. [DOI: 10.1007/s00264-014-2551-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/22/2014] [Indexed: 12/01/2022]
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Athwal KK, Hunt NC, Davies AJ, Deehan DJ, Amis AA. Clinical biomechanics of instability related to total knee arthroplasty. Clin Biomech (Bristol, Avon) 2014; 29:119-28. [PMID: 24332382 DOI: 10.1016/j.clinbiomech.2013.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/01/2013] [Accepted: 11/05/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tibiofemoral instability is a common reason for total knee arthroplasty failure, and may be attributed to soft tissue deficiency and incorrect ligament balancing. There are many different designs of implant with varying levels of constraint to overcome this instability; however there is little advice for surgeons to assess which is suitable for a specific patient, and soft tissue balance testing during arthroplasty is very subjective. METHOD The current theories on primary and secondary soft tissue restraints to anterior/posterior, varus/valgus, and internal/external rotational motion of the knee are discussed. The paper reviews biomechanics literature to evaluate instability in the intact and implanted knee. FINDINGS The paper highlights important intra- and extra-capsular structures in the knee and describes the techniques used by clinicians to assess instability perioperatively. In vitro cadaveric studies were found to be a very useful tool in comparing different implants and contributions of different soft tissues. INTERPRETATION In vitro cadaveric studies can be utilised in helping less experienced surgeons with soft tissue releases and determining the correct implant. For this to happen, more biomechanical studies must be done to show the impact of release sequences on implanted cadavers, as well as determining if increasingly constrained implants restore the stability of the knee to pre-deficient conditions.
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Affiliation(s)
- Kiron K Athwal
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - Nicola C Hunt
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Medical School, Framlington Place Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | | | - David J Deehan
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Medical School, Framlington Place Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London SW7 2AZ, UK; Orthopaedic Surgery Group, Imperial College London School of Medicine, Charing Cross Hospital, London W6 8RF, UK.
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Vecchini E, Christodoulidis A, Magnan B, Ricci M, Regis D, Bartolozzi P. Clinical and radiologic outcomes of total knee arthroplasty using the Advance Medial Pivot prosthesis. A mean 7 years follow-up. Knee 2012; 19:851-5. [PMID: 22571852 DOI: 10.1016/j.knee.2012.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial Pivot total knee prosthesis has been designed according to studies on normal knee kinematics aiming to replicate physiological knee movement. The purpose of this study was to evaluate clinical and radiologic results of the Advance Medial Pivot Total Knee Arthroplasty, at a mean follow-up of seven years. METHODS One hundred seventy two Medial Pivot total knee arthroplasties in 160 consecutive patients have been evaluated using the American Knee Society Score and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Statistical analysis was performed using the Student's t-test and the Wilcoxon matched-pairs signed-rank (Mann-Whitney) test in order to evaluate the significance of differences within the groups of patients. Patients compliance was 93.75% thus only six patients (3.75%) lost to follow-up and four patients (2.5%) died for reasons unrelated to the surgery. RESULTS The mean Knee Society score and range of motion was improved from 77.6 points and 97.7° to 152.8 points and 112.5° respectively (p<.001). In total 85.8% and 82.4% of the knees had an excellent (≥ 80) or good (70-79) functional and knee scores respectively. Relief of pain was satisfactory in 88.9% of the patients, while 96% of the patients return to age-related daily life activities. Stability and comfort during walking was subjectively judged by the patients as satisfactory in about 90%. Anterior knee pain was observed in eight patients (5.4%). The Kaplan-Meier survivorship analysis showed a cumulative success rate of 98.6%. CONCLUSIONS The results are encouraging but longer follow-up of this cohort is necessary in the study of this specific design. Level of evidence IV.
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Affiliation(s)
- E Vecchini
- Department of Orthopaedics and Traumatology, University of Verona, GB Rossi Hospital, Verona, Italy
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15
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Arno S, Chaudhary M, Walker PS, Forman R, Glassner P, Regatte R, Oh C. Anterior-posterior stability of the knee by an MR image subtraction method. Knee 2012; 19:445-9. [PMID: 21665481 DOI: 10.1016/j.knee.2011.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 04/11/2011] [Accepted: 05/23/2011] [Indexed: 02/02/2023]
Abstract
The purpose of our study was to test the hypothesis that when a shear force was applied posteriorly to the loaded knee in vivo, there would be no relative motion between the tibia and the medial femoral condyle. Siemens 7 Tesla high-resolution MRI machine was used to scan eight healthy male volunteers with the knee at 15° of flexion. Two scans were obtained: the first with a compressive force of 660 N along the tibial long axis and a second with the compressive force and a posterior shear force of 36 N applied to the tibia. Solid models were created of the femur, tibia, and menisci for both loading conditions. The tibial models were superimposed enabling the displacements of the femur and menisci to be determined, relative to a fixed tibia. On average, the lateral femoral condyle displaced anteriorly by 0.66 mm but the medial femoral condyle displaced posteriorly by 0.36 mm. This indicated an axial rotation with a center between the lateral and medial condyles, but closer to the medial. The menisci displaced with the femoral condyles, but there was no indication that the medial meniscus was contributing to the pivoting action. This study supported the concept of medial anterior-posterior stability under weight-bearing conditions, but with structures other than the medial meniscus providing the stability. This study has application to the treatment of knee injuries and to knee arthroplasty design.
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Affiliation(s)
- Sally Arno
- Department of Orthopaedic Surgery, Laboratory for Minimally Invasive Surgery, NYU Hospital for Joint Diseases, New York, NY 10010, USA
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Wong JM, Khan WS, Chimutengwende-Gordon M, Dowd GSE. Recent advances in designs, approaches and materials in total knee replacement: literature review and evidence today. J Perioper Pract 2011; 21:165-71. [PMID: 21834287 DOI: 10.1177/175045891102100503] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ever since Themistocles Gluck described the use of an ivory cup as a tibial hemiarthroplasty in 1894, knee arthoplasty has continued to evolve. Both human ingenuity and intensive clinical research has led to an improved understanding of biomaterials and knee kinematics, resulting in the modern total knee replacement which has enjoyed such a clinical and commercial success. As it increases in popularity, attempts to improve knee arthroplasty have been driven by demands for improved function and implant survival, particularly in younger, more demanding patients. Research continues to see if advances in implant instrumentation, materials and design will translate into improved clinical outcomes and longevity.
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Affiliation(s)
- James M Wong
- UCL Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex
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17
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Bae DK, Song SJ, Cho SD. Clinical outcome of total knee arthroplasty with medial pivot prosthesis a comparative study between the cruciate retaining and sacrificing. J Arthroplasty 2011; 26:693-8. [PMID: 20637557 DOI: 10.1016/j.arth.2010.04.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 04/20/2010] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study is to evaluate results after total knee arthroplasty using a medial pivot prosthesis with the posterior cruciate ligament (PCL)-retaining and PCL-sacrificing techniques. The PCL was retained in 67 knees and sacrificed in 70 knees. The mean Knee Society knee score increased from 59.6 before surgery to 91.5 at the last follow-up, and the mean function score increased from 53.6 to 85.4. The mean preoperative femorotibial angle was varus 4.1°, which corrected to valgus 5.8° after surgery. The increased knee and function score did not vary significantly between the cruciate-retaining and cruciate-sacrificing groups (P > .108), nor did the mean preoperative and postoperative femorotibial angle (P > .140). The clinical results of total knee arthroplasty with a medial pivot prosthesis were satisfactory, whether the PCL was retained or sacrificed.
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Affiliation(s)
- Dae Kyung Bae
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, South Korea
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18
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Knee arthroplasty with a medially conforming ball-and-socket tibiofemoral articulation provides better function. Clin Orthop Relat Res 2011; 469:55-63. [PMID: 20700674 PMCID: PMC3008885 DOI: 10.1007/s11999-010-1493-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A knee design with a ball-and-socket articulation of the medial compartment has a femoral rollback profile similar to the native knee. Compared to a conventional, posterior-stabilized knee design, it provides AP stability throughout the entire ROM. However, it is unclear whether this design difference translates to clinical and functional improvement. QUESTIONS/PURPOSES We asked whether the medially conforming ball-and-socket design differences would be associated with (1) improved ROM; and (2) improved American Knee Society, WOMAC, Oxford Knee, SF-36, and Total Knee Function Questionnaire scores compared to a conventional, fixed-bearing posterior-stabilized TKA. PATIENTS AND METHODS We enrolled 82 patients in a single-center, single-blinded, randomized, controlled trial comparing the medially conforming ball-and-socket design knee prosthesis to a posterior-stabilized total knee prosthesis. Our primary end point was ROM. Our secondary end points were American Knee Society, WOMAC, Oxford Knee, SF-36, and Total Knee Function Questionnaire scores. All patients were followed at 1 and 2 years. RESULTS The mean ROM was 100.1° and 114.9° in the posterior-stabilized and medially conforming ball-and-socket groups, respectively. The physical component scores of SF-36 and Total Knee Function Questionnaire were better in the medially conforming ball-and-socket group. We found no difference in American Knee Society, WOMAC, and Oxford Knee scores. CONCLUSIONS Both implant designs similarly relieved pain and improved function. The medially conforming ball-and-socket articulation provided better high-end function as reflected by the Total Knee Function Questionnaire. LEVEL OF EVIDENCE Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Walker PS, Yildirim G, Arno S, Heller Y. Future directions in knee replacement. Proc Inst Mech Eng H 2010; 224:393-414. [PMID: 20408486 DOI: 10.1243/09544119jeim655] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The use of artificial joints for the treatment of osteoarthritis is expected to expand considerably over the next decade. While newer technologies can offer yet further improvements in total knee systems, implementation will be strongly affected by the need to satisfy apparently competing requirements. Patients expect quicker rehabilitation, improved performance, and lifelong durability; on the other hand, economic constraints require a reduction in cost for each procedure, as well as early intervention and preventative measures, while there is increased pressure from health care systems to use evidence-based medicine as the standard of choice for implants and techniques. The success of a knee replacement depends on the design itself, the surgical technique, the rehabilitation, and, not least, the patient. The major goal of the implant design can be redefined as a restoration of normal knee mechanics, whether by maximum preservation of tissues, or by guiding surfaces that replace their function. Surgical technique needs to be less invasive but achieve optimal patient-specific alignment and soft tissue balancing. Rehabilitation procedures must achieve the expectations of realistic patients. Testing and evaluation methods need to be upgraded for enhanced predictability. This paper discusses current trends and future possibilities to address this expansive scope of design criteria.
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Affiliation(s)
- P S Walker
- Laboratory for Minimally-Invasive Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10010, USA.
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Karachalios T, Roidis N, Giotikas D, Bargiotas K, Varitimidis S, Malizos KN. A mid-term clinical outcome study of the Advance Medial Pivot knee arthroplasty. Knee 2009; 16:484-8. [PMID: 19349182 DOI: 10.1016/j.knee.2009.03.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 03/08/2009] [Accepted: 03/09/2009] [Indexed: 02/02/2023]
Abstract
The Advance Medial Pivot Total Knee Arthroplasty (Wright Medical Technology, Arlington, Tennessee, USA) has been designed to reproduce modern ideas of knee kinematics. We report a prospective clinical outcome study of 284 arthroplasties in 225 consecutive patients with a mean follow-up of 6.7 years (range 4 to 9 years). For evaluation, both objective and subjective clinical rating systems and serial radiographs were used. At final follow-up, 10 (4.4%) patients (10 knees) only were lost from follow-up and four (1.8%) patients (five knees) had died for reasons unrelated to the surgery with their knees performing well. There was an 82% compliance in the intervals of follow-up evaluation. All patients showed a statistically significant improvement (p=0.01) in the Knee Society clinical rating system, WOMAC questionnaire, SF-12 questionnaire, and Oxford knee score. The majority of patients (92%) were able to perform age-appropriate activities with a mean knee flexion of 117 degrees (range 85 degrees to 135 degrees) at final follow-up. Survival analysis showed a cumulative success rate of 99.1% at 5 years. Two (0.7%) arthoplasties, in which patient selection and surgical errors were identified, were revised due to aseptic loosening, one due to infection and one due to a traumatic dislocation. This study demonstrates satisfactory mid-term clinical results for this knee design.
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Affiliation(s)
- Theofilos Karachalios
- Department of Orthopaedics, School of Medicine, Faculty of Health Sciences, University of Thessalia, Larissa, Hellenic Republic, Greece.
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Mannan K, Scott G. The Medial Rotation total knee replacement: a clinical and radiological review at a mean follow-up of six years. ACTA ACUST UNITED AC 2009; 91:750-6. [PMID: 19483227 DOI: 10.1302/0301-620x.91b6.22124] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We describe the survivorship of the Medial Rotation total knee replacement (TKR) at ten years in 228 cemented primary replacements implanted between October 1994 and October 2006, with their clinical and radiological outcome. This implant has a highly congruent medial compartment, with the femoral component represented by a portion of a sphere which articulates with a matched concave surface on the medial side of the tibial insert. There were 78 men (17 bilateral TKRs) and 111 women (22 bilateral TKRs) with a mean age of 67.9 years (28 to 90). All the patients were assessed clinically and radiologically using the American Knee Society scoring systems. The mean follow-up was for six years (1 to 13) with only two patients lost to follow-up and 34 dying during the period of study, one of whom had required revision for infection. There were 11 revisions performed in total, three for aseptic loosening, six for infection, one for a periprosthetic fracture and one for a painful but well-fixed replacement performed at another centre. With revision for any cause as the endpoint, the survival at ten years was 94.5% (95% CI 85.1 to 100), and with aseptic loosening as the endpoint 98.4% (95% CI 93 to 100). The mean American Knee Society score improved from 47.6 (0 to 88) to 72.2 (26 to 100) and for function from 45.1 (0 to 100) to 93.1 (45 to 100). Radiological review failed to detect migration in any of the surviving knees. The clinical and radiological results of the Medial Rotation TKR are satisfactory at ten years. The increased congruence of the medial compartment has not led to an increased rate of loosening and continued use can be supported.
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Affiliation(s)
- K Mannan
- Bone and Joint Research Unit, Royal London Hospital, London, UK.
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