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Budhiparama NC, Lumban-Gaol I, Novito K, Hidayat H, De Meo F, Cacciola G, Cavaliere P. PCL retained is safe in medial pivot TKA-a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:5856-5863. [PMID: 37962615 PMCID: PMC10719124 DOI: 10.1007/s00167-023-07634-2] [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: 06/28/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Medial pivot (MP) designs resemble native knee kinematics and restore the "natural" kinematics of a knee after total knee arthroplasty (TKA). However, whether to preserve or resect the posterior cruciate ligament (PCL) is still under debate. We inquired whether sacrificing the PCL would improve range of motion, functional outcomes, and limb alignment compared to preserving the PCL in TKA using medial pivot implants (MP-TKA). METHODS This prospective, double-blinded, randomized controlled trial consisted of 33 patients (66 knees) undergoing bilateral simultaneous MP-TKA. In one knee, a PCL preservation technique was performed, and in the contralateral knee, the PCL was resected. The primary outcome was postoperative range of motion (ROM). The secondary outcomes were visual analogue scale (VAS) score for knee pain at walking, Knee Injury and Osteoarthritis Outcome Score for symptoms (KOOS-S) and quality of life (KOOS-QoL), Oxford knee score (OKS), and Forgotten Joint Score (FJS), and measurement of the mechanical femoral-tibial axis (mFTA) on X-ray images. All patients were followed up for a minimum of 2 years after surgery. RESULTS Patients who underwent MP-TKA with PCL preservation had a similar ROM at 2 years (125.45 ± 7.00 vs. 126.21 ± 6.73, p = 0.65) as those who underwent MP-TKAs with PCL resection. There was also no difference in VAS score (1.94 ± 0.79 vs. 2.00 ± 0.71, respectively, p = 0.51), OKS (39.97 ± 2.01 vs. 39.67 ± 2.03, respectively, p = 0.52), KOOS-S (84.41 ± 3.77 vs. 84.19 ± 3.57, respectively, p = 0.92), KOOS-QoL (82.94 ± 4.76 vs. 82.75 ± 4.70, respectively, p = 0.84), or FJS (72.66 ± 8.99 vs. 72.35 ± 8.64, respectively, p = 0.76) at the 2-year follow-up. No difference in the measurement of the mFTA was found between the two groups (180.27 ± 2.25 vs. 181.30 ± 2.13, respectively, p = 0.59). CONCLUSION This study demonstrated that both medial pivot TKA with PCL preservation and PCL resection achieved excellent results. There was no difference at the 2-year follow-up in terms of postoperative ROM, patient-reported outcomes, or radiographic evaluation. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Nicolaas C Budhiparama
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands.
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia.
| | - Imelda Lumban-Gaol
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Kiki Novito
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Hendy Hidayat
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Federico De Meo
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Pietro Cavaliere
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
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Staunton DM, Mohan R, Carter JR, Highcock AJ. Total knee replacement survivorship by Design Philosophy: are we ignoring medial pivot design? Analysis based on the UK National Joint Registry. Acta Orthop Belg 2023; 89:37-43. [PMID: 37294983 DOI: 10.52628/89.1.9913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The UK National Joint Registry(NJR) has not reported total knee replacement (TKR) survivorship based on design phi- losophy alone, unlike its international counterparts. We report outcomes of implant survivorship based on design phi- losophy using data from NJR's 2020 annual report. All TKR implants with an identifiable design philosophy from NJR data were included. Cumulative revision data for cruciate-retaining(CR), posterior stabilised(PS), mobile-bearing(MB) design philosophies was derived from merged NJR data. Cumulative revision data for individual brands of implants with the medial pivot (MP) philosophy were used to calculate overall survivorship for this design philosophy. The all-cause revision was used as the endpoint and calculated to 15 years follow-up with Kaplan-Meier curves. 1,144,384 TKRs were included. CR is the most popular design philosophy (67.4%), followed by PS(23.1%), MB (6.9%) and least commonly MP (2.6%). MP and CR implants showed the best survivorship (95.7% and 95.6% respectively) at 15 years which is statistically significant at, and beyond, 10 years. Observed survivorship was lower at all time points with the PS and MB implants (94.5% for both designs at 15 years). While all design philosophies considered in this study survive well, CR and MP designs offer statistically superior survivorship at and beyond 10 years. MP design performs better than CR beyond 13 years yet, remain the least popular design philosophy used. Publishing data based on knee arthroplasty design phi- losophy would help surgeons when making decisions on implant choice.
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Karahan M, Acar E, Serarslan U, Gültekin A. Medial pivot total knee arthroplasty: Mid-term results. Acta Orthop Belg 2023; 89:97-102. [PMID: 37294991 DOI: 10.52628/89.1.10252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to evaluate the mid-term results of patients who underwent medial pivot total knee arthroplasty at a single center. A total of 304 knees of 236 patients (40 males, 196 females; mean operation age and standard deviation : 66,64 ±7,09 years; range, 45 to 82 years) treated with medial pivot total knee prosthesis in our center between January 2010 and December 2014 were retrospectively analyzed. The American Knee Society Score, Oxford Knee Score, and especially flexion angles were recorded during pre- and postoperative follow-up. Of the operated knees, 71.2% were unilateral and 28.8% were bilateral. The mean follow-up was 79.30±14.76 months. The postoperative results with the Functional Score, Knee Score, Oxford Score, Total Knee Society Score, and flexion angles were significantly higher compared to baseline (p<0.01). All postoperative scores were significantly lower inpatients aged ≥65years, compared to those aged <65 years (p<0.01). In patients who underwent resection of anterior and posterior the cruciate ligaments, only the mean flexion angles were found to increase (p<0.01). Our study results suggest that medial pivot knee prostheses are reliable in the mid-term and provide favorable results in terms of function and patient satisfaction. Level of Evidence: Level IV retrospective study.
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Wittig U, Moshammer M, Vielgut I, Hauer G, Reinbacher P, Leithner A, Sadoghi P. Higher use of fixed-bearing over mobile-bearing and posterior-stabilized over medial pivot designs in total knee arthroplasty (TKA): a systematic comparative analysis using worldwide arthroplasty registers from England and Wales, Australia, Norway, New Zealand, Germany and Switzerland. Arch Orthop Trauma Surg 2023; 143:1021-1029. [PMID: 35303145 PMCID: PMC9925559 DOI: 10.1007/s00402-022-04410-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to compare the use of mobile-bearing, fixed-bearing, posterior-stabilized (PS) and medial pivot design to describe epidemiological differences and subsequent outcomes. MATERIALS AND METHODS A systematic literature search was performed using the NORE website to identify the relevant arthroplasty registers. Inclusion criteria were the following: (1) reports had to be publicly available, (2) reports had to be written in German or English language, (3) differentiation between mobile- and fixed-bearing, posterior-stabilized, and if possible, medial pivot designs had to be possible from the present reports, and (4) data had to be reported for at least three consecutive years and the latest report had to be from the year 2020 to retrieve recent data. RESULTS Six registries (England and Wales, Australia, Norway, New Zealand, Germany, Switzerland) offered sufficient data according to the inclusion criteria. In all countries, the dominant type of bearing used for total knee arthroplasty (TKA) was fixed-bearing, with percentages ranging from 60.8% to 84.1% in 2018, 63.6% to 85.7% in 2019 and 66.2% to 87.4% in 2020. A large variation was observed concerning mobile-bearing design, which showed a range from 2.8% to 39.2% in 2018, 2.6% to 36.4% in 2019 and 2.9% to 33.8% in 2020. Some variation was found regarding the use of PS TKA, as its percentage frequency ranged from 9.7% to 29.2% in 2018, 9.8% to 29.4% in 2019 and 10.1% to 28.5% in 2020. Medial pivot design had a share of 9.1% in 2018, 8.6% in 2019 and 8.4% in 2020 in Australia, while it only accounted for 1.4% in 2018, 2.1% in 2019 and 2.5% in 2020 in Germany. CONCLUSION The comparison of arthroplasty registers from England and Wales, Australia, Norway, New Zealand, Germany and Switzerland revealed large differences regarding the application of posterior-stabilized designs, but also common ground considering the overwhelming use of fixed-bearing inserts, which, when inserted correctly, eradicate the potential complication of bearing dislocation. Arthroplasty registers offer a real-world clinical perspective with the aim to improve quality and patient safety.
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Affiliation(s)
- Ulrike Wittig
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Maximilian Moshammer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Ines Vielgut
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria.
| | - Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
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Li C, Chen J, Yang Y, jin Y, Wang C, Tsai T, Li P. Asymmetry of Posterior Condyles in Resection Plane and Axial Curvature for Total Knee Arthroplasty. Orthop Surg 2022; 14:3340-3348. [PMID: 36346140 PMCID: PMC9732622 DOI: 10.1111/os.13529] [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: 10/05/2021] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Understanding the morphology of the distal femur is essential for improving bone-implant match in total knee arthroplasty (TKA) and understanding the mechanisms behind knee kinematics. However, little is known about the asymmetry of the posterior condyles. Thus, this study aimed to thoroughly investigate asymmetries in sizes and shapes between the medial and lateral posterior condyles before and after femoral resections during TKA in osteoarthritic (OA) knees. METHODS Three-dimensional femoral models of 74 OA knees were constructed using computed tomography images. The morphologic measurements of the posterior condyle pre- and post-simulated osteotomy for TKA included the radii of the posterior condyles fitted to a circle on the sagittal and axial planes of the femoral coordinate system, the inclination angle of the articular surface and resected surface, and the width and height of the resected surface. Differences in the data were assessed using Student's t-test, and correlations were evaluated using the Pearson product-moment correlation. RESULTS The radii of the medial posterior condyles fitted to the circle were, on average, 6 mm larger than those of the lateral condyles on the axial plane (p < 0.001) and 0.7 mm smaller than those of the lateral condyles on the sagittal plane (p = 0.046). The inclination angles of the medial and lateral posterior condyles on the axial plane were significantly different with both pre-simulated and post-simulated osteotomy, respectively (both p < 0.001). The resected plane of the lateral posterior condyles displaced opposite inclination directions between the distal and proximal portions. Neither heights or widths of the medial posterior condyles were significantly different from those of their lateral counterparts (both p > 0.107). CONCLUSIONS This study found asymmetrical inclination of the resected surface and coronal radii between the medial and lateral posterior condyles, which may relate to the posterolateral overhang of the lateral condyle after TKA and the progression of the knee OA. These findings provides valuable morphological information and may help improve the implant designs for TKA.
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Affiliation(s)
- Changzhao Li
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina,Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Department of OrthopedicsGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Jiarong Chen
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina
| | - Yiming Yang
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina,Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Department of OrthopedicsGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Yan jin
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina,Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Department of OrthopedicsGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Cong Wang
- School of Biomedical Engineering & Med‐X Research Institute, Shanghai Jiao Tong UniversityShanghaiChina,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing TechnologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tsung‐Yuan Tsai
- School of Biomedical Engineering & Med‐X Research Institute, Shanghai Jiao Tong UniversityShanghaiChina,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing TechnologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Pingyue Li
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina,Branch of National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
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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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Ueyama H, Kanemoto N, Minoda Y, Yamamoto N, Taniguchi Y, Nakamura H. No Difference in Postoperative Knee Flexion and Patient Joint Awareness Between Cruciate-Substituting and Cruciate-Retaining Medial Pivot Total Knee Prostheses: A 10-Year Follow-Up Study. J Arthroplasty 2022; 37:279-285. [PMID: 34793858 DOI: 10.1016/j.arth.2021.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to clarify differences in clinical results, including in patients' joint awareness, between cruciate-substituting (CS) and cruciate-retaining (CR) medial pivot total knee arthroplasty (TKA) over a 10-year follow-up. METHODS A total of 333 TKAs were included in this study. There were 257 cases of CS and 76 cases of CR TKAs. Knee range of motion, Knee Society Score, and radiological outcomes were assessed. The patients' joint awareness was evaluated using the Forgotten Joint Score-12 at the final follow-up. The survival rate with respect to reoperation or revision was analyzed. RESULTS The mean follow-up period was 10 ± 1.7 years, and the loss to follow-up was 5.4%. All clinical outcomes improved significantly after surgery in both groups (P < .001). Postoperative knee flexion was 118° ± 13° in the CS group and 116° ± 10° in the CR group (P = .10). The mean Forgotten Joint Score-12 scores were 57 ± 27 points in the CS group and 56 ± 28 points in the CR group (P = .59). Ten years after the operation, the survival rates for reoperation were 96.3% in the CS group and 94.2% in the CR group (P = .61), and those for revision were 98.4% and 98.7% in the CS and CR groups, respectively (P = .87). Other postoperative clinical results did not differ between the 2 groups. CONCLUSION In this 10-year follow-up study, medial pivot TKA, regardless of polyethylene insert type, showed a high survival rate and good patient awareness of the prosthetic joint.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan; Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe, Wakayama, Japan; Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
| | - Narihiro Kanemoto
- Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe, Wakayama, Japan
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
| | - Nobuo Yamamoto
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
| | - Yoshiki Taniguchi
- Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe, Wakayama, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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9
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Al Juhani W, Alwhaid MS, Almuqbel AM, Alshathri AA, Almatrafi SD, Alsalman M, Altahan H. Clinical and Radiological Outcomes Following Medial Pivot Total Knee Arthroplasty: A Retrospective Chart Review Study. Cureus 2021; 13:e16447. [PMID: 34422478 PMCID: PMC8369966 DOI: 10.7759/cureus.16447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/01/2022] Open
Abstract
Medial pivot total knee arthroplasty (MP-TKA) is a relatively new design that simulates normal knee mechanics with the aim of enhancing postoperative recovery. Furthermore, it reduces postoperative complications in patients with end-stage osteoarthritis of the knee. No study has been done regarding this topic in Saudi Arabia yet, so we aimed to study the post-operative clinical and radiological outcomes of MP-TKA, as well as the postoperative complications. A retrospective cohort chart review study was conducted on 46 patients and 70 knees after applying our inclusion/exclusion criteria. The patients were followed up for an average period of two years. Clinical outcomes were assessed pre- and postoperatively by the validated Saudi Arabian version of the Knee Injury and Osteoarthritis Outcome Score (KOOS), as well as radiological outcomes and postoperative complications gathered from patients’ charts. The postoperative KOOS score showed a statistically significant improvement in pain, symptoms, and activities of daily living in comparison with the preoperative score (P-value < 0.0001). The mean time until ambulation and length of hospital stay were five and 14 days, respectively. Four patients (8.7%) showed radiological complications. Deep vein thrombosis was observed in only two knees (4.3%), and there were no revision cases. Thus, MP-TKA has been shown to improve pain, symptoms, and activities of daily living with a relatively short time until ambulation and length of hospital stay, in addition to a low incidence of postoperative and radiological complications.
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Affiliation(s)
- Wazzan Al Juhani
- Department of Surgery, Ministry of National Guard Health Affairs, Riyadh, SAU.,Orthopaedics, King Abdullah International Medical Research Center, Riyadh, SAU.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammed S Alwhaid
- Radiation Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | | | | | | | - Husam Altahan
- Orthopaedics, King Abdulaziz Medical City, Riyadh, SAU
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10
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Malhotra R, Janardhanan R, Batra S. Total Knee Arthroplasty in Rheumatoid Arthritis patients with a medial stabilized prosthesis - A retrospective analysis. J Clin Orthop Trauma 2021; 21:101566. [PMID: 34471601 PMCID: PMC8385158 DOI: 10.1016/j.jcot.2021.101566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Total Knee Arthroplasty (TKA) has been described as an effective and successful mode of treatment in alleviation of pain and restoration of function in patients with Rheumatoid Arthritis (RA). The array of bone and soft tissue deformities in RA patients can impact initial success and long term durability of TKA. Medial Pivot (MP) prosthesis is fixed bearing asymmetric pivoting design that provides anterior-posterior stability without any post and conserves bone on the femoral side. There are few reports of suitability of experience with MP in RA. METHODS Twenty six patients (average age 55 years) with end stage arthritis secondary to RA operated with MP prosthesis were retrospectively followed up. At a minimum follow up of three years, all patients were assessed using Knee Society Score (KSS), Oxford Knee Score (OKS), Pain Catastrophising Scale (PCS) and radiological outcomes. RESULTS At final follow-up, patients reported significant improvement in mean KSS-Objective and Functional scores, Oxford Knee Score and Pain Catastrophising Scale (p < 0.05). The mean range of motion achieved at the end of two years ranged from 0 ͦ (extension) to 109.4 ͦ (full flexion). There was no evidence of loosening or osteolysis at minimum follow up of three years. CONCLUSION These results endorse satisfactory clinical and radiological outcomes at minimum follow up of three years following Medial Pivot Prosthetic Knee design in RA patients. Further long term follow up is needed to determine the survival analysis of MP design in these patients.
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Affiliation(s)
| | | | - Sahil Batra
- Corresponding author. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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11
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A Mid-term Comparison of the Functional Outcomes of Medial Pivot and Rotating Platform Mobile-Bearing Total Knee Arthroplasty in the Indian Population. Indian J Orthop 2021; 56:271-279. [PMID: 35140858 PMCID: PMC8789967 DOI: 10.1007/s43465-021-00472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/31/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Both medial pivot (MP) and rotating platform (RP) mobile-bearing (MB) total knee arthroplasty (TKA) have been developed to better mimic the natural knee kinematics and femoral roll back in flexion. The purpose of this retrospective study was to compare the mid-term functional outcomes and range of motion (ROM) of MP and RP types of total knee arthroplasty. METHODS 116 patients (mean age of 66.3 years) undergoing TKA (52 Medial pivot design and 64 Rotating Platform design) were evaluated retrospectively with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee score, knee society score (KSS) with its subgroups namely, Knee Score (KSKS) and Functional Score (KSFS) and forgotten joint score (FJS) at a mean follow-up of 7.1 years. Range of motion (ROM) and tibiofemoral anatomic angle on the radiographs were also compared. RESULTS Mean ROM, WOMAC and KSKS improved significantly from pre-operative to postoperative knees in both the groups. There was, however, no significant difference between the two groups at the final follow-up. In contrast, mean KSFS score improved to 89.5 ± 8.1 in MP group and 86.3 ± 7.1 in RP Group (p = 0.025), while mean FJS was 85.6 ± 4.1 and 80.9 ± 5.4 in the MP and RP groups, respectively (p = < 0.0001). CONCLUSION Satisfactory clinical and functional outcomes can be obtained using either a MP or RP knee joint in tricompartmental osteoarthritis of knee. The MP design scores better on the KSFS score and FJS than the RP-TKA.
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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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Xiang S, Wang Y, Lv C, Wang C, Zhang H. Mid-term clinical outcomes and survivorship of medial-pivot total knee arthroplasty-a mean five year follow-up based on one thousand, one hundred and twenty eight cases. INTERNATIONAL ORTHOPAEDICS 2021; 45:2877-2883. [PMID: 33783585 DOI: 10.1007/s00264-021-05017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The unique medial-pivot (MP) design of ADVANCE® system largely simulates the movement of a normal knee joint and a high mid- and long-term success rate has been reported in limited populations. The aims of this study are to investigate the mid-term clinical outcomes and survivorship based on a large cohort with 1128 cases. METHODS One thousand seven patients received 1276 ADVANCE® MP TKAs from January 2011 to April 2016 in our institution were retrospectively investigated. The range of motion (ROM), the Knee Society Score (KSS), the Knee Society Function Score (KSFS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and the Forgotten Joint Score (FJS) were used to evaluate clinical outcomes and Kaplan-Meier survival curve was used to calculate the survivorship. RESULTS In an averaged five year follow-up, the results of 879 patients (1128 knees) were successfully obtained and the clinical outcomes of 1107 knees were recorded. One hundred forty-eight knees (11.6%) were lost to follow-up. Excellent mid-term ROM, KSS, KSFS, and WOMAC score were recorded. A total of 53 complications were identified and most complications were related to the discordance of femoropatellar joint. Taking revision for any reason as end point, the overall survivorship was 99.2% at seven years. When taking all cases lost to follow-up as failures, the survivorship was 83.8% at five years and 50.6% at seven years. CONCLUSION For MP designs, the intermediate clinical outcomes are good to excellent and the mid-term survivorship related to reasons other than infection is also satisfactory.
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Affiliation(s)
- Shuai Xiang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Yingzhen Wang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chengyu Lv
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Changyao Wang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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15
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Alesi D, Marcheggiani Muccioli GM, Roberti di Sarsina T, Bontempi M, Pizza N, Zinno R, Di Paolo S, Zaffagnini S, Bragonzoni L. In vivo femorotibial kinematics of medial-stabilized total knee arthroplasty correlates to post-operative clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29:491-497. [PMID: 32253483 DOI: 10.1007/s00167-020-05975-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/30/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate if there was a correlation between in vivo kinematics of a medial-stabilized (MS) total knee arthroplasty (TKA) and post-operative clinical scores. We hypothesized that (1) a MS-TKA would produce a medial pivot movement and that (2) this specific pattern would be correlated with higher clinical scores. METHODS 18 patients were evaluated through clinical and functional scores evaluation (Knee Society Score clinical and functional, Womac, Oxford), and kinematically through dynamic radiostereometric analysis (RSA) at 9 months after MS-TKA, during the execution of a sit-to-stand and a lunge motor task. The anteroposterior (AP) Low Point translation of medial and lateral femoral compartments was compared through Student's t test (p < 0.05). A correlation analysis between scores and kinematics was performed through the Pearson's correlation coefficient r. RESULTS A significantly greater (p < 0.0001) anterior translation of the lateral compartment with respect to the medial one was found in both sit-to-stand (medial 2.9 mm ± 0.7 mm, lateral 7.1 mm ± 0.6 mm) and lunge (medial 5.3 mm ± 0.9 mm, lateral 10.9 mm ± 0.7 mm) motor tasks, thus resulting in a medial pivot pattern in about 70% of patients. Significant positive correlation in sit-to-stand was found between the peak of AP translation in the lateral compartment and clinical scores (r = 0.59 for Knee Society Score clinical and r = 0.61 for Oxford). Moreover, we found that the higher peak of AP translation of the medial compartment correlated with lower clinical scores (r = - 0.55 for Knee Society Score clinical, r = - 0.61 for Womac and r = - 0.53 for Oxford) in the lunge. A negative correlation was found between Knee Society Score clinical and VV laxity during sit-to-stand (r = - 0.56) and peak of external rotation in the lunge motor task (r = - 0.66). CONCLUSIONS The MS-TKA investigated produced in vivo a medial pivot movement in about 70% of patients in both examined motor tasks. There was a correlation between the presence of medial pivot and higher post-operative scores. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
| | - Tommaso Roberti di Sarsina
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Marco Bontempi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Raffaele Zinno
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Stefano Di Paolo
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Bologna, Italy
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16
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Sun X, Gao X, Sun X, Su Z. Comparison of clinical and radiographic results between total knee arthroplasties using medial pivot and posterior-stabilized prosthesis: A meta-analysis. Medicine (Baltimore) 2021; 100:e23809. [PMID: 33530177 PMCID: PMC7850707 DOI: 10.1097/md.0000000000023809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/19/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To evaluate the clinical and radiographic outcomes of total knee arthroplasties (TKA) between using medial-pivot (MP) and posterior-stabilized (PS) prosthesis. Does MP prosthesis and PS prosthesis influence the clinical results of a TKA? METHODS An electronic literature search of PubMed Medline and the Cochrane Library was performed from inception to October 1, 2019. A meta-analysis to compare postoperative outcomes of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), range of motion (ROM), complications, and radiographic results between MP and PS prosthesis were conducted. RESULTS Seven eligible studies involving 934 adult patients (MP group, n = 461; PS group, n = 473) were identified for analysis. This study showed no significant difference between the 2 groups in the WOMAC scores, KSS, ROM, and complications (P > .05). The differences of the femorotibial angle, position of implant, and patellar tilt were also not significant between the 2 groups (P > .05). CONCLUSION The present meta-analysis has shown that patients with the MP prosthesis have similar clinical results as patients with PS prosthesis. Furthermore, the radiographic results, especially patella tilt angle, were also similar between the 2 groups. Therefore, surgeons should be aware that the types of prostheses are not a decisive factor to ensure successful operation.
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Affiliation(s)
| | | | | | - Zheng Su
- Department of Medical Oncology, Weifang People's Hospital, Weifang, China
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Hokari S, Tanifuji O, Kobayashi K, Mochizuki T, Katsumi R, Sato T, Endo N. The inclination of the femoral medial posterior condyle was almost vertical and that of the lateral was tilted medially. Knee Surg Sports Traumatol Arthrosc 2020; 28:3858-3864. [PMID: 32016580 DOI: 10.1007/s00167-020-05856-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to three-dimensionally analyse the size and shape of the femoral posterior condyles of the normal knee. METHODS A total of 62 healthy Japanese volunteers (37 males and 25 females) providing a sample of 124 normal knee joints, who had no knee-related symptoms and no history of major trauma, underwent computed tomography scans of the bilateral femur and tibia. Three-dimensional digital models of the femur were constructed from computed tomography data using visualisation and modelling software. The following parameters were evaluated: (1) the radii of the posterior condyles approximated to spheres and (2) the inclination angle of the posterior condyles in the coronal plane of the femoral coordinate system. RESULTS The radii of the medial and lateral condyles approximated to spheres were 17.0 ± 1.6 and 17.1 ± 1.8 mm, respectively and were not different. The inclination angles of the medial and lateral condyles in the coronal plane were - 0.6° ± 4.6° and 9.7° ± 5.7°, respectively. The medial condyle was almost vertical, whereas the lateral one was medially tilted. CONCLUSIONS This study found an asymmetrical inclination between medial and lateral condyles. This may be related to the asymmetrical motion of the knee, which is known as medial pivot motion. This finding provides valuable morphological information and may be useful for implant designs for total knee arthroplasty. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sho Hokari
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan.
| | - Koichi Kobayashi
- Department of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Ryota Katsumi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan
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Abstract
Total knee arthroplasty (TKA) is a satisfactory procedure for end-stage knee joint pathology. However, there is a significant incidence of unsatisfied patients. In recent years conventional total knee arthroplasty surgical technique has been challenged and a modern trend to respect individual anatomy, alignment and soft tissue laxities has been developed. The indications, limits and outcomes of these modern techniques in selected patients are not well-defined. Modern technology (navigation, patient-specific instrumentation and robotics) has improved accuracy of the osteotomies but their effect on long-term outcomes is still unclear. A technique which respects individual anatomy, laxities and alignment in combination with an implant which is designed to incorporate contemporary knee kinematics, without the use of modern technology, is presented.
Cite this article: EFORT Open Rev 2020;5:663-671. DOI: 10.1302/2058-5241.5.190085
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Affiliation(s)
- Theofilos Karachalios
- School of Health Sciences, Faculty of Medicine, University of Thessalia, Greece.,Orthopaedic Department, University General Hospital of Larissa, Greece
| | - George A Komnos
- Orthopaedic Department, University General Hospital of Larissa, Greece
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Esposito F, Freddolini M, Marcucci M, Latella L, Corvi A. Biomechanical analysis on total knee replacement patients during gait: Medial pivot or posterior stabilized design? Clin Biomech (Bristol, Avon) 2020; 78:105068. [PMID: 32535478 DOI: 10.1016/j.clinbiomech.2020.105068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 03/03/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total Knee Replacement surgery restores joint function in patients with advanced osteoarthritis. There are several prostheses available based on different mechanisms, which guarantee knee stability during Activities of Daily Living. The aim of this study is to compare ball-in-socket (or Medial Pivot) and post-cam mechanisms to detect possible differences in terms of biomechanical parameters between these two prosthesis designs and to evaluate which design is closer to physiological biomechanics. METHODS A kinematics, kinetics and electromyography lower limb analyses were performed during gait on sixty subjects: twenty with Medial Pivot prosthesis, twenty with posterior stabilized prosthesis and twenty healthy subjects to obtain a physiologic reference. FINDINGS Total Knee Replacement gait pattern for both patient groups were characterized by reduced walking speed, reduced stride length and increased stance time respect to control group. Comparison between Medial Pivot and Posterior Stabilized groups showed a reduction of knee flexion and flexor moment in patients with ball-in-socket mechanism. A prolonged muscular activity of rectus femoris was observed in Medial Pivot patients compared to Posterior Stabilized and control groups. INTERPRETATION "Stiff knee pattern" mechanism was showed for both patient groups but more enhanced in Medial Pivot patients. Even though the Posterior Stabilized design introduces the non-physiological paradoxical motion and the Medial Pivot design seems to better reproduce the physiological condylar movement as gait analysis parameters, including kinematics, kinetics and electromyographic parameters were closer to control group and, in turn, to physiological gait for the Posterior Stabilized than Medial Pivot group parameters.
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Affiliation(s)
- Francesco Esposito
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054 Fucecchio (FI), Italy; Industrial Engineering Department, University of Florence, Via di S. Marta 3, 50139 Firenze (FI), Italy.
| | - Marco Freddolini
- Italian Institute of Technology, Via Morego 30, 16163 Genova (GE), Italy
| | - Massimiliano Marcucci
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054 Fucecchio (FI), Italy; "Centro di Eccellenza Sostituzioni Articolari Toscana (C.E.S.A.T.)", Piazza Spartaco Lavignini 1, 50054 Fucecchio (FI), Italy; Health Sciences Department, University of Florence, Viale Pieraccini 6, 50139 Firenze (FI), Italy
| | - Leonardo Latella
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054 Fucecchio (FI), Italy; "Centro di Eccellenza Sostituzioni Articolari Toscana (C.E.S.A.T.)", Piazza Spartaco Lavignini 1, 50054 Fucecchio (FI), Italy
| | - Andrea Corvi
- Laboratorio congiunto di Analisi del Movimento, "Fondazione ONLUS: In cammino…", Piazza Spartaco Lavignini 1, 50054 Fucecchio (FI), Italy; Industrial Engineering Department, University of Florence, Via di S. Marta 3, 50139 Firenze (FI), Italy
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20
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Cassar-Gheiti AJ, Jamieson PS, Radi M, Wolfstadt JI, Backstein DJ. Evaluation of the Medial Stabilized Knee Design Using Data From National Joint Registries and Current Literature. J Arthroplasty 2020; 35:1950-1955. [PMID: 32224003 DOI: 10.1016/j.arth.2020.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/02/2020] [Accepted: 02/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Various designs of total knee arthroplasty (TKA) have provided satisfactory outcomes for the treatment of knee osteoarthritis for many years. The aim of the study is to evaluate the success and failure rate of the medial stabilized (MS) TKA design through national joint registries and the current literature. MATERIALS AND METHODS A comprehensive literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was carried out through PubMed and MEDLINE database. The international registries analyzed included the National Joint Registry, the Australian Orthopedic Association National Joint Replacement Registry, the Dutch Arthroplasty Register, the New Zealand Orthopedic Association Joint Registry, and the Michigan Arthroplasty Registry Collaborative Quality Initiative. We are reporting descriptive data which include means and percentages of survival rates and revision rates and number of years after the primary procedure. The revision rates and the cumulative revision rates are reported separately for each MS implant. RESULTS Our detailed review identified 5 of 12 registries and 25 of 550 studies reporting on the survivorship of an MS TKA design. There were a total of 3684 procedures between the 25 studies, with an average survivorship free of aseptic loosening of 99% at 6.9 years. There are 26,693 (2.5%) MS TKAs in the current National Joint Registry with a mean cumulative revision rate of 2.63% at 5 years, 3.35% at 10 years, and 4.6% at 15 years. The Australian Orthopedic Association National Joint Replacement Registry provides survivorship data on 19,249 (2.9%) MS TKAs, with a mean cumulative revision rate of 3.34% at 5 years, 7.4% at 10 years, and 8.1% at 15 years. The Dutch Arthroplasty Register contains survivorship data on 1490 MS designs and a mean revision rate of these implants is 0.8% at 1 year, 5.95% at 5 years, and 9.8% at 10 years. The Evolution MP is the only implant reported in the Michigan Arthroplasty Registry Collaborative Quality Initiative and has a revision rate of 2.28% at 3 years. CONCLUSION The MS TKA design has comparable results to traditional TKA designs across several joint registries and 25 studies in the literature.
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Affiliation(s)
- Adrian J Cassar-Gheiti
- Department of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul S Jamieson
- Department of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mehran Radi
- Department of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jesse I Wolfstadt
- Department of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David J Backstein
- Department of Orthopaedics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Lin Y, Chen X, Li L, Li Z, Zhang Y, Fan P. Comparison of Patient Satisfaction Between Medial Pivot Prostheses and Posterior-Stabilized Prostheses in Total Knee Arthroplasty. Orthop Surg 2020; 12:836-842. [PMID: 32390346 PMCID: PMC7307254 DOI: 10.1111/os.12687] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/14/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To compare medial pivot (MP) prostheses to two types of posterior-stabilized (PS) prostheses (NexGen and NRG) in terms of patient satisfaction, causes of dissatisfaction, and risk factors for dissatisfaction after total knee arthroplasty (TKA). METHODS A total of 453 patients who underwent primary TKA by one senior surgeon from August 2016 to August 2018 were investigated in a retrospective study, including 121, 219, and 113 patients in the MP, NexGen, and NRG groups, respectively. The mean age and follow-up time of patients were 70.82 ± 7.06 years and 20.64 ± 3.88 months. A survey was designed and responses were collected by telephone, WeChat, and outpatient follow up. Patient satisfaction, causes of dissatisfaction, post-TKA pain on a numeric rating scale (NRS), and range of motion (ROM) were compared among groups, and risk factors were investigated. Patient satisfaction included a five-level satisfaction rating (very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied), with five options for causes of dissatisfaction (persistent pain, limited ROM, knee instability, asthenia, and/or other factors). RESULTS Overall, 89.84% of patients were satisfied with the results of primary TKA. There were no significant differences among the three groups regarding the side of the operation, the length of hospitalization in days, or the average follow-up time. Patient satisfaction was similar among the MP (87.38%), NexGen (89.89%), and NRG groups (90.32%). Persistent pain after TKA was the major cause of dissatisfaction (32/40), but no difference in the frequency of this complaint was found among the groups (P = 0.663). The NRS score (P = 0.598) and the ROM (P = 0.959) of the MP group were not significantly different from those of the NexGen and NRG groups. Gender, length of hospitalization, and follow-up time were all uncorrelated with patient satisfaction, but age showed a very weak correlation with patient satisfaction (r = 0.110, P = 0.033). Moreover, the NRS score (r = 0.459, P < 0.000) and the ROM (r = -0.175, P = 0.001) were significantly correlated with patient dissatisfaction. The odds ratio of dissatisfaction was 6.37 (P < 0.000) in patients with moderate to severe pain (NRS ≥ 3) compared to patients with mild pain (NRS < 3). CONCLUSION Patient satisfaction and function were not found to be higher in the MP group than in the two PS groups, and persistent pain was the major cause of and an important risk factor for patient dissatisfaction.
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Affiliation(s)
- Yuanyuan Lin
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Xueyan Chen
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Li Li
- Department of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Zhenxing Li
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yu Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Pei Fan
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
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22
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Kulshrestha V, Sood M, Kanade S, Kumar S, Datta B, Mittal G. Early Outcomes of Medial Pivot Total Knee Arthroplasty Compared to Posterior-Stabilized Design: A Randomized Controlled Trial. Clin Orthop Surg 2020; 12:178-186. [PMID: 32489539 PMCID: PMC7237261 DOI: 10.4055/cios19141] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
Backgroud The indications for total knee arthroplasty (TKA) have been expanded to include younger, demanding patients. Some TKA patients expect a return to high-performance activities to restore optimum quality of life. The concept of the medial pivot (MP) TKA is that more natural knee kinematics can be achieved by altering the bearing design. In the present study, we compared the early outcomes of MP TKA with posterior-stabilized (PS) TKA in terms of patient-reported outcomes, function, and performance. Methods This randomized study was performed in a high volume joint replacement facility of a tertiary care military hospital. We enrolled 40 patients each in the MP group and PS group and assessed knee flexion, patient-reported outcome (new Knee Society Score [new KSS]), patient performance (Delaware Osteoarthritis Profile Score [DOPS]), and function (Forgotten Joint Score [FJS]) at 2 years after surgery. Results Compared to PS group patients, MP group patients had similar patient-reported outcomes assessed by new KSS (satisfaction, expectation, and activity scales) and FJS. MP knee patients had better performance in the timed up and go test (p < 0.026) and self-paced walk test (p < 0.002) of DOPS. The gain in knee flexion (9.3° ± 14°) compared to baseline was significantly greater in the PS group (p < 0.013). Conclusions When assessed by DOPS, getting up from chair and walking speed were significantly better in MP knee patients than in PS knee patients. However, considering the predictable rollback ensured by cam and post, the PS knee produced better knee flexion. Despite these results, patients were equally satisfied with the two designs.
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Affiliation(s)
| | - Munish Sood
- Department of Orthopaedics, Command Hospital, Chandigarh, India
| | - Sarang Kanade
- Department of Orthopaedics, Dr Shyama Prasad Mukherjee Hospital, Lucknow, India
| | - Santhosh Kumar
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bengaluru, India
| | - Barun Datta
- Department of Orthopaedics, Joint Replacement Centre, Army Hospital R & R, New Delhi, India
| | - Gaurav Mittal
- Department of Orthopaedics, Military Hospital, Kilkee, India
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23
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French SR, Munir S, Brighton R. A Single Surgeon Series Comparing the Outcomes of a Cruciate Retaining and Medially Stabilized Total Knee Arthroplasty Using Kinematic Alignment Principles. J Arthroplasty 2020; 35:422-428. [PMID: 31611163 DOI: 10.1016/j.arth.2019.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) designs are developed to optimize kinematics and improve patient satisfaction. The cruciate retaining (CR) and medially stabilized (MS) TKA designs have reported good mid-term follow-up outcomes. However, reasons for consistently high rates of patient dissatisfaction following a TKA remain poorly understood. To further investigate this, we compared the short-term functional outcomes and quality of life, using patient-reported outcome measures (PROMs) and range of motion (ROM), between a CR and MS TKA. METHODS A prospective comparison was made between 2 groups (44 CR-TKAs vs 46 MS-TKAs). The Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS-12, KOOS-Short form, KOOS-Joint Replacement, Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, UCLA Activity Scale, and EuroQuality of life - 5 Dimension were completed preoperatively and 1 year postoperatively. The Forgotten Joint Score (FJS) and Visual Analogue Scale-Satisfaction were completed at 1 year postoperatively. ROM was collected preoperatively and 1 year postoperatively. RESULTS Patients who underwent an MS-TKA scored significantly better than the CR-TKA on the FJS (MS = 79.87, CR = 63.8, P = .005), the KOOS-12 Quality of Life subscale (MS = 82.8, CR = 74.4, P = .43), and the KOOS Quality of Life subscale (MS = 82.8, CR = 74.6, P = .44). There was no difference between the groups in all assessed PROMs or ROM, preoperatively and 1 year postoperatively. CONCLUSION Patients who underwent the MS-TKA scored significantly better on the FJS and the quality of life subscale of the KOOS and KOOS-12 than those who underwent a CR-TKA. All other assessed PROMs and ROM were comparable between the 2 groups and demonstrated that both implants facilitated symptom relief and improved daily function at 1 year postoperatively. These findings suggest that at short-term follow-up, the MS device is more likely to allow a patient to "forget" that a joint has been replaced and restore their quality of life. Long-term assessment of MS-TKA design outcomes in larger cohorts is recommended.
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Affiliation(s)
- Sofie R French
- Research Department, Australian Institute of Musculoskeletal Research, Wollstonecraft, New South Wales, Australia
| | - Selin Munir
- Research Department, Australian Institute of Musculoskeletal Research, Wollstonecraft, New South Wales, Australia
| | - Roger Brighton
- Orthopaedic Department, Westmead Private Hospital, Westmead, New South Wales, Australia
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24
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Beach A, Regazzola G, Neri T, Verheul R, Parker D. The effect of knee prosthesis design on tibiofemoral biomechanics during extension tasks following total knee arthroplasty. Knee 2019; 26:1010-1019. [PMID: 31402095 DOI: 10.1016/j.knee.2019.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 07/05/2019] [Accepted: 07/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Determine whether the tibiofemoral motion and electromyographic activity of the knee differs in patients with a medial pivot implant, compared to those with cruciate-retaining and posterior-stabilised designs, during knee extension after Total Knee Arthroplasty (TKA). METHODS An observational study was conducted on a cohort of patients that had undergone TKA for a minimum of 12 months prior. Three matched groups (n = 18) were categorised based on implant type: medial-pivot (MP), posterior-stabilised (PS) and cruciate-retaining (CR). Kinematics, with motion analysis (Vicon, USA) and surface electromyography (Delsys, USA) were assessed during step-ascent and walking tasks. RESULTS All groups displayed a similar amount of knee extension in both tasks. They also paradoxically produced an average mean internal rotation movement during knee extension in both the step-ascent and walking tasks. The only significant difference was found in the step-ascent task, in which the MP group produced a larger absolute amount of rotation than the CR implant group (P = 0.007), but neither group differed from the PS implant group. The groups did not differ in rotation during the walking task (P > 0.05). The MP group displayed significantly (P < 0.01) greater knee extensor activation during the step-ascent than the PS group. CONCLUSION The MP design was only significantly different to another implant design for the step-ascent task. Patients with either knee implant types were not strictly limited to producing the traditional "screw-home" mechanism, defined by external rotation during extension. Furthermore, comparison with the non-implant contralateral limb suggested that rotation is not necessarily dictated by implant design.
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Affiliation(s)
- Aaron Beach
- Sydney Orthopaedic Research Institute, Sydney, Australia.
| | | | - Thomas Neri
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | | | - David Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
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25
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Symmetrical cruciate-retaining versus medial pivot prostheses: The effect of intercondylar sagittal conformity on knee kinematics and contact mechanics. Comput Biol Med 2019; 108:101-110. [DOI: 10.1016/j.compbiomed.2019.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 01/28/2023]
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Abstract
AIMS Between 15% and 20% of patients remain dissatisfied following total knee arthroplasty (TKA). The SAIPH knee system (MatOrtho, Surrey, United Kingdom) is a medial ball and socket TKA that has been designed to replicate native knee kinematics in order to maximize the range of movement, stability, and function. This system is being progressively introduced in a stepwise fashion, with this study reporting the mid-term clinical and radiological outcomes. PATIENTS AND METHODS A retrospective review was undertaken of the first 100 consecutive patients with five-year follow-up following SAIPH TKA performed by the senior authors. The data that were collected included the demographics of the patients, clinical findings, the rate of intraoperative ligamentous release, patient-reported outcome measures (PROMS), radiological assessment, complications, and all-cause revision. Revision data were cross-checked with a national registry. RESULTS A total of 100 TKAs in 92 patients were included. Three patients died (three TKAs) and a further two TKAs were revised. Of the remaining 95 TKAs, five-year follow-up data were available for 81 TKAs (85%) in 87 patients. There were significant improvements in all PROMs and high satisfaction. The mean ROM at final follow-up was from 0° (full extension) to 124° flexion. There were seven major complications (7%): one infection, two deep vein thromboses, one cerebrovascular event, and two patients with stiffness requiring a manipulation under anaesthesia. Two patients required a lateral retinacular release to optimize patellar tracking in valgus knees; no additional ligament releases were performed in any patient. Radiological analysis demonstrated no evidence of implant-related complications. CONCLUSION These results demonstrate satisfactory clinical and radiological outcomes at five years following a medial ball and socket TKA. The complication and revision rates are consistent with those previously reported for patients undergoing TKA. These results demonstrate the safety and efficacy of the SAIPH Knee TKA system and support its wider use.
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Affiliation(s)
- A M Katchky
- Department of Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont; Orthopaedic Surgeon, University of Vermont Medical Center, Burlington, Vermont, USA
| | - C W Jones
- Fiona Stanley Hospital Group and Orthopaedics Western Australia; Senior Research Fellow, Curtin University, Western Australia; Senior Clinical Lecturer, University of Sydney, Sydney, Australia
| | - W L Walter
- Orthopaedics and Traumatic Surgery, University of Sydney, Sydney, Australia, Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
| | - A J Shimmin
- Monash University, Melbourne, Melbourne Orthopaedic Group, Melbourne, Australia
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Karachalios T, Komnos G, Amprazis V, Antoniou I, Athanaselis S. A 9-Year Outcome Study Comparing Cancellous Titanium-Coated Cementless to Cemented Tibial Components of a Single Knee Arthroplasty Design. J Arthroplasty 2018; 33:3672-3677. [PMID: 30077469 DOI: 10.1016/j.arth.2018.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The cemented Advance Medial-Pivot total knee arthroplasty (TKA) was designed to reflect contemporary knee kinematics data and has shown satisfactory long-term outcomes. METHODS We retrospectively evaluated prospectively collected data from 2 groups of patients. Group A consisted of 54 patients (54 TKAs), 18 men and 36 women, and mean age at surgery was 63.2 ± 5.2 years; group B consisted of 54 patients (54 TKAs), 17 men and 37 women, and mean age at surgery was 63.8 ± 5.1 years. Patients of both groups were matched for age, gender, side, body mass index, and length of follow-up. The cementless components of this design were implanted in group A and the cemented in group B. Implant failure, complication rates, clinical (both subjective and objective) and radiological outcomes were assessed in all patients of both groups. RESULTS All patients of both groups were available for final follow-up evaluation at a mean of 8.6 ± 0.4 years. Survival analysis at 9 years showed a cumulative success rate of 100% in both groups with all end points. In neither group were implant-related, surgeon-related, or patient-related failures observed. When both groups were compared, in all time intervals, no differences were recorded on Knee Society system, Western Ontario and McMaster University Osteoarthritis Index, Short Form-12, and Oxford Knee Scores. On radiological examination, for both groups, all parameters evaluated were satisfactory. CONCLUSION This study presents satisfactory midterm clinical and radiological outcomes with the use of both versions of this design. Moreover, no implant-related failures were observed with the use of cancellous titanium-coated tibial implants.
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Affiliation(s)
- Theofilos Karachalios
- Orthopaedic Department, University of Thessalia, University General Hospital, Biopolis, Larissa, Thessalia, Hellenic Republic
| | - George Komnos
- Orthopaedic Department, University of Thessalia, University General Hospital, Biopolis, Larissa, Thessalia, Hellenic Republic
| | - Vasilios Amprazis
- Orthopaedic Department, University of Thessalia, University General Hospital, Biopolis, Larissa, Thessalia, Hellenic Republic
| | - Ioannis Antoniou
- Orthopaedic Department, University of Thessalia, University General Hospital, Biopolis, Larissa, Thessalia, Hellenic Republic
| | - Stratis Athanaselis
- Orthopaedic Department, University of Thessalia, University General Hospital, Biopolis, Larissa, Thessalia, Hellenic Republic
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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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Young T, Dowsey MM, Pandy M, Choong PF. A Systematic Review of Clinical Functional Outcomes After Medial Stabilized Versus Non-Medial Stabilized Total Knee Joint Replacement. Front Surg 2018; 5:25. [PMID: 29696144 PMCID: PMC5905240 DOI: 10.3389/fsurg.2018.00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/05/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medial stabilized total knee joint replacement (TKJR) construct is designed to closely replicate the kinematics of the knee. Little is known regarding comparison of clinical functional outcomes of patients utilising validated patient reported outcome measures (PROM) after medial stabilized TKJR and other construct designs. PURPOSE To perform a systematic review of the available literature related to the assessment of clinical functional outcomes following a TKJR employing a medial stabilized construct design. METHODS The review was performed with a Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) algorithm. The literature search was performed using variouscombinations of keywords. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. RESULTS In the nineteen unique studies identified, there were 2,448 medial stabilized TKJRs implanted in 2,195 participants, there were 1,777 TKJRs with non-medial stabilized design constructs implanted in 1,734 subjects. The final mean Knee Society Score (KSS) value in the medial stabilized group was 89.92 compared to 90.76 in the non-medial stabilized group, with the final KSS mean value difference between the two groups was statistically significant and favored the non-medial stabilized group (SMD 0.21; 95% CI: 0.01 to 0.41; p = 004). The mean difference in the final WOMAC values between the two groups was also statistically significant and favored the medial stabilized group (SMD: -0.27; 95% CI: -0.47 to -0.07; p = 0.009). Moderate to high values (I2 ) of heterogeneity were observed during the statistical comparison of these functional outcomes. CONCLUSION Based on the small number of studies with appropriate statistical analysis, we are unable to reach a clear conclusion in the clinical performance of medial stabilized knee replacement construct. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Tony Young
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
- Department of Orthopaedic Surgery, St. Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
| | - Michelle M. Dowsey
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
- Department of Orthopaedic Surgery, St. Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
| | - Marcus Pandy
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Parkville, VIC, Australia
| | - Peter F. Choong
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
- Department of Orthopaedic Surgery, St. Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
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Kim YH, Park JW, Kim JS. Clinical Outcome of Medial Pivot Compared With Press-Fit Condylar Sigma Cruciate-Retaining Mobile-Bearing Total Knee Arthroplasty. J Arthroplasty 2017; 32:3016-3023. [PMID: 28601246 DOI: 10.1016/j.arth.2017.05.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 04/19/2017] [Accepted: 05/10/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the long-term clinical results, radiographic results, range of knee motion, patient satisfaction, and the survival rate of Medial-Pivot posterior cruciate-substituting, knee prosthesis and a press-fit condylar (PFC) Sigma cruciate-retaining mobile-bearing knee prosthesis in the same patients. METHODS One hundred eighty-two patients received Medial-Pivot knee prosthesis in one knee and a PFC Sigma knee prosthesis in the contralateral knee. The minimum duration of follow-up was 11 years (range, 11-12.6 years). RESULTS The knees with a Medial-Pivot knee prosthesis had significantly worse results than those with a PFC Sigma knee prosthesis at the final follow-up with regard to the mean postoperative Knee Society knee scores (90 compared with 95 points), Western Ontario and McMaster Universities Osteoarthritis Index score (25 compared with 18 points), and range of knee motion (117° compared with 128°). Patients were more satisfied with PFC Sigma knee prosthesis (93%) than with Medial-Pivot knee prosthesis (75%). Complication rates were significantly higher in the Medial-Pivot knee group (26%) than those in the PFC Sigma knee group (6.5%). Radiographic results and survival rates (99% compared with 99.5%) were similar between the 2 groups. CONCLUSION Although the long-term fixation and survival rate of both Medial-Pivot and PFC Sigma prostheses were similar, we observed a worse knee score, worse range of knee motion, and patient satisfaction was less in the Medial-Pivot knee group than in the PFC Sigma knee group. Furthermore, complication rate was also higher in the Medial-Pivot knee group than the other group.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Ewha Womans University, Seonam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University, Mokdong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, Ewha Womans University, Mokdong Hospital, Seoul, Republic of Korea
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Carvalho Júnior LHD, Teixeira BP, Bernardes CODS, Soares LFM, Gonçalves MBJ, Temponi EF. Range of motion predictability after total knee arthroplasty with medial pivot prosthesis. Rev Bras Ortop 2017; 52:197-202. [PMID: 28409138 PMCID: PMC5380804 DOI: 10.1016/j.rboe.2017.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022] Open
Abstract
Objective To assess whether there the final range of motion (ROM) results achieved by patients undergoing total knee arthroplasty (TKA) with prosthesis using Medial Pivot design are predictable. Methods Between January and August of 2014, 155 patients with primary osteoarthritis of knee who underwent TKA using the prosthesis ADVANCE® Medial Pivot were prospectively assessed. All ROM measures were made and recorded before, during, and after surgery. All patients were clinically assessed preoperatively and postoperatively (15, 45 days, three months, six months, one year, and annually thereafter after surgery); their functional status was assessed using the WOMAC questionnaire. Results Significant differences (p < 0.001) were observed between the means and medians of ROM in the preoperative when compared with those during the perioperative; the perioperative values, when compared with those after six months postoperative, were also different (p < 0.001). No significant differences were found between the means and medians ROM between the intraoperative period and at the 45-day assessment (ns) and between the means and medians ROM between the preoperative period and at the six-month evaluation (ns). Conclusion The final ROM achieved by patients that underwent TKA with medial pivot prosthesis can be predicted. The perioperative ROM correlates with that at 45 days after surgery. The final ROM is correlated with that of the pre-operative period.
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Affiliation(s)
- Lúcio Honório de Carvalho Júnior
- Hospital Madre Teresa, Belo Horizonte, MG, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento do Aparelho Locomotor, Belo Horizonte, MG, Brazil.,Pontifícia Universidade Católica de Minas Gerais, Departamento de Medicina, Belo Horizonte, MG, Brazil
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Carvalho Júnior LHD, Teixeira BP, Bernardes CODS, Soares LFM, Gonçalves MBJ, Temponi EF. Previsibilidade da amplitude de movimento após artroplastia total do joelho com prótese medial pivot. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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A long term clinical outcome of the Medial Pivot Knee Arthroplasty System. Knee 2017; 24:447-453. [PMID: 28143683 DOI: 10.1016/j.knee.2017.01.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 01/15/2017] [Accepted: 01/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The ideal total knee arthroplasty (TKA) should provide maximum range of motion and functional stability for all desired daily activities and, if possible, to replicate normal knee kinematics and function. The ADVANCE® Medial Pivot (AMP) Knee System was designed with a highly congruent medial compartment and a less conforming lateral compartment to more closely mimic the kinematics of the normal knee and to offer more stability through out of range of motion (ROM). The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of this TKA system. METHODS Three hundred and twenty-five (325) patients (347 knees) with knee osteoarthritis underwent a TKA using the AMP prosthesis in our Department. For evaluation, objective and subjective clinical rating systems along with radiograph series were used. The average follow-up was 15.2years. RESULTS All patients showed a statistically significant improvement (p<0.0005) in the Knee Society clinical rating system, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, SF-12® questionnaire, and Oxford knee score. The majority of patients (94%) were able to perform age-appropriate activities with a mean knee flexion of 120° (range, 105°-135°) at final follow-up. Survival analysis showed a cumulative success rate of 98.8% at 17years. CONCLUSION The obtained results demonstrate excellent long-term clinical outcome for this knee design.
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Van Overschelde PP, Fitch DA. Patient satisfaction at 2 months following total knee replacement using a second generation medial-pivot system: follow-up of 250 consecutive cases. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:339. [PMID: 27761443 DOI: 10.21037/atm.2016.08.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patient dissatisfaction following total knee replacement (TKR) has been reported as high as 24%. Most previous studies have focused on satisfaction for TKR overall, with few reporting satisfaction for specific implant designs. The purpose of this study was to assess patient satisfaction for TKRs performed using a second generation medial-pivot system (EVOLUTION®, MicroPort Orthopedics Inc., Arlington, TN, USA). METHODS Of a single surgeon's first 250 consecutive TKRs performed using the subject system, 224 completed a patient satisfaction assessment, the Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and radiographs at 2 months follow-up. RESULTS The overall very satisfied/satisfied rate was 94.6% at 2 months. Following the first 50 TKRs, the satisfied rate improved to 99.4% suggesting a bias towards the initial cases potentially due to learning the system and instrumentation. Overall KOOS, range of motion, and radiographic outcomes were satisfactory at final follow-up. CONCLUSIONS In conclusion, more subjects implanted with a second generation medial-pivot system were satisfied compared to previous reports for TKR.
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Affiliation(s)
| | - David A Fitch
- Clinical Affairs, Microport Orthopedics Inc., Arlington, TN, USA
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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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Bordini B, Ancarani C, Fitch DA. Long-term survivorship of a medial-pivot total knee system compared with other cemented designs in an arthroplasty registry. J Orthop Surg Res 2016; 11:44. [PMID: 27094740 PMCID: PMC4837619 DOI: 10.1186/s13018-016-0388-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Orthopaedic Data Evaluation Panel (ODEP) monitors the performance of primary total knee arthroplasty (TKA) implants against guidance provided by the National Institute for Health and Care Excellence (NICE) and issues ratings based upon survivorship data meeting or exceeding 95 % at 10-year follow-up. The objectives of the current study were to determine if the survivorship for the ADVANCE Medial-Pivot System in an arthroplasty registry exceeds this threshold and if its survivorship is significantly different than that of all other cemented bi-, tricompartmental, minimally stabilized, and fixed bearing TKAs in the same registry. METHODS The database of an arthroplasty registry was searched for all TKAs performed with the subject system and all other cemented TKAs. The Kaplan-Meier survivorship for the subject system was compared to the NICE criteria and also that of all other cemented TKAs. Complication modes were also examined for the two groups. RESULTS The 10-year survivorship for the included 506 TKAs using the subject system (96.3 %) exceeded the NICE guidelines of 95 % at 10 years. Survivorship also exceeded that of all other cemented TKAs (95.7 %) in the same registry, but the difference was not significantly different. CONCLUSIONS The subject system was associated with survivorship that exceeds the NICE guidelines at 10 years and is similar to that of other cemented TKA systems. The use of this unique tibial insert design does not negatively impact component survivorship.
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Affiliation(s)
| | | | - David A Fitch
- MicroPort Orthopedics Inc., 5677 Airline Rd., Arlington, TN, 38002, USA.
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Waddell DD, Sedacki K, Yang Y, Fitch DA. Early radiographic and functional outcomes of a cancellous titanium-coated tibial component for total knee arthroplasty. Musculoskelet Surg 2016; 100:71-74. [PMID: 26410423 PMCID: PMC4819930 DOI: 10.1007/s12306-015-0382-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/07/2015] [Indexed: 06/01/2023]
Abstract
BACKGROUND Various surface coatings have been developed over the past decades to enhance fixation of cementless total knee arthroplasty (TKA). BIOFOAM(®) (MicroPort Orthopedics Inc., Arlington, TN, USA) is a novel cancellous titanium surface coating intended to increase both initial and long-term fixation. The purpose of this study was to investigate the early functional and radiographic outcomes of this coating used in a TKA application. MATERIALS AND METHODS One hundred and four (104) primary TKAs in 85 subjects using BIOFOAM-coated tibial components were prospectively enrolled at four centers. Subjects were evaluated using Knee Society Scores and radiographic analysis at a minimum follow-up of 24 months. RESULTS Knee Society Scores and flexion were all significantly improved at final follow-up compared to baseline. Radiographic analyses were satisfactory, with no progressive radiolucencies and only a single subject presenting with a radiolucency surrounding a tibial component. There were two revisions in the cohort: one for instability following a ruptured lateral collateral ligament and one for recurrent tibial insert dislocation. CONCLUSIONS This is the first study to report clinical outcomes associated with the BIOFOAM coating used in a cementless TKA application. Early functional scores and radiographic analyses are promising, but further investigations are needed to confirm long-term clinical success with these components.
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Affiliation(s)
- D D Waddell
- Orthopedic Specialists of Louisiana, Shreveport, LA, USA
| | - K Sedacki
- MicroPort Orthopedics Inc., 5677 Airline Rd., Arlington, TN, 38002, USA
| | - Y Yang
- MicroPort Orthopedics Inc., 5677 Airline Rd., Arlington, TN, 38002, USA
| | - D A Fitch
- MicroPort Orthopedics Inc., 5677 Airline Rd., Arlington, TN, 38002, USA.
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Steinbrück A, Schröder C, Woiczinski M, Fottner A, Pinskerova V, Müller PE, Jansson V. Femorotibial kinematics and load patterns after total knee arthroplasty: An in vitro comparison of posterior-stabilized versus medial-stabilized design. Clin Biomech (Bristol, Avon) 2016; 33:42-48. [PMID: 26945720 DOI: 10.1016/j.clinbiomech.2016.02.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/02/2015] [Accepted: 02/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femorotibial kinematics and contact patterns vary greatly with different total knee arthroplasty (TKA) designs. Therefore, guided motion knee systems were developed to restore natural knee kinematics and make them more predictable. The medial stabilized TKA design is supposed to replicate physiological kinematics more than the posterior-stabilized TKA system. We conducted this study to compare a newly developed medial stabilized design with a conventional posterior-stabilized design in terms of femorotibial kinematics and contact patterns in vitro. METHODS Twelve fresh-frozen knee specimens were tested in a weight-bearing knee rig after implantation of a posterior stabilized and medial-stabilized total knee arthroplasty under a loaded squat from 20° to 120° of flexion. Femorotibial joint contact pressures in the medial and lateral compartments were measured by pressure sensitive films and knee kinematics were recorded by an ultrasonic 3-dimensional motion analysis system. FINDINGS The medial stabilized design showed a reduction of medial femorotibial translation compared to posterior-stabilized design (mean 3.5mm compared to 15.7 mm, P<0.01). In the lateral compartment, both designs showed a posterior translation of the femur with flexion, but less in the medial stabilized design (mean 14.7 mm compared to 19.0mm, P<0.01). In the medial femorotibial compartment of medial stabilized design, we observed an enlarged contact area and lower peak pressure, in contrast in the lateral compartment there was a reduced contact area and an increased peak pressure. INTERPRETATION While posterior-stabilized design enforces a medio-lateral posterior translation, the medial stabilized arthroplasty system enables a combination of a lateral translation with a medial pivot, which restores the physiological knee kinematics better.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
| | - Vera Pinskerova
- 1st Orthopaedic Clinic, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
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Atzori F, Salama W, Sabatini L, Mousa S, Khalefa A. Medial pivot knee in primary total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:6. [PMID: 26855942 DOI: 10.3978/j.issn.2305-5839.2015.12.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.
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Affiliation(s)
- Francesco Atzori
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Wael Salama
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Luigi Sabatini
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Shazly Mousa
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
| | - Abdelrahman Khalefa
- 1 Unit of Orthopaedics and Traumatology, Hospital San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, Torino, Italy ; 2 Sohag University Hospital, 82524 Sohag, Egypt
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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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41
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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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42
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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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Fitch DA, Sedacki K, Yang Y. Mid- to long-term outcomes of a medial-pivot system for primary total knee replacement: a systematic review and meta-analysis. Bone Joint Res 2014; 3:297-304. [PMID: 25325997 PMCID: PMC4212805 DOI: 10.1302/2046-3758.310.2000290] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives This systematic review and meta-analysis was conducted to determine
the mid- to long-term clinical outcomes for a medial-pivot total
knee replacement (TKR) system. The objectives were to synthesise
available survivorship, Knee Society Scores (KSS), and reasons for
revision for this system. Methods A systematic search was conducted of two online databases to
identify sources of survivorship, KSS, and reasons for revision.
Survivorship results were compared with values in the National Joint
Registry of England, Wales, and Northern Ireland (NJR). Results A total of eight studies that included data for 1146 TKRs performed
in six countries satisfied the inclusion/exclusion criteria. Pooled
component survivorship estimates were 99.2% (95% CI, 97.7 to 99.7)
and 97.6% (95% CI, 95.8 to 98.6) at five and eight years, respectively.
Survivorship was similar or better when compared with rates reported
for all cemented TKRs combined in the NJR and was significantly
better than some insert types at mid-term intervals. The weighted
mean post-operative KSS was 87.9 (73.2 to 94.2), in the excellent
range. Similar cumulative revision rates and KSS were reported at
centres in the United States, Europe, and Asia. Conclusions The subject system was associated with survivorship and KSS similar
or better than that reported for other TKR systems. Cite this article: Bone Joint Res 2014;3:297–304
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Affiliation(s)
- D A Fitch
- MicroPort Orthopedics Inc., 5677 Airline Road, Arlington, Tennessee 38002, USA
| | - K Sedacki
- MicroPort Orthopedics Inc., 5677 Airline Road, Arlington, Tennessee 38002, USA
| | - Y Yang
- MicroPort Orthopedics Inc., 5677 Airline Road, Arlington, Tennessee 38002, USA
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44
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Youm YS, Cho SD, Lee SH, Cho HY. Total Knee Arthroplasty Using a Posterior Cruciate Ligament Sacrificing Medial Pivot Knee: Minimum 5-year Follow-up Results. Knee Surg Relat Res 2014; 26:135-40. [PMID: 25229042 PMCID: PMC4163570 DOI: 10.5792/ksrr.2014.26.3.135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/29/2014] [Accepted: 06/16/2014] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate minimum 5-year follow-up clinical and radiological results of total knee arthroplasty (TKA) using a posterior cruciate ligament sacrificing (PS), non-substituting Advance Medial Pivot Knee. MATERIALS AND METHODS One hundred and twenty knees in 80 patients who could be followed up for more than 5 years after TKA using the PS Advance Medial Pivot Knee were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemoral angle, Knee Society (KS) knee and function scores, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. The Kaplan-Meier method was used for survival analysis. RESULTS The ROM increased from a preoperative mean flexion contracture of 7.6° and further flexion of 115.1° to a postoperative mean flexion contracture of 1.5° and further flexion of 120.5°. The tibiofemoral angle was changed from 4.6° varus preoperatively to 5.8° valgus postoperatively. The KS knee and function scores as well as WOMAC score significantly improved after surgery (p<0.05). Complications developed in 4 cases (3.3%): 2 cases of periprosthetic patellar fracture (1.7%) and 2 cases of aseptic loosening (1.7%). The seven-year survival rate was 98.1% in the Kaplan-Meier survival analysis. CONCLUSIONS The minimum 5-year follow-up results of TKA using the PS Medial Pivot Knee were satisfactory.
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Affiliation(s)
- Yoon-Seok Youm
- Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung-Do Cho
- Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seon-Ho Lee
- Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye-Yong Cho
- Department of Orthopedic Surgery, Arthro-center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Midterm clinical and radiographic results of the medial pivot total knee system. INTERNATIONAL ORTHOPAEDICS 2014; 38:2495-8. [DOI: 10.1007/s00264-014-2444-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
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No difference between double-high insert and medial-pivot insert in TKA. Knee Surg Sports Traumatol Arthrosc 2014; 22:576-80. [PMID: 23223966 DOI: 10.1007/s00167-012-2314-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the clinical midterm results in ADVANCE total knee arthroplasty (TKA) with double-high (DH) insert, with same type implant with medial-pivot (MP) insert. METHOD Forty ADVANCE TKAs were randomly divided into two groups, and two different design insert, DH insert, and MP insert were used in each group. At midterm, 4-5 years after surgery, Knee Society Scores (KSS), Knee Society Functional Scores (KSFS), range of motion (ROM), and UCLA activity score were assessed and reported in this study. RESULTS Midterm clinical results, including ROM and KSS, were comparable with both groups. KSFS and UCLA activity score were equally good between the two groups. CONCLUSION The results in this study revealed equally good clinical results with these types of implants at midterm follow-up, although the significant better ROM has not achieved by using DH insert. We concluded that the selection of inserts only could not achieve the better clinical results, including ROM and activity level in this study. LEVEL OF EVIDENCE Therapeutic studies-investigating the results of treatment, Level II.
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Chinzei N, Ishida K, Tsumura N, Matsumoto T, Kitagawa A, Iguchi T, Nishida K, Akisue T, Kuroda R, Kurosaka M. Satisfactory results at 8 years mean follow-up after ADVANCE® medial-pivot total knee arthroplasty. Knee 2014; 21:387-90. [PMID: 24440451 DOI: 10.1016/j.knee.2013.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/26/2013] [Accepted: 10/14/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although good overall results have been reported with TKA, certain problems and limitations remain, primarily due to postoperative differences in joint kinematics, when compared with the normal knee. ADVANCE® Medial-Pivot TKA involves replicating the medial pivoting behavior observed in normal knees. Here, we aimed to investigate the clinical and radiological results and complications of TKA using this implant, at mid-term follow-up. METHODS From January 2001 to March 2012, we retrospectively selected 76 patients (85 knees; mean age at operation, 70.2±8.1 years; range, 51-88 years) with a mean follow-up period of 93.1±14.3 months (range, 72-132 months). Indications for TKA included primary degenerative osteoarthritis (60 knees), rheumatoid arthritis (22 knees), osteonecrosis (two knees), and osteoarthritis following high tibial osteotomy (one knee). The clinical and radiographic results were evaluated. RESULTS Kaplan-Meier survivorship analysis indicated a success rate of 98.3% (95% confidence interval, 96.6-99.9%). Comparison of pre- and postoperative knee extension angles and ranges of motion showed significant improvement postoperatively, in both the Knee Society Scores (KSS) and Knee Society Functional Scores (KSFS) (p<0.05). In one case, radiographic assessment indicated implant loosening due to infection; however, despite this complication, significant improvement of postoperative varus or valgus deformity angles were noted in all cases (p<0.05). CONCLUSION Patients undergoing ADVANCE® Medial-Pivot TKA achieved excellent clinical and radiographic results without any implant-related failures at mid-term follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Centre Central Hospital, 1070 Akebono-cho, Nishi-ku, Kobe 651-2181, Japan.
| | - Nobuhiro Tsumura
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Centre Central Hospital, 1070 Akebono-cho, Nishi-ku, Kobe 651-2181, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Atsushi Kitagawa
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Centre Central Hospital, 1070 Akebono-cho, Nishi-ku, Kobe 651-2181, Japan
| | - Tetsuhiro Iguchi
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Centre Central Hospital, 1070 Akebono-cho, Nishi-ku, Kobe 651-2181, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Abstract
OBJECTIVE This article reviews current concepts of knee replacement. Features of traditional and new prosthetic designs, materials, and surgical techniques are discussed. Normal and abnormal postoperative imaging findings are illustrated. Complications are reviewed and related to the current understanding about how and why these failures occur. CONCLUSION It is well known that after knee replacement, patients with complications may be asymptomatic, and, for this reason, assessment of postoperative imaging is important. The foundation of radiologic interpretation of knee replacement is knowledge of the physiologic purpose, orthopedic trends, imaging findings, and complications.
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Brinkman JM, Bubra PS, Walker P, Walsh WR, Bruce WJM. Midterm results using a medial pivot total knee replacement compared with the Australian National Joint Replacement Registry data. ANZ J Surg 2013; 84:172-6. [DOI: 10.1111/ans.12428] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Preet Singh Bubra
- Orthopaedic Department; Concord Repatriation and General Hospital; Sydney New South Wales Australia
| | - Peter Walker
- Orthopedics; Hip and Knee Clinic; Sydney New South Wales Australia
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratory; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Warrick J. M. Bruce
- Orthopedics; Hip and Knee Clinic; Sydney New South Wales Australia
- Concord Clinical School; The University of Sydney; Sydney New South Wales Australia
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Cho SH, Cho HL, Lee SH, Jin HK. Posterior femoral translation in medial pivot total knee arthroplasty of posterior cruciate ligament retaining type. J Orthop 2013; 10:74-8. [PMID: 24403754 DOI: 10.1016/j.jor.2013.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 04/01/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report clinical results and demonstrate posterior femoral translation (PFT) in medial pivot total knee arthroplasty (TKA) of posterior cruciate ligament (PCL) retaining type. MATERIALS AND METHODS A prospective study was performed upon thirty consecutive subjects who were operated on with medial pivot TKA of PCL retaining type between March 2009 and March 2010 and had been followed up for at least 2 years. Clinically, the knee society knee score and function score were used. In full extension and active flexion lateral radiograph, anteroposterior (AP) condylar position and magnitude of PFT was determined. RESULTS At last follow-up, the mean knee society knee score and function score improved significantly compared to preoperative scores. The AP condylar positions were consistently posterior to midline throughout the entire range of flexion. The PFTs averaged 0.31 (±0.12) of half length of tibial base plate and were greater in higher flexion cases (r = 0.56, p = 0.0012). There were no cases having either component migration or radiolucent line wider than 2 mm except for one case showing instability related to trauma. CONCLUSIONS In medial pivot TKA of PCL retaining type, clinical outcomes were satisfactory and posterior femoral translations were consistently observed during progressive flexions of knees at two- to three-year follow-up.
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Affiliation(s)
- Su Hyun Cho
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan 617-718, Republic of Korea
| | - Hyung Lae Cho
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan 617-718, Republic of Korea
| | - Soo Ho Lee
- Department of Orthopaedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Hong Ki Jin
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan 617-718, Republic of Korea
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