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Hasegawa M, Tone S, Naito Y, Sudo A. Predicting outcomes after total knee arthroplasty using intraoperative knee kinematics measured by navigation. Mod Rheumatol 2023; 33:1183-1189. [PMID: 36264180 DOI: 10.1093/mr/roac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/03/2022] [Accepted: 10/16/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The objective of the study is to evaluate the relationship between clinical results following posterior-stabilized total knee arthroplasty (TKA) and intraoperative kinematic pattern determined from navigation. METHODS Participants were patients with knee osteoarthritis and varus deformity who underwent primary posterior-stabilized TKA. Preoperative and post-implantation kinematic data were recorded, and all kinematic patterns were divided into two types: medial pivot (MP) or non-MP. Knees with MP and non-MP patterns after implantation were compared in terms of postoperative flexion angle, pain, patient satisfaction, expectations, and activity using the new Knee Society Score 2011 at 1 year postoperatively. RESULTS This study involved 55 patients (12 men, 43 women) with a mean age of 73.1 years and mean body mass index of 26.5 kg/m2. Preoperative kinematic measurements showed MP in 23 knees and non-MP in 32 knees. After implantation, navigation showed MP in 25 knees and non-MP in 30 knees. No significant differences were found between kinematic patterns preoperatively and after implantation. Postoperative flexion angle, pain, patient satisfaction, expectations, and activity using Knee Society Score 2011 showed no differences between MP and non-MP knees. CONCLUSION Intraoperative knee kinematics as measured by navigation could not predict postoperative outcomes of TKA.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
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Ueno A, Hashimoto S, Oshima A, Ohsawa T, Takase R, Kaneko S, Shimada T, Chikuda H. Postoperative Medial Tilting of the Joint Line and Preoperative Kinematics Influence Postoperative Medial Pivot Pattern Reproduction in Total Knee Arthroplasty. Arthroplast Today 2023; 23:101178. [PMID: 37712071 PMCID: PMC10498393 DOI: 10.1016/j.artd.2023.101178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/02/2023] [Accepted: 07/03/2023] [Indexed: 09/16/2023] Open
Abstract
Background Reproducing the medial pivot pattern after total knee arthroplasty (TKA) is known to improve patient satisfaction. However, the factors affecting the postoperative medial pivot pattern in TKA are controversial. The purpose of this study was to examine the factors affecting the postoperative medial pivot pattern in posterior-stabilized TKA. Methods This study involved 30 cases with knee osteoarthritis who underwent primary posterior-stabilized TKA. The preoperative and postoperative kinematics were measured using a computed tomography-free navigation system, and the patients were divided into the following 2 groups: the medial pivot pattern (MP) group and non-medial pivot pattern (non-MP) group. In addition, we measured each of the following angles on X-ray films (preoperative and postoperative femorotibial angle, hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle). We examine the factors affecting the postoperative medial pivot pattern. Results There were 14 cases in the MP group and 16 cases in the non-MP group at the preoperative knee kinematic assessment and 17 cases in the MP group and 13 cases in the non-MP group at the postoperative knee kinematic assessment. The preoperative kinematic pattern was conserved after the surgery at a rate of 76.7%. The postoperative MP-group showed a significantly smaller preoperative femorotibial angle and hip-knee-ankle and a significantly smaller postoperative mechanical lateral distal femoral angle and medial proximal tibial angle in comparison to the postoperative non-MP group. Conclusions Preoperative kinematics and postoperative mechanical lateral distal femoral angle and medial proximal tibial angle may be important factors that affect the postoperative medial pivot pattern.
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Affiliation(s)
- Akira Ueno
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Shogo Hashimoto
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Atsufumi Oshima
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Ryota Takase
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Soya Kaneko
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Takeshi Shimada
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
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Tsuda T, Hino K, Kutsuna T, Watamori K, Kinoshita T, Takao M. Difference in implant design affects midflexion rotational laxity in cruciate-retaining total knee arthroplasty: a computer navigation study. J Exp Orthop 2023; 10:85. [PMID: 37605070 PMCID: PMC10441849 DOI: 10.1186/s40634-023-00652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE This study aimed to compare midflexion rotational laxity between two different design concept models of cruciate-retaining total knee arthroplasty: symmetrical surface design of neutral joint line obliquity and asymmetrical surface design of varus joint line obliquity. METHODS Sixty-three knees that underwent cruciate-retaining total knee arthroplasty were evaluated. Manual maximum passive rotational stress without acceleration was applied to the knees under navigation monitoring. Pre-operative and post-operative internal and external rotational angles were measured at 30°, 45°, 60°, and 90° knee flexion. RESULTS The post-operative internal rotational laxity was significantly increased compared with pre-operative levels at 30°, 45°, 60°, and 90° flexion among all subjects (mean 9.7° vs 11.1°, 10.6° vs 11.6°, 11.2° vs 12.9°, and 13.2° vs 14.9°; p = 0.01, 0.04, 0.001, and 0.008, respectively). The post-operative external rotational laxity was significantly decreased compared to pre-operative levels at 30°, 45°, 60°, and 90° flexion among all subjects (mean 10.8° vs 6.8°, 12.5° vs 9.4°, 12.8° vs 10.0°, and 11.3° vs 9.5°; p < 0.0001, < 0.0001, < 0.0001, and 0.0008, respectively). The post-operative total rotational laxity significantly decreased, compared with pre-operative levels, at 30° and 45° flexion among all subjects (mean 20.4° vs 17.9°, and 23.1° vs 21.1°; p = 0.002 and 0.04, respectively). The post-operative total rotational laxity was significantly smaller in asymmetrically designed total knee arthroplasty than in symmetrically designed total knee arthroplasty at 30°, 45°, and 60° flexion (mean 19.3° vs 15.8°, 22.8° vs 18.7°, and 24.4° vs 20.8°; p = 0.03, 0.03, and 0.02, respectively), whereas no significant difference was observed at 90° flexion. CONCLUSION Compared to symmetrical surface design, asymmetrical surface design resulted in lower rotational laxity at the midflexion range in cruciate-retaining total knee arthroplasty. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takashi Tsuda
- Department of Bone and Joint Surgery, Ehime University, Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Kazunori Hino
- Department of Joint Reconstruction, Ehime University, Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
| | - Tatsuhiko Kutsuna
- Department of Bone and Joint Surgery, Ehime University, Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Kunihiko Watamori
- Department of Joint Reconstruction, Ehime University, Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Tomofumi Kinoshita
- Department of Bone and Joint Surgery, Ehime University, Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Masaki Takao
- Department of Bone and Joint Surgery, Ehime University, Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
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Seito N, Suzuki K, Mikami S, Uchida J, Hara N. The medial gap is a reliable indicator for intraoperative soft tissue balancing in posterior-stabilized total knee arthroplasty. Knee 2021; 29:68-77. [PMID: 33578283 DOI: 10.1016/j.knee.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/06/2020] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Appropriate soft tissue balance and accurate alignment are important for successful total knee arthroplasty (TKA). However, the optimal technique for establishing and measuring soft tissue balancing remains unclear. The aim of this study was to analyze the intraoperative medial and lateral gap pattern using digital knee balancer in posterior-stabilized (PS) TKA. METHODS This study involved 55 patients with medial osteoarthritis who underwent a primary TKA using an image-free navigation system. The extension gap and the flexion gap at 90° knee flexion were assessed using an offset seesaw-type digital balancer. Continuous joint distraction force from 10 lb to 60 lb was applied. Medial gap, lateral gap, and varus angle were measured. RESULTS The medial bone gap difference between extension and flexion was constant regardless of the distraction force from 20 lb to 60 lb. The lateral bone gap was significantly greater than the medial bone gap in extension and flexion from 30 lb to 60 lb (P < 0.05). The varus angle changed depending on the distraction force, especially in flexion. The varus angle in flexion was significantly greater than that in extension from 40 lb to 60 lb (P < 0.05). CONCLUSIONS The medial bone gap is a reliable indicator unaffected by the distraction force during surgery and is useful for adjusting the medial gap in extension and flexion appropriately to ensure medial stability in PS-TKA. The digital knee balancer and navigation system support both precise gap assessment and surgery.
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Affiliation(s)
- Naoki Seito
- Hokkaido Orthopaedic Memorial Hospital, Hiragishi, Toyohira-ku, Sapporo, Japan
| | - Koji Suzuki
- Hokkaido Orthopaedic Memorial Hospital, Hiragishi, Toyohira-ku, Sapporo, Japan.
| | - Susumu Mikami
- Hokkaido Orthopaedic Memorial Hospital, Hiragishi, Toyohira-ku, Sapporo, Japan
| | - Jun Uchida
- Hokkaido Orthopaedic Memorial Hospital, Hiragishi, Toyohira-ku, Sapporo, Japan
| | - Noriyuki Hara
- Hokkaido Orthopaedic Memorial Hospital, Hiragishi, Toyohira-ku, Sapporo, Japan
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Wakama H, Okamoto Y, Otsuki S, Nakagawa K, Okuno N, Neo M. Preoperative factors associated with extension gap in cruciate-retaining total knee arthroplasty: A retrospective study on continuous determination of distraction force. J Orthop Sci 2020; 25:1035-1039. [PMID: 31902557 DOI: 10.1016/j.jos.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this retrospective study was to identify the preoperative patient-related factors affecting the soft tissue balancing in cruciate-retaining total knee arthroplasty. This is an important clinical issue, as the acquisition of adequate soft tissue balancing is essential for successful outcomes. METHODS The study group included 59 knees treated for medial compartment osteoarthritis. The extension gap was measured using the newly electric tensor that enables continuous quantification of a distraction force ranging from 0 to 40 lbf. We performed regression analyses to identify the relationship between preoperative factors and the extension gap. RESULTS Patient height, weight, and percent mechanical axis showed univariate correlation with the extension gap of either 30 lbf or 40 lbf. In the multivariate regression analysis without encountering multicollinearity, percent mechanical axis was inversely associated with the extension gap (t-value = -2.31, p = 0.02 for 30 lbf; and t-value = -2.39; p = 0.02 for 40lbf) as a significant independent factor. CONCLUSIONS We revealed the significant influence of several factors on the absolute value of the extension gap. Particularly, the severity of preoperative coronal alignment was a statistically independent explanatory variable, and the extension gap was overvalued in knees with severe varus deformity. This influence should be considered when comparing different individual cases longitudinally. Our feasible strategies could lead to a better understanding about the soft tissue balancing in total knee arthroplasty.
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Affiliation(s)
- Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
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Grassi A, Pizza N, Lopomo NF, Marcacci M, Capozzi M, Marcheggiani Muccioli GM, Colle F, Zaffagnini S. No differences in knee kinematics between active and passive flexion-extension movement: an intra-operative kinematic analysis performed during total knee arthroplasty. J Exp Orthop 2020; 7:12. [PMID: 32166475 PMCID: PMC7067969 DOI: 10.1186/s40634-020-00229-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose The objective of the present study was to acquire and compare by the use of a navigation system the intra-operative flexion-extension movement of the knee performed actively by the patient and passively by the surgeon before and after a total knee arthroplasty (TKA) implantation. Methods A cohort of 31 patients with primary knee osteoarthritis (OA), candidate for TKA underwent intra-operative kinematics assessment with a commercial navigation system before and after the definitive implant positioning of a Cruciate Retaining (CR) Mobile Bearing (MB) prostheses. The kinematical data were acquired while surgeon performed the flexion-extension movement (passive ROM - pROM), and while the patient performed it (active ROM - aROM). Differences between pre- and post- implantation and between active and passive motions, were statistically analyzed using paired Student t-tests (p = 0.05). Results No statistically significant difference were found between aROM and pROM with paired Student t-test regarding internal-external rotation and anterior-posterior translation of the femoral component with respect to the tibia during flexion-extension movement before and after TKA implant (p > 0.05). Conclusions Active muscle contraction seems to not significantly affect TKA kinematics. The ROM performed by the surgeon during operation resemble the movement actively performed by the patient. The clinical relevance of this study further supports the use of CAS system in performing intra-operative analysis concerning knee biomechanics.
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Affiliation(s)
- Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicola Pizza
- II Clinica Ortopedica e Traumatologica, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Nicola Francesco Lopomo
- Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, via Branze, 38 25123, Brescia, BS, Italy
| | | | - Michele Capozzi
- Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, I-40136, Bologna, BO, Italy
| | | | - Francesca Colle
- Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, I-40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento Scienze Biomediche e Neuromotorie-DIBINEM, Università di Bologna, Bologna, Italy
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Intraoperative kinematic analysis of posterior stabilized total knee arthroplasty with asymmetric helical post-cam design. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:675-681. [DOI: 10.1007/s00590-018-2318-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
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