1
|
Sakai S, Nakamura S, Maeda T, Kuriyama S, Nishitani K, Morita Y, Morita Y, Yamawaki Y, Shinya Y, Matsuda S. Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study. Knee Surg Relat Res 2024; 36:29. [PMID: 39380115 PMCID: PMC11459880 DOI: 10.1186/s43019-024-00233-6] [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: 05/21/2024] [Accepted: 09/07/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. METHODS Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. RESULTS Medial joint gap significantly increased from stages 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). CONCLUSIONS Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.
Collapse
Affiliation(s)
- Sayako Sakai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Takahiro Maeda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yugo Morita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yugo Morita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yusuke Yamawaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yuki Shinya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| |
Collapse
|
2
|
Seki K, Seki T, Imagama T, Okazaki T, Kaneoka T, Yamazaki K, Sakai T. The Factors Impacting on Patient-Reported Outcomes After Bicruciate-Stabilized Total Knee Arthroplasty for Varus Knee Osteoarthritis. Indian J Orthop 2024; 58:1395-1401. [PMID: 39324079 PMCID: PMC11420412 DOI: 10.1007/s43465-024-01186-4] [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: 11/13/2023] [Accepted: 05/12/2024] [Indexed: 09/27/2024]
Abstract
Background The aim of this study was to investigate the factors affecting patient-reported outcomes after bicruciate-stabilized total knee arthroplasty (BCS TKA) in patients. Methods We retrospectively examined 122 knees with primary varus knee osteoarthritis that underwent BCS TKA. This study analyzed preoperative, intraoperative, and postoperative predictors of patient satisfaction and persistent postsurgical pain following BCS TKA at 1 year after surgery. We evaluated persistent postsurgical pain using Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale and patient satisfaction using a visual analog scale. Results The univariate analysis showed a significant negative correlation between the KOOS pain subscale and three factors: the preoperative central sensitization inventory (CSI) score, medial joint laxity at 90° flexion, and acute postsurgical pain. Patient satisfaction was significantly positively correlated with lateral joint laxity at 90° flexion and postoperative extension angle. Acute postsurgical pain had a significant negative correlation with patient satisfaction. The multiple regression analysis revealed preoperative CSI score and medial joint laxity at 90° flexion influenced patients' KOOS pain subscale responses. Only lateral joint laxity at 90° flexion had an impact on patient satisfaction. Conclusions The acquisition of adequate soft tissue balance according to the concept of BCS TKA and preoperative central sensitization syndrome affects the clinical outcomes in BCS TKA.
Collapse
Affiliation(s)
- Kazushige Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Toshihiro Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Tomoya Okazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Takehiro Kaneoka
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Kazuhiro Yamazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| |
Collapse
|
3
|
Gardner J, Roman ER, Bhimani R, Mashni SJ, Whitaker JE, Smith LS, Swiergosz A, Malkani AL. Aetiology of patient dissatisfaction following primary total knee arthroplasty in the era of robotic-assisted technology. Bone Jt Open 2024; 5:758-765. [PMID: 39260450 PMCID: PMC11390183 DOI: 10.1302/2633-1462.59.bjo-2024-0099.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Aims Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction. Methods This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups. Results Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior anterior cruciate ligament (ACL) reconstruction (p < 0.001), and preoperative symptomatic lumbar spine disease (p = 0.004). Group A was also younger (p = 0.023). Multivariate analysis revealed preoperative opioid use (p = 0.012), prior ACL reconstruction (p = 0.038), male sex (p = 0.006), and preoperative psychotropic medication use (p = 0.001) as independent predictive factors of patient dissatisfaction. Conclusion The use of RA-TKA demonstrated a high rate of patient satisfaction (629 of 674, 93.3%). Demographics for patients not satisfied following RA-TKA included: male sex, chronic opioid use, chronic psychotropic medication use, and prior ACL reconstruction. Patients in these groups should be identified preoperatively and educated on realistic expectations given their comorbid conditions.
Collapse
Affiliation(s)
- Jonathan Gardner
- Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Elliott R Roman
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Rohat Bhimani
- Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Sam J Mashni
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - John E Whitaker
- Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Andrew Swiergosz
- Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Arthur L Malkani
- Adult Reconstruction Program, Dept. of Orthopedic Surgery, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
4
|
Jagota I, Al-Dirini RMA, Taylor M, Twiggs J, Miles B, Liu D. Functional preoperative assessment of coronal knee laxity better predicts postoperative patient outcomes than intraoperative surgeon-defined laxity in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39224040 DOI: 10.1002/ksa.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Intraoperative laxity assessments in total knee arthroplasty (TKA) are subjective, with few studies comparing against standardised preoperative and postoperative assessments. This study compares coronal knee laxity in TKA patients awake and anaesthetised, preprosthesis and postprosthesis implantation, evaluating relationships to patient-reported outcome measures. METHODS A retrospective analysis of 49 TKA joints included preoperative and postoperative computed tomography scans, stress radiographs and knee injury and osteoarthritis outcome score (KOOS) questionnaire results preoperatively and 12 months postoperatively. The imaging was used to assess functional laxity (FL) in awake patients, whereas computer navigation measured intraoperative surgical laxity (SL) preimplantation and postimplantation, with patients anaesthetised. Varus and valgus stress states and their difference, joint laxity, were measured. RESULTS SL was greater than FL in both preimplantation [8.1° (interquartile range, IQR 2.0°) and 3.8° (IQR 2.9°), respectively] and postimplantation [3.5° (IQR 2.3°) and 2.5° (IQR 2.7°), respectively]. Preimplantation, SL was more likely than FL to categorise knees as correctable to ±3° of the mechanical axis. Preoperative FL correlated with KOOS Symptoms (r = 0.33, p = .02) and quality of life (QOL) (r = 0.38, p = .01), whereas reducing medial laxity with TKA enhanced postoperative QOL outcomes (p = .02). CONCLUSIONS Functional coronal knee laxity assessment of awake patients is generally lower than intraoperative surgical assessments of anaesthetised patients. Preoperative SL may result in overcorrection of coronal TKA alignment, whereas preoperative FL better predicts postoperative patient outcomes and reflects the patients' native and tolerable knee laxity. Preoperative FL assessment can be used to guide surgical planning. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Ishaan Jagota
- Research and Development, 360 Med Care, Sydney, Australia
- Research and Development, Enovis ANZ, Sydney, Australia
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - Rami M A Al-Dirini
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - Mark Taylor
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - Joshua Twiggs
- Research and Development, 360 Med Care, Sydney, Australia
- Research and Development, Enovis ANZ, Sydney, Australia
| | - Brad Miles
- Research and Development, 360 Med Care, Sydney, Australia
- Research and Development, Enovis ANZ, Sydney, Australia
| | - David Liu
- The Gold Coast Centre for Bone and Joint Surgery, Palm Beach, Queensland, Australia
| |
Collapse
|
5
|
Sakai S, Nakamura S, Kuriyama S, Nishitani K, Morita Y, Matsuda S. Anterior Position of the Femoral Condyle During Mid-Flexion Worsens Knee Activity After Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty 2024; 39:S230-S236. [PMID: 38350519 DOI: 10.1016/j.arth.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The effects of kinematics on patient-reported outcome measures (PROMs) after cruciate-retaining (CR) total knee arthroplasty (TKA) remain unclear. This study investigated the effects of kinematic patterns after CR-TKA on PROMs. METHODS We examined 35 knees (27 patients) undergoing primary CR-TKA. Knee kinematics and 2011 Knee Society Score were evaluated at a mean follow-up of 72.4 (± 28.2) months. Knee kinematics was analyzed using fluoroscopy, and the femoral antero-posterior position relative to the tibial component was assessed separately for medial and lateral compartments during a squat. The correlations between kinematics and PROMs were evaluated. RESULTS The average amount of posterior femoral translation from full extension to maximum flexion was 0.2 (± 2.6) mm for the medial femoral condyle and 4.1 (± 2.9) mm for the lateral condyle. Medial pivot motion was observed in 24 knees (68.6%) with a low rate (14.3%) of paradoxical anterior translation. The anterior position of the medial femoral condyle at 60° had a negative impact on discretionary activities (ρ = -0.37; P = .039), and at maximum flexion, had a negative impact on total functional activities (ρ = -0.46; P = .005), advanced activities (ρ = -0.45; P = .006), and discretionary activities (ρ = -0.63; P < .001). Anterior position of the lateral femoral condyle at 30° had a negative impact on total functional activities (ρ = -0.48; P = .005), walking and standing (ρ = -0.56; P < .001), and advanced activities (ρ = -0.49; P = .004), and at 60° had a negative impact on walking and standing (ρ = -0.45; P = .010). CONCLUSIONS The anterior positions of the medial and lateral femoral condyles at mid-flexion and maximum flexion had negative impacts on PROMs. Soft tissue conditions should be carefully managed to achieve medial knee joint stability, which can improve PROMs.
Collapse
Affiliation(s)
- Sayako Sakai
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Yugo Morita
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
6
|
Inokuchi T, Muratsu H, Kamenaga T, Tsubosaka M, Nakano N, Hayashi S, Kuroda R, Matsumoto T. Intraoperative lateral laxity greater than 4° is associated with inferior functional improvement in posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39031659 DOI: 10.1002/ksa.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE The study aimed to determine the impact of intraoperative lateral laxity at extension on clinical and functional outcomes 1 year after posterior-stabilised total knee arthroplasty (PS-TKA). METHODS In total, 91 varus-type osteoarthritic knees that underwent PS-TKA using the medial preservation gap technique were included. After the femoral trial component placement and patellofemoral joint reduction, the soft-tissue balance was assessed using an offset-type tensor with a 40-lb joint-distraction force. Patients were divided into the following three groups according to the intraoperative lateral laxity at extension (i.e., varus ligament balance) using the mean ± 1 standard deviation: Groups A, ≤0°; B, 0-4°; and C, >4°. The 2011 Knee Society Score (KSS) and 3-m timed up-and-go test (TUG) time 1-year postoperatively, and their improvements were compared among the groups. RESULTS While significant improvements were observed in all subscales of the 2011 KSS and TUG post-TKA (p < 0.05), the improvement of functional activities and TUG time were significantly lower in Group C than in Group B (p < 0.05). However, no significant differences were observed in symptom improvement, patient satisfaction or patient expectation scores among the groups. CONCLUSION An excessive lateral laxity (varus angle) >4° at extension was associated with lower improvement in functional ability 1-year postoperatively. Therefore, excessive intraoperative lateral laxity should be avoided in PS-TKA. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Takao Inokuchi
- Department of Orthopaedic Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
7
|
Hijikata H, Mochizuki T, Maeda K, Tanifuji O, Omori G, Yamamoto N, Kawashima H. Varus/valgus stability in imageless robotic-assisted total knee arthroplasty applying three-dimensional assessment of varus/valgus stress X-rays. Biomed Mater Eng 2024; 35:179-189. [PMID: 38043002 DOI: 10.3233/bme-230146] [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] [Indexed: 12/04/2023]
Abstract
BACKGROUND The postoperative varus/valgus stability assessment in stress X-rays has been established as an evaluation index. However, it is performed by the two-dimensional (2D) method rather than the three-dimensional (3D) method. OBJECTIVE This study aimed to identify the precision and reproducibility of measuring varus/valgus stress X-rays three-dimensionally and to examine varus/valgus stability under anesthesia in imageless robotic assisted total knee arthroplasty (rTKA). METHODS This prospective study analyzed 52 consecutive rTKAs (five males, 67 ± 5.3 years; 47 females, 74 ± 5.9 years). Postoperative varus/valgus stress X-rays in knee extension under anesthesia at manual maximum stress were three-dimensionally assessed by 2D-3D image matching technique using the 3D bone and component models. Varus/valgus angle between components (VV angle) in no stress, valgus stress, varus stress, medial joint opening (MJO), and lateral joint opening (LJO) were evaluated, clarifying this method's precision and reproducibility and valgus/varus stability. RESULTS All parameters' precision and reproducibility had <1° mean differences and high intra- and inter-class correlation coefficients. Bland-Altman plots showed no fixed and proportional bias. Non-stress VV angle, valgus VV angle, varus VV angle, MJO, and LJO were 3.6 ± 1.2°, 1.0 ± 1.4°, 7.1 ± 1.9°, 1.5 ± 1.0 mm, and 2.8 ± 2.7 mm, respectively. CONCLUSION This prospective study demonstrated that (1) the three-dimensional measurement method provided sufficient precision and reproducibility, and (2) the rTKAs could achieve good postoperative varus/valgus stability with a small standard deviation.
Collapse
Affiliation(s)
- Hiroki Hijikata
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| | - Tomoharu Mochizuki
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| | - Keisuku Maeda
- Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
| | - Osamu Tanifuji
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | - Noriaki Yamamoto
- Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan
| |
Collapse
|
8
|
Song YD, Nakamura S, Kuriyama S, Nishitani K, Morita Y, Yamawaki Y, Maeda T, Sakai S, Matsuda S. Comparison of knee kinematics and ligament forces in single and multi-radius cruciate-retaining total knee arthroplasty: A computer simulation study. Knee 2023; 45:92-99. [PMID: 37925809 DOI: 10.1016/j.knee.2023.09.007] [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: 04/11/2023] [Revised: 07/19/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The single-radius design in total knee arthroplasty has been designed to develop a more fixed flexion-extension axis without mid-flexion instability compared with the multi-radius design. It remains unclear whether differences between the multi-radius and single-radius designs can affect kinematics and collateral ligament forces. This study aimed to simulate knee kinematics and kinetics between single-radius and multi-radius models using a musculoskeletal computer model. METHODS The single-radius and multi-radius femoral components were virtually implanted in a computer simulation using the same tibial insert. The effects of implant design on kinematics and medial collateral ligament forces during squatting and gait activities were analyzed. RESULTS During squatting, the multi-radius model exhibited paradoxical anterior translation on both the medial and lateral flexion facet center where peak anterior translation was 2.4 mm for medial flexion facet center and 2.2 mm for the lateral flexion facet center, while the peak anterior translation of the single-radius model was less than 1 mm at early flexion. A rapid decrease in medial collateral ligament tension was observed in the early flexion phase in the multi-radius model, which occurred simultaneously with paradoxical anterior translation, whereas the relatively constant medial collateral ligament tension was observed in the single-radius model. During gait activity, the single-radius model exhibited a more posterior position than the multi-radius model. CONCLUSION These suggest that abrupt changes in the medial collateral ligament force influence anterior sliding of the femur, and that the single-radius design is a reasonable choice for prevention of mid-flexion instability.
Collapse
Affiliation(s)
- Young Dong Song
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
| | - Shinichi Kuriyama
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Yugo Morita
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yamawaki
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Maeda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Sayako Sakai
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
9
|
Van de Graaf VA, Chen DB, Allom RJ, Wood JA, MacDessi SJ. Functional alignment in total knee arthroplasty best achieves balanced gaps and minimal bone resections: an analysis comparing mechanical, kinematic and functional alignment strategies. Knee Surg Sports Traumatol Arthrosc 2023; 31:5118-5127. [PMID: 37789215 DOI: 10.1007/s00167-023-07567-w] [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: 06/21/2023] [Accepted: 09/02/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Key concepts in total knee arthroplasty include restoration of limb alignment and soft-tissue balance. Although differences in balance have been reported amongst mechanical alignment (MA), kinematic alignment (KA) and functional alignment (FA) techniques, it remains unclear whether there are differences in gap imbalance or resection thicknesses when comparing different constitutional alignment subgroups. METHODS MA (measured resection technique), KA (matched resections technique) and FA (technique based on the restricted KA boundaries) were compared in 116 consecutive patients undergoing 137 robotic-assisted cruciate-retaining total knee arthroplasties. The primary outcome was the proportion of balanced gaps (differential laxities ≤ 2 mm) for extension, flexion, medial and lateral gap measurements. Manual pre-resection laxity measurements were obtained for MA and KA and manual post-resection measurements were obtained for FA in 10° and in 90° of knee flexion. Secondary outcomes were resection depths and implant alignment. All outcomes were analysed per constitutional coronal alignment and joint line obliquity subgroups. RESULTS The proportions of balance in all four gap measurements were 54.7%, 66.4% and 96.5%, with MA, KA and FA, respectively. Across all constitutional alignment types, FA achieved the highest proportion of balance. MA resected the least amount of bone from the medial tibial plateau. KA had femoral components in most valgus and most internally rotated, tibial components in most varus and was the most bone-preserving for the posteromedial femoral condyle. FA had the most externally rotated femoral components and was most bone-preserving for the distal femoral resections. CONCLUSION The study shows that implant alignment to the mechanical axis or joint line anatomy (equal resections) alone does not guarantee a balanced total knee arthroplasty. FA resulted in the highest proportion of balanced knees across all analysed subgroups. Future research will consider whether one alignment philosophy leads to superior outcomes for different constitutional alignment subgroups. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Victor A Van de Graaf
- Sydney Knee Specialists, Suite 201, 131 Princes Highway, Kogarah, Sydney, NSW, 2217, Australia
| | - Darren B Chen
- Sydney Knee Specialists, Suite 201, 131 Princes Highway, Kogarah, Sydney, NSW, 2217, Australia
- CPAK Research Group, Suite 201, 131 Princes Highway, Kogarah, Sydney, NSW, 2217, Australia
| | - Richard J Allom
- Sydney Knee Specialists, Suite 201, 131 Princes Highway, Kogarah, Sydney, NSW, 2217, Australia
| | - Jil A Wood
- Sydney Knee Specialists, Suite 201, 131 Princes Highway, Kogarah, Sydney, NSW, 2217, Australia
| | - Samuel J MacDessi
- Sydney Knee Specialists, Suite 201, 131 Princes Highway, Kogarah, Sydney, NSW, 2217, Australia.
- CPAK Research Group, Suite 201, 131 Princes Highway, Kogarah, Sydney, NSW, 2217, Australia.
- University of NSW, Medicine and Health, St George and Sutherland Campus, Clinical Sciences (WR Pitney) Building, St George Hospital Clinical School, Short Street, Kogarah, Sydney, NSW, 2217, Australia.
| |
Collapse
|
10
|
Edelstein AI, Wakelin EA, Plaskos C, Suleiman LI. Laxity, Balance, and Alignment of a Simulated Kinematic Alignment Total Knee Arthroplasty. Arthroplast Today 2023; 23:101204. [PMID: 37745959 PMCID: PMC10514418 DOI: 10.1016/j.artd.2023.101204] [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: 03/31/2023] [Revised: 06/23/2023] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
Background Kinematic alignment (KA) and related personalized alignment strategies in total knee arthroplasty (TKA) target restoration of native joint line obliquity and alignment. In practice, deviations from exact restoration of the prearthritic joint surface are tolerated for either the femur or tibia to achieve ligamentous balance. It remains unknown what laxity, balance, and alignment would result if a pure resurfacing of both femur and tibia were performed in a KA TKA technique. Methods We used data from 382 robot-assisted TKA performed with a digital joint tensioner to simulate TKA with a pure resurfacing KA technique for both femur and tibia. All knees had the posterior cruciate ligament retained. Knees were subdivided into 4 groups based on preoperative coronal alignment: valgus, neutral, varus, and high varus. Medial and lateral laxity in extension and flexion, balance in extension and flexion, and coronal plane alignment were compared between groups using analysis of variance testing. Results In simulated pure resurfacing KA TKA across a range of preoperative coronal plane deformities, only 11%-31% of knees would have mediolateral extension ligament balance within ±1 mm, and 20%-41% would have a medial flexion gap that is looser than the lateral flexion gap. Over 45% of knees would have coronal hip-knee-ankle angle >3 degrees from mechanical neutral. Conclusions In simulations of pure resurfacing KA TKA, there was wide variability in the resulting laxity and alignment outcomes. Most knees had alignment and balance outcomes outside of normally accepted ranges. Techniques that deviate from pure resurfacing in order to achieve balance appear favorable.
Collapse
Affiliation(s)
- Adam I. Edelstein
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Linda I. Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
11
|
Campi S, Papalia R, Esposito C, Candela V, Gambineri A, Longo UG. The Correlation between Objective Ligament Laxity and the Clinical Outcome of Mechanically Aligned TKA. J Clin Med 2023; 12:6007. [PMID: 37762946 PMCID: PMC10532354 DOI: 10.3390/jcm12186007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Instability is one of the causes of failure in total knee arthroplasty (TKA). The aim of this study was to analyze the correlation between objective ligament laxity and the clinical outcome of mechanically aligned TKA. Fifty-one knees in 47 patients were evaluated at a minimum follow-up of 6 months. The correlation between the angular displacement and functional scores (Knee Society Score and Knee Injury and Osteoarthritis Score) was analyzed. A negative correlation (p-value < 0.05) was observed between medial laxity ≥5° at 0, 30, 60, and 90° of flexion and the outcome measures. Lateral laxity did not correlate with the clinical outcome. At 30° of knee flexion, a total varus and valgus laxity ≥10° was related to poorer outcomes. The same amount of angular displacement did not influence the outcome in the other flexion angles. There was no difference in single-radius vs multi-radius implants in terms of medial and lateral laxity and clinical outcome. A valgus displacement ≥5° measured at 0, 30, 60, and 90 degrees of flexion correlated with an inferior clinical outcome. In contrast, the same amount of displacement measured on the lateral compartment did not influence the clinical outcome after TKA.
Collapse
Affiliation(s)
- Stefano Campi
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (S.C.); (R.P.); (V.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Rocco Papalia
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (S.C.); (R.P.); (V.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Carlo Esposito
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Vincenzo Candela
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (S.C.); (R.P.); (V.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Andrea Gambineri
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Umile Giuseppe Longo
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (S.C.); (R.P.); (V.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| |
Collapse
|
12
|
Lee SS, Lee J, Alharthi H, Moon YW. Effect of mediolateral gap difference on postoperative outcomes in navigation-assisted total knee arthroplasty using an ultracongruent insert and the medial stabilising technique. Knee Surg Sports Traumatol Arthrosc 2023; 31:3745-3754. [PMID: 36708379 DOI: 10.1007/s00167-023-07324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE This study was aimed to compare the clinical, functional, and radiographic outcomes between symmetric and asymmetric extension and mediolateral gap balance after navigation-assisted (NA) total knee arthroplasty (TKA) using ultracongruent (UC) insets and the medial stabilising technique (MST). METHODS In all, 363 knees of 275 patients who underwent mechanical alignment-target NA TKA with MST between January 2015 and December 2017 were analysed. Patients were divided into balanced (extension mediolateral gap difference ≤ 2 mm) and tight medial (difference ≥ 3 mm) groups. Pre- and postoperative clinical, functional (range of motion, Western Ontario and McMaster University Osteoarthritis [WOMAC] index, Knee Society Knee Score [KSKS], and Knee Society Function Score [KSFS]) and radiographic (hip-knee-ankle [HKA] angle, femoral condylar offset, extension angle [a minus indicates hyperextension], and joint line distance) outcomes were compared between the groups. Student's t- or Chi-squared test was used to compare the outcomes. RESULTS Among the 363 knees analysed, 279 (77%) were assigned to the balanced group and 84 (23%) to the tight medial group. The preoperative HKA angle was significantly greater in the tight medial group than in the balanced group (9.7° ± 4.1° vs 14.3° ± 4.7°, P < 0.001). The postoperative WOMAC index, KSKS, and KSFS were similar between the groups. The change in the joint line distance was not significantly different (1.5 ± 3.7 vs 2.0 ± 3.3; n.s). CONCLUSION The clinical, functional, and radiographic outcomes, including joint line distance, were comparable between the tight medial and balanced group after mechanical alignment-targeted UC TKA with MST. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Korea
| | - Jeounghun Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon Street, Gangnam-Gu, Seoul, 06351, Korea
| | - Hail Alharthi
- Arthroplasty Division, Taif University, Taif, Saudi Arabia
| | - Young-Wan Moon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon Street, Gangnam-Gu, Seoul, 06351, Korea.
| |
Collapse
|
13
|
Zou D, Ling Z, Tan J, Zheng N, Dimitriou D, Chen Y, Tsai TY. Medial stability and lateral flexibility of the collateral ligaments during mid-range flexion in medial-pivot total knee arthroplasty patients demonstrates favorable postoperative outcomes. Knee Surg Sports Traumatol Arthrosc 2023; 31:3734-3744. [PMID: 36670261 DOI: 10.1007/s00167-023-07307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/26/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE The objectives of the present study were to investigate the length change in different bundles of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) during lunge, and to evaluate their association with Knee Society Score (KSS) following medial-pivot total knee arthroplasty (MP-TKA). METHODS Patients with unilateral MP-TKA knees performed a bilateral single-leg lunge under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The contralateral non-operated knees were used as the control group. The attachment sites of the sMCL and LCL were marked to calculate the 3D wrapping length. The sMCL and LCL were divided into anterior, intermediate, and posterior portions (aMCL, iMCL, pMCL, aLCL, iLCL, pLCL). Correlations between lengths/elongation rate of ligament bundles from full extension to 100° flexion and the KSS were examined. RESULTS The sMCL and LCL demonstrated relative stability in length at low flexion, but sMCL length decreased whereas LCL increased with further flexion on operated knees. The sMCL length increased at low flexion and remained stable with further flexion, while the LCL length decreased with flexion on the contralateral non-operated knees. The lengths of aMCL, iMCL, and pMCL showed moderate (0.5 < r < 0.7, p < 0.05) negative correlations with the KSS, and the lengths of aLCL, iLCL, and pLCL were positively correlated with the KSS at mid flexion on operated knees (p < 0.05). The elongation rates of aLCL, iLCL, and pLCL were negatively correlated with the KSS at high flexion on operated knees (p < 0.05). However, no significant correlations between the length of different bundles of sMCL or LCL with KSS were found on contralateral non-operated knees. CONCLUSIONS The elongation pattern of sMCL/LCL on MP-TKA knees showed differences with contralateral non-operated knees. The sMCL is tense at low to middle flexion and relaxed at high flexion, while LCL is relaxed at low to middle flexion and tense at high flexion following MP-TKA. Medial stability and proper lateral flexibility during mid flexion were associated with favorable postoperative outcomes in MP-TKA patients. In contrast, lateral relaxation at deep flexion should be avoided when applying soft-tissue balancing in MP-TKA. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi Ling
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tan
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland.
| | - Yunsu Chen
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Itamoto A, Nishitani K, Kuriyama S, Nakamura S, Matsuda S. Catastrophic Mid-Flexion Instability After Avulsion Fractures of the Articular Capsule of the Femur and Tibia in a Patient With Posterior-Stabilized Total Knee Arthroplasty: A Case Report. Cureus 2023; 15:e44379. [PMID: 37779772 PMCID: PMC10540869 DOI: 10.7759/cureus.44379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Mid-flexion instability can be caused by patient-related, implant-related, or technique-specific factors and impairs the activities of daily living after total knee arthroplasty (TKA). In this study, we report a rare case of a patient with severe mid-flexion instability following tibial and femoral avulsion fractures after posterior-stabilized (PS) TKA for knee osteoarthritis. An 82-year-old female with bilateral knee osteoarthritis underwent staged bilateral TKA with a posterior-stabilized prosthesis. The course of the early postoperative period was good, and the patient was able to walk independently with a cane. Two months postoperatively, the patient fell and then experienced left knee pain and instability in the mid-flexion range. Radiographic images showed avulsion fractures of the articular capsule of the femur and tibia, and fluoroscopic examination showed severe posterior subluxation of the tibia between 40° and 60° of flexion. Conservative treatment with a functional knee brace and quadriceps training was initiated due to the patient's hesitation to undergo a second surgery; however, no improvement was observed. Eventually, revision surgery was planned three months after the fall incident (five months after the left primary TKA). At revision surgery, osteosynthesis of the tibial avulsion fracture and thickening of the PS insert did not sufficiently stabilize the instability, and revision TKA with a rotating-hinge prosthesis was needed. The postoperative course was uneventful, and she was able to walk with a cane within two weeks after revision TKA with no complaints of instability. Two years postoperatively, the patient recovered well and had no recurrence of instability, pain, or dysfunction. This case report shows that loss of support by the joint capsules due to avulsion fractures may cause significant anteroposterior instability in the mid-flexion position after posterior-stabilized TKA. In such a case, conservative treatment failed, and the revision of the rotating-hinge prosthesis provided stability and good improvement.
Collapse
Affiliation(s)
- Akihiro Itamoto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, JPN
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, JPN
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, JPN
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, JPN
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, JPN
| |
Collapse
|
16
|
Seki K, Seki T, Imagama T, Matsuki Y, Kaneoka T, Kawakami T, Sakai T. Medial Soft Tissue-Preserving Technique Impact on Sagittal Stability in Bi-cruciate Stabilized Total Knee Arthroplasty. Indian J Orthop 2023; 57:1049-1053. [PMID: 37383999 PMCID: PMC10293138 DOI: 10.1007/s43465-023-00905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/01/2023] [Indexed: 06/30/2023]
Abstract
Background Sagittal stability in total knee arthroplasty is achieved through complex processes enabled by prosthetic design and intraoperative soft tissue balancing. This study investigated the effects of preserving medial soft tissue on sagittal stability in bicruciate stabilized total knee arthroplasty (BCS TKA). Method This retrospective study included 110 patients who underwent primary BCS TKA. The patients were divided into two groups: 44 TKAs were performed releasing medial soft tissue (CON group), and 66 TKAs were performed preserving medial soft tissue (MP group). We assessed joint laxity using tensor device and anteroposterior translation immediately after surgery using the arthrometer at 30° knee flexion. Propensity score matching (PSM) was performed according to preoperative demographic and intraoperative medial joint laxity, and further comparisons between the two groups were performed. Result After PSM analysis, medial joint laxity in the mid-flexion range tended to be smaller in the MP group than in the CONT group, with a significant difference at 60 degrees (CON group: - 0.2 ± 0.9 mm, MP group: 0.8 ± 1.3 mm, P < 0.05). Anteroposterior translation was significantly different between the two cohorts (CON group: 11.6 ± 2.5 mm, MP group: 8.0 ± 3.1 mm, P < 0.001). Conclusion This study demonstrated the effects of preserving medial soft tissue on postoperative sagittal stability in BCS TKA. We concluded that this surgical procedure enhances postoperative sagittal stability in the mid-flexion range in BCS TKA.
Collapse
Affiliation(s)
- Kazushige Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Toshihiro Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Yuta Matsuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Takehiro Kaneoka
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Takehiro Kawakami
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 Japan
| |
Collapse
|
17
|
Tamaki Y, Hamada D, Wada K, Takasago T, Nitta A, Omichi Y, Goto T, Tsuruo Y, Sairyo K. Kinematic comparison between the knee after bicruciate stabilized total knee arthroplasty and the native knee: A cadaveric study. Knee 2023; 42:289-296. [PMID: 37120864 DOI: 10.1016/j.knee.2023.04.004] [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: 12/13/2022] [Revised: 03/07/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Although bicruciate stabilized total knee arthroplasty (BCS-TKA) is expected to provide kinematics similar to those of the normal knee, there are limited data available for comparison of the kinematics of the knee after BCS-TKA with those of the normal knee. The purpose of this study was to confirm whether the knee after BCS-TKA are the same as those of the native knee. METHODS Seven fresh-frozen cadavers underwent TKA using a BCS-type prosthesis with navigation system. Anteroposterior translation of the femur and internal rotation of the tibia were evaluated using the navigation system. RESULTS There was no statistically significant difference in anteroposterior translation of the femur between the native knee and the knee after BCS-TKA in the early flexion phase (0°-30°) or in the deep flexion phase (over 100°). In the middle flexion phase (40°-90°), the knee after BCS-TKA was placed significantly more anteriorly than the native knee. The knee after BCS-TKA also showed a gradual internal rotation pattern similar to that of the native knee but the total tibial internal rotation angle was significantly smaller than that of the native knee. At each angle from 0° to 120° of flexion, internal rotation of the knee after BCS-TKA was significantly greater than that of the native knee. CONCLUSION Kinematics of BCS-TKA is close to that of the native knee. However, there is a statistically significant difference in AP position of the femur during mid flexion and initial rotational position of the tibia between the BCS-TKA knee and the native knee.
Collapse
Affiliation(s)
- Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Akihiro Nitta
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Yasuyuki Omichi
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Yoshihiro Tsuruo
- Department of Anatomy and Cell Biology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| |
Collapse
|
18
|
Maciąg BM, Kordyaczny T, Maciąg GJ, Łapiński M, Jegierski D, Świderek J, Tsitko H, Dorocińska M, Żarnovsky K, Świercz M, Stępiński P, Adamska O, Stolarczyk A. Comparison of Femoral Component Rotation between Robotic-Assisted vs. Soft-Tissue Tensor Total Knee Arthroplasty with Anatomic Implants. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050880. [PMID: 37241112 DOI: 10.3390/medicina59050880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Total knee arthroplasty (TKA) is the most effective treatment method for end-stage osteoarthritis. One of the most important aspects of this surgery is adequate implant positioning, as it guarantees the desired outcome of restoring limb biomechanics. Surgical technique is being continuously improved along with hardware development. There are two novel devices designed to help establish proper femoral component rotation: soft-tissue tensor and robotic-assisted TKA (RATKA). This study compared the femoral component rotation achieved with the use of three methods: RATKA, soft tissue tensioner and the conventional measured-resection technique, all of them utilizing anatomical design prosthesis components. Materials and Methods: A total of 139 patients diagnosed with end-stage osteoarthritis underwent total knee arthroplasty between December 2020 and June 2021. After the surgery, they were divided into three groups depending on procedure technique and implant type: Persona (Zimmer Biomet) + Fuzion Balancer, RATKA + Journey II BCS or conventional TKA + Persona/Journey. Postoperatively, a computed tomography examination was performed in order to measure femoral component rotation. All three groups were compared independently during statistical analysis. Fisher's exact, Kruskal-Wallis and Dwass-Steel-Crichtlow-Fligner tests were used for particular calculations. Results: Statistically significant differences in femoral component rotation between groups were noticed. However, in terms of values other than 0° in external rotation, no significant variance was revealed. Conclusions: Additional total knee arthroplasty instruments seem to improve the outcomes of the surgery, providing better component positioning than in the conventional measured-resection technique based only on bone landmarks.
Collapse
Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Jakub Świderek
- Faculty of Medicine, Medical University of Białystok, 15-089 Białystok, Podlaskie Voivodeship, Poland
| | - Hanna Tsitko
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Lubelskie Voivodeship, Poland
| | - Monika Dorocińska
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Maciej Świercz
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Piotr Stępiński
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Olga Adamska
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| |
Collapse
|
19
|
Kato M, Warashina H, Kataoka A, Mitamura S. Comparison of weight-bearing full-length radiography and three-dimensional computed tomography scan-based models to assess knee joint coronal alignment following total knee arthroplasty. Knee 2023; 42:227-235. [PMID: 37086539 DOI: 10.1016/j.knee.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/23/2023] [Accepted: 03/29/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The validity of standing long-leg radiography (LLR) - the standard method for evaluating coronal alignment after total knee arthroplasty (TKA) - remains controversial. We evaluated the measurement reliability and validity of LLR following TKA by comparing postoperative radiographs with three-dimensional computed tomography (3DCT) scans of the lower extremities. METHODS We retrospectively collected the data of 55 knees from 44 patients who underwent postoperative 3DCT and 5-day and 6-month LLR for coronal alignment evaluation following TKA. The coronal femoral component angle (CFA) and coronal tibial component angle (CTA) were measured using 3DCT and LLR images. Correlations between the hip-knee-ankle angle (HKAA), CFA and CTA were analysed using Pearson's correlation coefficient (PCC); Bland-Altman plots were constructed to assess agreement between 5-day and 6-month radiographic and 3DCT scan measurements. RESULTS The mean difference in HKAA between 3DCT, and 5-day and 6-month LLR was 1.3 ± 1° and 1.1 ± 0.7°, respectively. Differences of >1° in HKAA between 3DCT, and 5-day and 6-month LLR were observed in 31 (56.4%) and 28 (50.9%) knees, respectively; differences of >2° in these parameters were observed in 15 (27.3%) and nine (16.4%) knees, respectively. The 3DCT scan and radiograph measurements of HKAA, CFA and CTA were strongly correlated (PCC, 0.81-0.92; P < 0.001). Bland-Altman plot validity was within acceptable limits. CONCLUSION LLR shows good reliability and validity for measuring coronal alignment. When comparing 3DCT scans and radiographs, a high number of HKAA values differed by more than 1° and 2°; this indicates that rigorous alignment evaluation requires 3DCT measurements.
Collapse
Affiliation(s)
- Michitaka Kato
- Nagoya Joint Replacement Orthopaedic Clinic, Aichi, Japan.
| | | | - Akito Kataoka
- Nagoya Joint Replacement Orthopaedic Clinic, Aichi, Japan
| | | |
Collapse
|
20
|
Kinoshita T, Hino K, Kutsuna T, Watamori K, Miura H. Rotational Soft-Tissue Balance Is Highly Correlated with Rotational Kinematics in Total Knee Arthroplasty. J Knee Surg 2023; 36:47-53. [PMID: 33992034 DOI: 10.1055/s-0041-1729619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recovery of normal knee kinematics is critical for improving functional outcomes and patient satisfaction after total knee arthroplasty (TKA). The kinematics pattern after TKA varies from case to case, and it remains unclear how to reproduce normal knee kinematics. The present study aimed to evaluate rotational knee kinematics and soft-tissue balance using a navigation system and to assess the influence of intraoperative soft-tissue balance on the rotational knee kinematics. We evaluated 81 osteoarthritic knees treated with TKA using a posterior stabilized (50 knees) or cruciate retaining (31 knees) prosthesis. Rotational kinematics were assessed at 0, 30, 45, 60, and 90 degrees flexion angles by using a computer-assisted navigation system. Correlation between femorotibial rotational position and measured soft tissue balance was assessed by using Spearman's rank correlation coefficient. Rotational soft-tissue balance (the median angle of rotational stress) was significantly correlated with rotational kinematics (rotational axis of the femur relative to the tibia throughout the range of motion) at all measured angles after TKA. The correlation coefficients between the median angle of rotational stress and rotational kinematics were 0.97, 0.80, 0.74, 0.71, and 0.70 at 0, 30, 45, 60, and 90 degrees of flexion, respectively (p-values <0.0001 in all measured angles). The correlation coefficient increased as the knee approached full extension. Our findings suggest that soft-tissue balance is a key factor for rotational kinematics, following both cruciate-retaining and posterior-stabilized TKA.
Collapse
Affiliation(s)
- Tomofumi Kinoshita
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazunori Hino
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tatsuhiko Kutsuna
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kunihiko Watamori
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| |
Collapse
|
21
|
Kato M, Warashina H, Mitamura S, Kataoka A. Medial pivot-based total knee arthroplasty achieves better clinical outcomes than posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:998-1010. [PMID: 36089624 PMCID: PMC9464619 DOI: 10.1007/s00167-022-07149-2] [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: 05/08/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Stability in the sagittal plane, particularly regarding anterior cruciate ligament compensation, and postoperative functionality and satisfaction remain issues in total knee arthroplasty. Therefore, this prospective study compared the clinical outcomes between medial-pivot-based and posterior-stabilised total knee arthroplasty based on anterior translation and clinical scores. METHODS To assess outcomes of total knee arthroplasty for varus osteoarthritis, the anterior translation distance of the tibia relative to the femur was measured at 30 and 60° of flexion using a KS measure Arthrometer at 6 months postoperatively. The 2011 Knee Society Score, Forgotten Joint Score, visual analogue scale for pain, and range of motion were assessed at 6 months and 1 year postoperatively. The correlations among each score, anterior translation distance, range of motion, and visual analogue scale score for pain were investigated. RESULTS The medial-pivot and posterior-stabilised groups comprised 70 and 51 patients, respectively. The medial-pivot group exhibited a significantly shorter anterior translation distance at 60° flexion than the posterior-stabilised group. Furthermore, the medial-pivot group achieved significantly better outcomes regarding the visual analogue scale for pain, 2011 Knee Society Score, and Forgotten Joint Score than the posterior-stabilised group. A significant negative correlation was observed between the anterior translation distance and the function score of the 2011 Knee Society Score, whereas a significant positive correlation was found between the anterior translation distance and flexion angle, and between the extension angle and score of the Forgotten Joint Score or 2011 Knee Society Score. Significant negative correlations were also found between the pain visual analogue scale and both the 2011 Knee Society Score and Forgotten Joint Score. CONCLUSION In total knee arthroplasty for osteoarthritis, the medial-pivot group displayed a shorter anterior translation distance than the posterior-stabilised group at 6 months postoperatively. The visual analogue scale score for pain was also significantly lower in the medial-pivot group than that in the posterior-stabilised group at both 6 months and 1 year postoperatively. Because a correlation was observed between the anterior translation distance and the function score, medial-pivot-based total knee arthroplasty was considered to significantly improve postoperative function compared to posterior-stabilised total knee arthroplasty.
Collapse
Affiliation(s)
- Michitaka Kato
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi, 481-0011, Japan.
| | - Hideki Warashina
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Shingo Mitamura
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Akito Kataoka
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| |
Collapse
|
22
|
Effects of Severe Varus Deformity on Soft Tissue Balancing in Total Knee Arthroplasty. J Clin Med 2022; 12:jcm12010263. [PMID: 36615063 PMCID: PMC9821530 DOI: 10.3390/jcm12010263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
This study aimed to establish the effect of severe varus deformity on soft tissue balance in total knee arthroplasty (TKA), which is not yet well established. We retrospectively enrolled 205 patients (270 knees) who underwent primary TKA using the measured resection technique. Four intraoperatively measured TKA gaps and gap differences were compared between the severe varus deformity group (Hip-knee-ankle [HKA] varus angle ≥ 10°) and the mild varus deformity group (HKA varus angle < 10°). Pearson’s correlation analysis and multiple linear regression analysis were used to investigate the factors affecting flexion and extension gap differences (FGD and EGD). A receiver operating characteristic curve was applied to assess the cut-off value of the HKA varus angle to discriminate the rectangular gap. The FGD (1.42 ± 1.35 mm vs. 1.05 ± 1.16 mm, p = 0.019) and the EGD (1.45 ± 1.32 mm vs. 0.97 ± 1.53 mm, p = 0.006) were significantly larger in severe varus deformity group than in mild varus deformity group. The HKA varus angle was positively correlated with both FGD (r = 0.264, p < 0.001) and EGD (r = 0.319, p < 0.001) and was an influencing factor for FGD (β = 0.232, p = 0.040) and EGD (β = 0.229, p = 0.037). A preoperative HKA angle of 12.4° was selected as the cutoff value to discriminate between rectangular and trapezoidal gaps. Thus, the severity of varus deformity (HKA varus angle) was found to be a significant factor affecting the mediolateral gap difference in TKA. When performing TKA in a knee with an HKA varus angle ≥ 12.4°, a trapezoidal gap is more likely to be expected. Level of evidence III, case−control study.
Collapse
|
23
|
Kakuta A, Ikeda R, Takeshita B, Takamatsu T, Otani T, Saito M. Intraoperative changes in medial joint gap after posterior femoral condylar resection, posterior osteophyte removal, and femoral component placement during primary total knee arthroplasty. Knee 2022; 39:1-9. [PMID: 36115177 DOI: 10.1016/j.knee.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 06/18/2022] [Accepted: 08/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND "Mid-flexion stability" is important for superior patient satisfaction following total knee arthroplasty (TKA). Thus, it is important to control medial joint gap intraoperatively as a countermeasure. However, reports on the precise intraoperative changes in medial joint gap during TKA are scarce. This study evaluated the intraoperative changes in medial joint gap during TKA. METHODS We studied 167 knees with varus osteoarthritis that underwent 80 cruciate-retaining (CR) and 87 posterior-stabilized (PS) TKAs between January 2018 and December 2020. We measured the intraoperative changes in medial joint gap with a tensor device at 137.5 N. RESULTS The medial joint gap after posterior femoral condylar resection was significantly increased not only at 90° of flexion but also at 0° of extension in CR and PS TKAs (p < 0.01). The medial joint gap after posterior osteophyte removal was significantly increased not only at 0° of extension but also at 90° of flexion in CR and PS TKAs (p < 0.01). The medial joint gap at 0° of extension was reduced by 0.60 mm after femoral component placement in PS TKA. CONCLUSION Surgeons need to pay close attention to these intraoperative changes in medial joint gap by measuring the medial joint gap before and after each procedure or assuming the changes in those values before bone cutting to achieve superior patient satisfaction following TKA.
Collapse
Affiliation(s)
- Atsuhito Kakuta
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Ryo Ikeda
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Biyu Takeshita
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Tomoaki Takamatsu
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| |
Collapse
|
24
|
Tibiofemoral lift-off and resulting laxity following total knee arthroplasty: Frequency in a series of 906 continuous cases and functional consequences at 4 years' follow-up in a case-control study. Orthop Traumatol Surg Res 2022; 108:103444. [PMID: 36252927 DOI: 10.1016/j.otsr.2022.103444] [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: 04/22/2022] [Revised: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Tibiofemoral instability is one reason for early revision of total knee arthroplasty. It can be the consequence of tibiofemoral laxity, especially in the coronal plane with tibiofemoral lift-off. But does femoral condyle lift-off on conventional postoperative radiographs suggest the presence of laxity or potential instability? To our knowledge, this question has not yet been answered. This led us to conduct a retrospective study to evaluate (1) the frequency of lift-off on postoperative radiographs, (2) the relationship between lift-off and laxity in the short term and (3) the functional consequences of lift-off. HYPOTHESIS Postoperative lift-off is a rare event that is predictive of laxity. METHODS We carried out a single-center retrospective study using postoperative radiographs from patients who underwent primary total knee arthroplasty between 2014 and 2016. The sample consisted of 906 patients. Lift-off was defined as a tibiofemoral angle of 3° or more on immediate postoperative radiographs (day 0) that were non-weightbearing and had no stress applied. The functional outcomes were determined in the 17 patients identified as having lift-off who had been operated in the first year (2014) to ensure the follow-up was long enough. These patients were compared to 34 matched control patients who were operated the same year and chosen randomly among patients not having lift-off. The matching ratio was 2 controls to 1 case. Preoperative and surgical data were compiled from each patient's electronic medical record. Patients were evaluated at 4 years postoperatively using the subjective Oxford-48, objective HSS score, IKS score, overall patient satisfaction and stress radiographs of the knee. The cases of lift-off observed in 2014 (n=17) were paired with a control group of patients selected randomly during 2014. RESULTS The frequency of the lift-off event was 63/906 or 7%. The frequency was consistent over the three years studied: 7.1% in 2014 (19/269), 6.2% in 2015 (22/354) and 7.8% in 2016 (22/283). There was no significant difference between the two groups (17 with lift-off and 34 without) in the sex, age, body mass index and coronal plane deformity (preoperative HKA angle). At a mean follow-up of 4 years (range 12-49 months), the knees with postoperative lift-off had more laxity (p=0.002), particularly laxity when varus stress was applied (p=0.009). There were no other significant differences in the outcomes. DISCUSSION Immediate postoperative lift-off after total knee arthroplasty is not a rare event, with a 7% frequency in our study. While it reveals that laxity is present in the particular compartment, there is no evidence of functional consequences at 4 years' follow-up; however, a long-term assessment is required to verify this finding. LEVEL OF EVIDENCE III - case-control study.
Collapse
|
25
|
Sameshima S, Inui H, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Kage T, Tanaka S. The intraoperative gap differences due to joint distraction force differences in total knee arthroplasty are affected by preoperative lower limb alignment and body mass index. Clin Biomech (Bristol, Avon) 2022; 99:105765. [PMID: 36150289 DOI: 10.1016/j.clinbiomech.2022.105765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Soft tissue balance is important for a good clinical result in total knee arthroplasty. Nevertheless, the appropriate evaluation of the intraoperative gap has not been established. We investigated the relationship between physical characteristics and gap differences due to distraction force, in order to determine whether intraoperative adjustment of the distraction force can be considered based on the physical characteristics of the patient. METHODS A total of 115 varus knees in which primary total knee arthroplasty was performed were retrospectively evaluated. The component gaps were measured under 60 and 80 N. The gap difference under 60 and 80 N was calculated. We performed a linear regression analysis to determine the correlation between the gap differences and patient parameters. FINDINGS Each gap was significantly larger under 80 N than under 60 N. The component gap difference is larger in the lateral compartment than in the medial compartment at each knee flexion angle. The gap difference negatively correlated with preoperative hip-knee-ankle angle at a knee flexion of 0° and 120° (r = -0.21, -0.19; p = 0.02, 0.05) and positively correlated with BMI in the lateral compartment at a knee flexion of 90° (r = 0.31, p < 0.001). INTERPRETATION The difference in the intraoperative gap due to the joint distraction force was affected by the preoperative HKA axis angle and the body mass index in the lateral compartment. Surgeons should consider the effect of preoperative limb alignment and body mass index in interpreting intraoperative gap measurement.
Collapse
Affiliation(s)
- Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| |
Collapse
|
26
|
Toyooka S, Masuda H, Nishihara N, Miyamoto W, Kobayashi T, Kawano H, Nakagawa T. Assessing the Role of Minimal Medial Tissue Release during Navigation-Assisted Varus Total Knee Arthroplasty Based on the Degree of Preoperative Varus Deformity. J Knee Surg 2022; 35:1236-1241. [PMID: 33472261 DOI: 10.1055/s-0040-1722658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We assessed the impact of a minimal medial soft-tissue release with complete peripheral osteophyte removal on the ability to attain manual preresection deformity correction during navigation-assisted total knee arthroplasty (TKA) for varus osteoarthritis. We included 131 TKAs for 109 patients with medial compartment predominant osteoarthritis. The steps for achieving minimal medial soft-tissue release were performed as follows: (1) elevation of a periosteal sleeve to 5-mm distal to the joint line and (2) complete removal of peripheral osteophytes. The evaluation criteria of this study were as follows: (1) age, (2) height, (3) weight, (4) body mass index (BMI), (5) sex, (6) the preoperative femorotibial mechanical angle in the neutral position before medial release and (7) the mechanical angle in maximum manual valgus stress after the two-step medial-release procedure (measured on the navigation screens). Multiple regression analysis of the criteria was performed to determine the degree of varus deformity that allowed neutral alignment but required extensive medial release. The femorotibial mechanical angle in the neutral position before medial release and sex correlated with the mechanical angle in maximum manual valgus stress on the navigation screen after medial release (r = 0.72, p < 0.001). Based on the regression formula, the maximum degree of preoperative varus deformity that allowed neutral alignment by the minimum medial-release procedure was 5.3 degrees for males and 9.1 degrees for females. The magnitude of deformity which has an impact on the ability to correct varus deformity (by minimal soft-tissue release and complete osteophyte removal) was clarified. If the preoperative degree of varus deformity was within 5.3 degrees for males and 9.1 degrees for females, an extensive medial release was not required to obtain neutral alignment.
Collapse
Affiliation(s)
- Seikai Toyooka
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hironari Masuda
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuhiro Nishihara
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Kobayashi
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
27
|
Hasegawa M, Tone S, Naito Y, Sudo A. Intraoperative midflexion medial laxity using navigation affects patient expectations following posterior stabilized total knee arthroplasty. J Orthop Surg (Hong Kong) 2022; 30:10225536221119512. [PMID: 37583311 DOI: 10.1177/10225536221119512] [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] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Patient satisfaction and expectations are now recognized as an outcome measure for successful total knee arthroplasty (TKA). The purpose of this study was to determine which factors including soft tissue balance during surgery affect patient satisfaction and expectations after TKA. METHODS A total of 135 patients (157 knees) with knee osteoarthritis who underwent primary TKA with a posterior stabilized design were studied. After implantation of all components, varus/valgus laxity of the knee was measured intraoperatively with the knee at 0°, 30°, 60°, 90°, and 120° guided by an image-free navigation system. Factors that affected patient satisfaction and expectations, including lateral and medial laxities, were evaluated using the 2011 Knee Society score. RESULTS The mean intraoperative lateral laxity was 1.1°, 1.6°, 0.9°, 1.3°, and 1.7° with the knee at 0°, 30°, 60°, 90°, and 120°, respectively. The mean intraoperative medial laxity was 1.1°, 1.4°, 1.1°, 1.1°, and 1.7° with the knee at 0°, 30°, 60°, 90°, and 120°, respectively. Patient satisfaction after TKA correlated positively with symptom (R = 0.61, p < 0.01) and functional activity (R = 0.47, p < 0.01) scores. Patient expectations after TKA weakly positively correlated with symptom (R = 0.29, p < 0.01) and functional activity (R = 0.20, p = 0.01) scores, and weakly negatively with medial laxity at 30° (R = -0.21, p < 0.01). CONCLUSION Midflexion medial laxity was associated with worse patient expectations after TKA. Avoiding medial laxity could be one of the important techniques during TKA.
Collapse
Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine 2-174 Edobashi, Tsu City 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine 2-174 Edobashi, Tsu City 514-8507, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine 2-174 Edobashi, Tsu City 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine 2-174 Edobashi, Tsu City 514-8507, Japan
| |
Collapse
|
28
|
Kinematic alignment fails to achieve balancing in 50% of varus knees and resects more bone compared to functional alignment. Knee Surg Sports Traumatol Arthrosc 2022; 30:2991-2999. [PMID: 35962840 DOI: 10.1007/s00167-022-07073-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Evidence is emerging that tibio-femoral compartmental balancing is related to clinical outcomes after total knee arthroplasty (TKA). The purpose of this study was to assess if kinematic alignment (KA) delivered a balanced knee in flexion and extension after TKA on varus deformity, compared to functional alignment (FA). METHODS This single-centre retrospective cohort study assessed 110 consecutive TKAs performed with an image-based robotic system for pre-operative varus deformity. The ligament balancing in the medial and lateral femorotibial compartments was assessed intra-operatively with a robotic system to evaluate if a KA plan would deliver a balanced knee. Balance was considered achieved if tibio-femoral compartments (medial/lateral) were equal to or less than 1.5 mm, or if the estimated final gap position more than 2 mm from the global implant thickness (17 mm). Implant positioning was modified within limits previously defined for a FA philosophy to achieve balancing. Resection thickness and implant positioning were compared with the KA plan and after the FA adjustments; and also, between the patients with a final balanced knee in extension and at 90° of flexion. RESULTS A total of 102 patients were eligible for final analysis. Mean age was 67.3 ± 8.2 years, average BMI was 29.1 ± 5.2 kg/m2, mean pre-operative coronal alignment was 174.0° ± 3.3° and sagittal alignment 3.4° ± 5.9°. Mean post-operative coronal alignment was 177.7° ± 1.0° and sagittal alignment 0.8° ± 1.9°. A KA plan delivered medial-lateral tibio-femoral compartment balancing in 67 cases (65.7%) for the extension gap and in 50 cases (49.1%) for the flexion gap. All measured bone resection depths were significantly less for FA compared to KA. To achieve balancing targets, final femoral component position was more externally rotated relative to the posterior condylar axis, (0.5° with KA compared to 1.7° with FA (p < 0.0001), and the tibia in more varus (3.0° KA vs. 3.5° FA p = 0.0024). Only one soft tissue release was required. CONCLUSION KA failed to deliver a balanced TKA in more than 50% of cases, especially regarding the flexion gap. Consideration of soft tissue laxity led to significantly less bone resection, with more externally rotated femoral component and more varus tibial component.
Collapse
|
29
|
Lee GC, Wakelin E, Plaskos C. What Is the Alignment and Balance of a Total Knee Arthroplasty Performed Using a Calipered Kinematic Alignment Technique? J Arthroplasty 2022; 37:S176-S181. [PMID: 35300880 DOI: 10.1016/j.arth.2022.01.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
METHODS We simulated calipered kinematic alignment total knee arthroplasty (cKATKA) using alignment data and ligament tensions acquired during 607 consecutive robotic-assisted TKAs performed using a dynamic ligament tensor. The distal femur was resected parallel to the native joint line accounting for cartilage loss. The proximal tibial resection necessary to achieve extension gap balance was calculated for each knee. Similarly, symmetric posterior condylar resections prescribed by this method were simulated and the tibial resection needed to achieve a balanced flexion gap calculated. Finally, the resultant limb alignment and degree of joint balance in both flexion and extension of each knee were determined and categorized according to the preoperative knee alignment. RESULTS Increasing preoperative varus deformity required a greater tibial varus cut to achieve a balanced extension gap (P < .0001). There was no correlation between tibial varus angle and flexion gap balance (P > .1). For mild varus deformities 81% and 95% of knees could be balanced and have an overall limb alignment within 3° and 5° from the mechanical axis respectively. For knees with moderate-severe varus, only 37% and 74% could be balanced within these alignment boundaries (P < .01). Overall, 95% of these simulated knees could be balanced with an overall alignment within 0° ± 5°. However, 50% of the simulated TKAs had looser medial gaps in flexion compared to the lateral gap. CONCLUSIONS Application of the cKATKA method can yield TKAs within 0° ± 5° of mechanical axis alignment by simply adjusting the proximal tibial resection without ligament releases. However, an undesirable flexion gap balance was predicted in nearly 50% of the TKAs.
Collapse
Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | | | | |
Collapse
|
30
|
Vajapey SP, Fitz W, Iorio R. The Role of Stability and Alignment in Improving Patient Outcomes After Total Knee Arthroplasty. JBJS Rev 2022; 10:01874474-202205000-00001. [PMID: 35749640 DOI: 10.2106/jbjs.rvw.22.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Total knee arthroplasty (TKA) is an effective treatment option for many patients, but a small group of patients are dissatisfied following TKA. » Alignment, in combination with balance, stability, and knee kinematics, is an important modifiable surgical factor that can affect patient outcomes. » Driven by the subset of dissatisfied patients after TKA, new techniques have evolved in the search for a more anatomic reconstruction of individual knee morphology and a more accurate approximation of the individual lower-extremity alignment. » There is a need to optimize 3 aspects of TKA to improve patient outcomes-mechanical tooling processes, implants that resurface the epiphysis, and techniques that respect the variable anatomy of patients.
Collapse
Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | |
Collapse
|
31
|
Takagi K, Taketomi S, Yamagami R, Kawaguchi K, Sameshima S, Kage T, Tanaka S, Inui H. Both Intraoperative Medial and Lateral Joint Stabilities at Midflexion Influence Postoperative Patient-Reported Outcome Measures Following Bi-Cruciate Stabilized Total Knee Arthroplasty. J Knee Surg 2022. [PMID: 35259765 DOI: 10.1055/s-0042-1744191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) was developed to approximate normal knee kinematics and is expected to improve clinical outcomes. However, the effects of soft tissue balance at the medial or lateral compartment on patient-reported outcome measures (PROMs) following BCS TKA are unclear. The purpose of this study was to clarify the relationship between the medial or lateral component gaps and PROMs following BCS TKA. One hundred seventeen knees with varus deformities which underwent BCS TKA were included in this study. They were divided into two groups according to the validated Japanese version of the Knee Injury and Osteoarthritis Outcome Score for each subscale of pain, symptoms, and activities of daily living (ADL) at 1 year postoperatively: group H consisted of patients with ≥90 points and group L consisted of patients with <90 points. Intraoperative medial and lateral joint laxities at 0°, 30°, 60°, 90°, and 120° flexion measured using a tensor device were compared between the two groups in each subscale. In the pain subscale, the medial joint laxities at 30° (p < 0.05) and 60° flexion (p < 0.05) in group H were significantly smaller than those in group L. In the ADL subscale, the medial joint laxity at 60° flexion in group H was significantly smaller than that in group L (p < 0.05). In the symptom subscale, the lateral joint laxity at 60° flexion in group H was significantly smaller than that in group L (p < 0.05). Surgeons should pay attention to the importance of both medial and lateral joint stabilities to achieve better postoperative PROMs following BCS TKA.
Collapse
Affiliation(s)
- Kentaro Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kouhei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
32
|
Wakelin EA, Shalhoub S, Lawrence JM, Keggi JM, DeClaire JH, Randall AL, Ponder CE, Koenig JA, Lyman S, Plaskos C. Improved total knee arthroplasty pain outcome when joint gap targets are achieved throughout flexion. Knee Surg Sports Traumatol Arthrosc 2022; 30:939-947. [PMID: 33580346 DOI: 10.1007/s00167-021-06482-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Achieving a balanced knee is accepted as an important goal in total knee arthroplasty; however, the definition of ideal balance remains controversial. This study therefore endeavoured to determine: (1) whether medio-lateral gap balance in extension, midflexion, and flexion are associated with improved outcome scores at one-year post-operatively and (2) whether these relationships can be used to identify windows of optimal gap balance throughout flexion. METHODS 135 patients were enrolled in a multicenter, multi-surgeon, prospective investigation using a robot-assisted surgical platform and posterior cruciate ligament sacrificing gap balancing technique. Joint gaps were measured under a controlled tension of 70-90 N from 10°-90° flexion. Linear correlations between joint gaps and one-year KOOS outcomes were investigated. KOOS Pain and Activities of Daily Living sub-scores were used to define clinically relevant joint gap target thresholds in extension, midflexion, and flexion. Gap thresholds were then combined to investigate the synergistic effects of satisfying multiple targets. RESULTS Significant linear correlations were found throughout extension, midflexion, and flexion. Joint gap thresholds of an equally balanced or tighter medial compartment in extension, medial laxity ± 1 mm compared to the final insert thickness in midflexion, and a medio-lateral imbalance of less than 1.5 mm in flexion generated subgroups that reported significantly improved KOOS pain scores at one year (median ∆ = 8.3, 5.6 and 2.8 points, respectively). Combining any two targets resulted in further improved outcomes, with the greatest improvement observed when all three targets were satisfied (median ∆ = 11.2, p = 0.002). CONCLUSION Gap thresholds identified in this study provide clinically relevant and achievable targets for optimising soft tissue balance in posterior cruciate ligament sacrificing gap balancing total knee arthroplasty. When all three balance windows were achieved, clinically meaningful pain improvement was observed. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
| | | | | | - John M Keggi
- Connecticut Joint Replacement Institute, Hartford, CT, USA
| | | | | | - Corey E Ponder
- Oklahoma Sports and Orthopedics Institute, Edmond, OK, USA
| | - Jan A Koenig
- NYU Langone Long Island Hospital, Mineola, NY, USA
| | - Stephen Lyman
- Hospital for Special Surgery, New York, NY, USA.,Kyushu University School of Medicine, Fukuoka, Japan
| | | |
Collapse
|
33
|
Is Static Alignment a Good Predictor of Dynamic Alignment after Total Knee Arthroplasty? Healthcare (Basel) 2022; 10:healthcare10030418. [PMID: 35326896 PMCID: PMC8956110 DOI: 10.3390/healthcare10030418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/02/2023] Open
Abstract
Background: Total knee arthroplasty (TKA) is the only effective treatment of end-stage knee osteoarthritis (OA). Lower limb neutral alignment has been a criterion to predict prosthesis life; however, there has been recent controversy over this. Some researchers believe that lower limb static alignment does not significantly affect prosthesis life and some researchers have found that dynamic mechanical alignment may affect prosthesis life, which needs to be further studied. Methods: Eighty-seven patients with knee OA were evaluated by a three-dimensional (3D) gait analysis system before TKA and six months after TKA, dynamic mechanical alignment and basic gait parameters were then calculated. Based on the static alignment of the lower limb on the postoperative X-radiographs, they were divided into a neutral alignment group (58 cases), varus alignment group (20 cases), and valgus alignment group (9 cases). Simple linear regression was used to assess the correlation between static and dynamic alignment. One-way analysis of variance (ANOVA) was used to compare the differences in gait parameters between and within groups. Results: Eighty-seven patients were followed up for an average of six months after the operation. There was no significant difference in all gait parameters among the three groups after TKA. There was no correlation found between static alignment and dynamic alignment/knee adduction moment (KAM) after TKA, although patients showed a significant linear correlation before operation. There was a significant linear correlation between dynamic alignment and KAM before and after the operation. Conclusions: Static alignment has no significant effect on postoperative gait function. Static alignment is no longer an effective predictor of the dynamic alignment or KAM six months after TKA, although they are correlated before TKA. The dynamic alignment allows for better prediction of KAM, which may be a risk factor for the life of the prosthesis.
Collapse
|
34
|
Inui H, Yamagami R, Kono K, Kawaguchi K, Sameshima S, Kage T, Tanaka T, Taketomi S, Tanaka S. Comparison of the joint laxity of total knee arthroplasty evaluated by the distraction force and the varus-valgus force. Knee 2022; 34:98-107. [PMID: 34875500 DOI: 10.1016/j.knee.2021.10.019] [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: 03/23/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Component gap (CG) measurement help surgeons evaluate intraoperative soft-tissue balance. One technique is measuring the CG using tensioner devices with distraction force. Another is to evaluate the laxity under a varus-valgus force using navigation or robotics. The aim was to compare the JL evaluated by CG and varus-valgus force between the different types of total knee arthroplasties. METHODS Forty-three bi-cruciate stabilized (BCS) knees and 33 bi-cruciate retaining (BCR) knees were included. After bone resection and soft tissue balancing, the CG was measured and after the final implantation and capsule closure, JL under a maximum varus-valgus stress was recorded with navigation. JL evaluated by the CG (JLCG) was defined as CG minus selected thickness of the tibial component and JL under varus-valgus force (JLVV) was defined as difference between varus-valgus angles without stress and maximum varus-valgus angles under varus-valgus force. The evaluations were performed at flexions of 10°, 30°, 60° and 90°. RESULTS Although JLCGs of lateral compartment of BCS were larger than those of BCR, no difference was found between JLVVs of BCS and BCR. Although JLCGs of lateral compartment did not change at each knee flexion angle in both BCS and BCR, JLVVs of lateral compartment increased by 3° from 10° to 90° knee flexion. CONCLUSION JLVVs of BCS and BCR were equivalent, whereas BCS showed larger JLCGs of lateral compartment. JLVVs of lateral compartment increased by 3° in the range from 10° to 90° knee flexion whereas JLCGs remained stable.
Collapse
Affiliation(s)
- Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeyuki Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
35
|
Rao L, Taylor WR, Horn N, List R, Preiss S, Schütz P. Can tibio-femoral kinematic and kinetic parameters reveal poor functionality and underlying deficits after total knee replacement? A systematic review. Knee 2022; 34:62-75. [PMID: 34883331 DOI: 10.1016/j.knee.2021.11.002] [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: 02/15/2021] [Revised: 09/13/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extensive efforts have been made to understand joint kinematics and kinetics in total knee arthroplasty (TKA) in subjects with satisfactory outcomes during daily functional activities and clinical tests, but it remains unclear whether such movement characteristics hold the potential to indicate the underlying aetiology of unsatisfactory or bad TKA outcomes. PURPOSE To investigate which kinematic and kinetic parameters assessed during passive clinical tests and functional activities of daily living are associated with poor functionality and underlying deficits after total knee replacement. METHODS We focused on studies characterizing the kinematic or kinetic parameters of the knee joint that are associated with poor clinical outcome after TKA. Seventeen articles were included for the review, and kinematic and kinetic data from 719 patients with minimal follow up of 6 months were extracted and analyzed. RESULTS Passive posterior translation at 90°flexionexhibited good potential for differentiating stable and unstable TKAs. Anterior-posterior (A-P) translation of the medial condyle at 0-30° and 30-60° flexion, A-P translation of the lateral condyle at 60-90°during closed chain exercises, as well asknee extension moment during stair ascent and descent, knee abduction moment during stair descent, knee internal rotation moment and plantar flexion moment during walking, 2ndpeak ground reaction force during stair ascent and walkingshowed the greatest promise as functional biomarkers for a dissatisfied/poor outcome knee after TKA. CONCLUSION In this study, we systematically reviewed the state-of-the-art knowledge of kinematics and kinetics associated with functional deficits, and found 11 biomechanical parameters that showed promise for supportingdecision making in TKA.
Collapse
Affiliation(s)
- L Rao
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - W R Taylor
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland.
| | - N Horn
- Schulthess Clinic, Zürich, Switzerland
| | - R List
- Schulthess Clinic, Zürich, Switzerland
| | - S Preiss
- Schulthess Clinic, Zürich, Switzerland
| | - P Schütz
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| |
Collapse
|
36
|
Alessio-Mazzola M, Clemente A, Russo A, Mertens P, Burastero G, Formica M, Felli L. Clinical radiographic outcomes and survivorship of medial pivot design total knee arthroplasty: a systematic review of the literature. Arch Orthop Trauma Surg 2022; 142:3437-3448. [PMID: 34633511 PMCID: PMC9522696 DOI: 10.1007/s00402-021-04210-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 09/29/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Total knee arthroplasty is a reliable procedure able to reduce pain and disability in patients suffering from osteoarthritis. However, a considerable percentage of patients still experiences unsatisfactory results. Medial pivot total knee arthroplasty has been introduced in the clinical practice to overcome problems related with classic design implants and better mimic native knee kinematics. The aim of this study was to analyze survivorship and clinical and radiographic outcomes of medial pivot implants. METHODS A systematic research was conducted in eight different databases. Thirty-four studies met the inclusion criteria and were included in the analysis. Data on objective and patients-reported outcomes, radiographic alignment, and survivorship were collected and analyzed. Revision rate was expressed as revision per 100 components years. RESULT A total of 3377 procedures were included. Mean follow-up was 85.7 months (range, 12-182). The revision per 100 components years was 0.19, which corresponds to a revision rate of 1.9% after 10 years. Mean post-operative range of motion was 117.3 ± 0.4°. Mean clinical and functional Knee Society Score were, respectively, 85.9 ± 1.1 and 84.7 ± 3.5 at final follow-up. Post-operative femorotibial alignment was 177.1 ± 0.5°. Alfa and beta angles were 95.7 ± 0.1° and 89.2 ± 0.1°, respectively. Gamma and delta angles were 2.3 ± 0.6° and 86.7 ± 0.4°. CONCLUSION Medial pivoting implants provided excellent survivorship and low revision rate, as well as good-to-excellent results in term of objective and patient-reported clinical outcomes, and reliable correction of radiographic parameters. More high-quality studies with long-term follow-up are needed to clarify the role of medial pivoting implants.
Collapse
Affiliation(s)
- Mattia Alessio-Mazzola
- Orthopedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy.
| | - Antonio Clemente
- Orthopedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
| | - Antonio Russo
- Orthopedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
| | - Peter Mertens
- Orthopaedics and Traumatology Department, ZNA Middelheim, Antwerp, Belgium
| | - Giorgio Burastero
- Centro di Chirurgia Protesica, Istituto Ortopedico Galeazzi IRCCS, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Matteo Formica
- Orthopedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy
| | - Lamberto Felli
- Istituto Ortopedico Galeazzi IRCCS Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| |
Collapse
|
37
|
Keggi JM, Wakelin EA, Koenig JA, Lawrence JM, Randall AL, Ponder CE, DeClaire JH, Shalhoub S, Lyman S, Plaskos C. Impact of intra-operative predictive ligament balance on post-operative balance and patient outcome in TKA: a prospective multicenter study. Arch Orthop Trauma Surg 2021; 141:2165-2174. [PMID: 34255172 DOI: 10.1007/s00402-021-04043-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION New technologies exist which may assist surgeons to better predict final intra-operative joint balance. Our objectives were to compare the impact of (1) a predictive digital joint tensioning tool on intra-operative joint balance; and (2) joint balance and flexion joint laxity on patient-reported outcomes. MATERIALS AND METHODS Two-hundred Eighty patients received posterior cruciate ligament sacrificing TKA with ultra-congruent tibial inserts using a robotic-assisted navigation platform. Patients were divided into those in which a Predictive Plan with a digital joint-tensioning device was used (PP) and those in which it was not (NPP), in all cases final post-operative joint gaps were collected immediately before final implantation. Demographics and KOOS were collected pre-operatively. KOOS, complications and satisfaction were collected at 3, 6 and 12 months post-operatively. Optimal balance difference between PP and NPP was defined and compared using area-under-the-curve analysis (AUC). Outcomes were then compared according to the results from the AUC. RESULTS AUC analysis yielded a balance threshold of 1.5 mm, in which the PP group achieved a higher rate of balance throughout flexion compared to the NPP group: extension: 83 vs 52%; Midflexion: 82 vs 55%; Flexion 89 vs 68%; Flexion to Extension 80 vs 49%; p ≤ 0.003. Higher KOOS scores were observed in knees balanced within 1.5 mm across all sub-scores at various time points, however, differences did not exceed the minimum clinically important difference (MCID). Patients with > 1.5 mm flexion laxity medially or laterally had an increased likelihood of 2.2 (1.1-4.4) and 2.5 (1.3-4.8), respectively, for failing to achieve the Patient Acceptable Symptom State for KOOS Pain at 12 months. Patient satisfaction was high in both the PP and NPP groups (97.4 and 94.7%, respectively). CONCLUSIONS Use of a predictive joint tensioning tool improved the final balance in TKA. Improved outcomes were found in balanced knees; however, this improvement did not achieve the MCID, suggesting further studies may be required to define optimal balance targets. Limiting medial and lateral flexion laxity resulted in an increased likelihood of achieving the Patient Acceptable Symptom State for KOOS Pain.
Collapse
Affiliation(s)
- John M Keggi
- Connecticut Joint Replacement Institute, Hartford, CT, USA
| | | | - Jan A Koenig
- NYU Langone Hospital, Department of Orthopedic Surgery, Long Island, NY, USA
| | | | | | - Corey E Ponder
- Oklahoma Sports and Orthopedics Institute, Edmond, OK, USA
| | | | - Sami Shalhoub
- Corin USA, 480 Paramount Drive, Raynham, MA, 02767, USA
| | - Stephen Lyman
- Hospital for Special Surgery, New York, NY, USA.,Kyushu University School of Medicine, Fukuoka, Japan
| | | |
Collapse
|
38
|
Effect of medial collateral ligament release and osteophyte resection on medial laxity in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2021; 29:3418-3425. [PMID: 32876711 DOI: 10.1007/s00167-020-06257-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE The concept of medial stabilizing technique total knee arthroplasty (MST-TKA) is to minimize the medial release without the superficial layer of medial collateral ligament (MCL). However, it is unclear at what stage the proper medial laxity is obtained during surgery. The purpose of this study was to investigate the implication of deep layer of MCL (dMCL) and osteophyte resection on medial laxity during MST-TKA. METHODS A total of 103 consecutive patients who underwent cruciate-retaining TKA using the navigation system were included. The intraoperative hip-knee-ankle (HKA) angle was recorded under three conditions (no stress, valgus, and varus stress) at four time points after the resection of the anterior cruciate ligament (ACL) and meniscus (1st evaluation), after the dMCL release (2nd evaluation), and after osteophyte resection on both the femoral and tibial side (3rd evaluation). To assess valgus laxity, the differences in intraoperative HKA angle between 1st and 2nd evaluation (stage 1) and between 2nd and 3rd evaluation (stage 2) were calculated. RESULTS Under the valgus stress condition, the intraoperative HKA angle change in stage 2 was significantly larger than that in stage 1 in full extension (stage 1; - 0.5 ± 1.0°, stage 2; - 2.0 ± 1.3°, p < 0.001) and 30° flexion (stage 1; - 0.8 ± 1.4°, stage 2; - 1.5 ± 2.0°, p = 0.008). There were no significant differences at 60° and 90° of knee flexion. Under the no stress and varus stress conditions, there were no significant differences in knee flexion at all angles. CONCLUSION The medial laxity during MST-TKA increased significantly more after dMCL release and osteophyte resection than after just dMCL release at full extension and 30° flexion, and it was, therefore, considered that osteophyte resection is a key procedure for a successful MST-TKA. LEVEL OF EVIDENCE Level II, therapeutic prospective cohort study.
Collapse
|
39
|
Takagi K, Inui H, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Sameshima S, Kage T, Tanaka S. Both intraoperative medial and lateral soft tissue balances influence intraoperative rotational knee kinematics in bi-cruciate stabilized total knee arthroplasty: A retrospective investigation. BMC Musculoskelet Disord 2021; 22:830. [PMID: 34579677 PMCID: PMC8477560 DOI: 10.1186/s12891-021-04709-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/11/2021] [Indexed: 11/12/2022] Open
Abstract
Background Tibial internal rotation following total knee arthroplasty (TKA) is important in achieving favorable postoperative clinical outcomes. Studies have reported the effect of intraoperative soft tissue balance on tibial internal rotation in conventional TKA, no studies have evaluated the effects of soft tissue balance at medial or lateral compartments separately on tibial internal rotation in bi-cruciate stabilized (BCS) TKA. The purpose of this study was to clarify the relationship between medial or lateral component gaps and rotational knee kinematics in BCS TKA. Methods One hundred fifty-eight knees that underwent BCS TKA were included in this study. The intraoperative medial and lateral joint laxities which was defined as the value of component gap minus the thickness of the tibial component were firstly divided into two groups, respectively: Group M-stable (medial joint laxity, ≤ 2 mm) or Group M-loose (medial joint laxity, ≥ 3 mm) and Group L-stable (lateral joint laxity, ≤ 3 mm) or Group L-loose (lateral joint laxity, ≥ 4 mm). And finally, the knees enrolled in this study were divided into four groups based on the combination of Group M and Group L: Group A (M-stable and L-stable), Group B (M-stable and L-loose), Group C (M-loose and L-stable), and Group D (M-loose and L-loose). The intraoperative rotational knee kinematics were compared between the four Groups at 0°, 30°, 60°, and 90° flexion, respectively. Results The rotational angular difference between 0° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group A at 30° flexion (*p < 0.05). The rotational angular difference between 30° flexion and maximum flexion in Group B at 30° flexion was significantly larger than that in Group D at 30° flexion (*p < 0.05). The rotational angular differences between 30° or 90° flexion and maximum flexion in Group B at 60° flexion were significantly larger than those in Group A at 60° flexion (*p < 0.05). Conclusion Surgeons should pay attention to the importance of medial joint stability at midflexion and lateral joint laxities at midflexion and 90° flexion on a good tibial internal rotation in BCS TKA.
Collapse
Affiliation(s)
- Kentaro Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|
40
|
Rodriguez-Merchan EC. Patient Satisfaction Following Primary Total Knee Arthroplasty: Contributing Factors. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:379-386. [PMID: 34423084 DOI: 10.22038/abjs.2020.46395.2274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/14/2020] [Indexed: 11/06/2022]
Abstract
The reported dissatisfaction rate after primary total knee arthroplasty (TKA) ranges between 15% and 25%. The purpose of this article is to perform a narrative review of the literature with the aim of answering the following question: What are the main factors contributing to patient dissatisfaction after TKA? A review of the literature was performed on patient satisfaction after TKA. The search engines used were MedLine (PubMed) and the Cochrane Library. The keywords used were "TKA" and "satisfaction". The main reported preoperative factors positively contributing to patient satisfaction were the following: fulfilment of preoperative expectations, preoperative complete joint space collapse, increasing patellar and lateral compartment osteophyte size, and TKA communication checklist. The principal preoperative factors negatively contributing to patient satisfaction included female sex, comorbidities, and Hispanic race. The chief perioperative factor positively contributing to patient satisfaction was cosmetic closure, whereas the fundamental perioperative factors negatively contributing to patient satisfaction included joint laxity, anterior tibial component slope, and greater femoral component valgus angle. The principal postoperative factors positively contributing to patient satisfaction were the following: ameliorated walking distance, improved range of motion, and improvements in pain. The most important postoperative factors negatively contributing to patient satisfaction included poor postoperative knee stability and soft-tissue balance, functional limitation, surgical complication and reoperation, staff or quality of care issues, and increased stiffness.
Collapse
|
41
|
Kinetic Sensors for Ligament Balance and Kinematic Evaluation in Anatomic Bi-Cruciate Stabilized Total Knee Arthroplasty. SENSORS 2021; 21:s21165427. [PMID: 34450869 PMCID: PMC8399549 DOI: 10.3390/s21165427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 11/16/2022]
Abstract
Sensor technology was introduced to intraoperatively analyse the differential pressure between the medial and lateral compartments of the knee during primary TKA using a sensor to assess if further balancing procedures are needed to achieve a “balanced” knee. The prognostic role of epidemiological and radiological parameters was also analysed. A consecutive series of 21 patients with primary knee osteoarthritis were enrolled and programmed for TKA in our unit between 1 September 2020 and 31 March 2021. The VERASENSE Knee System (OrthoSensor Inc., Dania Beach, FL, USA) has been proposed as an instrument that quantifies the differential pressure between the compartments of the knee intraoperatively throughout the full range of motion during primary TKA, designed with a J-curve anatomical femoral design and a PS “medially congruent” polyethylene insert. Thirteen patients (61.90%) showed a “balanced” knee, and eight patients (38.10%) showed an intra-operative “unbalanced” knee and required additional procedures. A total of 13 additional balancing procedures were performed. At the end of surgical knee procedures, a quantitatively balanced knee was obtained in all patients. In addition, a correlation was found between the compartment pressure of phase I and phase II at 10° of flexion and higher absolute pressures were found in the medial compartment than in the lateral compartment in each ROM degree investigated. Moreover, those pressure values showed a trend to decrease with the increase in flexion degrees in both compartments. The “Kinetic Tracking” function displays the knee’s dynamic motion through the full ROM to evaluate joint kinetics. The obtained kinetic traces reproduced the knee’s medial pivot and femoral rollback, mimicking natural knee biomechanics. Moreover, we reported a statistically significant correlation between the need for soft tissue or bone resection rebalancing and severity of the initial coronal deformity (>10°) and a preoperative JLCA value >2°. The use of quantitative sensor-guided pressure evaluation during TKA leads to a more reproducible “balanced” knee. The surgeon, evaluating radiological parameters before surgery, may anticipate difficulties in knee balance and require those devices to achieve the desired result objectively.
Collapse
|
42
|
Kuriyama S, Hamamoto Y, Arai R, Nakamura S, Nishitani K, Ito H, Matsuda S. Anatomical evaluation of the femoral attachment of the posterior oblique ligament. Arch Orthop Trauma Surg 2021; 141:1035-1041. [PMID: 33417017 DOI: 10.1007/s00402-020-03728-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Tibiofemoral joint instability reduces patient satisfaction after total knee arthroplasty (TKA). However, surgeons sometimes encounter excessive medial joint laxity without medial over-release on the tibial side. It was hypothesized that over-resection of the posteromedial femoral condyle can injure the medial stabilizers, especially the posterior oblique ligament (POL) at its femoral attachments. MATERIALS AND METHODS Thirteen fixed cadaveric knees were exposed, and 3 anatomical points were identified: the posterior edge and midpoint of the POL femoral attachment, and the posterior edge of the superficial medial collateral ligament (sMCL) femoral attachment. The distance from the surface of the posteromedial femoral condyle to each point was measured. Correlations between each point and the anterior-posterior or medial-lateral dimensions of the distal femur were also calculated. RESULTS The average distances to the posterior edge and midpoint of the POL femoral attachment and the posterior edge of the sMCL femoral attachment were 13.7 mm (9.0-18.4), 17.9 mm (11.5-22.6), and 22.7 mm (14.7-29.4), respectively. There were moderate correlations between the distance to each point and the anterior-posterior or medial-lateral dimensions of the distal femur. CONCLUSIONS The minimal distance from the surface of the posteromedial condyle to the POL posterior edge was 9.0 mm. Over-resection of the posteromedial femoral condyle, even with a general TKA femoral component, might injure the POL at its femoral attachments, especially in patients with small distal femurs, while the sMCL is rarely damaged. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yosuke Hamamoto
- Department of Orthopaedic Surgery, Hamamoto Orthopaedic Clinic, 45-5 Johoku, Aoi-ku, Shizuoka, 420-0805, Japan
| | - Ryuzo Arai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
43
|
Liu J, Yang Y, Wan S, Yao Z, Zhang Y, Zhang Y, Shi P, Zhang C. A new prediction model for patient satisfaction after total knee arthroplasty and the roles of different scoring systems: a retrospective cohort study. J Orthop Surg Res 2021; 16:329. [PMID: 34016153 PMCID: PMC8136158 DOI: 10.1186/s13018-021-02469-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although total knee arthroplasty (TKA) is an efficacious treatment for end-stage osteoarthritis, ~20% of patients are dissatisfied with the results. We determined which factors contribute to patient satisfaction and compared the various scoring systems before and after surgery. METHODS In this retrospective cohort study, 545 patients were enrolled and evaluated preoperatively and 1 year postoperatively. Patient demographics, as well as scores for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF)-12, and 1989 Knee Society Clinical Rating System (1989 KSS), were recorded preoperatively and postoperatively. The possible predictors were introduced into a prediction model. Scores for overall satisfaction and the 2011 Knee Society Score (2011 KSS) were also assessed after TKA to identify the accuracy and agreement of the systems. RESULTS There were 134 male patients and 411 female patients, with an overall prevalence of satisfaction of 83.7% 1 year after surgery. A history of surgery (p < 0.001) and the 1989 KSS and SF-12 were of the utmost importance in the prediction model, whereas the WOMAC score had a vital role postoperatively (change in WOMAC pain score, p < 0.001; change in WOMAC physical function score, p < 0.001; postoperative WOMAC pain score, p = 0.004). C-index of model was 0.898 > 0.70 (95% confidence interval (CI): 0.86-0.94). The Hosmer-Lemeshow test showed a p value of 0.586, and the AUC of external cohort was 0.953 (sensitivity=0.87, specificity=0.97). The agreement between the assessment of overall satisfaction and the 2011 KSS satisfaction assessment was general (Kappa=0.437 > 0.4, p < 0.001). CONCLUSION A history of surgery, the preoperative 1989 KSS, and the preoperative SF-12 influenced patient satisfaction after primary TKA. We recommend the WOMAC (particularly the pain subscale score) to reflect overall patient satisfaction postoperatively.
Collapse
Affiliation(s)
- Jinyu Liu
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yi Yang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shengcheng Wan
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhenjun Yao
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ying Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yueqi Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Peng Shi
- Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Chi Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
Threshold values for stress radiographs in unstable knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2021; 29:422-428. [PMID: 32236677 DOI: 10.1007/s00167-020-05964-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/23/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The primary aim of this study was to investigate the potential benefit of stress radiographs for diagnosis of unstable total knee arthroplasty (TKA) and to identify clinically relevant cut-off values to differentiate between unstable and stable TKAs. METHODS Data of 40 patients with 49 cruciate retaining (CR) TKA who underwent stress radiographs as part of the diagnostic algorithm in a painful knee clinic were prospectively collected. Anterior and posterior stress radiographs were done in 90° and 15° flexion, varus-valgus stress radiographs in 0° and 30° knee flexion. Knee laxity was measured in mm and degrees by two independent observers using standardized landmarks. Intra- and inter-observer single measure intraclass correlations were between 0.92 to 1 and 0.89 to 1, respectively. For evaluation and investigation of the potential cut-off values, two groups of patients with and without revision surgery due to instability were compared. Radiographic measures of standardized z values according to the group without revision due to instability were used to calculate average and maximum laxity z-scores. RESULTS Knees undergoing revision TKA due to instability showed significantly (p < 0.001) lower (KSS) pain/function scores (94 ± 6.3, range 80-100; control group: 112 ± 19.2, range 80-148) and total KSS scores when compared to the control group. The laxity values of patients with instability were significantly higher in terms of mean values (p < 0.01) when compared to the control group. The maximum laxity z-score showed the strongest difference between the groups (R2 = 0.26, p < 0.001). The following cut-off values indicating need of revision due to instability were established: in 90° (15°) flexion-anterior translation 5.2 mm (22.4 mm), posterior translation 16.6 mm (13.2 mm); varus stress in 0° (20°-30°) flexion-inlay gap 5.2 mm (6.1 mm) or joint angle 6.1° (6.8°); valgus stress in 0° (20°-30°) flexion-inlay gap 4.6 mm (5.7 mm) or joint angle 5.2° (7.1°). CONCLUSION Standardized stress radiographs are helpful tools for diagnosis of instability after TKA. The established cut-off values help to guide decision making in this challenging group of patients. However, laxity values should not be considered as the only criteria for diagnosis of unstable TKA. LEVEL OF EVIDENCE IV.
Collapse
|
46
|
Posterior stabilized total knee arthroplasty reproduces natural joint laxity compared to normal in kinematically aligned total knee arthroplasty: a matched pair cadaveric study. Arch Orthop Trauma Surg 2021; 141:119-127. [PMID: 33040208 DOI: 10.1007/s00402-020-03624-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE As the goal of kinematic aligned (KA) total knee arthroplasty (TKA) is to preserve soft tissue tension to the native knee, many KA surgeons recommend cruciate-retaining (CR) prosthesis. However, how a posterior-stabilizing (PS) prosthesis affects the biomechanics of a KA TKA remains unclear. This cadaveric study tested the hypothesis that a PS prosthesis in KA TKA would produce biomechanics similar to CR prosthesis and KA TKA with a PS prosthesis would produce more native knee biomechanics than mechanical aligned (MA) TKA with PA prosthesis. METHODS Fourteen cadaver knees (7 pairs) were mounted on a knee-testing system to measure knee motion during flexion. For each pair, 1 knee was assigned to KA TKA and the other to MA TKA. In the KA TKA group, the native knee, CR TKA, and PS TKA were tested sequentially. MA TKA was performed using conventional measured resection techniques with a PS prosthesis. All kinematics were measured and compared with the native knee before and after surgery. RESULTS A PS prosthesis restored femoral rollback similar to a CR prosthesis. CR TKA showed less lateral rollback at knee flexion ≤ 60° than the native knee. There were no differences in soft tissue tensions among the native knee, CR, and PS prosthesis, except in varus tension at 30° of flexion. Varus tension of CR TKA was larger than those of PS TKA and the native knee after KA TKA with < 1 degree difference. Meanwhile, KA TKA achieved knee motion that was closer to the native knee than did MA TKA at ≥ 60° of flexion when using a PS prosthesis. There were no differences in soft tissue tension between KA-PS and MA-PS TKA. CONCLUSIONS After KA TKA, a PS prosthesis affords similar femoral rollback and soft tissue tension when compared with a CR prosthesis. A PS TKA may be a feasible strategy for patients requiring a PS prosthesis when performing KA TKA. LEVEL OF EVIDENCE Therapeutic Laboratory study, I.
Collapse
|
47
|
Hsu CE, Huang JT, Tong KM, Huang KC. Total knee arthroplasty according to the original knee phenotypes with kinematic alignment surgical technique-early clinical and functional outcomes. BMC Musculoskelet Disord 2020; 21:839. [PMID: 33308196 PMCID: PMC7731459 DOI: 10.1186/s12891-020-03862-6] [Citation(s) in RCA: 13] [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: 09/01/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background The kinematic alignment (KA) technique in total knee arthroplasty (TKA) aims to restore the native alignment of pre-disease knee joint anatomy. Determining the individualized alignment targets is crucial for pre-operative planning, which can be set according to different original knee phenotypes. Five most common knee phenotypes have been categorized for KA-TKA alignment target setting in our previous study. The purpose of this study was to investigate the distribution of the five phenotypes in advanced OA knee patients and evaluate the clinical outcomes of this phenotype-oriented KA-TKA using the generic instrument, with particular emphasis on alignment strategy, surgical technique, survivorship, radiographic and functional outcomes. Methods The clinical data of 123 patients (88 women, 35 men) who had undergone 140 TKAs in our hospital were reviewed. All the TKAs were performed with alignment targets set according to the original phenotypes of the knee, with the KA method, using the generic total knee instrument. The patients’ demographics, preoperative and postoperative knee alignment angles, one-year postoperative range of motion (ROM), Oxford knee scores (OKS), Combined knee society score (CKSS) were collected and analyzed. Results The 3 years survivorship was 99.3% for all cause of revision, and 100% with revision other than infection as the endpoint. The preoperative phenotypes of the knee were as follows: neutral alignment 20.1% (type 1: 3.6%, type 2: 16.5%), varus alignment 71.2% (type 3: 46.0%, type 4: 25.2%), and valgus alignment (type 5: 8.6%). Using our protocol, patients with different knee phenotypes could get similar great functional improvement though the postoperative alignment parameters were significantly different between the knee phenotypes (P < 0.05). Conclusion The early outcomes of this phenotype-oriented KA-TKA using generic total knee instruments are promising. Setting individualized alignment target according to original knee phenotype is rational and practical. The residual varus alignment did not cause any aseptic loosening in the 3 years follow-up. Long-term survivorship and functional outcomes need to be evaluated in future studies.
Collapse
Affiliation(s)
- Cheng-En Hsu
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan.,Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Ting Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kwok-Man Tong
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kui-Chou Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan. .,Department of Occupational Therapy, Asia University, Taichung, Taiwan.
| |
Collapse
|
48
|
Stramazzo L, Bassi N, Ghirardelli S, Amoroso T, Osti L, Indelli PF. Posterior stability in posterior-stabilized vs medially congruent total knee replacement: A radiological comparison of two polyethylene designs in a single model. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720978988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The purpose of this radiological study was to assess the posterior laxity of a single model of a total knee arthroplasty design (TKA) having a medially constrained (MC) or a Posterior-Stabilized (PS) polyethylene insert using a well-documented stress x-ray. To the authors knowledge, this is the first report evaluating MC TKA outcomes according to the “kneeling view.” Materials and Methods: Sixty patients with non-traumatic primary knee osteoarthritis undergoing TKA were first matched by age, sex, BMI and diagnosis and then divided in two groups: group A (37 knees) received a MC TKA and group B (23 knees) a PS implant made by the same manufacturer. In all cases the posterior cruciate ligament (PCL) was resected. All patients underwent the same postoperative “kneeling view” and were also clinically evaluated according to the Knee Society Score (KSS) and Oxford Knee Score (OKS). Radiographic measurements were taken by tracing a line along the posterior cortex of the tibia and then measuring the perpendicular distance to a point marked at the posterior corner of Blumensaat’s line. Results: At 12 months minimum FU, no statistically significant differences were found between the two groups in all the clinical scores. There was a statistically significant difference on kneeling view values between the two groups (P = 0.0002): the mean value in the MC group was −1.97 ± 3.8 mm while was −5.6 ± 3.1 mm in the PS group. In both groups, the average position of the posterior cortex of the tibia was anterior to the posterior corner of Blumensaat’s line, showing absence of instability in flexion. Conclusion: This study highlighted that the PCL removal, accompanied by a precise surgical technique, did not increase the instability in flexion in two groups of patients having the same TKA design but polyethylene inserts characterized by different levels of constraint.
Collapse
Affiliation(s)
| | - Nicolo’ Bassi
- Universita degli Studi di Palermo, Palermo, Sicilia, Italy
| | | | | | - Leonardo Osti
- Universita degli Studi di Palermo, Palermo, Sicilia, Italy
| | | |
Collapse
|
49
|
Seki K, Seki T, Ogasa H, Imagama T, Matsuki Y, Yamazaki K, Sakai T. Investigation of the effect of intraoperative mediolateral stability on postoperative sagittal stability after bi-cruciate stabilized total knee arthroplasty. J Orthop 2020; 22:454-457. [PMID: 33093754 DOI: 10.1016/j.jor.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/28/2020] [Accepted: 10/04/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose This study investigated the effect of mediolateral stability on sagittal stability in bi-cruciate stabilized total knee arthroplasty. Method This study included 59 patients. We intraoperatively assessed the component gap with a joint distraction force of 60 N for each compartment. Immediately after surgery, sagittal stability was assessed using an arthrometer. Result The intraoperative medial joint laxity at 30° of flexion was significantly correlated with postoperative anteroposterior translation (r = 0.276, p < 0.05). Conclusion This study demonstrated the effect of intraoperative mediolateral stability effect on postoperative sagittal stability. Improving medial stability may enhance postoperative sagittal stability.
Collapse
Affiliation(s)
- Kazushige Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshihiro Seki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroyoshi Ogasa
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yuta Matsuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| |
Collapse
|
50
|
Small soft tissue tension changes do not affect patient-reported outcomes one year after primary TKA. INTERNATIONAL ORTHOPAEDICS 2020; 45:139-145. [PMID: 33040158 DOI: 10.1007/s00264-020-04839-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adequate soft tissue tension and balance is paramount to achieve favourable outcomes of total knee arthroplasty (TKA). Implant manufacturers offer 1-mm liner increments to fine-tune ligament tension and balance. In this study, we assessed if soft tissue tension changes introduced by minimal changes in liner thicknesses affect early patient reported outcomes. METHODS Eighty-nine patients undergoing 99 primary, elective TKAs by a single surgeon were included. After achieving adequate ligament balance, the first 50 knees received an insert that would allow 2-3 mm of medial and lateral opening (control group), whereas the last 49 received an insert which was 1 mm thicker, resulting in a slight increase in ligament tension (study group). Sensor technology was used to record compartmental loads. Knee Society Score (KSS), KOOS Jr., and ROM were recorded pre-operatively, six weeks, four and 12 months post-operatively. The Forgotten Joint Score (FJS) was administered four and 12 months post-operatively. RESULTS No differences were observed in demographic variables, pre-operative outcome scores, and ROM measures between groups. Six weeks post-operatively, there was no statistically significant difference in the outcome variables. Four months post-operatively, statistically significant differences were only observed in KOOS Jr. (79 and 73.6; p = 0.05), and FJS (59.9 and 45.5; p < 0.01); all of which favoured the control group. There was no difference in the outcome variables at 12 months. CONCLUSION Minor changes in soft tissue tension induced by 1-mm changes in liner thickness resulted in clinically meaningful differences favouring the control group four months post-operatively, but in no clinically noticeable differences 12 months post-operatively. It is possible that lower soft tissue tension may lead to transient improvement in patient-reported early outcomes.
Collapse
|