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Watanabe S, Akagi R, Shiko Y, Ono Y, Kawasaki Y, Ohdera T, Ohtori S, Sasho T. Intra- and inter-observer reliability of implant positioning evaluation on a CT-based three-dimensional postoperative matching system for total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:363. [PMID: 33865360 PMCID: PMC8053298 DOI: 10.1186/s12891-021-04228-2] [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: 11/02/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The evaluation of postoperative total knee arthroplasty (TKA) alignment mainly relies on measurement data obtained from plain radiographs. The aim of this retrospective observational study was to document the intra- and inter-observer reliability in assessment of TKA component positioning after surgery using a three-dimensional (3D) computed tomography (CT) image matching system. Methods Fourteen knees from 14 patients who received primary TKA were included, and images were analyzed by blinded readers not associated with the surgeries. The examiner digitized the reference points according to defined landmarks, and the designated size component was superimposed to the 3D reconstructed CT model for measurement. In addition to the evaluation of implant position against the coronal and sagittal lower limb mechanical axes that were defined based on bony landmarks, implant position against axes connecting implant-based reference points that are easier to indicate was evaluated. Results The overall intra- and inter-observer reliabilities determined by the intraclass correlation coefficients (ICC) of the implant alignment measurement for both femoral and tibial components were good (ICC > 0.60), except in the direction of femoral flexion and extension, for both mechanical and implant-based axes. The difference between implant alignment measurements according to the traditional mechanical axis and the implant-based axis ranged between means of 0.08o and 1.70o and were statistically significantly different. Conclusions The postoperative evaluation of implant position in the coronal and sagittal planes using 3D-CT image matching is reliable and has good reproducibility except for the sagittal alignment assessment of the femoral component. The measured implant position according to the traditional mechanical axis and the implant-based axis were slightly but significantly different.
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Affiliation(s)
- Shotaro Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.,Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Yoshimasa Ono
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Toshihiro Ohdera
- Fukuoka Orthopaedic Hospital, 2-10-50 Yanagouchi, Minami-ward, Fukuoka-city, Fukuoka, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.,Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
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Jin QH, Lee WG, Song EK, Kim WJ, Jin C, Seon JK. No difference in the anteroposterior stability between the GRADIUS and multi-radius designs in total knee arthroplasty. Knee 2020; 27:1197-1204. [PMID: 32711882 DOI: 10.1016/j.knee.2020.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/22/2020] [Accepted: 05/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This retrospective study aimed to compare stability and clinical and radiological outcomes of total knee arthroplasty (TKA) for the GRADIUS and multi-radius femoral designs after minimum of two-year follow-up. METHODS A total of 142 patients who underwent TKA using ATTUNE posterior stabilized (PS) implants (68 patients, GRADIUS group) or Persona PS implants (74 patients, multi-radius group) for degenerative osteoarthritis were included. After an average of 2-year follow-up, the anteroposterior (AP) stability at 30°, 60°, and 90° was measured using KT 2000 device and compared between the two groups. The clinical outcome measurements included range of motion (ROM) of the knee, patient-reported outcomes and anterior knee pain (AKP). For the clinical evaluation of mid-flexion instability, pain was evaluated using the visual analog scale (VAS) score recorded during climbing up or going down stairs. The radiolucent lines on knee radiographs obtained at final follow-up were evaluated and compared between two groups. RESULTS The average AP stability at 30° knee flexion was 5.7 mm in the GRADIUS group and 5.9 mm in the multi-radius group; however, the difference was not significant. The AP stability at 60° and 90° knee flexion was also similar in both groups. There were no significant differences in the ROM, patient-reported outcomes at follow-up, incidence of AKP and VAS scores between the two groups. There were no differences in the incidence of radiolucency around the components between the two groups. CONCLUSION The GRADIUS design did not show any advantage with respect to the stability or clinical outcomes compared with the multi-radius design in TKA.
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Affiliation(s)
- Quan He Jin
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Won-Gyun Lee
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Eun-Kyoo Song
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Woo-Jong Kim
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Cheng Jin
- Department of Orthopaedic Surgery, Zhoushan Hospital, Zhoushan, Zhejiang, China
| | - Jong-Keun Seon
- Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea.
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No reduced patellar loading with latest-generation cruciate-retaining total knee arthroplasty-a comparative study of Attune and Press-Fit Condylar®. INTERNATIONAL ORTHOPAEDICS 2020; 45:1205-1213. [PMID: 32676779 PMCID: PMC8102291 DOI: 10.1007/s00264-020-04717-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/07/2020] [Indexed: 11/02/2022]
Abstract
PURPOSE To investigate if the latest-generation cruciate-retaining total knee arthroplasty (CR-TKA) systems through more patella-friendly femoral trochlea reduce the patellar bone loading. METHODS Twenty patients who underwent Attune CR-TKA were matched with twenty-one patients who underwent Press-Fit Condylar® (PFC) CR-TKA. The patella was always preserved. The in vivo patellar loading was measured twice by two blinded observers and localised on an 8-quadrant grid on 1-year post-operatively SPECT/CT images. The position of the TKA components, patella height, thickness, tilt, and tibial tuberosity-trochlear groove index were measured in 3D CT. Knee function was assessed pre-operatively, at 12 and 24 months post-operatively with the knee society score (KSS). All data were compared between groups with the Mann-Whitney U test and within groups with Spearman's correlation. RESULTS A significantly higher bone tracer uptake (BTU) was seen in the Attune group in the lateral non-articular patellar quadrants. No other significant differences of the BTU were seen. The post-operative KSS did not differ significantly. Spearman's correlation showed no correlations between the significantly higher BTU of the lateral non-articular patellar quadrants and the position of the TKA and patellar measurements. All patellar measurements did not correlate with bone stress in SPECT/CT. CONCLUSION No significant improvement in terms of in vivo patellar bone stress was seen with the latest-generation CR-TKA system. The increased bone stress at the non-articular lateral patellar quadrants of the Attune could be due to higher stabilising quadriceps forces.
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Ammann N, Schiapparelli FF, Moser LB, Rasch H, Amsler F, Hirschmann MT. Good correlation between bone tracer uptake in SPECT/CT and intraoperative findings of chondral lesions graded with the ICRS scoring. J Orthop Res 2019; 37:522-528. [PMID: 30378184 DOI: 10.1002/jor.24171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/15/2018] [Indexed: 02/04/2023]
Abstract
The question if bone tracer uptake in SPECT/CT reflects the intraoperative cartilage status of the knee is still unanswered. In this study, thirty-three consecutive patients (male:female = 11:22; mean age ± standard deviation 61 ± 15) with bi- or tri-compartmental knee osteoarthritis who underwent SPECT/CT before total knee arthroplasty (TKA) were collected. The knee was graded in eleven different anatomical regions. In each region, the maximal relative bone tracer uptake (mrBTU) was measured twice by two observers with a six weeks interval. The intraclass correlation coefficients (ICC) showed excellent correlations and mean values were used. Intraoperatively every region was assessed with the macroscopic International Cartilage Repair Society (ICRS) scoring. A factorial analysis and a non-parametrical Spearman's correlation were calculated among the 11 knee regions on both mrBTU and ICRS scores and significant correlations were seen between regions belonging to the same knee compartment (p < 0.05). A non-parametrical Spearman's correlation was also performed to investigate the correlation between rmBTU in SPECT/CT and intraoperative ICRS cartilage grading. Significant correlations were seen on the medial compartment, on the proximal femoral trochlea and on the medial patellar facet (p < 0.05). A significant correlation between SPECT/CT and intraoperative findings was so demonstrated in several regions. The low accuracy of the macroscopic ICRS scoring system on grade I-II lesions could have affected the missing correlations on the lateral compartment since the selected presented mainly a varus gonarthrosis. The use of an objective measure as the rmBTU could overcome the limit of the subjectivity of MRI findings in early osteoarthritis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:522-528, 2019.
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Affiliation(s)
- Nora Ammann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - Filippo-Franco Schiapparelli
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, CH-4101 Bruderholz, Switzerland
| | | | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
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