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Pitsaer E, Chergui S, Lavoie F. Long-term results of a rotationally unconstrained fixed-bearing total knee prosthesis. INTERNATIONAL ORTHOPAEDICS 2024; 48:965-970. [PMID: 38308765 DOI: 10.1007/s00264-024-06097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Introduced in the market in 1990 by Ceraver (France), the posterior-stabilised (PS) Hermes prosthesis has limited literature regarding long-term survivability. The purpose of the study is to evaluate the survival and functional outcomes of the prosthesis. METHODS A retrospective case series was performed including 164 patients (176 knees) having undergone total knee arthroplasty with the Hermes prosthesis between 1997 and 2000 with a follow-up period of 18 years. RESULTS Kaplan-Meier analysis showed a survival rate of 99.4% (95% CI. 96.0-100.0%) at 18.4 years with one revision. At final follow-up, the International Knee Society (IKS) functional score was 93.2 ± 15.6 and IKS knee score was 99.1 ± 2.5. CONCLUSION The Hermes PS model is a low conformity prosthesis that offers reliable durability that is comparable to other popular designs while minimizing rotational constraints and having an approachable learning curve for new users.
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Affiliation(s)
- E Pitsaer
- Division of Orthopaedic Surgery, Denain Hospital Center, 25 Bis Avenue Jean Jaurès, 59220, Denain, France
| | - S Chergui
- Division of Orthopaedic Surgery, McGill University Health Center, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada.
| | - F Lavoie
- Division of Orthopaedic Surgery, University of Montreal Health Center, 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
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Lee SS, Chang MJ, Cho JH, Oh J, Moon YW. No differences in long-term clinical outcomes and survival rate of navigation-assisted versus conventional primary mobile-bearing total knee arthroplasty: A minimum 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2024; 32:445-453. [PMID: 38270291 DOI: 10.1002/ksa.12060] [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: 11/22/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE This study aimed to compare long-term clinical and radiographic outcomes and survival rates between navigation-assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA using a mobile-bearing insert. METHODS From May 2008 to December 2009, 45 and 63 mobile-bearing TKA patients were enroled in the CON- and NAV-TKA groups with 146.8 months follow-up, respectively. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (hip-knee-ankle [HKA], lateral distal femoral, medial proximal tibial, γ, and δ angles), and survivorship were compared between both groups. RESULTS The number of HKA angle outliers (more than 3 degrees or less than -3 degree) was significantly lower in the NAV-TKA group (24.4% vs. 9.5%, p = 0.036) than in the CON-TKA group. However, long-term clinical outcomes were similar between both groups. The cumulative survival rate (best-case scenario) was 98.3% in the CON-TKA group and 97.5% in the NAV-TKA group, with no significant difference between the groups (p = 0.883). CONCLUSION Long-term clinical outcomes and survival rates were similar between the two groups despite fewer outliers of postoperative lower-limb alignment in the NAV-TKA group. Excellent survival rates were observed in both groups using mobile-bearing inserts. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Ho Cho
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, South Korea
| | - Juyong Oh
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Lefèvre M, Cavailhès J, Ferri C, Sirveaux F, Roche O, Galois L. CORIN KneeTec DeepDishTM: Functional outcomes after a follow-up of 12 months and comparison with the STRYKER Triathlon PS. Acta Orthop Belg 2022; 88:61-71. [PMID: 35512156 DOI: 10.52628/88.1.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Several competing concepts of anteroposterior stabilization have been developed for total knee arthroplasty (TKA), with an overall great success despite some differences in terms of clinical or radiological outcomes. The CORIN KneeTec DeepDish TM is a novel mobile-bearing implant, stabilized with an ultra-congruent deep-dish poly- ethylene insert. The aim of the present study was to report clinical and radiological outcomes of a series of patients who received the KneeTec DeepDish TM after a follow-up of 12 months, and to compare them to those of a comparable series of patients who received the STRYKER Triathlon ® posterior- stabilized. This was a retrospective comparative cohort study (level of evidence III). Demographic data, radiographic data and range of motion (ROM), as well the International Knee Society score and Oxford Knee Score were collected pre-operatively, and after a follow-up of 12 months. 106 KneeTec DeepDish TM and 80 Triathlon ® PS were evaluated at follow-up. Patients who received the KneeTec DeepDish TM had significant improvement in ROM, radiographic and clinical outcomes. There were no significant differences between the cohorts in terms of ROM, radiographic and clinical outcomes, as well as antero-posterior stability. This study is the first to report the 12-month outcomes of the CORIN KneeTec DeepDish TM. The novel KneeTec DeepDish TM achieved comparable ROM, radiographic and clinical outcomes to the Triathlon ® PS after 12 months. Further studies will be necessary to evaluate the mid- to long-term outcomes of the KneeTec DeepDish TM .
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Jenny JY, Bercovy M, Cazenave A, Gaillard T, Châtain F, Jolles BE, Rouvillain JL, Saragaglia D. No difference in 13-year survival after medial pivot or central pivot mobile bearing total knee arthroplasty. A propensity matched comparative analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3648-3653. [PMID: 33165636 DOI: 10.1007/s00167-020-06355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study was designed to evaluate the long-term results (more than 10 years) of mobile bearing total knee arthroplasty (TKA) and to compare the survival of medial pivot axis (MPA) and central pivot axis (CPA) TKAs. The primary hypothesis was that the 10- to 15-year survival rate of MPA TKAs will be better than CPA TKAs. METHODS A national, multicenter, retrospective study was performed in France. In this case-control design, 1154 TKAs were paired into the CPA group (control group: 577 cases) and MPA group (study group: 577 cases) based on a logistic regression analysis of age, gender, body mass index and severity of the coronal deformity, defining the propensity score for each case. Final survival information follow-up was obtained for 946 cases (82%). RESULTS There was no significant difference between the control and study groups for any baseline data. Twenty-two prosthetic revisions (2%) were performed for mechanical reasons during the follow-up period. There was no significant difference between the 13-year survival rates of CPA (98%) and MPA (97%) TKAs. There was no significant difference between groups in their final Oxford and Knee Society scores. CONCLUSION Our findings do not support the assumption that medialization of the pivot axis of a mobile bearing TKA improves clinical results or survival. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jean-Yves Jenny
- University Hospital Strasbourg, CCOM, 10 avenue Baumann, 67400, Illkirch, France.
| | - Michel Bercovy
- Clinique Arago, 187A Rue Raymond Losserand, 75014, Paris, France
| | - Alain Cazenave
- Institut CALOT, Department of Orthopedic Surgery, 52 rue du Dr Calot, 62600, Berck-sur-Mer, France
| | - Thierry Gaillard
- Polyclinique du Beaujolais, 120 Ancienne Route de Beaujeu, 69400, Arnas, France
| | - Frédéric Châtain
- Pole Santé Axone, 75 Avenue Gabriel Péri, 38400, Saint-Martin-d'Hères, France
| | - Brigitt E Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Avenue Louis-Ruchonnet 57, 1003, Lausanne, Switzerland.,Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, 1015, Lausanne, Switzerland
| | - Jean-Louis Rouvillain
- Department of Orthopaedic and Trauma Surgery, Hôpital Zobda Quitman, 97261, Fort-de-France, France
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, 38130, Echirolles, France
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Lee DY, Park YJ, Hwang SC, Park JS, Kang DG. No differences in mid- to long-term outcomes of computer-assisted navigation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:3183-3192. [PMID: 31784782 DOI: 10.1007/s00167-019-05808-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Accurate implant position in total knee arthroplasty (TKA) can potentially lead to better long-term functional outcomes and implant survival. Recent studies on whether better clinical results could be obtained from computer-navigated or conventional TKA were inconclusive. In addition, recent reviews only included short-term follow-up studies without performing quantitative mid- to long-term follow-up analysis. Thus, the purpose of the present study was to perform a meta-analysis comparing mid- to long-term clinical outcomes (such as knee scoring and functional results) and radiological outcomes (such as normal alignment of the limb axis or component) between computer-navigated TKA and conventional TKA to determine which method of TKA could obtain better clinical and radiological results. METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and SCOPUS electronic databases were searched for relevant articles published through August 2018 that compared outcomes of computer-navigated TKA and conventional TKA. Data search, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. Clinical and radiological outcomes of both techniques were evaluated using various outcome measures. RESULTS Seven randomized controlled trials were included. Based on Knee Society Scores, the Western Ontario and McMaster Universities Osteoarthritis Index, pain, and range of motion, there were no significant differences in clinical outcomes between the two techniques. Based on outliers from the normal axis, outliers of femoral components in the coronal plane, and outliers of tibial components in the coronal plane, radiologic outcomes showed no significant differences between the two techniques either. CONCLUSIONS The present study revealed that there were no significant differences in clinical or radiological outcomes between computer-navigated TKA and conventional TKA. It remains unclear which TKA technique yields better results in terms of mid- to long-term clinical and radiological outcomes. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Young-Jin Park
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin-Sung Park
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dong-Geun Kang
- Department of Orthopaedic Surgery and Institute of Health Science, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Samjeongja-ro 11, Seongsan-gu, Changwon, 51472, Republic of Korea.
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Jenny JY, Saragaglia D, Bercovy M, Cazenave A, Gaillard T, Châtain F, Jolles B, Rouvillain JL. Inconsistent relationship between body weight/body mass index prior to total knee arthroplasty and the 12-year survival. Knee 2019; 26:1372-1378. [PMID: 31635946 DOI: 10.1016/j.knee.2019.08.013] [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: 06/21/2019] [Revised: 08/06/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The primary hypothesis was that body weight (BW) and body mass index (BMI) significantly impact the long-term survival rate after implantation of a mobile bearing total knee arthroplasty (TKA). METHODS A national, multicentric, retrospective study was performed in France. A total of 1604 TKAs were included. The 10-year follow-up was documented, and the influence of BW and BMI on the survival rate was assessed. RESULTS There was a significant influence of the BW on the 12-year survival rate for any reason and for infection; but this influence was not proportional to the BW or BMI. There was no significant influence of the BMI on the 12-year survival rate for any reason, for any mechanical reason or for infection. CONCLUSION Our results suggest that a higher BMI should not be considered as a risk factor for revision for mechanical purpose if a mobile bearing TKA with confirming design is implanted.
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Affiliation(s)
- Jean-Yves Jenny
- University Hospital Strasbourg, Pôle Locomax, 1 Avenue Molière, Strasbourg, France.
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, Echirolles, France
| | - Michel Bercovy
- Clinique Arago, 187A Rue Raymond Losserand, Paris, France
| | - Alain Cazenave
- Institut CALOT, Department of Orthopedic Surgery, 52 rue du Dr Calot, Berck-sur-Mer, France
| | - Thierry Gaillard
- Polyclinique du Beaujolais, 120 Ancienne Route de Beaujeu, Arnas, France
| | - Frédéric Châtain
- Pole Santé Axone, 75 Avenue Gabriel Péri, Saint-Martin-d'Hères, France
| | - Brigitte Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Avenue Louis-Ruchonnet 57, Lausanne, Switzerland; Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, Lausanne, Switzerland
| | - Jean-Louis Rouvillain
- Department of Orthopaedic and Trauma Surgery, Hôpital Zobda Quitman, Fort-de-France, France
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Sappey-Marinier E, White N, Gaillard R, Cheze L, Servien E, Neyret P, Lustig S. Increased valgus laxity in flexion with greater tibial resection depth following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1450-1455. [PMID: 29846753 DOI: 10.1007/s00167-018-4988-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/15/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Soft tissue balancing is of central importance to outcome following total knee arthroplasty (TKA). However, there are lack of data analysing the effect of tibial bone cut thickness on valgus laxity. A cadaveric study was undertaken to assess the biomechanical consequences of tibial resection depth on through range knee joint valgus stability. We aimed to establish a maximum tibial resection depth, beyond which medial collateral ligament balancing becomes challenging, and a constrained implant should be considered. METHODS Eleven cadaveric specimens were included for analysis. The biomechanical effects of increasing tibial resection were studied, with bone cuts made at 6, 10, 14, 18 and 24 mm from the lateral tibial articular surface. A computer navigation system was used to perform the tibial resection and to measure the valgus laxity resulting from a torque of 10 Nm. Measurements were taken in four knee positions: 0° or extension, 30°, 60° and 90° of flexion. Intra-observer reliability was assessed. A minimum sample size of eight cadavers was necessary. Statistical analysis was performed using a nonparametric Spearman's ranking correlation matrix at the different stages: in extension, at 30°, 60° and 90° of knee flexion. Significance was set at p < 0.05. RESULTS There was no macroscopic injury to the dMCL or sMCL in any of the specimens during tibial resection. There was no significant correlation found between the degree of valgus laxity and the thickness of the tibial cut with the knee in extension. There was a statistically significant correlation between valgus laxity and the thickness of the tibial cut in all other knee flexion positions: 30° (p < 0.0001), 60° (p < 0.001) and 90° (p < 0.0001). We identified greater than 5° of valgus laxity, at 90° of knee flexion, after a tibial resection of 14 mm. CONCLUSION Increased tibial resection depth is associated with significantly greater valgus laxity when tested in positions from 30° to 90° of flexion, despite stability in extension. Greater than 5° of laxity was identified with a tibial resection of 14 mm. When a tibial bone cut of 14 mm or greater is necessary, as may occur with severe preoperative coronal plane deformity, it is recommended to consider the use of a constrained knee prosthesis.
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Affiliation(s)
- E Sappey-Marinier
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France
| | - N White
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France
| | - R Gaillard
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - L Cheze
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - E Servien
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France
| | - P Neyret
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France
| | - S Lustig
- Centre Albert Trillat, Orthopaedic Surgery, Croix-Rousse Hospital, Lyon, France.
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France.
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Total knee arthroplasty with the Medial-Pivot knee system: Clinical and radiological outcomes at 9.5 years' mean follow-up. Orthop Traumatol Surg Res 2018; 104:185-191. [PMID: 29274863 DOI: 10.1016/j.otsr.2017.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 09/26/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The "ball-in-socket" design of the Medial-Pivot knee system (MicroPort Orthopedics, Arlington, Tennessee, USA) aims to reproduce normal knee kinematics by medializing its rotational axis. The goal of this study was to measure knee range of motion (ROM) with this implant after a mean follow-up of 10 years and to report the survivorship and long-term clinical and radiological outcomes. We hypothesized the prosthetic knee would have at least 120° flexion at 10 years. MATERIAL AND METHODS This was retrospective, single-centre study of 74 Medial-Pivot knees implanted in 71 patients (average age of 69 years) between May 2005 and November 2007. All patients who received a Medial-Pivot knee were included consecutively. The mean follow-up was 10 years. Clinical and radiological assessments were performed using the Knee Society Score (KSS) and Ewald's score. Kaplan-Meir survival analysis was used to calculate survivorship. RESULTS Seven percent of cases were lost to follow-up. The knee ROM was 110° at 10 years. The survivorship was 93% for all revision causes and 95.9% when revisions due to trauma or infection were excluded. The mean KSS score was 195. Stable radiolucent lines were found in 14% of cases. No aseptic loosening was observed. CONCLUSION Our hypothesis was not confirmed. Knee flexion at the final follow-up was comparable to other semi-constrained implant designs but was not as large as expected. The survival of the Medial-Pivot knee at 10 years is good. Its radiological and clinical outcomes are satisfactory. LEVEL OF EVIDENCE IV (retrospective cohort study).
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Franck F, Ouanezar H, Jacquel A, Pibarot V, Wegrzyn J. The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2017; 42:1051-1060. [PMID: 28889222 DOI: 10.1007/s00264-017-3630-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/28/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The decision to resurface the patella during total knee arthroplasty (TKA) remains controversial. This prospective cohort study aimed to evaluate the outcome and survivorship of the native patella in computer-assisted TKA (CAS TKA) implanted for primary knee osteoarthritis, and to determine the predictive factors of secondary patellar resurfacing (SPR). METHODS A prospective cohort of 273 cementless ultra-congruent mobile-bearing CAS TKA implanted without patellar resurfacing was included in our total joint registry. Patients were evaluated with the International Knee Society (IKS) and Hospital for Special Surgery Patellar (HSSP) scores. Radiographic evaluation was focused on the patellofemoral (PF) compartment to assess: the patellar dysplasia (Wiberg classification), PF osteoarthritis (Iwano classification), femoral trochlear dysplasia (femoral sulcus angle), patellar maltracking (patellar tilt and lateralization), and patella height (Blackburne-Peel ratio). RESULTS At a six-year median follow-up, the CAS TKA survivorship using SPR as end-point was 95% (range, 91-99%). The IKS and HSSP improved significantly after SPR (p = 0.001 and 0.004, respectively). No significant difference in the IKS and HSSP was detected between TKA with native patella and SPR-TKA at latest follow-up. Importantly, four pre-operative radiographic PF parameters were significantly associated with SPR: higher stages of patellar dysplasia and PF osteoarthritis, and higher sulcus angle and patellar lateralization (hazard ratios = 5.1 to 11.6, p = 0.009 to 0.04). CONCLUSION When preserving the native patella, surgeons should be aware of pre-operative PF radiographic parameters that could influence the outcome and survivorship of CAS TKA leading to SPR. Particularly, evidence of PF dysplasia, osteoarthritis and maltracking should be determined pre-operatively to resurface the patella at the time of TKA. LEVEL OF EVIDENCE Therapeutic Level II (prospective cohort study).
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Affiliation(s)
- Florent Franck
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Hervé Ouanezar
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Alexandre Jacquel
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Vincent Pibarot
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Julien Wegrzyn
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France. .,INSERM UMR 1033, Université de Lyon, Lyon, France.
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Conventional versus computer-navigated TKA: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2017; 25:1778-1783. [PMID: 27306985 DOI: 10.1007/s00167-016-4196-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to assess the midterm results of total knee arthroplasty (TKA) implanted with a specific computer navigation system in a group of patients (NAV) and to assess the same prosthesis implanted with the conventional technique in another group (CON); we hypothesized that computer navigation surgery would improve implant alignment, functional scores and survival of the implant compared to the conventional technique. METHODS From 2008 to 2009, 225 patients were enrolled in the study and randomly assigned in CON and NAV groups; 240 consecutive mobile-bearing ultra-congruent score (Amplitude, Valence, France) TKAs were performed by a single surgeon, 117 using the conventional method and 123 using the computer-navigated approach. Clinical outcome assessment was based on the Knee Society Score (KSS), the Hospital for Special Surgery Knee Score and the Western Ontario Mac Master University Index score. Component survival was calculated by Kaplan-Meier analysis. RESULTS Median follow-up was 6.4 years (range 6-7 years). Two patients were lost to follow-up. No differences were seen between the two groups in age, sex, BMI and side of implantation. Three patients of CON group referred feelings of instability during walking, but clinical tests were all negative. NAV group showed statistical significant better KSS Score and wider ROM and fewer outliers from neutral mechanical axis, lateral distal femoral angle, medial proximal tibial angle and tibial slope in post-operative radiographic assessment. There was one case of early post-operative superficial infection (caused by Staph. Aureus) successfully treated with antibiotics. No mechanical loosening, mobile-bearing dislocation or patellofemoral complication was seen. At 7 years of follow-up, component survival in relation to the risk of aseptic loosening or other complications was 100 %. There were no implant revisions. CONCLUSION This study demonstrates superior accuracy in implant positioning and statistical significant better functional outcomes of computer-navigated TKA. Computer navigation for TKAs should be used routinely in primary implants. LEVEL OF EVIDENCE II.
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Denjean S, Chatain F, Tayot O. One-stage computer-assisted total knee arthroplasty and tibial osteotomy. Orthop Traumatol Surg Res 2017; 103:381-386. [PMID: 28263806 DOI: 10.1016/j.otsr.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 02/02/2023]
Abstract
Same-stage tibial osteotomy may deserve consideration in candidates to total knee arthroplasty (TKA) who have severe bone deformities, particularly at extra-articular sites. This strategy obviates the need for either a major and technically difficult ligament release procedure, which may compromise ligament balancing, or the use of a semi-constrained prosthesis. This technical note describes a one-stage, computer-assisted technique consisting in TKA, followed by corrective tibial osteotomy to obtain an overall mechanical axis close to 180° without extensive ligament balancing. This technique provided satisfactory outcomes in 8 patients followed-up for at least 3years, with no specific complications or ligament instability and with a hip-knee-ankle angle close to 180°. After planning, intra-operative computer assistance ensures accurate determination of both implant position and the degree of correction achieved by the osteotomy.
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Affiliation(s)
- S Denjean
- Polyclinique du Val-de-Saône, 44, rue Ambroise-Paré, 71000 Macon, France
| | - F Chatain
- Clinique Belledonne, pôle santé Axone, 75, avenue G.-Péri, 38400 Saint-Martin-d'Hères, France.
| | - O Tayot
- Clinique du Parc, 155 Ter, boulevard Stalingrad, 69006 Lyon, France
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Czekaj J, Fary C, Gaillard T, Lustig S. Does low-constraint mobile bearing knee prosthesis give satisfactory results for severe coronal deformities? A five to twelve year follow up study. INTERNATIONAL ORTHOPAEDICS 2017; 41:1369-1377. [PMID: 28396931 DOI: 10.1007/s00264-017-3452-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Severe varus and valgus knee deformities traditionally are replaced with constrained implants, with a number of disadvantages. We present our results in this challenging group using a low constraint deep-dish mobile bearing implant design. METHODS One hundred fifty-four patients (170 arthroplasties) who underwent primary TKA using a deep-dish, mobile bearing posterior-stabilized implant for severe varus (HKA < 170°) or valgus (HKA > 190°) deformity between 2004 and 2009 were evaluated at a mean of 6.6 years post-operatively (minimum of 5 years). RESULTS Alignment improved from a pre-operative mean (±SD) varus deformity of 167.4° (±2.6°) and a mean (±SD) valgus deformity of 194.1° (±4.0°) to an overall mean (±SD) post-operative mechanical alignment of 178.6° (±3.2°). Twenty-three patients had post-operative varus alignment, five patients had post-operative valgus alignment and 134 knees were in neutral alignment (within 3° spread). Clinical scores at final follow-up were excellent (IKS score 93.8 (±7.4) and function score 82.4 (±20.2)). Three patients were re-operated upon: one deep infection, one periprosthetic fracture and one revision at 144 months for aseptic loosening of the femoral component. No patient was revised for instability or implant failure. The survival rate at five years was 99.4% and at ten years 98.6%. CONCLUSIONS Satisfactory outcomes can be achieved in patients with substantial varus or valgus deformities using low constraint deep-dish mobile bearing implant, standard approach and appropriate soft tissue releases.
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Affiliation(s)
- Jaroslaw Czekaj
- Albert TRILLAT Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Camdon Fary
- Western Hospital and Epworth Musculoskeletal Institute, Melbourne, Australia
| | - Thierry Gaillard
- Centre de Chirurgie Orthopédique du Beaujolais, 120, Ancienne Route de Beaujeu, 69653, Villefranche-sur-Sâone, France
| | - Sebastien Lustig
- Albert TRILLAT Center, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
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Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis. Knee 2017; 24:179-190. [PMID: 27916580 DOI: 10.1016/j.knee.2016.11.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/29/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Utilization of unicompartmental knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) as alternatives to total knee arthroplasty (TKA) for unicompartmental knee osteoarthritis (OA) has increased. However, no single resource consolidates survivorship data between TKA and partial resurfacing options for each variant of unicompartmental OA. This meta-analysis compared survivorship between TKA and medial UKA (MUKA), lateral UKA (LUKA) and PFA using annual revision rate as a standardized metric. METHODS A systematic literature search was performed for studies quantifying TKA, MUKA, LUKA and/or PFA implant survivorship. Studies were classified by evidence level and assessed for bias using the MINORS and PEDro instruments. Annual revision rates were calculated for each arthroplasty procedure as percentages/observed component-year, based on a Poisson-normal model with random effects using the R-statistical software package. RESULTS One hundred and twenty-four studies (113 cohort and 11 registry-based studies) met inclusion/exclusion criteria, providing data for 374,934 arthroplasties and 14,991 revisions. The overall evidence level was low, with 96.7% of studies classified as level III-IV. Annual revision rates were lowest for TKA (0.49%, CI 0.41 to 0.58), followed by MUKA (1.07%, CI 0.87 to 1.31), LUKA (1.13%, CI 0.69 to 1.83) and PFA (1.75%, CI 1.19 to 2.57). No difference was detected between revision rates for MUKA and LUKA (p=0.222). CONCLUSIONS Revisions of MUKA, LUKA and PFA occur at an annual rate of 2.18, 2.31 and 3.57-fold that of TKA, respectively. These estimates may be used to inform clinical decision-making, guide patient expectations and evaluate the cost-effectiveness of total versus partial knee replacement in the setting of unicompartmental OA.
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Does computer-assisted surgery influence survivorship of cementless total knee arthroplasty in patients with primary osteoarthritis? A 10-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2016; 24:3448-3456. [PMID: 27056689 DOI: 10.1007/s00167-016-4112-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Computer-assisted surgery (CAS) has been proposed to improve the performance of total knee arthroplasty (TKA) by reducing implant mal-position and mechanical axis mal-alignment. However, no clinical study has been performed to evaluate whether CAS improves survivorship of cementless TKA at long-term follow-up. This prospective and comparative study evaluated the outcome and survivorship of a cementless rotating mobile-bearing TKA performed with or without CAS at a minimum 10-year follow-up. METHODS A continuous series of 138 TKA (SCORE®, Amplitude, Valence, France) comparing 87 CAS TKA versus 51 conventional mechanical technique (MECA) TKA was prospectively included in our total joint registry. RESULTS At 10.5 years after implantation, 95 TKA (59 CAS and 36 MECA TKA) were evaluated. No significant difference was detected in the clinical outcome and mechanical axis between the two groups. The overall 10-year survivorship using revision for any reason as end-point was 91 ± 5 % without significant difference detected between the two groups [86 ± 10 % in the MECA group and 94 ± 5 % in the CAS group (n.s.)]. Using aseptic loosening as end-point, the 10-year survivorship was 100 % in both groups. Using secondary patellar resurfacing as end-point, the 10-year survivorship was significantly higher in the CAS than in MECA group (100 and 85 ± 15 %, respectively; p = 0.0039). CONCLUSION With no implant aseptic loosening or mechanical failure at 10.5 years after implantation, the cementless rotating mobile-bearing SCORE® TKA demonstrated favourable survivorship without influence of CAS. However, CAS might influence TKA survivorship by limiting secondary patellar resurfacing. LEVEL OF EVIDENCE Therapeutic, Level II.
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