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Nazir A, Gohar A, Lin SC, Jeng JY. Flexural Properties of Periodic Lattice Structured Lightweight Cantilever Beams Fabricated Using Additive Manufacturing: Experimental and Finite Element Methods. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:1381-1393. [PMID: 38116218 PMCID: PMC10726199 DOI: 10.1089/3dp.2022.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Lattice structures are a type of lightweight structure that is more commonly being applied to engineering systems as a way to reduce mass and enhance mechanical properties. The cantilever beam case is one of the primary modes of loading in many engineering applications, where light-weighting is also crucial. However, lightweight lattice structured cantilever beams have not been investigated considerably due to design and manufacturing limitations. Therefore, the aim of this study was to investigate the response of four different lattice structured cantilever beams comprising of unit cells made from Schwarz-P, Schwarz-D, Gyroid, and Octet-truss structures fabricated using Multi Jet Fusion additive manufacturing technology. An investigation into the cross-sections of these structures leads to a conclusion that the beams made from such structures are non-prismatic in nature as a result of variation in cross-sections. This led to the development of equations for the moment of inertia of these structures, which helped in calculating symmetric and un-symmetric bending. These beams were subjected to cantilever loading until failure, which provided insights into flexural properties such as flexural stress, stiffness, and strain energy. Experimental results indicate that the surface-based structures, due to better surface-area-to-volume ratio, have better ability in transferring loads and hence perform better than the beam-based Octet-truss beam. The Schwarz-D beam had performed the best among all the beams, which is further supported in literature due to its stretch-dominated topology that results in higher values of modulus. The finite element analysis (FEA) findings also validate these findings in which the distribution of stresses can be seen to be better transmitted than the other structures. The FEA validation shows that the distribution of Von-Mises stress and their position in experimental tests and failure of these structures is also very close, which provides validation to the experimental setup and the testing of beams.
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Affiliation(s)
- Aamer Nazir
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Ahmed Gohar
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
| | - Shang-Chih Lin
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
| | - Jeng-Ywan Jeng
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
- President Office, LungHwa University of Science and Technology, Taoyuan, Taiwan, Republic of China
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Erard J, Schmidt A, Batailler C, Shatrov J, Servien E, Lustig S. Higher knee survivorship in young patients with monocompartmental osteoarthritis and constitutional deformity treated by high tibial osteotomy then total knee arthroplasty compared to an early total knee arthroplasty : a comparative study at a minimum follow-up of ten years. Bone Jt Open 2023; 4:62-71. [PMID: 36722347 PMCID: PMC10011927 DOI: 10.1302/2633-1462.42.bjo-2023-0002.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AIMS The use of high tibial osteotomy (HTO) to delay total knee arthroplasty (TKA) in young patients with osteoarthritis (OA) and constitutional deformity remains debated. The aim of this study was to compare the long-term outcomes of TKA after HTO compared to TKA without HTO, using the time from the index OA surgery as reference (HTO for the study group, TKA for the control group). METHODS This was a case-control study of consecutive patients receiving a posterior-stabilized TKA for OA between 1996 and 2010 with previous HTO. A total of 73 TKAs after HTO with minimum ten years' follow-up were included. Cases were matched with a TKA without previous HTO for age at the time of the HTO. All revisions were recorded. Kaplan-Meier survivorship analysis was performed using revision of metal component as the endpoint. The Knee Society Score, range of motion, and patient satisfaction were assessed. RESULTS Mean follow-up was 13 years (SD 3) after TKA in both groups. The 20-year Kaplan-Meier survival estimate was 98.6% in TKA post-HTO group (HTO as timing reference) and 81.4% in control group (TKA as timing reference) (p = 0.030). There was no significant difference in clinical outcomes, radiological outcomes, and complications at the last follow-up. CONCLUSION At the same delay from index surgery (HTO or TKA), a strategy of HTO followed by TKA had superior knee survivorship compared to early TKA at long term in young patients.Level of evidence: IIICite this article: Bone Jt Open 2023;4(2):62-71.
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Affiliation(s)
- Julien Erard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Axel Schmidt
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cecile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,University Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,University Lyon, Claude Bernard Lyon 1 University, Lyon, France
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More passive internal tibial rotation with posterior cruciate ligament retention than with excision in a medial pivot TKA implanted with unrestricted caliper verified kinematic alignment. Knee Surg Sports Traumatol Arthrosc 2023; 31:852-860. [PMID: 34921630 PMCID: PMC9958185 DOI: 10.1007/s00167-021-06840-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Excision of the posterior cruciate ligament (PCL) is recommended when implanting a medial pivot (MP) total knee arthroplasty (TKA) to reduce the risk of limiting flexion by over-tensioning the flexion space. The present study determined whether PCL retention (1) limits internal tibial rotation and (2) causes anterior lift-off of the insert in 90° flexion after implantation of an MP design with unrestricted caliper verified kinematic alignment (KA). METHODS Four surgeons implanted an MP TKA design with medial ball-in-socket and lateral flat tibial insert in ten fresh-frozen cadaveric knees. Before and after PCL excision, trial inserts with medial goniometric markings measured the angular I-E tibial orientation relative to the trial femoral component's medial condyle in extension and at 90° flexion, and the surgeon recorded the occurrence of anterior lift-off of the insert at 90° flexion. RESULTS PCL retention resulted in greater internal tibial rotation than PCL excision, with mean values of 15° vs 7° degrees from maximum extension to 90° flexion, respectively (p < 0.0007). At 90° flexion, no TKAs with PCL retention and one TKA with PCL excision had anterior lift-off of the insert (N.S.). CONCLUSIONS This preliminary study of ten cadaveric knees showed that PCL retention restored more passive internal tibial rotation than PCL excision with a negligible risk of anterior lift-off. However, in vivo analysis from multiple authors with a larger sample size is required to recommend PCL retention with an MP TKA design implanted with unrestricted caliper verified KA.
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Implant survival of 3rd-condyle and post-cam posterior-stabilised total knee arthroplasty are comparable at follow-up > 10 years: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1001-1024. [PMID: 33660055 DOI: 10.1007/s00167-021-06507-w] [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: 12/11/2020] [Accepted: 02/14/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To summarise the literature on 3rd-condyle total knee arthroplasty (TKA) designs and compare their survival rates to those of post-cam TKA designs. The null hypothesis was that 3rd-condyle TKAs would have equivalent survival rates compared to contemporary post-cam TKAs. METHODS An electronic literature search for Level I-V studies was independently conducted by two researchers using Medline® and Web of Science for studies published between January 1984 and October 2020 that specifically reported on rates of implant survival and complications, joint kinematics, clinical outcomes, and radiographic outcomes of 3rd-condyle TKA. The methodological quality of clinical studies was assessed according to the Downs and Black Quality Checklist for Health Care Intervention Studies, and for in vitro and in silico studies according to the Joanna Briggs Institute (JBI) tool for assessing analytical cross-sectional studies. Findings extracted for each TKA design were presented as reported and synthesised narratively. Survival rates at 5, 10 and > 10 years of 3rd-condyle TKA designs were graphically compared to rates of post-cam TKA designs published in joint registries. RESULTS A total of 38 studies were identified that reported on kinematics, clinical outcomes, radiographic alignment, and rates of complications and survival. Mean survival rates ranged from 96 to 98% at 5 years, 78-100% at 5-10 years, and 86-99% at > 10 years for 3rd-condyle PS TKAs. Mean survival rates ranged from 93 to 98% at 5 years, 89-99% at 5-10 years, and 88-95% at > 10 years for post-cam PS TKAs. CONCLUSION Implant survival rates of 3rd-condyle TKAs are comparable to those of post-cam TKAs at follow-up > 10 years. When compared to post-cam PS TKA, 3rd-condyle designs offer an alternative for younger and more active patients when considering the added benefits of a lowered point-of-contact and larger congruent contact area at the intercondylar tibial sulcus, that reduce risks of loosening and component wear. LEVEL OF EVIDENCE V.
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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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Erard J, Batailler C, Swan J, Sappey-Marinier E, Servien E, Lustig S. Lateral approach total knee arthroplasty achieves equivalent patellar tracking in severe valgus deformity compared to mild valgus deformity. Knee Surg Sports Traumatol Arthrosc 2022; 30:740-752. [PMID: 33492408 DOI: 10.1007/s00167-021-06451-9] [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: 11/25/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Patellar tracking problems represent 2-10% of complications of total knee arthroplasties (TKA) in valgus knees. However, there are no studies assessing patellar tracking according to the severity of the valgus deformity. The hypothesis was that lateral approach TKA in severe valgus deformity provides equivalent patellar tracking to that in knees with mild valgus deformity. METHODS Between 1988 and 2016, 77 TKAs were performed via a lateral approach on a severe valgus deformity (HKA > 195°). Forty-three TKAs performed without tibial tubercle osteotomy and with complete radiological data were included in this study. These were compared with 86 matched TKAs performed via a lateral approach with a mild valgus deformity (HKA between 181° and 190°). Patellar tilt and patellar position were assessed by axial view radiographs at the last follow-up. Complications and clinical outcomes were also evaluated. RESULTS The follow-up was mean 52 ± 21 months in the severe valgus group. No significant differences were found between the severe valgus deformity group and the mild valgus deformity groups in patellar tilt (1.6° ± 6.6° versus 1.9° ± 3.2°, respectively) or patellar subluxation. There were complications in 12% (n = 5) and 11% (n = 9) of the severe valgus group and the mild valgus group respectively, without significant difference. There was no significant difference in extensor mechanism complication rate (2.3% versus 4.7%, respectively). CONCLUSION Lateral parapatellar approach, without tibial tubercle osteotomy, for TKA in severe valgus deformity results in good patellar tracking. With this approach, the extensor mechanism complication rate in severe valgus deformity was not higher than for mild valgus deformity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julien Erard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France.
| | - John Swan
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Elliot Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
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Mesnard G, Batailler C, Fary C, Schmidt A, Servien E, Lustig S. Posterior-Stabilized TKA in Patients With Severe Genu Recurvatum Achieves Good Clinical and Radiological Results at 5-year Minimum Follow-Up: A Case-Controlled Study. J Arthroplasty 2021; 36:3154-3160. [PMID: 33966942 DOI: 10.1016/j.arth.2021.04.020] [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: 12/07/2020] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Genu recurvatum is a rare knee deformity. Total knee arthroplasty (TKA) in severe preoperative recurvatum requires surgical adjustments. Few studies have assessed the clinical and radiological results of TKA in recurvatum. The aim was to compare the clinical and radiological outcomes, complications, and revision rates after posterior-stabilized TKA in severe recurvatum with those without recurvatum. METHODS Between 1987 and 2015, 32 primary posterior-stabilized TKA were performed with a preoperative genu recurvatum greater than 10° and minimum follow-up of 60 months. In severe genu recurvatum, the extension gap needs to be decreased compared with flexion gap. To achieve this, the distal femoral cut is distalized, whereas the posterior femoral and tibial cuts are performed as usual. They were compared with 64 matched posterior-stabilized TKAs without recurvatum. The demographic data were similar between groups. The clinical and radiological outcomes, complications, and revision rates were assessed at the last follow-up. RESULTS At a mean follow-up of 7.4 years ± 1.9, there was no significant difference in International Knee Score functional score (77.5 vs. 73.4; P = .50) and knee score (86.6 vs. 89.5; P = .37) between the recurvatum group and the control group, respectively. 6 patients had a postoperative recurvatum equal or superior to 10° in the recurvatum group (18.8%). There was no difference between both groups in radiological outcomes, complication, or revision rates. No instability was found in the recurvatum group. CONCLUSION Posterior-stabilized TKA with controlled distalization of the femoral component in the setting of severe preoperative genu recurvatum achieves good clinical and radiological outcomes at a minimum follow-up of 5 years and similar to TKA without preoperative recurvatum. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Guillaume Mesnard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
| | - Axel Schmidt
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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Fournier G, Yener C, Gaillard R, Kenney R, Lustig S, Servien E. Increased survival rate in extension stemmed TKA in obese patients at minimum 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 2020; 28:3919-3925. [PMID: 32040680 DOI: 10.1007/s00167-020-05860-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/16/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) is frequently performed for obese patients. TKA in this population shows a high rate of complication, particularly tibial component loosening. The aim of this study is to compare the survival rate of tibial components in obese population using TKA with stem versus without stem. METHODS From a prospective database of 4216 TKA, obese patients [body mass index (BMI) > 30 kg m²] with primary TKA using a tibial short stem extension (30 mm) at a minimum follow-up of 2 years were retrospectively reviewed and compared to a matched control group (1:3 ratio) with a standard tibial stem. Inclusion criteria were BMI > 30 kg m², first knee surgery and 24 months minimum of follow-up. The primary outcome was revision for tibial aseptic loosening. Secondary outcomes were all-cause revisions and Knee Society Scores (KSS). RESULTS The final study population consisted of 35 TKA with tibial extension stem versus 105 TKA with standard stem. The mean age was 69.2 and 69.5 years, respectively, with a mean follow-up of 52 months. Both groups were comparable before surgery. After 2 years of follow-up, we observed seven tibial loosening in the group without stem (6.6%) versus no tibial loosening in the stemmed group (p < 0.001). The difference in KSS knee score (83 versus 86; p = 0.06) and the KSS function score (73 versus 77; p = 0.84) were not statistically significant at the final follow-up. CONCLUSION Using stemmed TKA for obese patients significantly decreased tibial loosening rate at minimum 2 years of follow-up. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- Gaspard Fournier
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.
| | - Can Yener
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Romain Gaillard
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Raymond Kenney
- Department of Orthopaedics, University of Rochester Medical Center, 4901 Lac De Ville Blvd Building D, Rochester, NY, 14618, USA
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.,EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
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Patellar facet ratio affects knee pain, stair climbing and stair descent after TKA without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2020; 28:3796-3804. [PMID: 31989190 DOI: 10.1007/s00167-020-05868-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine whether knee pain or functional impairment after total knee arthroplasty (TKA) without patellar resurfacing are correlated with preoperative patellar morphology or postoperative patellar orientation. The hypotheses were that patellar shape, increased tilt and lateral displacement would be associated with pain and functional impairment. METHODS From a consecutive series of 152 knees that received a cemented postero-stabilized TKA, the Oxford Knee Score (OKS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected at a minimum follow-up of 12 months. Uni- and multi-variable linear regression analyses were performed to determine associations between the collected clinical scores and patient demographics and patellar morphology, measured from pre- and post-operative frontal, lateral and skyline view radiographs. RESULTS The OKS was 75 ± 23, whereas the KOOS pain, stair climbing, and descent were respectively 77 ± 24, 3.9 ± 1.1 and 3.8 ± 1.2. OKS was not associated with any radiographic outcomes, whereas KOOS pain was better for knees with larger medial patellar facets. The KOOS stair climbing and descent were also better for knees with larger medial patellar facets. CONCLUSION The findings of this study partly confirm the hypotheses that pain and functional impairments after TKA without patellar resurfacing are associated with patellar shape. No association was revealed between postoperative patellar orientation and function nor pain. Quantitative consideration of patellar congruency could therefore prevent pain and improve function after TKA without patellar resurfacing. LEVEL OF EVIDENCE Retrospective study, Level III.
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Fournier G, Muller B, Gaillard R, Batailler C, Lustig S, Servien E. Increased survival rate for primary TKA with tibial short extension stems for severe varus deformities at a minimum of 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 2020; 28:3780-3786. [PMID: 31965216 DOI: 10.1007/s00167-020-05848-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare the clinical results, radiographic loosening and early complications between patients undergoing primary knee arthroplasty (TKA) with tibial short stem extension and those with standard stem for gross varus deformities at minimum two years after surgery. METHODS From a prospective TKA database of 4216 patients, patients with a primary TKA with a tibial short stem extension (30 mm) for severe varus deformity (hip-kneeankle angle, HKA < 170°) and a minimum follow-up of 2 years, were reviewed and compared to a matched control group with tibial components with a standard stem, in a 1:3 ratio. Demographics, surgical parameters, pre- and postoperative alignment and outcome parameters were collected for all patients. The primary outcome was aseptic loosening of the tibial component. Secondary outcomes were knee society scores (KSS), postoperative HKA, general postoperative complications and implant survival rates. RESULTS Forty-five patients with tibial short stem extensions (mean HKA 166.2°) were compared in a 1:3 ratio to a matched case-control group of 135 patients with standard stems (mean HKA 167.1°) at a mean follow-up of 57 and 64 months respectively after primary TKA. In the extension stem group, 4 patients encountered complications (8.9%) versus 12 patients in the standard stem group (8.9%). There were no cases of tibial component loosening in the short extension stem versus four cases in the standard stem group (3%). This difference was significant between groups, p = 0.04. CONCLUSION In patients with varus deformities > 10°, undergoing primary total knee arthroplasty, prophylactic use of a tibial short extension stem may lead to less loosening of the tibial component. In this study, 3% of patient with big varus deformity without stemmed TKA had a tibial implant loosening versus 0% in the stemmed TKA group. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Gaspard Fournier
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.
| | - Bart Muller
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Romain Gaillard
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France.,EA 7424 - Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
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Batailler C, Malemo Y, Demey G, Kenney R, Lustig S, Servien E. Cemented vs Uncemented Femoral Components: A Randomized, Controlled Trial at 10 Years Minimum Follow-Up. J Arthroplasty 2020; 35:2090-2096. [PMID: 32312645 DOI: 10.1016/j.arth.2020.03.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The type of total knee arthroplasty (TKA) fixation (cemented or uncemented) is still subject to debate. The aim of this study is to assess the survival rate, clinical outcomes, and radiological results of TKA according to the fixation type. METHODS A total of 130 patients were randomly assigned to either the cement group (cemented femoral and tibial implants) or the hybrid group (cemented tibial implant, uncemented femoral implant). The inclusion criteria were patients between 50 and 90 years old who underwent primary TKA for osteoarthritis between 2004 and 2005 without a history of open knee surgery. Revisions and complications were reported, as well as clinical scores and radiological signs of loosening. RESULTS One hundred eighteen patients had complete data at 10 years of minimum follow-up (59 in each group). The mean age was 72 years old. The mean follow-up was 13 years. The survival rate was 98% at 13 years in both groups (1 aseptic loosening at 2 years in the cement group, 1 septic loosening in the hybrid group). The complication rate in the cement group was 8.5% (n = 5) vs 12.1% (n = 7) in the hybrid group (P = .8). The clinical results were not significantly different. In the cement group, 25% of patients (n = 15) had radiolucent lines at 10 years. In the hybrid group, 33% of patients had bone transparencies, not evolving or symptomatic. CONCLUSION At a minimum follow-up of 10 years, there were no significant differences between cemented TKA and hybrid TKA for the survivorship, the complication rate, the clinical scores, or the radiological signs of loosening. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Yves Malemo
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Guillaume Demey
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Lyon, France
| | - Raymond Kenney
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, Villeurbanne, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
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12
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Petershofer A, Trieb K. Rotating Hinge Implants in Knee Arthroplasty. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:383-389. [PMID: 31404939 DOI: 10.1055/a-0896-2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Due to demographic transition an increasing number of primary knee arthroplasty is expected. A consequence is a rise in frequency in revision knee arthroplasty. Rotating hinge prostheses are a development of former hinge prostheses, due to changes in implant design the outcome of modern rotating hinge implants clearly improved in comparison to former models. Interpretation of outcome in present literature is difficult due to the small number of cases and the heterogeneous indications. Nevertheless the use of rotating hinge knee prostheses in primary and revision arthroplasty is associated with good clinical outcomes, when indicated appropriately.
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Affiliation(s)
| | - Klemens Trieb
- University of Applied Sciences Upper Austria, Wels, Austria
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13
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Tiwari V, Meshram P, Park CK, Bansal V, Kim TK. New mobile-bearing TKA with unique ball and socket post-cam mechanism offers similar function and stability with better prosthesis fit and gap balancing compared to an established fixed-bearing prosthesis. Knee Surg Sports Traumatol Arthrosc 2019; 27:2145-2154. [PMID: 30810785 DOI: 10.1007/s00167-019-05430-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A mobile-bearing (MB) posterior-stabilized total knee arthroplasty (TKA) system with ball and socket post-cam mechanism has been developed with the aims of better prosthesis fit and enhanced stability. However, the data are limited to compare its clinical outcomes with an already established fixed-bearing (FB) implant design. METHODS This is a prospective randomized study comparing 260 patients in the MB group and 133 patients in FB group with a minimum 2 years of follow-up. Intraoperative variables, post-operative functional outcomes and incidence of adverse events were compared. RESULTS MB group showed better prosthesis fit as the incidence of over-hang of femoral component at junction (medial: 1% vs. 5% and lateral: 2% vs 4%, p < 0.001) and trochlea (medial: 2% vs 30%, p = 0.042 and lateral: 13% vs 21%, p = 0.015) was less than FB group. MB group also showed better gap balancing as the incidence of medio-lateral gap difference more than 2 mm was less in flexion (2.3% vs. 16%, p < 0.001) and extension (3.1% vs. 9.8%, p = 0.005). Post-operative functional outcomes and incidence of adverse events showed no difference between the two groups at 2 years. CONCLUSIONS New MB design offers similar functional outcomes and stability along with better intraoperative prosthesis fit and gap balancing compared to an established fixed-bearing design. Hence, this new MB design could be an alternative prosthesis of choice for posterior-stabilized TKA. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Vivek Tiwari
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Prashant Meshram
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Chang Kyu Park
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Vivek Bansal
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 82 Gumi-ro, 173, Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Tae Kyun Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea. .,, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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14
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Patellofemoral design enhancements reduce long-term complications of postero-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1241-1250. [PMID: 30203198 DOI: 10.1007/s00167-018-5137-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/06/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Few studies investigated whether trochlear and patellar design enhancements improve long-term outcomes of total knee arthroplasty (TKA). This study aimed to compare the long-term survival and complication rates of two consecutive generations of the same TKA system with identical tibiofemoral geometry, but different patellofemoral designs. METHODS The authors retrieved the records of 93 patients (104 knees) operated with the HLS II system and 116 patients (122 knees) operated with HLS Evolution system. Patients were evaluated preoperatively and at a minimum of 10 years noting all complications. Kaplan-Meier (KM) survival was compared for two endpoints: (1) revision of all components and (2) revision of any component. RESULTS From the HLS II series, the incidence of revision of all components was 6.4%, and of any component was 9.8%. From the HLS Evolution series, the incidence of revision of all components was 4.1%, and of any component was 5.1%. Comparing the survival at equivalent follow-up of 14 years, considering revision of all components, the HLS II had higher survival than the HLS Evolution (98.9% vs 95.9%), while considering revision of any component, the HLS II had lower survival than the HLS Evolution (93.0% vs 94.9%). The differences in survival of the two implants were not significant, neither at equivalent follow-up of 14 years (n.s.), nor at maximum follow-up of each cohort (n.s.). The complication rate was higher for the HLS II series compared to the HLS Evolution (28% vs 12%, p = 0.009), but patellofemoral complications were not more frequent (8% vs 6%, n.s.). CONCLUSIONS Though the differences in survival of the two implants were not significant, conflicting findings are observed due to partial revisions for patellar fractures (5 in the HLS II series and 1 in the HLS Evolution series) which could be related to patellofemoral design enhancements. This study highlights the importance of patello-femoral geometry, which is often overlooked in TKA. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Mouton J, Gaillard R, Bankhead C, Batailler C, Servien E, Lustig S. Increased Patellar Fracture Rate in Total Knee Arthroplasty With Preoperative Varus Greater Than 15°: A Case-Control Study. J Arthroplasty 2018; 33:3685-3693. [PMID: 30197216 DOI: 10.1016/j.arth.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Management of severe varus deformity requires soft tissue balancing for implantation of low-constraint knee prosthesis. Patellar complications have been rarely studied in this specific group. Our hypothesis was that severe genu varum (>15°) would increase the rate of patellar complications. METHODS Using a prospective cohort of 4216 prostheses performed at a single center beginning in 1987, we analyzed 280 prostheses having preoperative varus greater than 15°, compared to 673 total knee arthroplasties (TKAs) with a preoperative hip-knee-ankle angle of 180° ± 2°. Preoperative and postoperative clinical and radiological characteristics were compared between the 2 groups, with particular attention paid to patellar complications. RESULTS Average follow-up was 40.2 months (24-239). The mean preoperative Knee Society Score (KSS) was statistically higher in the normal (hip-knee-ankle angle 180° ± 2) axis group (62.65 vs 37.47, P = .001). At the last follow-up, no significant difference was found between the 2 groups in terms of postoperative KSS (87.5 in the varus group vs 87.3 in the normal axis group, P = .87). The rate of satisfied patients was identical between the 2 groups (85.3% vs 88.8%, P = .49). However, at mid-term, there were more patellar fractures in the varus group (2.9% vs 0.9%, P = .005). A significantly lower patellar height in both the varus group and the group of patella fractures (P < .001) was also found. CONCLUSION TKA in severe varus knees produces a KSS equivalent to TKA in knees with a mechanical axis of 0 ± 2. The risk of patellar fracture could initiate a decline in patella resurfacing in patients with major varus deformation, especially in case of a preoperative patella baja.
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Affiliation(s)
- Jordane Mouton
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France; Orthopedic Surgery Department, CHU Rouen, University of Rouen, Rouen, France
| | - Romain Gaillard
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | | | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
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16
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Ode Q, Gaillard R, Batailler C, Herry Y, Neyret P, Servien E, Lustig S. Fewer complications after UKA than TKA in patients over 85 years of age: A case-control study. Orthop Traumatol Surg Res 2018; 104:955-959. [PMID: 29684539 DOI: 10.1016/j.otsr.2018.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/17/2018] [Accepted: 02/21/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Implanting a knee prosthesis in patients aged over 85 years is not without risk. Unicompartmental knee arthroplasty (UKA) is reputed to show lower morbidity and mortality than total knee arthroplasty (TKA). Elderly patients with isolated unicompartmental osteoarthritis without specific contraindications are thus good candidates for this procedure. The present retrospective case-control study compared complications rates in elderly patients receiving UKA versus TKA. The study hypothesis was that UKA incurs fewer complications, with equivalent functional results. MATERIAL AND METHODS Five hundred and forty-four UKAs were performed between 1987 and 2015; all patients aged 85 years or over (n=30) were included, and age-matched at a rate of 1 UKA for 3 TKAs in our database of 4,216 TKA procedures. Mean age was 87.5 years (range, 85-92 years). The main endpoint was complications rate; secondary endpoints comprised satisfaction, IKS function and knee scores, and implant survival. RESULTS Mean follow-up was 32 months (range, 12-118 months) for UKA and 34 months (range, 12-100 months) for TKA. The medical complications rate was significantly lower with UKA (6.7% versus 25.6%; P=0.02), with no early mortality. IKS scores were identical between UKA and TKA groups at last follow-up: knee, 93.8 (95% CI [89.7-98.0]) versus 89.5 (95% CI [85.6-93.4]), P=0.06; function, 63.8 (95% CI [53.1-74.5]) versus 67.0 (95% CI [61.3-72.7]), P=0.62. Satisfaction rates were likewise identical: 96% and 97%, respectively (P=0.77); and implant survivorship was identical (P=0.54). DISCUSSION Early medical complications were fewer after UKA than TKA in a population aged ≥85 years, with comparable clinical outcome. These results argue in favor of UKA in elderly patients with comorbidities. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Quentin Ode
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - Romain Gaillard
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - Cécile Batailler
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Laboratoire de biomécanique et mécanique des chocs, université Claude-Bernard Lyon 1, IFSTTAR, 69622 Villeurbanne, France
| | - Yannick Herry
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | | | - Elvire Servien
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - Sébastien Lustig
- Service de chirurgie orthopédique, CHU Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Laboratoire de biomécanique et mécanique des chocs, université Claude-Bernard Lyon 1, IFSTTAR, 69622 Villeurbanne, France.
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17
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Liang H, Bae JK, Park CH, Kim KI, Bae DK, Song SJ. Comparison of mode of failure between primary and revision total knee arthroplasties. Orthop Traumatol Surg Res 2018; 104:171-176. [PMID: 29032308 DOI: 10.1016/j.otsr.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 09/24/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cognizance of common reasons for failure in primary and revision TKA, together with their time course, facilitates prevention. However, there have been few reports specifically comparing modes of failure for primary vs. revision TKA using a single prosthesis. The goal of the study was to compare the survival rates, modes of failure, and time periods associated with each mode of failure, of primary vs. revision TKA. HYPOTHESIS The survival rates, modes of failure, time period for each mode of failure, and risk factors would differ between primary and revision TKA. MATERIAL AND METHODS Data from a consecutive cohort comprising 1606 knees (1174 patients) of primary TKA patients, and 258 knees (224 patients) of revision TKA patients, in all of whom surgery involved a P.F.C® prosthesis (Depuy, Johnson & Johnson, Warsaw, IN), was retrospectively reviewed. The mean follow-up periods of primary and revision TKAs were 9.2 and 9.8 years, respectively. RESULTS The average 10- and 15-year survival rates for primary TKA were 96.7% (CI 95%,±0.7%) and 85.4% (CI 95%,±2.0%), and for revision TKA 91.4% (CI 95%,±2.5%) and 80.5% (CI 95%,±4.5%). Common modes of failure included polyethylene wear, loosening, and infection. The most common mode of failure was polyethylene wear in primary TKA, and infection in revision TKA. The mean periods (i.e., latencies) of polyethylene wear and loosening did not differ between primary and revision TKAs, but the mean period of infection was significantly longer for revision TKA (1.2 vs. 4.8 years, P=0.003). DISCUSSION Survival rates decreased with time, particularly more than 10 years post-surgery, for both primary and revision TKAs. Continuous efforts are required to prevent and detect the various modes of failure during long-term follow-up. Greater attention is necessary to detect late infection-induced failure following revision TKA. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- H Liang
- Department of orthopaedic surgery, college of Medicine, Kyung Hee university, 26, Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - J K Bae
- Department of orthopaedic surgery, college of Medicine, Kyung Hee university, 26, Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - C H Park
- Department of orthopaedic surgery, college of Medicine, Kyung Hee university, 26, Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - K I Kim
- Department of orthopaedic surgery, college of Medicine, Kyung Hee university, 26, Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - D K Bae
- Department of orthopaedic surgery, college of Medicine, Kyung Hee university, 26, Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - S J Song
- Department of orthopaedic surgery, college of Medicine, Kyung Hee university, 26, Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
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