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Christopher ZK, Pulicherla N, Iturregui JM, Brinkman JC, Spangehl MJ, Clarke HD, Bingham JS. Low Risk of Periprosthetic Joint Infection After Aseptic Revision Total Knee Arthroplasty With Intraosseous Vancomycin. J Arthroplasty 2024:S0883-5403(24)00477-7. [PMID: 38795854 DOI: 10.1016/j.arth.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Aseptic revisions are the most common reason for revision total knee arthroplasty (rTKA). Previous literature reports early periprosthetic joint infection (PJI) rates after aseptic rTKA to range from 3 to 9.4%. Intraosseous (IO) regional administration of vancomycin has previously been shown to produce high local tissue concentrations in primary and rTKA. However, no data exist on the effect of prophylactic IO vancomycin on early PJI rates in the setting of aseptic rTKA. The aim of this study was to determine the following: (1) what is the rate of early PJI during the first year after surgery in aseptic rTKA performed with IO vancomycin; and (2) how does this compare to previously published PJI rates after rTKA. METHODS A consecutive series of 117 cases were included in this study who underwent rTKA between January 2016 and March 2022 by 1 of 2 fellowship-trained adult reconstruction surgeons and received IO vancomycin at the time of surgery in addition to standard intravenous antibiotic prophylaxis. Rates of PJI at 3 months, 1 year, and the final follow-up were evaluated and compared to prior literature. RESULTS Follow-up at 3 months was available for 116 of the 117 rTKAs, with 1 lost to follow-up. The rate of PJI was 0% at 3 months postoperatively. Follow-up at 1 year was obtained for 113 of the 117 rTKAs, and the PJI rate remained 0%. The rate of PJI at the final follow-up of ≥ 1 year was 0.88% (95% confidence interval: -0.84 to 2.61). Previous literature reports PJI rates in aseptic rTKA to range from 3 to 9.4%. CONCLUSIONS Dual prophylactic antibiotics with IO vancomycin in conjunction with intravenous cephalosporins or clindamycin were associated with a substantial reduction in early PJI compared to prior published literature. These data supplement the early evidence about the potential clinical benefits of IO vancomycin for infection prevention in high-risk cases. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | | | - Jose M Iturregui
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Mark J Spangehl
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Henry D Clarke
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Joshua S Bingham
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
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Urbain A, Putman S, Migaud H, Pasquier G, Girard J, Dartus J. Long-term results (after a mean 11.3years, and up to 22years, of follow-up) of the Legacy Constrained Condylar Knee (LCCK™) in primary total knee arthroplasty. Orthop Traumatol Surg Res 2024; 110:103795. [PMID: 38081358 DOI: 10.1016/j.otsr.2023.103795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/24/2023] [Accepted: 08/30/2023] [Indexed: 12/31/2023]
Abstract
INTRODUCTION The use of a sliding prosthesis in total knee arthroplasty (TKA) with increased stress is an intermediate solution in primary surgery, between posteriorly stabilized prostheses and hinged prostheses, in cases of ligamentous laxity and/or loss of bone substance. Favorable results have been reported in the medium term but to our knowledge, this type of prosthesis has not been evaluated in Europe beyond 10 years of follow-up. We therefore conducted a retrospective study in order to carry out: 1) the study of the survival of the Legacy Constrained Condylar Knee (LCCK™) prosthesis in primary surgery, 2) the analysis of complications, functional scores and radiographic data, 3) the analysis of the link between the diaphyseal filling rate and prosthetic loosening. HYPOTHESIS The LCCK™ sliding prosthesis with increased constraint has equivalent long-term survival and clinical results to standard posteriorly stabilized TKA and superior to hinged TKA. MATERIAL AND METHOD A retrospective series of 141 LCCK™ implanted in 134 patients between 1997 and 2010 was analyzed. Survival was assessed with censoring through an evaluation of partial or total revision of the implants. The functional results were evaluated using the IKS and Oxford 12 scores. Data regarding the Canal Fill Ratio (CFR) and the presence of pathological periprosthetic lines were also collected. RESULTS The average follow-up was 11.3±5.3years with a maximum follow-up of 22.7years. Survival at 20years was 90.8% [95% CI: 83.7-95.7]. The rate of early complications was 13.5% (19/141), predominantly comprised of venous thrombosis (6/141), hematomas (3/141 including two requiring surgical drainage), stiffness (3/141) and early infections (3/141). The rate of late complications was 17% (24/141), led by stiffness (4.4%; 6/141), infections (2.9%; 4/141) and hardware failure (2. 2%; 3/141). Ten of the 141 patients (7.1%) had LCCK failure, including 3 (2.1%) for stiffness, 3 (2.1%) for hardware failure, 2 (1.4%) for infection, 1 (0.7%) for laxity and 1 (0.7%) for a periprosthetic fracture. No aseptic loosening was found. The total IKS score went from 65 [0-116] to 143 [79-200] at follow-up, the IKS knee score went from 30 [0-66] to 85 [44-100], and the IKS function score went from 35 [0-70] to 57 [0-100]. The Oxford score went from 14 [2-25] to 34 [15-48] at follow-up. Only two patients (1.4%) presented with a partial periprosthetic line. The tibial CFR was 0.81 and the femoral CFR was 0.76. The influence of the CFR could not be analyzed due to the absence of loosening. DISCUSSION The LCCK™ prosthesis in primary surgery has good medium-term survival, a significant improvement in functional scores and a complication rate comparable to posteriorly stabilized prostheses. The complication rate is lower than that of hinged prostheses. LEVEL OF EVIDENCE IV; single-center retrospective study.
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Affiliation(s)
- Antoine Urbain
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.
| | - Sophie Putman
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Henri Migaud
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Gilles Pasquier
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Julien Girard
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France; Université de Artois, Université Littoral Côte d'Opale, EA 7369 - Unité de Recherche Pluridisciplinaire Sport Santé Société (URePSS), 59000 Lille, France
| | - Julien Dartus
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
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Fiedler B, Bieganowski T, Singh V, Marwin S, Rozell JC, Schwarzkopf R. Clinical Outcomes of Offset Stem Couplers with or without Cone Augmentation in Revision Total Knee Arthroplasty. J Knee Surg 2024; 37:297-302. [PMID: 37142239 DOI: 10.1055/a-2086-4820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Intramedullary stems are often required in patients undergoing revision total knee arthroplasty (rTKA) to achieve stable fixation. Significant bone loss may require the addition of a metal cone to maximize fixation and osteointegration. The purpose of this study was to investigate clinical outcomes in rTKA using different fixation techniques. We conducted a single-institution retrospective review of all patients who received a tibial and femoral stem during rTKA between August 2011 and July 2021. Patients were separated into three cohorts based on fixation construct: press-fit stem with an offset coupler (OS), fully cemented straight (CS) stem, and press-fit straight (PFS) stem. A subanalysis of patients who received tibial cone augmentation was also conducted. A total of 358 patients who underwent rTKA were included in this study, of which 102 (28.5%) had a minimum 2-year follow-up and 25 (7.0%) had a minimum 5-year follow-up. In the primary analysis, 194 patients were included in the OS cohort, 72 in the CS cohort, and 92 in the PFS cohort. When stem type alone was considered, there was no significant difference in rerevision rate (p = 0.431) between cohorts. Subanalysis of patients who received augmentation with a tibial cone demonstrated that OS implants led to significantly higher rates of rerevision compared with the other two stem types (OS: 18.2% vs. CS: 2.1% vs. PFS: 11.1%; p = 0.037). The findings of the present analysis demonstrate that CS and cones in rTKA may provide more reliable long-term outcomes compared with press-fit stems with OS. LEVEL III EVIDENCE: Retrospective Cohort Study.
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Affiliation(s)
- Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Scott Marwin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Roof MA, Narayanan S, Lorentz N, Aggarwal VK, Meftah M, Schwarzkopf R. Impact of time to revision total knee arthroplasty on outcomes following aseptic failure. Knee Surg Relat Res 2023; 35:15. [PMID: 37254215 DOI: 10.1186/s43019-023-00191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Prior studies have demonstrated an association between time to revision total knee arthroplasty (rTKA) and indication; however, the impact of early versus late revision on post-operative outcomes has not been reported. MATERIALS AND METHODS A retrospective, observational study examined patients who underwent unilateral, aseptic rTKA at an academic orthopedic hospital between 6/2011 and 4/2020 with > 1-year of follow-up. Patients were early revisions if they were revised within 2 years of primary TKA (pTKA) or late revisions if revised after greater than 2 years. Patient demographics, surgical factors, and post-operative outcomes were compared. RESULTS 470 rTKA were included (199 early, 271 late). Early rTKA patients were younger by 2.5 years (p = 0.002). The predominant indications for early rTKA were instability (28.6%) and arthrofibrosis/stiffness (26.6%), and the predominant indications for late rTKA were aseptic loosening (45.8%) and instability (26.2%; p < 0.001). Late rTKA had longer operative times (119.20 ± 51.94 vs. 103.93 ± 44.66 min; p < 0.001). There were no differences in rTKA type, disposition, hospital length of stay, all-cause 90-day emergency department visits and readmissions, reoperations, and number of re-revisions. CONCLUSIONS Aseptic rTKA performed before 2 years had different indications but demonstrated similar outcomes to those performed later. Early revisions had shorter surgical times, which could be attributed to differences in rTKA indication. LEVEL OF EVIDENCE III, retrospective observational analysis.
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Affiliation(s)
- Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Shankar Narayanan
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Nathan Lorentz
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA.
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The Dopamine D1 Receptor Attenuates Titanium Particle-Induced Inhibition of Osteogenesis by Activating the Wnt Signaling Pathway. Mediators Inflamm 2023; 2023:6331650. [PMID: 36700172 PMCID: PMC9870688 DOI: 10.1155/2023/6331650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/20/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023] Open
Abstract
Periprosthetic osteolysis (PPO), caused by wear particles, has become a major cause of joint replacement failure. Secondary surgery after joint replacement poses a serious threat to public health worldwide. Therefore, determining how to effectively inhibit wear particle-induced PPO has become an urgent issue. Recently, the interaction between osteogenic inhibition and wear particles at the biological interface of the implant has been found to be an important factor in the pathological process. Previous studies have found that the central nervous system plays an important role in the regulation of bone formation and bone remodeling. Dopamine (DA), an important catecholamine neurotransmitter, plays an integral role in the physiological and pathological processes of various tissues through its corresponding receptors. Our current study found that upregulation of dopamine first receptors could be achieved by activating the Wnt/β-catenin pathway, improving osteogenesis in vivo and in vitro, and significantly reducing the inhibition of titanium particle-induced osteogenesis. Overall, these findings suggest that dopamine first receptor (D1R) may be a plausible target to promote osteoblast function and resist wear particle-induced PPO.
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Tibiofemoral lift-off and resulting laxity following total knee arthroplasty: Frequency in a series of 906 continuous cases and functional consequences at 4 years' follow-up in a case-control study. Orthop Traumatol Surg Res 2022; 108:103444. [PMID: 36252927 DOI: 10.1016/j.otsr.2022.103444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Tibiofemoral instability is one reason for early revision of total knee arthroplasty. It can be the consequence of tibiofemoral laxity, especially in the coronal plane with tibiofemoral lift-off. But does femoral condyle lift-off on conventional postoperative radiographs suggest the presence of laxity or potential instability? To our knowledge, this question has not yet been answered. This led us to conduct a retrospective study to evaluate (1) the frequency of lift-off on postoperative radiographs, (2) the relationship between lift-off and laxity in the short term and (3) the functional consequences of lift-off. HYPOTHESIS Postoperative lift-off is a rare event that is predictive of laxity. METHODS We carried out a single-center retrospective study using postoperative radiographs from patients who underwent primary total knee arthroplasty between 2014 and 2016. The sample consisted of 906 patients. Lift-off was defined as a tibiofemoral angle of 3° or more on immediate postoperative radiographs (day 0) that were non-weightbearing and had no stress applied. The functional outcomes were determined in the 17 patients identified as having lift-off who had been operated in the first year (2014) to ensure the follow-up was long enough. These patients were compared to 34 matched control patients who were operated the same year and chosen randomly among patients not having lift-off. The matching ratio was 2 controls to 1 case. Preoperative and surgical data were compiled from each patient's electronic medical record. Patients were evaluated at 4 years postoperatively using the subjective Oxford-48, objective HSS score, IKS score, overall patient satisfaction and stress radiographs of the knee. The cases of lift-off observed in 2014 (n=17) were paired with a control group of patients selected randomly during 2014. RESULTS The frequency of the lift-off event was 63/906 or 7%. The frequency was consistent over the three years studied: 7.1% in 2014 (19/269), 6.2% in 2015 (22/354) and 7.8% in 2016 (22/283). There was no significant difference between the two groups (17 with lift-off and 34 without) in the sex, age, body mass index and coronal plane deformity (preoperative HKA angle). At a mean follow-up of 4 years (range 12-49 months), the knees with postoperative lift-off had more laxity (p=0.002), particularly laxity when varus stress was applied (p=0.009). There were no other significant differences in the outcomes. DISCUSSION Immediate postoperative lift-off after total knee arthroplasty is not a rare event, with a 7% frequency in our study. While it reveals that laxity is present in the particular compartment, there is no evidence of functional consequences at 4 years' follow-up; however, a long-term assessment is required to verify this finding. LEVEL OF EVIDENCE III - case-control study.
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Derr T, MacDonald DW, Klein GR, Mont MA, Piuzzi NS, Kurtz SM. Short-Term Surface Damage Mechanisms of Retrieved Highly Cross-Linked Polyethylene Patellar Components. J Arthroplasty 2022; 38:939-944.e1. [PMID: 36574538 DOI: 10.1016/j.arth.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous retrieval studies of patellar components for total knee arthroplasty focused on historical designs and polyethylene materials that are no longer clinically relevant. Therefore, this study aimed to compare revision reasons and surface damage mechanisms of conventional, gamma inert sterilized polyethylene and highly cross-linked polyethylene (HXLPE) patellar components in contemporary designs from a single manufacturer. METHODS A total of 114 gamma inert and 76 HXLPE patellar components were gathered in a multicenter orthopaedic implant retrieval program. Patient age and body mass index were similar between cohorts (P = .27 and P = .42, respectively); however, the gamma inert cohort was implanted longer (μdifference = 3.1 years; P = .005). A matched subset was created based on the total knee arthroplasty design, patellar shape, and implantation time. Revision reasons were gathered from revision operating notes, and surface damage was examined via the Hood scoring method. Differences between HXLPE and gamma inert cohorts were evaluated using Mann-Whitney U-tests. RESULTS The most common revision reasons were infection, loosening, and instability, with the most common patellar complication resulting in revision being patellar loosening for both cohorts with similar incidences for both (chi-square; P = .60, P = .59). The most common surface damage modes were burnishing, scratching, and pitting in both cohorts. Total surface damage was significantly higher in the gamma inert components (P = .02), but not in the matched subset (P = .46). CONCLUSION Overall, the clinical performance of HXLPE was similar to that of conventional polyethylene for patellar components with short implantation times. While this study provides much needed information on the performance of HXLPE patellae in short-term retrievals, long-term studies are still needed.
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Affiliation(s)
- Tabitha Derr
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
| | | | | | - Michael A Mont
- Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | | | - Steven M Kurtz
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
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Benhenneda R, Le Nail LR, Druon J, Saad M, Rosset P, Samargandi R. Knee arthrodesis using a compression clamp and a single-plane external fixator to treat infection. Orthop Traumatol Surg Res 2022; 108:103330. [PMID: 35597544 DOI: 10.1016/j.otsr.2022.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/28/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In patients with knee infection, arthrodesis by external fixation is a limb-salvage procedure appropriate in highly selected patients. No hardware that might lead to infection is left in situ. However, the fusion rate is limited. Use of a device that applies compression in the coronal plane has been suggested in combination with sagittal external fixation to increase the fusion rate but has not been the focus of published studies. The objectives of this retrospective study were to determine: 1) the fusion rate and, 2) the rate of infection eradication. HYPOTHESIS Knee arthrodesis using an external fixator and a compression clamp provides higher fusion rates compared to reports of external fixation without compression. MATERIAL AND METHODS We retrospectively studied 30 patients who underwent knee arthrodesis using external fixation and a compression clamp. The reason for arthrodesis was recurrent infection after total knee arthroplasty in 18 patients and septic arthritis in 12 patients. There were 16 females and 14 males with a mean age of 66.0±11.6 years (range, 30-83 years). Mean follow-up was 42.5±23.6 months (range, 24-106 months). RESULTS Fusion was achieved in 25 (83%) patients, after a mean of 7.5 months (range, 6-12 months). Of the 8 patients with severe bone loss (≤25% bone contact), 4 experienced non-union, compared to 1 of the 22 patients whose bone loss was moderate or mild (50% and >50% bone contact, respectively) (p=0.01). After at least 2 years of follow-up, the infection was eradicated in 28 (93%) patients. Complications occurred in 9 patients and consisted of pin-site infection managed by lavage (n=3), recurrent infection requiring revision surgery for debridement and lavage combined with material exchange and antibiotic therapy (n=2), and femoral shaft fracture (n=3) or traumatic fracture of the arthrodesis (n=1) treated by changing the clamp and fixator assembly. DISCUSSION The fusion rate achieved using this combined technique is high and better than obtained with external fixation alone. Our results confirm that infection eradication is obtained more often than with nailing. This one-stage, simple, reproducible procedure does not leave any foreign material in situ. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Rayane Benhenneda
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France.
| | - Louis-Romée Le Nail
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Jérôme Druon
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Maxime Saad
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Philippe Rosset
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Ramy Samargandi
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
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Bulaïd Y, Djebara AE, Belhaouane R, Havet E, Dehl M, Mertl P. Beneficial effect of a zirconium-nitride-coated implant in total knee arthroplasty revision for suspected metal hypersensitivity. Orthop Traumatol Surg Res 2022; 108:103320. [PMID: 35577273 DOI: 10.1016/j.otsr.2022.103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Revision of total knee arthroplasty (rTKA) for suspicion of metal hypersensitivity (MHS) may require hypoallergenic implants. Results for coated implants have not been reported. The aim of the present study was to assess short-term results and survival of rTKA for MHS using a multilayer implant coating. HYPOTHESIS Multilayer implant coating improves functional results in rTKA, with survival comparable to primary coated implants. MATERIAL AND METHODS A single-center retrospective observational study included 28 patients (30 knees) undergoing rTKA for MHS using a coated implant between May 2011 and November 2016. Exclusion criteria comprised implant malpositioning and history of infection in the affected knee. Clinical and radiological results were assessed on the International Knee Society (IKS) and SF-36 functional scores and Ewald radiological score. Survival was calculated on Kaplan-Meier estimation. RESULTS Mean follow-up was 3.8 years. Mean IKS score increased by 40.2 points (40%) [range, 28.1-52.3] (p<0.05). Mean range of motion increased by 17° [range, 9.5-24.5°] (p<0.05). Mean physical and mental SF-36 components were respectively 44.7 and 46.1. Survivorship was 93%. DISCUSSION There was significant functional improvement after rTKA for MHS. There were no short-term complications related to the zirconium nitrate coating. However, studies with longer follow-up will be needed for confirmation. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Yassine Bulaïd
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Az-Eddine Djebara
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France.
| | - Ramy Belhaouane
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Eric Havet
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Massinissa Dehl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Patrice Mertl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
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Battut T, Argenson JN, Flecher X, Le Baron M. Comparison of morbidity-mortality and functional results between implant exchange and internal fixation by plate for periprosthetic femoral fracture in total knee arthroplasty: A 52-case series. Orthop Traumatol Surg Res 2022; 108:103293. [PMID: 35477035 DOI: 10.1016/j.otsr.2022.103293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 08/30/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Surgical options for periprosthetic femoral fracture in total knee arthroplasty (TKA) are controversial. The present retrospective study compared morbidity, mortality and functional results between implant exchange (group IE) and internal fixation by plate (group IF). The study hypothesis was that implant exchange does not give rise to more complications than plate fixation and that functional results are equivalent. METHODS Fifty-two femoral fractures in contact with a TKA implant were studied. The IE and IF groups (n 32 and 20, respectively), were comparable for age, gender and ASA score. Mean age was 80.5 years (range, 53-96 years). Morbidity and mortality were assessed on Clavien score; functional assessment used the KOOS questionnaire. RESULTS Mortality was 50% in group IF and 40% in group IE (p=0.4817). One patient was lost to follow-up. Complications were seen in 15 group IF patients (48.4%) versus 5 in group IE (26.3%) (p=0.14760), with infection in 5 (16.1%) and 2 patients (10.5%) respectively (p=0.69475). In both groups, 9 patients (i.e., 28.1% and 40% respectively) showed grade 2 complications (p=1). Revision surgery was performed in 8 grade 3b patients (25%) in the IF group and in 3 (15%) in the IE group (p=1). Mean KOOS score was 40 (range, 20-72) in IF and 65 (range, 50-93) in IE (p=0.0004). CONCLUSION Morbidity and mortality were comparable between implant exchange and plate fixation for periprosthetic femoral fracture in TKA. KOOS functional scores were better with implant exchange. Implant exchange may be suited to complex fracture with stable implant. LEVEL OF EVIDENCE IV, observational study.
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Affiliation(s)
- Thibault Battut
- Hôpital d'Instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France.
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Centre Hospitalo-Universitaire Sud, hôpital Sainte-Marguerite, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Xavier Flecher
- Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, Chemin des Bourrely, 13015 Marseille, France
| | - Marie Le Baron
- Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, Chemin des Bourrely, 13015 Marseille, France
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Limberg AK, Tibbo ME, Ollivier M, Tammachote N, Abdel MP, Berry DJ. Factors Affecting the Risk of Aseptic Patellar Complications in Primary TKA Performed with Cemented All-Polyethylene Patellar Resurfacing. J Bone Joint Surg Am 2022; 104:451-458. [PMID: 34932523 DOI: 10.2106/jbjs.21.00356] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patellar complications are a consequential cause of failure of primary total knee arthroplasty (TKA). The purpose of this study was to evaluate the association of demographic and patient factors with the long-term risk of patellar complications as a function of time in a very large cohort of primary TKAs performed with patellar resurfacing. METHODS We identified 27,192 primary TKAs utilizing cemented all-polyethylene patellar components that were performed at a single institution from 1977 through 2015. We evaluated the risk of any aseptic patellar complication and any aseptic patellar reoperation or revision, subanalyzed risks of reoperation or revision for loosening, maltracking/instability, and wear, and evaluated the risk of clinical diagnosis of patellar fracture and clunk/crepitus. The mean age at TKA was 68 years (range, 18 to 99 years); 57% of the patients were female. The mean body mass index (BMI) was 32 kg/m2. The primary diagnosis was osteoarthritis in 83%, and 70% of the TKAs were posterior-stabilized. Median follow-up was 7 years (range, 2 to 40 years). Risk factors for each outcome were evaluated with Cox regression models. RESULTS Nine hundred and seventy-seven knees with all-polyethylene patellae developed patellar complications. Survivorship free from any aseptic patellar complication was 93.3% at 20 years. Twenty-year survivorship free from any aseptic patellar reoperation was 97.3% and free from any aseptic patellar revision was 97.4%. Fifteen-year survivorship for the same end points for procedures performed from 2000 to 2015 was 95.7%, 99.2% and 99.3% respectively, representing substantial improvements compared with implants placed before 2000. Univariate analysis demonstrated that male sex (hazard ratio [HR], 1.4), an age of <65 years (HR, 1.3), and a BMI of ≥30 kg/m2 (HR, 1.2) were associated with increased risk of patellar complications (all p ≤0.01). Posterior-stabilized designs were associated with fewer patellar reoperations and revisions overall (HR, 0.4 and 0.4; p < 0.001) but higher risk of patellar clunk/crepitus (HR, 14.1; p < 0.001). CONCLUSIONS The 20-year survivorship free from any aseptic patellar complication in this series of cemented all-polyethylene patellae was 93%. Important risk factors for any aseptic patellar complication were male sex, an age of <65 years, a BMI of ≥30 kg/m2, and a patella implanted before 2000. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Afton K Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthieu Ollivier
- Department of Orthopedic Surgery, Aix-Marseille Université, Marseille, France
| | | | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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12
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Nagira K, Hagino H, Enokida M, Enokida S, Ishida K, Hayashi I, Nagashima H. Total knee arthroplasty in the past three decades: Trends in patient characteristics and implant survivorship. Mod Rheumatol 2022; 32:432-437. [PMID: 33853475 DOI: 10.1080/14397595.2021.1913823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore the trends in patient characteristics and implant survivorship (IS) for primary total knee arthroplasty (TKA) over the past three decades. METHODS This retrospective study enrolled a total of 635 knees who underwent TKA from 1985 to 2014. They were divided into three groups: group A, 125 knees in 1985-1994; group B, 203 knees in 1995-2004; and group C, 307 knees A in 2005-2014. The patient characteristics and IS were compared. RESULTS The mean age of patients undergoing TKA was getting older: 65.3 ± 9.7, 69.1 ± 10.0, and 74.6 ± 8.4 years, in groups A, B, and C, respectively (p = .001). The proportion of patients <60 years old with RA decreased (p < .001), whereas that of patients ≥ 80 years old with OA increased dramatically, it was 7.0%, 14.5%, and 32.0% in groups A, B, and C, respectively (p < .001). The IS free from infection was over 98% in all groups. Alternatively, the IS free from aseptic loosening become better, it was 83.7%, 95.2%, and 98.2% in groups A, B, and C, respectively (p = .014). CONCLUSIONS From these trends, we can estimate that the number of patients undergoing TKA will further increase in the future in an aging society.
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Affiliation(s)
- Keita Nagira
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hiroshi Hagino
- School of Health Science, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Makoto Enokida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Shinpei Enokida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Koji Ishida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Ikuta Hayashi
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
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13
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Khow YZ, Liow MHL, Goh GS, Chen JY, Lo NN, Yeo SJ. The oxford knee score minimal clinically important difference for revision total knee arthroplasty. Knee 2021; 32:211-217. [PMID: 34509827 DOI: 10.1016/j.knee.2021.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Minimal clinically important difference (MCID) is crucial for interpreting meaningful improvements in patient-reported outcome measures (PROMs). No previous study has evaluated the MCID for the Oxford Knee Score (OKS) in revision total knee arthroplasty (TKA). This study aimed to propose the OKS MCID for revision TKA. METHODS Prospectively collected data from 191 patients who underwent revision TKA at a single institution was analysed. Clinical assessment was performed preoperatively and at 2 years using OKS and Short-Form 36 Physical Component Score (SF-36 PCS). MCID was evaluated with a three-pronged methodology, using (1) anchor-based method with linear regression, (2) anchor-based method with receiver operating characteristic (ROC) and area under curve (AUC), (3) distribution-based method with standard deviation (SD). The anchors used were improvement in SF-36 PCS ≥ 12, patient satisfaction, and implant survivorship following revision TKA. RESULTS The MCID determined by anchor-based linear regression method using improvements in SF-36 PCS was 4.9 points. The MCID determined by anchor-based ROC was 10.5 points for satisfaction (AUC = 74.8%) and 13.5 points for implant survivorship (AUC = 73.7%). The MCID determined by distribution-based method of 0.5 SD was 4.7. CONCLUSION The proposed MCID for OKS following revision TKA is 4.9 points. Patients who achieve an improvement in OKS of at least 10.5-13.5 points by 2 years are likely to be satisfied with their surgery and not require a subsequent re-revision TKA. Patients undergoing revision TKA should aim for an improvement in OKS of at least 10.5-13.5 points as a target score.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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14
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Gkiatas I, Xiang W, Nocon AA, Youssef MP, Tarity TD, Sculco PK. Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:2907-2912. [PMID: 33840538 DOI: 10.1016/j.arth.2021.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) varies and is of unclear clinical significance. This study aimed to identify the incidence of HO in patients undergoing revision TKA for either stiffness or aseptic loosening/instability and determine if the presence of HO is associated with inferior absolute range of motion (ROM) and ROM gains. METHODS Eighty-seven patients were prospectively enrolled and separated into 2 cohorts to evaluate ROM after revision TKA (2017-2019). Group 1 (N = 40) patients were revised for stiffness, while group 2 (N = 47) patients were revised for either aseptic loosening or instability. Goniometer-measured ROM values were obtained preoperatively and at 6 weeks, 6 months, and 1 year postoperatively. Statistical analysis included a Fisher's exact test to assess for an association between preoperative HO and final ROM at 1 year after revision TKA. RESULTS HO was identified on preoperative radiographs in 17 patients (20%). There was a significantly higher rate of preoperative HO in patients revised for stiffness compared to patients revised for instability or loosening (30% vs 11%; P = .03). Five cases of HO qualitatively identified as most clinically severe were associated with lower ROM at each time point compared to the remainder of HO cases in this study cohort (P < .02). CONCLUSION The presence of HO is greater in patients undergoing revision TKA for stiffness. Additionally, HO severity appears to have a major effect on preoperative and postoperative ROM trajectory. This information should help guide patient expectations and highlight the need for a comprehensive, standardized classification system for HO.
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Affiliation(s)
- Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - William Xiang
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Allina A Nocon
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Mark P Youssef
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - T David Tarity
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
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15
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Chalmers BP, Elmasry SS, Kahlenberg CA, Mayman DJ, Wright TM, Westrich GH, Imhauser CW, Sculco PK, Cross MB. Additional distal femoral resection increases mid-flexion coronal laxity in posterior-stabilized total knee arthroplasty with flexion contracture : a computational study. Bone Joint J 2021; 103-B:87-93. [PMID: 34053287 DOI: 10.1302/0301-620x.103b6.bjj-2020-2444.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS Surgeons commonly resect additional distal femur during primary total knee arthroplasty (TKA) to correct a flexion contracture, which leads to femoral joint line elevation. There is a paucity of data describing the effect of joint line elevation on mid-flexion stability and knee kinematics. Thus, the goal of this study was to quantify the effect of joint line elevation on mid-flexion laxity. METHODS Six computational knee models with cadaver-specific capsular and collateral ligament properties were implanted with a posterior-stabilized (PS) TKA. A 10° flexion contracture was created in each model to simulate a capsular contracture. Distal femoral resections of + 2 mm and + 4 mm were then simulated for each knee. The knee models were then extended under a standard moment. Subsequently, varus and valgus moments of 10 Nm were applied as the knee was flexed from 0° to 90° at baseline and repeated after each of the two distal resections. Coronal laxity (the sum of varus and valgus angulation with respective maximum moments) was measured throughout flexion. RESULTS With + 2 mm resection at 30° and 45° of flexion, mean coronal laxity increased by a mean of 3.1° (SD 0.18°) (p < 0.001) and 2.7° (SD 0.30°) (p < 0.001), respectively. With + 4 mm resection at 30° and 45° of flexion, mean coronal laxity increased by 6.5° (SD 0.56°) (p < 0.001) and 5.5° (SD 0.72°) (p < 0.001), respectively. Maximum increased coronal laxity for a + 4 mm resection occurred at a mean 15.7° (11° to 33°) of flexion with a mean increase of 7.8° (SD 0.2°) from baseline. CONCLUSION With joint line elevation in primary PS TKA, coronal laxity peaks early (about 16°) with a maximum laxity of 8°. Surgeons should restore the joint line if possible; however, if joint line elevation is necessary, we recommend assessment of coronal laxity at 15° to 30° of knee flexion to assess for mid-flexion instability. Further in vivo studies are warranted to understand if this mid-flexion coronal laxity has negative clinical implications. Cite this article: Bone Joint J 2021;103-B(6 Supple A):87-93.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Shady S Elmasry
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Cynthia A Kahlenberg
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Michael B Cross
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
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Rothammer B, Marian M, Neusser K, Bartz M, Böhm T, Krauß S, Schroeder S, Uhler M, Thiele S, Merle B, Kretzer JP, Wartzack S. Amorphous Carbon Coatings for Total Knee Replacements-Part II: Tribological Behavior. Polymers (Basel) 2021; 13:1880. [PMID: 34198895 PMCID: PMC8201056 DOI: 10.3390/polym13111880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/27/2022] Open
Abstract
Diamond-like carbon coatings may decrease implant wear, therefore, they are helping to reduce aseptic loosening and increase service life of total knee arthroplasties (TKAs). This two-part study addresses the development of such coatings for ultrahigh molecular weight polyethylene (UHMWPE) tibial inlays as well as cobalt-chromium-molybdenum (CoCr) and titanium (Ti64) alloy femoral components. While the deposition of a pure (a-C:H) and tungsten-doped hydrogen-containing amorphous carbon coating (a-C:H:W) as well as the detailed characterization of mechanical and adhesion properties were the subject of Part I, the tribological behavior is studied in Part II. Pin-on-disk tests are performed under artificial synovial fluid lubrication. Numerical elastohydrodynamic lubrication modeling is used to show the representability of contact conditions for TKAs and to assess the influence of coatings on lubrication conditions. The wear behavior is characterized by means of light and laser scanning microscopy, Raman spectroscopy, scanning electron microscopy and particle analyses. Although the coating leads to an increase in friction due to the considerably higher roughness, especially the UHMWPE wear is significantly reduced up to a factor of 49% (CoCr) and 77% (Ti64). Thereby, the coating shows continuous wear and no sudden failure or spallation of larger wear particles. This demonstrated the great potential of amorphous carbon coatings for knee replacements.
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Affiliation(s)
- Benedict Rothammer
- Engineering Design, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Martensstr. 9, 91058 Erlangen, Germany; (K.N.); (M.B.); (S.W.)
| | - Max Marian
- Engineering Design, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Martensstr. 9, 91058 Erlangen, Germany; (K.N.); (M.B.); (S.W.)
| | - Kevin Neusser
- Engineering Design, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Martensstr. 9, 91058 Erlangen, Germany; (K.N.); (M.B.); (S.W.)
| | - Marcel Bartz
- Engineering Design, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Martensstr. 9, 91058 Erlangen, Germany; (K.N.); (M.B.); (S.W.)
| | - Thomas Böhm
- Forschungszentrum Jülich GmbH, Helmholtz-Institute Erlangen-Nürnberg for Renewable Energy, Cauerstr. 1, 91058 Erlangen, Germany; (T.B.); (S.T.)
| | - Sebastian Krauß
- Department of Materials Science & Engineering, Interdisciplinary Center for Nanostructured Films (IZNF) Institute I, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Cauerstr. 3, 91058 Erlangen, Germany; (S.K.); (B.M.)
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany; (S.S.); (M.U.); (J.P.K.)
| | - Maximilian Uhler
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany; (S.S.); (M.U.); (J.P.K.)
| | - Simon Thiele
- Forschungszentrum Jülich GmbH, Helmholtz-Institute Erlangen-Nürnberg for Renewable Energy, Cauerstr. 1, 91058 Erlangen, Germany; (T.B.); (S.T.)
- Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Egerlandstr. 3, 91058 Erlangen, Germany
| | - Benoit Merle
- Department of Materials Science & Engineering, Interdisciplinary Center for Nanostructured Films (IZNF) Institute I, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Cauerstr. 3, 91058 Erlangen, Germany; (S.K.); (B.M.)
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany; (S.S.); (M.U.); (J.P.K.)
| | - Sandro Wartzack
- Engineering Design, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Martensstr. 9, 91058 Erlangen, Germany; (K.N.); (M.B.); (S.W.)
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Dainty JR, Smith TO, Clark EM, Whitehouse MR, Price AJ, MacGregor AJ. Trajectories of pain and function in the first five years after total hip and knee arthroplasty : an analysis of patient reported outcome data from the National Joint Registry. Bone Joint J 2021; 103-B:1111-1118. [PMID: 34058866 DOI: 10.1302/0301-620x.103b6.bjj-2020-1437.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To determine the trajectories of patient reported pain and functional disability over five years following total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS A prospective, longitudinal cohort sub-study within the National Joint Registry (NJR) was undertaken. In all, 20,089 patients who underwent primary THA and 22,489 who underwent primary TKA between 2009 and 2010 were sent Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires at six months, and one, three, and five years postoperatively. OHS and OKS were disaggregated into pain and function subscales. A k-means clustering procedure assigned each patient to a longitudinal trajectory group for pain and function. Ordinal regression was used to predict trajectory group membership using baseline OHS and OKS score, age, BMI, index of multiple deprivation, sex, ethnicity, geographical location, and American Society of Anesthesiologists grade. RESULTS Data described two discrete trajectories for pain and function: 'level 1' responders (around 70% of cases) in whom a high level of improvement is sustained over five years, and 'level 2' responders who had sustained improvement, but at a lower level. Baseline patient variables were only weak predictors of pain trajectory and modest predictors of function trajectory. Those with worse baseline pain and function tended to show a greater likelihood of following a 'level 2' trajectory. Six-month patient-reported outcome measures data reliably predicted the class of five-year outcome trajectory for both pain and function. CONCLUSION The available preoperative patient variables were not reliable predictors of postoperative pain and function after THA and TKA. Reviewing patient outcomes at six months postoperatively is a reliable indicator of outcome at five years. Cite this article: Bone Joint J 2021;103-B(6):1111-1118.
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Affiliation(s)
- Jack R Dainty
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Emma M Clark
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Praz C, Gubbiotti L, Buia G, Chapus V, Dunet J, Grandhomme F, Michon J, Rochcongar G, Hulet C. Value of the synovial C-reactive protein test in the diagnosis of total hip and knee periprosthetic joint infections: A case-control study. Orthop Traumatol Surg Res 2021; 107:102903. [PMID: 33775885 DOI: 10.1016/j.otsr.2021.102903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The diagnosis of periprosthetic joint infection (PJI) can be challenging and rests on several principles. The use of diagnostic biomarkers, such as the synovial C-Reactive Protein (CRP), seems promising. The purpose of this study was to determine whether synovial CRP was a more discriminating test than serum CRP for the diagnosis of hip and knee PJI. MATERIALS AND METHODS In total, 194 patients were included in this single center prospective study: 42 primary arthroplasties (control group [CG]), 111 revisions for aseptic prosthesis (aseptic revision group [ARG]), and 41 revisions for septic prosthesis (septic revision group [SRG]) based on the Musculoskeletal Infection Society (MSIS) criteria. RESULTS The serum and synovial CRP levels were significantly higher in the SRG than the other two groups (SRG serum CRP=75.6mg/L vs. ARG serum CRP=6mg/L and CG serum CRP=2.7mg/L, p<0.001; SRG synovial CRP=31.5mg/L vs. CG synovial CRP=2.6mg/L and ARG synovial CRP=1.7mg/L, p<0.001). The positive likelihood ratios (LR+) were very similar for both the synovial CRP cut-off value of 4.4mg/L (LR+=7.04; sensitivity [Se] 82.5%, specificity [Sp] 88.3%) and the serum CRP cut-off value of 9mg/L (LR+=6.3; Se 87.5%, Sp 86.1%). CONCLUSION This study showed that synovial CRP testing was not more discriminating than serum CRP in the diagnosis of hip and knee PJI. A serum CRP level greater than 9mg/L was a sign of PJI. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- César Praz
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - Laura Gubbiotti
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Geoffrey Buia
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Valentin Chapus
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Julien Dunet
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Frederique Grandhomme
- Secteurs biochimie et hormonologie, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Jocelyn Michon
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Goulven Rochcongar
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Christophe Hulet
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
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Kerzner B, Kunze KN, O’Sullivan MB, Pandher K, Levine BR. Temporal Trends of Revision Etiologies in Total Knee Arthroplasty at a Single High-Volume Institution: An Epidemiological Analysis. Arthroplast Today 2021; 9:68-72. [PMID: 34041332 PMCID: PMC8141416 DOI: 10.1016/j.artd.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/04/2021] [Accepted: 04/04/2021] [Indexed: 01/16/2023] Open
Abstract
Background Temporal changes in revision total knee arthroplasty (rTKA) may have implications in determining the etiology for implant failure. The purpose of this study was to 1) perform an epidemiologic analysis of etiologies that required rTKA and 2) determine whether temporal changes existed for revision over the study period. Methods All rTKA procedures performed at a single institution from 2009 to 2019 were analyzed. Revision procedures were stratified into 2 time periods, 2009-2013 and 2014-2019, to assess for changes over time. Patients' electronic medical record, operative report, and radiographs were reviewed to ensure diagnosis information was accurately documented in relation to the predominate etiology necessitating the revision procedure. Results Three thousand and nine patients undergoing rTKA between 2009 and 2019 were identified with a mean age of 64.6 years. A total of 1,666 (55.4%) patients were female, and the majority of patients were Caucasian (2,306, 76.6%). The 3 most frequent rTKA etiologies were aseptic loosening (35.1%), periprosthetic infection (33.2%), and instability (16.0%). A higher proportion of patients underwent rTKA for arthrofibrosis (5.1% vs 3.4%, P = .023) and periprosthetic joint infection (38.9% vs 28.6%, P < .001) between 2009 and 2013, while a significantly higher proportion of patients underwent rTKA for instability (12.6% vs 18.8%, P < .001) between 2014 and 2019. Conclusion Aseptic loosening was the most common cause for rTKA over the last decade. rTKA for arthrofibrosis and periprosthetic joint infection was more frequent between 2009 and 2013, while a significantly higher proportion of patients underwent rTKA for instability in 2014-2019. Future studies will need to focus on identifying and reducing risk factors for the trending causes of rTKA.
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Affiliation(s)
- Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- Corresponding author. 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA.
| | - Kyle N. Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Karan Pandher
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brett R. Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Bové JC, Clavé A. Navigated total knee arthroplasty: Retrospective study of 600 continuous cases. Orthop Traumatol Surg Res 2021; 107:102857. [PMID: 33588092 DOI: 10.1016/j.otsr.2021.102857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Computer-assisted navigation in total knee arthroplasty (TKA) has existed for more than 20 years, although its use has been marginal. Its benefits are still largely debated, especially its efficacy for achieving the desired postoperative alignment. HYPOTHESIS A neutral hip-knee-ankle (HKA) angle (180°±3°) will be achieved in at least 85% of cases and there will be no difference between the different types of navigation systems used. MATERIAL AND METHODS In this retrospective, single-center, single-surgeon study, all the TKAs completed between September 2003 and December 2017 were included, giving a total of 753 navigated TKAs: Navitrack group: 196 Natural Knee II implants (Zimmer) with the Navitrack-OS Knee system (Zimmer CAS); Brainlab group: 557 implants (196 Profix, Smith & Nephew and 361 LCS, DePuy) with the Brainlab Vector Vision system. The aim of navigation was independent of the preoperative alignment and was always to achieve a neutral HKA mechanical axis (180°±3°). The primary endpoint was the postoperative HKA angle. This parameter was used to determine whether the navigation objective was achieved, to define how many patients were outliers and to compare navigation systems to each other. The potential influence of sex, body mass index (BMI) and preoperative deformity were secondary aims. Lastly, the final navigation values were compared to radiological data to detect any potential deviations. RESULTS We analyzed 600 of the cases, 160 in the Navitrack group and 440 in the Brainlab group (152 Profix and 288 LCS). A neutral HKA angle was found in 91% patients: 93% for the Navitrack group and 90% in the Brainlab group (90.8% Profix and 89.6% LCS). There was no significant difference between groups (p=0.68), nor between subgroups (p=0.85). An elevated BMI negatively influenced the ability to achieve a neutral HKA (p=0.015), regardless of the system used. CONCLUSION In our study of 600 TKA cases done with navigation, the postoperative alignment goal (HKA 180°±3°) was achieved in 91% of cases. There was no difference between navigation systems. Patients with a high BMI were more likely to be outliers (p=0.015). LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jean-Claude Bové
- Service d'Orthopédie, Polyclinique du Val de Sambre, Maubeuge, France.
| | - Arnaud Clavé
- Service d'Orthopédie, Polyclinique Saint-George, Nice, France; LaTIM, UMR 1101 INSERM-UBO, Brest, France
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Justo A, Vilette H, Ehlinger M, Pasquier G, Laumonerie P, Cavaignac É. A retrospective comparison of central and posterior hinge joints in 53 total knee arthroplasties. Orthop Traumatol Surg Res 2021; 107:102868. [PMID: 33636414 DOI: 10.1016/j.otsr.2021.102868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The number of hinged total knee arthroplasty (HTKA) procedures is constantly increasing. There are two hinge types: central (CHTKA) and posterior (PHTKA). The primary purpose of the study was to compare implant survival in patients with CHTKA versus PHTKA. The secondary purpose was to analyse the radiological and clinical results of the implants. HYPOTHESIS There is no difference between the two groups. MATERIALS AND METHODS This study involved 53 patients who received a HTKA for either primary, trauma or revision surgery, of these 32 were in the CHTKA group and 21 in the PHTKA group, with a mean age of 69 years (38-89). The exclusion criteria were: etiology of sepsis, incomplete records and refusal to use data. The revision rate, with the replacement of prosthetic components, was the primary endpoint. The secondary outcomes were: mobility, complications, VAS, IKS, Devane, Charnley and Oxford knee scores, and radiological progression. RESULTS The mean follow-up was 51 months (1-139). At 60 months, overall survival rate of the HTKA was 81%, with a confidence interval (CI) of 95% (71-93.2), and there was no difference between CHTKA and PHTKA, 77.7% (95% CI, 63.3-95.4) versus 85.7% (95% CI, 72-100), p=0.625, respectively. Flexion was 101°±15 (80-140) for CHTKA versus 98°±12 (30-130) for PHTKA, p=0.006. VAS was 0.5±16 (0-6) for CHTKA versus 1.6±14 (0-4) for PHTKA, p=0.000008. The IKS was 103±39 (15-180) for CHTKA versus 81±51 (9-200) for PHTKA, p=0.03. There were no differences in either radiological progression, complications or other functional scores. DISCUSSION No significant difference was observed between the survival of CHTKA and PHTKA. CHTKA had better flexion, reduced VAS and increased IKS. Surgeons should be aware of these findings and apply careful consideration to their choice of hinge. LEVEL OF EVIDENCE IV; retrospective single-centre study.
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Affiliation(s)
- Arthur Justo
- Service de chirurgie orthopédique et traumatologique, Hôpital Pierre-Paul-Riquet, 1, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France.
| | - Hugo Vilette
- Service de chirurgie orthopédique et traumatologique, Hôpital Pierre-Paul-Riquet, 1, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Matthieu Ehlinger
- Service de chirurgie du membre inférieur et de traumatologie, Hautepierre II, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Gilles Pasquier
- Service de chirurgie orthopédique et traumatologique, Hôpital Roger-Salengro, CHU de Lille, avenue Émile-Laine, 59037 Lille cedex, France
| | - Pierre Laumonerie
- Service de chirurgie orthopédique et traumatologique, Hôpital Pierre-Paul-Riquet, 1, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Étienne Cavaignac
- Service de chirurgie orthopédique et traumatologique, Hôpital Pierre-Paul-Riquet, 1, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
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Dartus J, Jacques T, Martinot P, Pasquier G, Cotten A, Migaud H, Morel V, Putman S. The advantages of cone-beam computerised tomography (CT) in pain management following total knee arthroplasty, in comparison with conventional multi-detector CT. Orthop Traumatol Surg Res 2021; 107:102874. [PMID: 33647454 DOI: 10.1016/j.otsr.2021.102874] [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: 05/13/2020] [Revised: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Revision of total knee arthroplasty (TKA) requires preoperative assessment to identify the causes of failure. Multidetector computerised tomography (MDCT) is a commonly used imaging technique, but is sensitive to certain artifacts, such as metal implants, limiting its use. Cone-beam CT (CBCT) is a new technique dedicated to musculoskeletal imaging that is less sensitive to artifacts and could be utilised in knee implantation surgery. CBCT has not yet been validated for this indication, and we therefore undertook a retrospective assessment of MDCT versus CBCT, comparing: 1) image quality; 2) reproducibility of angle measurements; 3) effectiveness in screening for periprosthetic radiolucency and implant loosening; and 4) radiation dose. HYPOTHESIS This study hypothesised that CBCT provides better image quality, angle measurement reproducibility, and screening for radiolucency and implant loosening at lower doses of radiation than MDCT. PATIENTS AND METHOD Between October 2017 and March 2018, 28 patients, with a mean age of 61±11.6 years [range, 45-85 years] underwent both MDCT and CBCT for pain following TKA. Two radiologists performed angle measurements on both devices: patellofemoral tilt (PFT), rotation angle of the femoral component (RAFC) and rotation angle of the tibial component (RATC). They also screened for pathological radiolucency and/or implant loosening, and assessed image quality at the various bone/implant interfaces. The mean CT dose index per examination was recorded. RESULTS Intraclass correlation coefficients for angles and radiolucency screening on MDCT and on CBCT were respectively good (0.73) and excellent (0.82) for PFT, borderline (0.28) and moderate (0.44) for RAFC, excellent (0.82) and excellent (0.96) for RATC, and moderate (0.45) and excellent (0.84) for radiolucency screening. The inter-observer kappa correlation coefficients for diagnosis of implant loosening and image quality assessment for MDCT and CBCT were respectively moderate (0.45) and excellent (0.93) for tibial loosening and low (0.19) and borderline (0.38) for femoral loosening. The mean image quality at the various interfaces for MDCT and CBCT was respectively 2.2/3 and 2.75/3 at the tibia/tibial implant interface, 1/3 and 2.3/3 at the trochlear region/femoral implant interface, 0.9/3 and 2/3 at the femoral condyle/femoral implant interface, and 1.25/3 and 2.1/3 at the patella/patellar medallion interface. The mean CT dose index was significantly lower, by a factor of 1.24, on CBCT (4.138 mGy) than MDCT (5.125 mGy) (p<00396). CONCLUSION The results of the present study revealed added value for CBCT in the etiological work-up for pain following a TKA. It was reliable and reproducible for the rotation measurement and diagnosis of implant loosening, due to enhanced image quality despite a lower radiation dose than conventional MDCT. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Julien Dartus
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France.
| | - Thibaut Jacques
- Service d'imagerie musculo-squelettique, CHU de Lille, Centre de consultations et d'imagerie de l'appareil locomoteur, 59000 Lille, France
| | - Pierre Martinot
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France; Service d'imagerie musculo-squelettique, CHU de Lille, Centre de consultations et d'imagerie de l'appareil locomoteur, 59000 Lille, France
| | - Gilles Pasquier
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France
| | - Anne Cotten
- Service d'imagerie musculo-squelettique, CHU de Lille, Centre de consultations et d'imagerie de l'appareil locomoteur, 59000 Lille, France
| | - Henri Migaud
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France
| | - Vincent Morel
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service d'imagerie musculo-squelettique, CHU de Lille, Centre de consultations et d'imagerie de l'appareil locomoteur, 59000 Lille, France
| | - Sophie Putman
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France
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Salib CG, Reina N, van Wijnen AJ, Hanssen AD, Berry DJ, Abdel MP. Absence of signature inflammatory markers in synovial fluid for total knee arthroplasties revised for arthrofibrosis. Orthop Traumatol Surg Res 2021; 107:102870. [PMID: 33639288 PMCID: PMC8087631 DOI: 10.1016/j.otsr.2021.102870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Current diagnostic criteria for arthrofibrosis are limited. Since many patients will be aspirated during their clinical course, synovial fluid analysis may supplement current diagnostic criteria for arthrofibrosis. The goal of this study was to determine a unique synovial fluid and inflammatory marker profile for diagnosing arthrofibrosis. HYPOTHESIS Patients with arthrofibrosis following total knee arthroplasty will have a unique synovial fluid aspirate profile compared to control patients to aid in diagnosis. MATERIALS AND METHODS Between 2013 and 2017, 32 patients (32 total knee arthroplasties [TKAs]) underwent revision TKAs for arthrofibrosis. Fourteen patients had pre-revision aspirations. They were 2:1 matched based on age, sex, body mass index (BMI), and year of revision to 28 patients who underwent aseptic revision TKAs for reasons other than arthrofibrosis (control group). Mean age at revision was 66years, with 64% males. RESULTS In TKAs revised for arthrofibrosis, mean total cell count was 828cells/uL. These aspirates contained a mean distribution of 46% macrophages (range: 4-76%), 31% lymphocytes (range: 11-68%), 21% neutrophils (range: 0-75%), 1% other cells (mainly synovial cells; range: 0-11%), and 1% eosinophils (range: 0-7%). There was no significant difference in mean total cell count (p=0.8) or mean distribution of macrophages (p=0.6), lymphocytes (p=0.1), neutrophils (p=0.2), eosinophils (p>0.9), or serum inflammatory markers (p>0.7) when compared to controls. All aspirations were culture negative for infection. DISCUSSION The profile of arthrofibrotic synovial fluid aspirates and serum inflammatory marker values were similar to patients revised for non-arthrofibrotic aseptic etiologies. This suggests synovial fluid and serum inflammatory markers in non-infected knees with arthrofibrosis should expect to have characteristics similar to synovial fluid and inflammatory marker profiles in other aseptic diagnoses. LEVEL OF EVIDENCE III; retrospective case-control study.
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Houfani F, Mainard D, Rubens-Duval B, Papin PE, Pasquier G, Ehlinger M. Rotating-hinge prosthesis for aseptic revision knee arthroplasty: A multicentre retrospective study of 127 cases with a mean follow-up of five years. Orthop Traumatol Surg Res 2021; 107:102855. [PMID: 33581278 DOI: 10.1016/j.otsr.2021.102855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The use of third-generation rotating-hinge knee prostheses has increased considerably in recent years. The more anatomical design of these prostheses, together with their controlled rotation system that reduces constraints generated by the single degree of liberty, have produced better outcomes. The objective of this study was to evaluate the clinical and radiological outcomes of revision knee arthroplasty for aseptic failure using rotating-hinge prostheses. HYPOTHESIS The rotating-hinge knee prostheses currently used in France provide significant improvements in function and self-sufficiency of patients undergoing revision knee arthroplasty, with outcomes comparable to those reported with constrained condylar knees. MATERIAL AND METHODS A multicentre retrospective study was conducted in 17 centres, under the auspices of the SoFCOT. The cohort consisted of 127 patients (127 knees) operated on before 2013. The main reasons for knee revision were aseptic loosening, major instability, mechanical failure, and extensor apparatus failure. Function and self-sufficiency were assessed using the International Knee Society (IKS) score and the Devane score, respectively. Survival was defined with all-cause surgical revision as the end point. RESULTS Mean follow-up was 67.3±11.8 months (range, 13-180 months). Significant improvements (p<0.001) were seen in the total IKS score (+42 points), the IKS function score (+12 points), and the knee IKS score (+30 points). Paradoxically, the Devane score decreased by 0.44 point. The 5-year survival rate was 77% (95% confidence interval, 0.70-0.85). Postoperative complications developed in 29% of patients (infection, n=12; aseptic loosening, n=11; and fracture, n=7). DISCUSSION Rotating-hinge prostheses provide satisfactory outcomes of knee arthroplasty revision and remain an effective option for complex cases, confirming our working hypothesis. Self-sufficiency diminishes slightly. The long-term outcomes obtained using rotating-hinge prostheses are, however, less satisfactory than those observed with constrained condylar knees for aseptic TKA revision, and the complication rate is higher, although the population and local circumstances are different. Discernment is therefore in order when determining the indications of rotating-hinge prostheses. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Fayçal Houfani
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHRU de Nancy, hôpital central, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France.
| | - Didier Mainard
- Service de chirurgie orthopédique, traumatologique et arthroscopique, CHRU de Nancy, hôpital central, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - Brice Rubens-Duval
- Service de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble-Alpes, 38130 Échirolles, France
| | - Pierre-Emmanuel Papin
- Service de chirurgie orthopédique et traumatologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - Gilles Pasquier
- Service d'orthopédie, hôpital Roger-Salengro, place de Verdun, centre hospitalier régional universitaire de Lille, 59037, Lille, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, CHU de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
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- SoFCOT, 56, rue Boissonade, 75014 Paris, France
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Caron É, Gabrion A, Ehlinger M, Verdier N, Rubens-Duval B, Neri T, Martz P, Putman S, Pasquier G. Complications and failures of non-tumoral hinged total knee arthroplasty in primary and aseptic revision surgery: A review of 290 cases. Orthop Traumatol Surg Res 2021; 107:102875. [PMID: 33652151 DOI: 10.1016/j.otsr.2021.102875] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Hinged total knee arthroplasty (TKA) implants are a commonly used option during revision or even primary surgery, but their complications are not as well known, due to the rapid adoption of gliding implants. The literature is inconsistent on this topic, with studies having a small sample size, varied follow-up duration and very different indications. This led us to carry out a large multicentre study with a minimum follow-up of 5 years to evaluate the complications after hinged TKA in a non-tumoral context based on the indications of primary arthroplasty, aseptic surgical revision or fracture treatment around the knee. HYPOTHESIS Hinged TKA was associated with a high complication rate, no matter the indication. MATERIAL AND METHODS Two hundred and ninety patients (290 knees) were included retrospectively between January 2006 and December 2011 at 17 sites, with a minimum follow-up of 5 years. The patients were separated into three groups: primary surgery (111 patients), aseptic revision surgery (127 patients) and surgery following a recent (<3 months) fracture (52 patients: 13 around the TKA and 39 around the knee treated by hinged TKA). Patients who had an active infection the knee of interest were excluded. All the patients were reviewed based on a standardised computer questionnaire validated by the SOFCOT. RESULTS The mean follow-up was 71±39 months [range, 0 to 188]. Of the 290 patients included in the study, 108 patients (37%) suffered at least one complication and 55 patients (19%) had to undergo revision surgery: 16 in the primary TKA group (16/111, 14% of primary TKA), 28 in the revision surgery group (28/127, 22% of revision TKA) and 11 in the fracture treatment group (11/52, 21% of fracture TKA). The complications due to the hinged TKA for the entire cohort from most to least common were stiffness (41/290, 14%), chronic postoperative pain (37/290, 13%), infection (32/290, 11%), aseptic loosening (23/290, 8%), general complications (20/290, 7%), extensor mechanism complications (19/290, 6%), periprosthetic fracture (9/290, 3%), mechanical failure (2/290, 0.7%). In the primary TKA group, the main complication leading to re-operation was infection (12/111, 11%), while it was loosening for the revision TKA group (15/127, 12%) and infection (8/52, 15%) for the fracture TKA group. DISCUSSION The 37% complication rate for hinged TKA implants is high, with 19% of them requiring re-operation. The frequency of complications differed depending on the context in which the hinged implant was used (primary, revision, fracture). The complications requiring revision surgery were major ones that prevented patients from preserving their autonomy (infection, symptomatic loosening, fracture, implant failure). The most found complications - stiffness and chronic pain - rarely led to revision. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Étienne Caron
- Université Lille Nord de France, 59000 Lille, France; Service de chirurgie orthopédique II, Hôpital Roger-Salengro, CHU Lille, place de Verdun, 59037 Lille, France.
| | - Antoine Gabrion
- Service de chirurgie orthopédique, Hôpital Sud, CHU Amiens-Picardie, 80054 Amiens, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - Nicolas Verdier
- Clinique Jean-Villar, avenue Maryse-Bastié, 33520 Bruges, France
| | - Brice Rubens-Duval
- Service de chirurgie de l'arthrose et du sport, Urgences traumatiques des membres, Hôpital sud, CHU Grenoble Alpes, CS 90338, 38434 Échirolles, France
| | - Thomas Neri
- Service de chirurgie orthopédique, Hôpital Nord, CHU Saint-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en Jarez, France
| | - Pierre Martz
- Service de chirurgie orthopédique et traumatologique adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon, France
| | - Sophie Putman
- Université Lille Nord de France, 59000 Lille, France; Service de chirurgie orthopédique II, Hôpital Roger-Salengro, CHU Lille, place de Verdun, 59037 Lille, France
| | - Gilles Pasquier
- Université Lille Nord de France, 59000 Lille, France; Service de chirurgie orthopédique II, Hôpital Roger-Salengro, CHU Lille, place de Verdun, 59037 Lille, France
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Joseph L, Batailler C, Roger J, Swan J, Servien E, Lustig S. Patellar component size effects patellar tilt in total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2021; 29:553-562. [PMID: 32274550 DOI: 10.1007/s00167-020-05984-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/06/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Patellar component positioning and patellofemoral kinematics are of great importance in total knee arthroplasty (TKA). The factors influencing patellar tilt are femoral rotation and lateral patellar release. However, the effect of patellar component size remains unknown. The aim of this study was to evaluate the intra-operative risk factors for patellar tilt, particularly the effect of the patellar component size. The hypothesis was that increasing the patellar component size would reduce the risk of patellar tilt. METHODS 878 primary TKAs with patellar resurfacing were included between January 2015 and October 2018. Analysis was performed at 1-year postoperatively on patients categorized into two groups: patellar tilt (PT) and no patellar tilt (NPT). A multivariate analysis was performed for the effect of patellar component size, femoral rotation, femoral overbuilding, patellar thickness and lateral release on patellar tilt risk. Secondary analysis was performed for any difference in clinical outcomes and revision rates between groups. RESULTS Multivariate analysis showed that increasing the patellar component size decreased the risk of patellar tilt by 37% (p < 0.001). Placing the femoral component at 3° of external rotation decreased the risk of patellar tilt by 67% (p < 0.001). Secondary analysis showed better clinical outcomes in the NPT group, especially regarding global satisfaction, and KSS objective and subjective scores. The revision for any cause was less in the NPT group (p = 0.019). The cause for TKA revision was related to the patellar in 11% of cases in the NPT group and 65% in the PT group (p < 0.001). CONCLUSION Increased patellar component size and positioning the femoral component in external rotation decreases the risk of patellar tilt, improves clinical outcomes and decreases the rate of surgical revision. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Léopold Joseph
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
| | - Julien Roger
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - John Swan
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon North University Hospital, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
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Yi Z, Yan L, Haibo S, Yuangang W, Mingyang L, Yuan L, Bin S. Effects of tourniquet use on clinical outcomes and cement penetration in TKA when tranexamic acid administrated: a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:126. [PMID: 33517881 PMCID: PMC7847577 DOI: 10.1186/s12891-021-03968-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023] Open
Abstract
Background The role of a tourniquet is still controversial for patients undergoing total knee arthroplasty (TKA). Our current study was performed to determine whether the nonuse of the tourniquet combine with tranexamic acid (TXA) application in TKA patients with end-stage osteoarthritis would accelerate the perioperative recovery rate and provide enough cement mantle thickness for implant fixation. Methods In this prospective, randomized controlled trial, 150 end-stage knee osteoarthritis patients receiving TKA were divided into three groups: group A (tourniquet group), group B (non-tourniquet group), and group C (tourniquet in cementation group). All enrolled patients received 3 g of intravenous TXA and 1 g topical TXA. The primary outcomes included blood loss variables and transfusion values. The secondary outcomes included VAS pain score, inflammatory factors level, range of motion, HSS score, postoperative hospital stay, and complication. Furthermore, by using a digital linear tomosynthesis technique, tibial baseplate bone cement mantle thickness was measured in four zones based on the knee society scoring system. Results No significant difference was found among the three groups with regards to total blood loss, transfusion, and complication. However, patients in group B showed lower inflammatory factors levels, shorter length of hospital stay, better range of motion, and lower postoperative pain. No significant difference was found among the three groups in four zones in terms of bone cement mantle thickness. Conclusions For end-stage knee osteoarthritis patients, the absence of tourniquet did not appear to affect blood loss and cement penetration in TKA patients. Furthermore, less inflammation reaction and better knee function can be achieved without a tourniquet. We recommend no longer use a tourniquet in primary TKA for patients with end-stage osteoarthritis when TXA is administrated. Trial registration ChiCTR-INR-16009026. Level of evidence Therapeutic Level I.
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Affiliation(s)
- Zeng Yi
- Department of Orthopaedic Surgery, Orthopaedic Research Institue, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan Province, Chengdu, 610041, China
| | - Li Yan
- Department of Radiology, West China Hospital, West China Medical School, Sichuan University, Sichuan Province, Chengdu, 610041, China
| | - Si Haibo
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Wu Yuangang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Li Mingyang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Liu Yuan
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Shen Bin
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China.
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Gordon AC, Conditt MA, Verstraete MA. Achieving a Balanced Knee in Robotic TKA. SENSORS 2021; 21:s21020535. [PMID: 33451019 PMCID: PMC7828562 DOI: 10.3390/s21020535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
Total knee arthroplasty (TKA) surgery with manual instruments provides a quantitatively balanced knee in approximately 50% of cases. This study examined the effect of combining robotics technology with real-time intra-operative sensor feedback on the number of quantitatively balanced cases in a consecutive series of 200 robotic-assisted primary TKAs. The robotics platform was used to plan the implant component position using correctable poses in extension and a manual, centrally pivoting the balancer in flexion, prior to committing to the femoral cuts. During the initial trialing, the quantitative state of balance was assessed using an instrumented tibial tray that measured the intra-articular loads in the medial and lateral compartments. These sensor readings informed a number of surgical corrections, including bone recuts, soft-tissue corrections, and cement adjustments. During initial trialing, a quantitatively balanced knee was achieved in only 65% of cases. After performing the relevant soft-tissue corrections, bone recuts, and cement adjustments, 87% of cases ended balanced through the range of motion. Meanwhile, this resulted in a wide range of coronal alignment conditions, ranging from 6° valgus to 9° varus. It is therefore concluded that gaps derived from robotics navigation are not indicative for a quantitatively balanced knee, which was only consistently achieved when combining the robotics platform with real-time feedback from intra-operative load sensors.
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Erivan R, Tardieu A, Villatte G, Ollivier M, Jacquet C, Descamps S, Boisgard S. Knee surgery trends and projections in France from 2008 to 2070. Orthop Traumatol Surg Res 2020; 106:893-902. [PMID: 32507586 DOI: 10.1016/j.otsr.2020.02.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Knee surgery makes up a large share of the orthopedic surgery practice. Data on how this activity has changed over time is not available in France, thus we wanted to do a study to determine 1) how many knee surgeries were performed in France in 2018, 2) how this changed between 2012 and 2018, and 3) how it is projected to change by 2070. The hypothesis is that the number of knee surgeries will increase over the next 50 years. METHODS This was an epidemiology study analysing coding data for surgical procedures in France between 2012 and 2018. Two scenarios were defined to assess the change over time: the first only considered population growth and how the age distribution changes over time, and the second extrapolated the trends observed over the past few years. RESULTS In 2018, 321,179 procedures were coded as a main knee surgery procedure. The three most frequent were primary knee arthroplasty with 113,600 procedures (31.2% of procedures) then meniscus surgery (110,510 procedures or 30.3%) and then ligament surgery (57,053 procedures or 15.7%). The number of primary knee arthroplasty procedures increased by 32.2% between 2012 and 2018. Between 2018 and 2050, the different scenarios suggested an increase of 30.8% to 152.8%. The number of ligament surgery procedures increased by 17.3% between 2012 and 2018. Between 2018 and 2050, an increase of 1.2% to 49.2% is expected. The number of meniscus procedures decreased by 14.2% between 2012 and 2018. Between 2018 and 2050, scenario 1 projects a 5.6% increase and scenario 2 a 73.6% reduction. DISCUSSION The number of knee surgery procedures per year has increased over the past few years in France and should continue to increase. LEVEL OF EVIDENCE IV, descriptive epidemiology study.
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Affiliation(s)
- Roger Erivan
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Anna Tardieu
- Université Clermont-Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France; Institute for Locomotion, Department of Orthopedics and Traumatology St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29 13274 Marseille, France
| | - Christophe Jacquet
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France; Institute for Locomotion, Department of Orthopedics and Traumatology St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29 13274 Marseille, France
| | - Stéphane Descamps
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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Lustig S, Ehlinger M, Vaz G, Batailler C, Putman S, Pasquier G. Hinged knee prostheses: To be used with due consideration, but indispensable in complex situations. Orthop Traumatol Surg Res 2020; 106:385-387. [PMID: 32197981 DOI: 10.1016/j.otsr.2020.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Sébastien Lustig
- Service de Chirurgie Orthopédique, CHU Lyon Croix-Rousse, Hospices Civils de Lyon, 103, Grande rue de la Croix Rousse, 69004 Lyon, France.
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Hôpital de Hautepierre 2, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - Gualter Vaz
- Service de Chirurgie Orthopédique, Centre Médico-Chirurgical des Massues, 92, rue Edmond Locard, 69005 Lyon, France
| | - Cécile Batailler
- Service de Chirurgie Orthopédique, CHU Lyon Croix-Rousse, Hospices Civils de Lyon, 103, Grande rue de la Croix Rousse, 69004 Lyon, France
| | - Sophie Putman
- Département Universitaire de Chirurgie Orthopédique et de Traumatologie, Hôpital Roger Salengro, rue Emile-Laine, 59037 Lille, France
| | - Gilles Pasquier
- Département Universitaire de Chirurgie Orthopédique et de Traumatologie, Hôpital Roger Salengro, rue Emile-Laine, 59037 Lille, France
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Ehlinger M, Soenen M, Bahlouli N, Bonnevialle P. Interprosthetic femoral fracture: Crime or punishment? Orthop Traumatol Surg Res 2019; 105:577-578. [PMID: 30885817 DOI: 10.1016/j.otsr.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Matthieu Ehlinger
- Pôle Locomax, service de chirurgie orthopédique et de traumatologie du membre inférieur, hôpital de Hautepierre II, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Équipe MMB, laboratoire ICube, 300, boulevard Sébastien-Brant, 67400 Illkirch, France.
| | - Marc Soenen
- Polyclinique du Parc, avenue des Sables, 49300 Cholet, France
| | - Nadia Bahlouli
- Équipe MMB, laboratoire ICube, 300, boulevard Sébastien-Brant, 67400 Illkirch, France
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital PP Riquet, place Baylac, 31052 Toulouse cedex, France
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