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Cheppalli NS, Purudappa PP, Price R, Kolwadkar Y, Metikala S. Isolated lateral-sided knee pain in total knee arthroplasty. A review. Orthop Rev (Pavia) 2024; 16:93014. [PMID: 38505137 PMCID: PMC10950199 DOI: 10.52965/001c.93014] [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: 07/10/2023] [Accepted: 01/08/2024] [Indexed: 03/21/2024] Open
Abstract
Isolated lateral-sided knee pain is a unique problem following total knee arthroplasty (TKA). Reported causes include soft tissue impingement against extruded cement, an overhanging tibial tray, remnant osteophytes rubbing against the iliotibial band (ITB), popliteal tendon impingement, fabella syndrome, and synovial tissue impingement in the lateral gutter. In addition, iliotibial band traction syndrome secondary to guided motion Bi-cruciate stabilizing knee arthroplasty has been recognized as a new clinical entity. Initial work up should include ruling out the most common causes of painful TKA including infection, aseptic loosening, and instability. Radiographs and CT scan are utilized to identify potential source of pain. Ultrasound evaluation (with elicited probe tenderness) can increase diagnostic accuracy. Ultrasound guided local anesthetic injections can confirm the source of pain. Anti-inflammatory medications, physical therapy with ITB stretches, and therapeutic local steroid injections are initial treatment modalities. Satisfactory resolution of symptoms may require surgical intervention directed at the specific cause and may avoid the morbidity associated with revision TKA.
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Affiliation(s)
| | | | - Ryan Price
- Orthopedic Surgery University of New Mexico School of Medicine
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Hirakawa M, Miyazaki M, Nagashima Y, Akase H, Matsuda S, Kaku N. Asymmetric Implant Design for Posterolateral Overhang of the Femoral Component in Total Knee Arthroplasty: A Retrospective Computed Tomography-Based Study. Cureus 2024; 16:e56862. [PMID: 38659568 PMCID: PMC11040276 DOI: 10.7759/cureus.56862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction During total knee arthroplasty (TKA), also referred to as total knee replacement (TKR), patients may experience pain in the posterolateral knee. One possible cause is the impingement between the popliteus tendon and the femoral components. The purpose of this study was to analyze the posterolateral overhang of the femoral component using 3D template software. Methods Preoperative CT scan images of 50 knees (11 males and 39 females) with osteoarthritis of grade 2 or lower according to the Kellgren-Lawrence classification were analyzed. The mean age of the subjects was 73.8±7.6 years (range 52-84 years). The Athena (Soft Cube Co., Ltd., Osaka, Japan) knee 3D image-matching software was used for the analysis. The positions of the two femoral components (symmetrical and asymmetrical) were simulated. In the coronal plane, the component overhang was measured between the resected lateral part of the posterior femur and its corresponding component size, and the two designs were compared in three zones (proximal, central, and distal). Results In the simulated femoral component, the asymmetric design had a significantly lower component overhang than the symmetric design in the proximal zone of the lateral posterior condyle (0.2±1.9 mm vs. 3.5±1.6 mm, p<0.01). In the proximal zone, significant overhang (>3 mm) was observed in 30 knees (60.0%) with the symmetric design, but only three knees (6.0%) had asymmetric designs (p<0.01). Conclusions The posterolateral overhang of the lateral posterior condyle occurs when a symmetrical prosthesis is used. The use of an asymmetric implant with a small, rounded proximal portion of the lateral posterior condyle improves this overhang and is expected to decrease problems such as impingement of the popliteus tendon and improve patient satisfaction.
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Affiliation(s)
| | | | - Yu Nagashima
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Hiroya Akase
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Shogo Matsuda
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
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Finsterwald MA, Lu V, Andronic O, Prosser GH, Yates PJ, Jones CW. Popliteal tendon impingement as a cause of pain following total knee arthroplasty: a systematic review. ARTHROPLASTY 2023; 5:45. [PMID: 37661253 PMCID: PMC10476413 DOI: 10.1186/s42836-023-00201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/04/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Popliteal tendon impingement (PTI) is an under-recognized cause of persistent pain following total knee arthroplasty (TKA). The purpose of the systematic review was to summarize and outline successful strategies in the diagnosis and management of PTI. METHODS A systematic review following the PRISMA guidelines was performed for four databases: MEDLINE (Pubmed), Ovid EMBASE, Web of Science, and Cochrane Database. It was registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42023398723. The risk of bias assessment was performed using the criteria of the methodological index for non-randomized studies (MINORS). RESULTS A total of 8 studies were included. There were 2 retrospective case series and 6 case reports. The follow-up ranged from 6 to 30 months. Two studies described PTI as an intraoperative phenomenon during TKA with "snapping"; whilst 6 studies described indications and outcomes for arthroscopic tenotomy for PTI following TKA. In making the diagnosis, there was concurrence that the posterolateral pain should be focal and that dynamic ultrasonography and diagnostic injection play an important role. Two specific clinical tests have been described. There was no consistency regarding the need for imaging. There were no reports of instability following popliteal tendon tenotomy or other complications. CONCLUSION PTI should be suspected as a cause for persistent focal pain at the posterolateral knee following TKA. The diagnosis can be suspected on imaging and should be confirmed with dynamic ultrasonography and an ultrasound-guided diagnostic injection. An arthroscopic complete tenotomy of the tendon can reliably alleviate pain and relies on correct diagnosis. There is no evidence for clinically relevant negative biomechanical consequences following tenotomy. LEVEL OF EVIDENCE Systematic Review of Level IV and V studies.
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Affiliation(s)
- Michael A Finsterwald
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, 6150, Australia
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, 6150, Australia
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - Octavian Andronic
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, 6150, Australia.
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, 6150, Australia.
- Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland.
| | - Gareth H Prosser
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, 6150, Australia
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, 6150, Australia
| | - Piers J Yates
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, 6150, Australia
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, 6150, Australia
| | - Christopher W Jones
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, 6150, Australia
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, 6150, Australia
- Curtin University, Bentley, Perth, 6120, Australia
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Bonnin MP, Gousopoulos L, Cech A, Bondoux L, Aït-Si-Selmi T. Arthroscopic popliteal tenotomy grants satisfactory outcomes in total knee arthroplasty with persistent localised posterolateral pain and popliteus tendon impingement. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07376-1. [PMID: 36920499 DOI: 10.1007/s00167-023-07376-1] [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: 01/02/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE The purpose was to estimate the prevalence of popliteus tendon impingement following TKA, and to describe the characteristics and the differential diagnosis protocol for this rare condition. The hypothesis was that arthroscopic popliteal tenotomy in TKA patients with suspected popliteus tendon impingement would relieve pain and improve satisfaction. METHODS Of 741 TKAs performed over three years, eight (1.1%, all women) had suspected popliteus tendon impingement, of which seven had severe localised posterolateral knee pain and one global knee pain. Upon confirmation of popliteus tendon impingement, arthroscopic popliteal tenotomy was performed, and outcomes (Pain on visual analogue scale (pVAS; best, 0; worst, 10), Oxford Knee Score (OKS; best, 48; worst, 0) and satisfaction (best, 100%; worst, 0%) assessed at mean 18-month follow-up. RESULTS At four to 30 months after TKA, arthroscopic exploration revealed popliteus tendon impingement in all eight knees. Six reported complete pain relief (pVAS, 0) the day following arthroscopic popliteal tenotomy, whilst one reported some residual pain (pVAS, 2). The remaining patient with global pain reported no pain relief, and required revision TKA at 12 months. Excluding the revised TKA, OKS was between 19 and 43, and satisfaction was rated ≥ 80% in five of the remaining seven patients. CONCLUSIONS Arthroscopic popliteal tenotomy relieved symptoms in TKA patients with persistent localised posterolateral pain and a positive popliteus test. These findings suggest that the popliteus test is reliable to diagnose popliteus tendon impingement following TKA, which could be treated by arthroscopic popliteal tenotomy. LEVEL OF EVIDENCE Level IV, Small case series.
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Affiliation(s)
- Michel P Bonnin
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Alexandre Cech
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Louka Bondoux
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Tarik Aït-Si-Selmi
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Knee Arthroscopy After Prior Total Knee ArthroplastyType of Study: Narrative Review. J Am Acad Orthop Surg 2023; 31:57-63. [PMID: 36580044 DOI: 10.5435/jaaos-d-21-01094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/19/2022] [Indexed: 12/30/2022] Open
Abstract
Total knee arthroplasty (TKA) results in substantial improvement for most patients with end-stage arthritis of the knee; however, approximately 20% of patients have an unsatisfactory result. Although many problems contributing to an unsatisfactory result after TKA are best addressed by revision TKA, some problems may be effectively addressed with arthroscopic treatment. The categories of pathology that can be addressed arthroscopically include peripatellar soft-tissue impingement (patellar clunk syndrome and patellar synovial hyperplasia), arthrofibrosis, and popliteus tendon dysfunction. Recognizing these disease entities and the role of arthroscopic surgery in the treatment of these lesions may be helpful in achieving a good outcome in certain patients who are unsatisfied with their knee arthroplasty.
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Li C, Chen J, Yang Y, jin Y, Wang C, Tsai T, Li P. Asymmetry of Posterior Condyles in Resection Plane and Axial Curvature for Total Knee Arthroplasty. Orthop Surg 2022; 14:3340-3348. [PMID: 36346140 PMCID: PMC9732622 DOI: 10.1111/os.13529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Understanding the morphology of the distal femur is essential for improving bone-implant match in total knee arthroplasty (TKA) and understanding the mechanisms behind knee kinematics. However, little is known about the asymmetry of the posterior condyles. Thus, this study aimed to thoroughly investigate asymmetries in sizes and shapes between the medial and lateral posterior condyles before and after femoral resections during TKA in osteoarthritic (OA) knees. METHODS Three-dimensional femoral models of 74 OA knees were constructed using computed tomography images. The morphologic measurements of the posterior condyle pre- and post-simulated osteotomy for TKA included the radii of the posterior condyles fitted to a circle on the sagittal and axial planes of the femoral coordinate system, the inclination angle of the articular surface and resected surface, and the width and height of the resected surface. Differences in the data were assessed using Student's t-test, and correlations were evaluated using the Pearson product-moment correlation. RESULTS The radii of the medial posterior condyles fitted to the circle were, on average, 6 mm larger than those of the lateral condyles on the axial plane (p < 0.001) and 0.7 mm smaller than those of the lateral condyles on the sagittal plane (p = 0.046). The inclination angles of the medial and lateral posterior condyles on the axial plane were significantly different with both pre-simulated and post-simulated osteotomy, respectively (both p < 0.001). The resected plane of the lateral posterior condyles displaced opposite inclination directions between the distal and proximal portions. Neither heights or widths of the medial posterior condyles were significantly different from those of their lateral counterparts (both p > 0.107). CONCLUSIONS This study found asymmetrical inclination of the resected surface and coronal radii between the medial and lateral posterior condyles, which may relate to the posterolateral overhang of the lateral condyle after TKA and the progression of the knee OA. These findings provides valuable morphological information and may help improve the implant designs for TKA.
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Affiliation(s)
- Changzhao Li
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina,Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Department of OrthopedicsGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Jiarong Chen
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina
| | - Yiming Yang
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina,Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Department of OrthopedicsGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Yan jin
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina,Guangdong Key Lab of Orthopedic Technology and Implant Materials, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Department of OrthopedicsGeneral Hospital of Southern Theater Command of PLAGuangzhouChina
| | - Cong Wang
- School of Biomedical Engineering & Med‐X Research Institute, Shanghai Jiao Tong UniversityShanghaiChina,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing TechnologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tsung‐Yuan Tsai
- School of Biomedical Engineering & Med‐X Research Institute, Shanghai Jiao Tong UniversityShanghaiChina,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing TechnologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Pingyue Li
- Department of OrthopaedicsGeneral Hospital of Southern Theatre CommandGuangzhouChina,Branch of National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
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Bernard de Villeneuve F, Jacquet C, Puech S, Parratte S, Ollivier M, Argenson JN. Minimum Five Years Follow-Up of Total Knee Arthroplasty Using Morphometric Implants in Patients With Osteoarthritis. J Arthroplasty 2021; 36:2502-2509. [PMID: 33744083 DOI: 10.1016/j.arth.2021.02.052] [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] [Received: 12/07/2020] [Revised: 01/27/2021] [Accepted: 02/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of morphometric implants in total knee arthroplasty (TKA) has shown better early clinical outcomes compared to conventional implants. The primary objective of this study is to evaluate the functional outcome and the implant survivorship of a morphometric TKA at a minimum of 5 years of follow-up. METHODS From May 2012 to June 2015, all patients undergoing primary TKA with a single design of morphometric posterior-stabilized prosthesis (Persona; Zimmer) in a prospective observational single-center study were evaluated. The Knee Society Scoring System (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were completed preoperatively, 1, 3, and 5 years postoperatively. Kaplan-Meier was used to calculate survivorship of the implants. The average follow-up was 75 months. RESULTS In total, 237 TKAs were performed in 235 patients with a mean age of 73 years (49-90). The KSS Knee Score increased from 44.7 (13-64) preoperatively to 93.6 (71-100), the KSS Function Score from 45.8 (17-69) to 92.2 (51-98), and the KSS Satisfaction Score from 26.6 (16-51) to 41 (35-55) at 5 years of follow-up. Similarly, for the KOOS score, a significant improvement of all the subscales was observed at 5 years of follow-up. Implant survival without reoperation at 5 years of follow up was 98.72% (95% confidence interval 0.95-1.00). CONCLUSION This is the first study demonstrating that significant improvements of the functional scores with good survivorship can be achieved at a minimum of 5 years of follow-up with TKA using morphometric implants.
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Affiliation(s)
| | - Christophe Jacquet
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Stephane Puech
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Sebastien Parratte
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jean-Noel Argenson
- Department of Orthopedics and Traumatology, Institute for Locomotion, St. Marguerite Hospital, Marseille, France
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8
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Are asymmetric tibial baseplates superior in primary total knee arthroplasty? A systematic review of clinical studies. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Increased focal bone tracer uptake at the popliteus muscle origin in primary TKA compared with revision TKA. Skeletal Radiol 2020; 49:1127-1133. [PMID: 32067053 DOI: 10.1007/s00256-020-03387-y] [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: 10/29/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of the study was to investigate if the TKA design (cruciate retaining (CR), posterior stabilized (PS), revision prostheses) had an influence on the bone tracer uptake (BTU) pattern at the origin of the popliteus muscle. MATERIALS AND METHODS A total of 92 knees (male:female = 46:46) which had undergone prior TKA were included in this retrospective study, comprising the following 3 groups: (i) CR primary TKA (n = 45); (ii) PS primary TKA (n = 24); (iii) revision TKA (n = 23). All patients received a SPECT/CT after TKA surgery. SPECT/CT images were reviewed for the presence of BTU in the lateral femoral condyle (origin of the popliteus muscle) by two observers using Syngo.via software (Siemens Healthcare, Erlangen, Germany). The observers recorded the BTU pattern qualitatively in the lateral femoral condyle as either (i) absent; (ii) present and diffuse; and (iii) present and focal in the region of the popliteus muscle origin. RESULTS In patients with a CR and PS design, focal increased BTU at the origin of the popliteus muscle was found in 80.0% and 83.3% respectively. Diffuse BTU was the predominant finding in patients with revision TKA (60.9%). The patterns of BTU did not show significant differences between the CR and the PS design. However, patterns of BTU differed significantly between primary TKA designs and revision TKA (p < 0.001). CONCLUSION Differences in patterns of BTU at the popliteus muscle origin between primary TKA and revision prosthesis may be the result of decreased insertional tensile forces of the popliteus muscle after revision surgery due to increased stability provided by the revision design.
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Ramalingam S, Somanath D. A Comprehensive Review of the Anatomy of Popliteus and Its Clinico-Surgical Relevance. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_59_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cucchi D, Menon A, Compagnoni R, Ferrua P, Fossati C, Randelli P. Significant differences between manufacturer and surgeon in the accuracy of final component size prediction with CT-based patient-specific instrumentation for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:3317-3324. [PMID: 29453487 DOI: 10.1007/s00167-018-4876-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/12/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) may improve component sizing. Little has been reported about accuracy of the default plan created by the manufacturer, especially for CT-based PSI. The goal of this study was to evaluate the reliability of this plan and the impact of the surgeon's changes on the final accuracy of the guide sizes. METHODS Forty-five patients eligible for primary TKA were prospectively enrolled. The planned implant sizes were prospectively recorded from the initial manufacturer's proposal and from the final plan adjusted in light of the surgeon's evaluation; these two sizes where then compared to the actually implanted sizes. Fisher's exact test was used to test differences for categorical variables. Agreement between pre-operative plans and final implant was evaluated with the Bland-Altman method. RESULTS The manufacturer's proposal differed from the final implant in 9 (20.0%) femoral and 23 (51.1%) tibial components, while the surgeon's plan in 6 (13.3%, femoral) and 12 (26.7%, tibial). Modifications in the pre-operative plan were carried out for five (11.1%) femoral and 23 (51.1%) tibial components (p = 0.03). Appropriate modification occurred in 22 (88.0%) and 19 (76.0%) cases of femoral and tibial changes. The agreement between the manufacturer's and the surgeon's pre-operative plans was poor, especially with regard to tibial components. CONCLUSION The surgeon's accuracy in predicting the final component size was significantly different from that of the manufacturer and changes in the initial manufacturer's plan were necessary to get an accurate pre-operative plan of the implant sizes. CLINICAL RELEVANCE Careful evaluation of the initial manufacturer's plan by an experienced knee surgeon is mandatory when planning TKA with CT-based PSI. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Riccardo Compagnoni
- U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Paolo Ferrua
- S.S.D. Chirurgia Articolare del Ginocchio, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
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Bizzozero P, Bulaid Y, Flecher X, Ollivier M, Parratte S, Argenson JN. Morphometric Tibial Implant Decreases Posterior Overhang Rate and Improves Clinical Outcomes: Results of a Prospective, Matched Controlled Study. J Arthroplasty 2018; 33:2804-2809. [PMID: 29748070 DOI: 10.1016/j.arth.2018.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/04/2018] [Accepted: 04/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tibial implant's positioning in total knee arthroplasty (TKA) requires a compromise between implant's rotation and bone coverage. We hypothesized that morphometric tibial trays (MTTs) would improve implant positioning and clinical outcomes as compared with symmetrical tibial trays. METHODS Thirty-three patients were included prospectively according to the following criteria: age from 18 to 85 years, body mass index <35 kg/m2, and posterostabilized cemented TKA performed for primary arthritis. Patients were matched for age, gender, body mass index, and preoperative international knee society (IKS) scoring system and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score, in a 1:1 fashion with patients from a prospectively collected database receiving a symmetrical tibial tray TKA. Tibial implant's rotation, bone coverage, and the percentage of patients with a posterior overhang (PO) >3 mm were assessed using computerized tomography. The IKS and the KOOS were compared at 3-year follow-up. RESULTS Bone coverage (90% vs 88%, P = .07) and rotation (mean difference 0.7 ± 3°; P = .69) were not different between the 2 groups. The percentage of patient with a PO was lower in the morphologic group (2/33 vs 14/33, P = .01, odds ratio = 10.3 [2.12-50.24]). Functional scores were superior in the morphometric group: IKS (mean difference 20 ± 21 points; P = .0005), mainly due to a difference in the IKS pain subscore (mean difference 11 ± 15 points; P = .0002). According to the multivariate analysis, an MTT had a positive, independent effect on IKS pain (P = .006) and KOOS pain subscores (P = .03) at the last follow-up. CONCLUSION The use of an MTT in TKA did not modify the tibial implant position in the axial plane; however, it decreased implant's posterior overhang and improved functional scores. The clinical improvement was mainly found on pain scores.
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Affiliation(s)
- Paul Bizzozero
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Yassine Bulaid
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Xavier Flecher
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Sébastien Parratte
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Jean-Noel Argenson
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
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Geannette C, Sahr M, Mayman D, Miller TT. Ultrasound Diagnosis of Osteophytic Impingement of the Popliteus Tendon After Total Knee Replacement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2279-2283. [PMID: 29476552 DOI: 10.1002/jum.14563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 06/08/2023]
Abstract
We report our experience with 6 patients who had total knee replacements with lateral-sided knee pain, referred for ultrasound (US) assessment and US-guided injection. All cases showed an osteophyte within the popliteus sulcus of the lateral femoral condyle impinging on the adjacent tendon. Five of 6 patients reported improvement of symptoms immediately after US-guided injection of an anesthetic and a steroid. Ultrasound has a unique role in the imaging of knee replacements because of its real-time capabilities and absence of artifacts at the popliteus tendon origin.
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Affiliation(s)
- Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Meghan Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - David Mayman
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
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Jones R, Nwelue E, Romero JA, Brown TS. The painful total knee arthroplasty: Keys to diagnosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1053/j.sart.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Simsek ME, Akkaya M, Gursoy S, Isik C, Zahar A, Tarabichi S, Bozkurt M. Posterolateral overhang affects patient quality of life after total knee arthroplasty. Arch Orthop Trauma Surg 2018; 138:409-418. [PMID: 29177951 DOI: 10.1007/s00402-017-2850-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the appropriate mediolateral placement of symmetrical tibial components and the amount of overhang expected from the posterolateral of tibial components implanted to give ideal coverage and the subsequent incidence of residual knee pain and reduction in functional capacity. METHOD A retrospective evaluation was made of 146 consecutive total knee arthroplasties. The posterolateral overhang, rotational alignment and coverage of the tibial component were measured on a post-operative CT scan and the effect of posterolateral overhang on clinical outcomes was analysed 3 years after surgery. RESULTS Complaints of local pain in the posterolateral corner were determined in 76 (52.1%) patients. At the Posterolateral corner, overhang was determined in 111 (76%) patients, in the cortical border in 11 (7.6%) patients and underhang in 24 (16.4%) patients. In 71 (48.6%) patients, pain was determined together with oversize and in the evaluation of the overhang of the tibial component in the posterolateral region and the rotation status, there was determined to be overhang in 75 (96.2%) patients where the tibial component was placed in ideal rotation, in 25 (100%) where placement was in external rotation and in 11 (25.6%) where placement was in internal rotation. The mean KSS, KSS-F and WOMAC-P scores were 83.9 ± 6.3, 83.3 ± 7.8 and 4.6 ± 2.9, respectively, in those with posterolateral overhang of the tibial component .The mean KSS, KSS-F and WOMAC-P scores were 86.6 ± 8.4, 89.5 ± 7.8 and 2.8 ± 2.1, respectively, in those with no overhang and the difference was determined to be statistically significant. The amount of overhang was determined as mean 3.6 ± 2.0 mm in those with posterolateral pain and 0.02 ± 3.4 mm in those without pain and the difference was statistically significant. CONCLUSIONS This study demonstrated that overhang in the posterolateral region is surprisingly high and negatively affects the clinical results following TKA, thereby presenting a danger to the success of TKA. The risk of posterolateral oversizing can increase with placement of the tibial component in external rotation.
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Affiliation(s)
- Mehmet Emin Simsek
- Department of Orthopedics and Traumatology, Ankara Yenimahalle Training and Research Hospital, Yildirim Beyazit University, 06100, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Yenimahalle Training and Research Hospital, Yildirim Beyazit University, 06100, Ankara, Turkey
| | - Safa Gursoy
- Department of Orthopedics and Traumatology, Ankara Yenimahalle Training and Research Hospital, Yildirim Beyazit University, 06100, Ankara, Turkey
| | - Cetin Isik
- Department of Orthopedics and Traumatology, Ankara Atatürk Training and Research Hospital, Yildirim Beyazit University, 06100, Ankara, Turkey
| | - Akos Zahar
- Department of Orthopedics and Traumatology, Helios Endo Clinic, 22767, Hamburg, Germany
| | - Samih Tarabichi
- Department of Orthopedics and Traumatology, Burjeel Hospital, Dubai, United Arab Emirates
| | - Murat Bozkurt
- Department of Orthopedics and Traumatology, Ankara Atatürk Training and Research Hospital, Yildirim Beyazit University, 06100, Ankara, Turkey.
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Bonnin MP, Saffarini M, Nover L, van der Maas J, Haeberle C, Hannink G, Victor J. External rotation of the femoral component increases asymmetry of the posterior condyles. Bone Joint J 2017; 99-B:894-903. [PMID: 28663394 DOI: 10.1302/0301-620x.99b7.bjj-2016-0717.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/21/2017] [Indexed: 11/05/2022]
Abstract
AIMS The morphometry of the distal femur was largely studied to improve bone-implant fit in total knee arthroplasty (TKA), but little is known about the asymmetry of the posterior condyles. This study aimed to investigate the dimensions of the posterior condyles and the influence of externally rotating the femoral component on potential prosthetic overhang or under-coverage. PATIENTS AND METHODS We analysed the shape of 110 arthritic knees at the time of primary TKA using pre-operative CT scans. The height and width of each condyle were measured at the posterior femoral cut in neutral position, and in 3º and 5º of external rotation, using both central and medial referencing systems. We compared the morphological characteristics with those of 14 TKA models. RESULTS In the neutral position, the dimensions of the condyles were nearly equal. Externally rotating the femoral cut by 3º and 5º with 'central referencing' induced width asymmetry > 3 mm in 23 (21%) and 33 (30%) knees respectively, while with 'medial referencing' it induced width asymmetry > 3 mm in 43 (39%) and 75 (68%) knees respectively. The asymmetries induced by rotations were not associated with gender, aetiology or varus-valgus alignment. CONCLUSION External rotation may amplify the asymmetry between the medial and lateral condyles, and exacerbate prosthetic overhang, particularly in the superolateral zone. 'Central referencing' guides result in less potential prosthetic overhang than 'medial referencing' guides. Cite this article: Bone Joint J 2017;99-B:894-903.
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Affiliation(s)
- M P Bonnin
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon, 69008, France
| | - M Saffarini
- ReSurg SA, ch. De la Vuarpilliere 35, 1260 Nyon, Switzerland
| | - L Nover
- ReSurg SA, ch. De la Vuarpilliere 35, 1260 Nyon, Switzerland
| | - J van der Maas
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon, 69008, France
| | - C Haeberle
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon, 69008, France
| | - G Hannink
- Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - J Victor
- Ghent University, De Pintelaan, Ghent, Belgium
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17
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Bonnin MP, de Kok A, Verstraete M, Van Hoof T, Van der Straten C, Saffarini M, Victor J. Popliteus impingement after TKA may occur with well-sized prostheses. Knee Surg Sports Traumatol Arthrosc 2017; 25:1720-1730. [PMID: 27671286 PMCID: PMC5487584 DOI: 10.1007/s00167-016-4330-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/15/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine the mechanisms and extents of popliteus impingements before and after TKA and to investigate the influence of implant sizing. The hypotheses were that (1) popliteus impingements after TKA may occur at both the tibia and the femur, and (2) even with an apparently well-sized prosthesis, popliteal tracking during knee flexion is modified compared to the preoperative situation. METHODS The location of the popliteus in three cadaver knees was measured using computed tomography, before and after implantation of plastic TKA replicas, by injecting the tendon with radiopaque liquid. The pre- and post-operative positions of the popliteus were compared from full extension to deep flexion using normosized, oversized, and undersized implants (one size increments). RESULTS At the tibia, TKA caused the popliteus to translate posteriorly, mostly in full extension: 4.1 ± 2 mm for normosized implants, and 15.8 ± 3 mm with oversized implants, but no translations were observed when using undersized implants. At the femur, TKA caused the popliteus to translate laterally at deeper flexion angles, peaking between 80° and 120°: 2 ± 0.4 mm for normosized implants and 2.6 ± 0.5 mm with oversized implants. Three-dimensional analysis revealed prosthetic overhang at the posterosuperior corner of normosized and oversized femoral components (respectively, up to 2.9 mm and 6.6 mm). CONCLUSIONS A well-sized tibial component modifies popliteal tracking, while an undersized tibial component maintains more physiologic patterns. Oversizing shifts the popliteus considerably throughout the full arc of motion. This study suggests that both femoro- and tibio-popliteus impingements could play a role in residual pain and stiffness after TKA.
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Affiliation(s)
- Michel P. Bonnin
- grid.418176.dCentre Orthopédique Santy, 24 Av Paul Santy, Lyon, France ,Hopital Privé Jean Mermoz, 55 Av Jean Mermoz, 69008 Lyon, France
| | - Arnoud de Kok
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
| | - Matthias Verstraete
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
| | - Tom Van Hoof
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
| | - Catherine Van der Straten
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
| | - Mo Saffarini
- Accelerate Innovation Management, Rue de Hollande 4-6, 1204 Geneva, Switzerland
| | - Jan Victor
- 0000 0001 2069 7798grid.5342.0Department of Orthopaedics, Ghent University, De Pintelaan, 185, Ghent, Belgium
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18
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Bonnin MP, Van Hoof T, De Kok A, Verstraete M, Van der Straeten C, Saffarini M, Victor J. Imaging the implant-soft tissue interactions in total knee arthroplasty. J Exp Orthop 2016; 3:24. [PMID: 27699662 PMCID: PMC5047872 DOI: 10.1186/s40634-016-0061-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/22/2016] [Indexed: 12/27/2022] Open
Abstract
Background In Total Knee Arthroplasty (TKA), residual pain may be secondary to soft tissue impingements, which are difficult to visualize around chromium-cobalt implants using medical imaging, so their interactions remain poorly understood. The goal of this work was to establish a protocol for in-vitro imaging of the soft tissues around TKA, usable during throughout the range of motion (ROM). Methods The full size range of a commercially available TKA prosthesis was manufactured by 3D-printing in non-magnetic and non-radiopaque polymer and implanted in 12 cadaveric knees. The relations between these implants and the soft tissues (Popliteus tendon, Medial and Lateral Collateral Ligament, Patellar and Quadriceps tendons) were analyzed, using MRI (5 embalmed specimens) and CT scans after injection of the tissues with barium-sulfate (3 embalmed and 4 fresh-frozen specimens). Results Both MRI and CT scans enabled good identification of the soft tissues before TKA implantation. MRI produced minimal loss in signal and contrast, and neither the low temperature nor the embalming fluids compromised image quality. CT scans were more precise after TKA implantation, particularly the borders of the implant and the differentiation of soft tissues. Full ROM investigation, manual segmentation and three-dimensional reconstructions were possible only with the CT scan. Conclusion The experimental approach described in this study was successful in visualizing the interactions between the soft tissue and the implants before and after TKA and during the full ROM. The coordinate system allows to localize precisely the different anatomic structures and to quantify any change due to prosthetic implantation.
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Affiliation(s)
- Michel P Bonnin
- Centre Orthopédique Santy, 24 Av Paul Santy, Lyon, France. .,Hopital Privé Jean Mermoz, 55 Av Jean Mermoz, 69008, Lyon, France.
| | | | | | | | | | - Moreno Saffarini
- Accelerate Innovation Management, Rue de Hollande 4-6, 1204, Geneva, Switzerland
| | - Jan Victor
- UZ Gent, De Pintelaan, 185, Gent, Belgium
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Kim JB, Lyu SJ, Kang HW. Are Western Knee Designs Dimensionally Correct for Korean Women? A Morphometric Study of Resected Femoral Surfaces during Primary Total Knee Arthroplasty. Clin Orthop Surg 2016; 8:254-61. [PMID: 27583107 PMCID: PMC4987308 DOI: 10.4055/cios.2016.8.3.254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 04/18/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the shape of the distal femur of Korean women compared with the prostheses currently available in Korea. METHODS Morphometric data (5 parameters) were measured in 356 resected femurs of Korean women undergoing primary total knee arthroplasty (TKA) utilizing the LCS knee implant (DePuy). The data were then compared with 5 additional contemporary TKA implant systems. RESULTS Implant designs based on Caucasian population data do not ideally match the distal femoral morphology of Korean women. Overhang at the anterior mediolateral width was observed in 84.8% for the LCS while a gender-specific implant resulted in undercoverage of the bone in 86%. Posterior overhang was observed in up to 51.2%. Most implant designs have a narrower intercondylar notch than the morphologic data of Korean women. CONCLUSIONS Since there is some difference between the shape of distal femur of Korean women and that of the implants, surgeons should have this in mind when selecting an implant for a patient. These data may also be used as a guideline for future prosthetic design options for Korean women population.
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Affiliation(s)
- Jun-Bae Kim
- Department of Orthopedic Surgery, Seoul NOW Hospital, Anyang, Korea.; Orthopaedic Research Laboratories, Cleveland, OH, USA
| | - Suk-Joo Lyu
- Department of Orthopedic Surgery, Seoul NOW Hospital, Seongnam, Korea
| | - Hyung Wook Kang
- Department of Orthopedic Surgery, Seoul NOW Hospital, Seongnam, Korea
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20
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Bonnin MP, Saffarini M, Shepherd D, Bossard N, Dantony E. Oversizing the tibial component in TKAs: incidence, consequences and risk factors. Knee Surg Sports Traumatol Arthrosc 2016; 24:2532-40. [PMID: 25605560 DOI: 10.1007/s00167-015-3512-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The incidence of anteroposterior overhang of the tibial component after TKA and its effect on clinical outcome were investigated, and the morphometric characteristics of the knees in which tibial baseplates were oversized were identified. METHOD One hundred and fourteen consecutive TKAs were retrospectively assessed. The dimensions of the tibia were measured on a pre-operative CT scan and were compared with those of the implanted tibial component. We analysed the effect of anteroposterior and mediolateral size variations on clinical outcomes 1 year after surgery. RESULTS An anteroposterior overhang was observed in 87 % of cases on the lateral plateau, in 88 % on the central plateau and in 25 % on the medial tibial plateau. The mean post-pre-operative size differences were 3.2 ± 2.7, 2.8 ± 2.7 and -1.6 ± 2.3 mm, respectively. (Positive value means oversizing). A mediolateral overhang of the tibial component was found in 61 % of the patients. Oversizing was significantly greater and more frequent in females. Patients oversized in the anteroposterior dimension had lower post-operative pain scores. Patients with mediolateral oversizing had decreased flexion 1 year after surgery. Anteroposterior oversizing was observed more frequently in patients with asymmetric tibial plateaus, while mediolateral oversizing was observed more frequently in patients with small tibias. CONCLUSIONS This study demonstrates that the incidence of oversized tibial plateau components is surprisingly high and that functional outcomes are lower in the case of mediolateral or anteroposterior oversizing. The risk of oversizing could be predicted as it occurs predominantly in patients with asymmetric proximal tibia and/or small tibia. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michel P Bonnin
- Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France.
| | - Mo Saffarini
- Accelerate Innovation Management, 1 rue de la navigation, 1201, Geneva, Switzerland
| | - David Shepherd
- Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Nadine Bossard
- Service de Biostatistique, Hospices Civils de Lyon, 69424, Lyon, France.,Université Lyon I, 69622, Villeurbanne, France.,CNRS, UMR 5558, Laboratoire Biostatistique Santé, 69495, Pierre-Bénite, France
| | - Emmanuelle Dantony
- Service de Biostatistique, Hospices Civils de Lyon, 69424, Lyon, France.,Université Lyon I, 69622, Villeurbanne, France.,CNRS, UMR 5558, Laboratoire Biostatistique Santé, 69495, Pierre-Bénite, France
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21
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Arthroscopic Management of Popliteal Tendon Dysfunction in Total Knee Arthroplasty. Arthrosc Tech 2015; 4:e565-8. [PMID: 26900555 PMCID: PMC4722494 DOI: 10.1016/j.eats.2015.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/04/2015] [Indexed: 02/03/2023] Open
Abstract
Unexplainable knee pain may follow knee replacement surgery. The popliteal tendon should be evaluated as a possible cause of lateral knee pain and dysfunction after knee arthroplasty. The tendon can snap over or impinge on lateral osteophytes or prominent femoral components and produce mechanical symptoms and pain. Ultrasound-guided injections may confirm the diagnosis and provide symptomatic relief in some patients. Those who respond well to injections and in whom conservative management ultimately fails may be offered arthroscopic release of the popliteal tendon. We present the arthroscopic technique for popliteal tendon release in a symptomatic patient whose pain resolved immediately postoperatively. We recommend the use of an anterolateral viewing portal and an accessory lateral working portal to access the posterolateral knee. There can be extensive scar tissue overlying the popliteal tendon after arthroplasty. Arthroscopic tendon transection and excision comprise a reliable procedure for popliteal tendon impingement after knee arthroplasty without compromising knee stability.
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22
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Young SW, Clarke HD, Graves SE, Liu YL, de Steiger RN. Higher Rate of Revision in PFC Sigma Primary Total Knee Arthroplasty With Mismatch of Femoro-Tibial Component Sizes. J Arthroplasty 2015; 30:813-7. [PMID: 25534956 DOI: 10.1016/j.arth.2014.11.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty (TKA) systems permit a degree of femoro-tibial component size mismatch. The effect of mismatched components on revision rates has not been evaluated in a large study. We reviewed 21,906 fixed-bearing PFC Sigma primary TKAs using the Australian Orthopaedic Association National Joint Replacement Registry, dividing patients into three groups: no femoro-tibial size mismatch, tibial component size > femoral component size, and femoral component > tibial component. Revision rates were higher when the femoral size was greater than the tibia, compared to both equal size (HR = 1.20 (1.00, 1.45), P = 0.047) and to tibial size greater than femoral (HR = 1.60 (1.08, 2.37), P = 0.019). Potential mechanisms to explain these findings include edge loading of polyethylene and increased tibial component stresses.
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Affiliation(s)
| | | | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - Yen-Liang Liu
- Data Management and Analysis Centre, University of Adelaide, Adelaide, SA, Australia
| | - Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
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Abstract
There are many reasons why a total knee replacement (TKR) may fail and qualify for revision. Successful revision surgery depends as much on accurate assessment of the problem TKR as it does on revision implant design and surgical technique. Specific modes of failure require specific surgical solutions. Causes of failure are often presented as a list or catalogue, without a system or process for making a decision. In addition, strict definitions and consensus on modes of failure are lacking in published series and registry data. How we approach the problem TKR is an essential but neglected aspect of understanding knee replacement surgery. It must be carried out systematically, comprehensively and efficiently. Eight modes of failure are described: 1) sepsis; 2) extensor discontinuity; 3) stiffness; 4) tibial- femoral instability; 5) patellar tracking; 6) aseptic loosening and osteolysis; 7) periprosthetic fracture and 8) component breakage. A ninth 'category', unexplained pain is an indication for further investigation but not surgery.
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Affiliation(s)
- K G Vince
- Northland District Health Board, Department of Orthopaedic Surgery, Whangarei, New Zealand
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24
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Bou Monsef J, Schraut N, Gonzalez M. Failed Total Knee Arthroplasty. JBJS Rev 2014; 2:01874474-201412000-00001. [PMID: 27490508 DOI: 10.2106/jbjs.rvw.n.00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jad Bou Monsef
- Department of Orthopedic Surgery, University of Illinois at Chicago, 835 South Walcott Avenue, Room E270, Chicago, IL, 60612
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26
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Abstract
OBJECTIVE The purpose of this article is to illustrate the causes of snapping knee. The value of imaging techniques is discussed with an emphasis on dynamic sonography in light of the available surgical and radiologic literature. CONCLUSION Because of its dynamic capabilities, dynamic sonography provides real-time visualization of snapping knee syndrome and may be used as a first-line modality.
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Iatrogenic popliteus tendon injury during total knee arthroplasty results in decreased knee function two to three years postoperatively. INTERNATIONAL ORTHOPAEDICS 2012; 36:2061-5. [PMID: 22851125 DOI: 10.1007/s00264-012-1631-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The popliteus tendon is known to play a key role in the stability of the posterolateral corner of the knee. While prior work suggests that isolated sectioning of the popliteus tendon has little consequence for the static stability of the knee following TKA, no studies have evaluated the effect of iatrogenic popliteal tendon injury on patient oriented outcome and knee function following TKA. The aims of this study are (1) to compare patient-oriented outcome scores of patients who suffered an iatrogenic injury to the popliteus tendon with a control group without such an injury and (2) to identify risk factors associated with iatrogenic injury to the popliteus tendon. METHODS Fifteen patients with an iatrogenic complete transection of the popliteus tendon during TKA were compared to the 666 patients who underwent TKA during the same time period without popliteus tendon injury. RESULTS Postoperatively, IKS knee scores were similar between the two groups; however, significantly lower IKS function scores were noted in the study group (71 ± 31) compared to the control group (86 ± 19) (p = 0.0036). Iatrogenic popliteal tendon injury was only noted to occur in patients in whom components of size four or smaller were used. CONCLUSIONS Intraoperative complete section of the popliteus tendon during the performance of TKA results in decreased IKS functional scores two to three years postoperatively. Patients with smaller knees may be at higher risk for this complication.
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28
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Guillin R, Marchand AJ, Roux A, Niederberger E, Duvauferrier R. Imaging of snapping phenomena. Br J Radiol 2012; 85:1343-53. [PMID: 22744321 DOI: 10.1259/bjr/52009417] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Snapping phenomena result from the sudden impingement between anatomical and/or heterotopical structures with subsequent abrupt movement and noise. Snaps are variously perceived by patients, from mild discomfort to significant pain requiring surgical management. Identifying the precise cause of snaps may be challenging when no abnormality is encountered on routinely performed static examinations. In this regard, dynamic imaging techniques have been developed over time, with various degrees of success. This review encompasses the main features of each imaging technique and proposes an overview of the main snapping phenomena in the musculoskeletal system.
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Affiliation(s)
- R Guillin
- Department of Musculoskeletal Imaging, Rennes University Hospital, CHU de Rennes, Rennes, France.
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29
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Demey G, Hobbs H, Lustig S, Servien E, Trouillet F, Magnussen RA, Neyret P. Influence of gender on the outcome of total knee arthroplasty. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s12570-012-0094-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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van den Heever D, Scheffer C, Erasmus P, Dillon E. Method for selection of femoral component in total knee arthroplasty (tka). AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2011; 34:23-30. [PMID: 21234738 DOI: 10.1007/s13246-011-0053-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
A method is proposed enabling a surgeon to preoperatively determine the preeminent type and size of prosthesis, from those available, to be used in a particular patient undergoing knee replacement surgery. Parameters of healthy knee geometry were estimated by employing an unsupervised neural network. These estimated parameters were then applied in a χ(2) goodness of fit (GoF) test to determine which femoral prosthesis type and size delivers the most appropriate fit. This approach was used to determine the most suitable match of three implants for 34 different cases. Implant C performed the best and was the optimal fit in 59% of the cases, Implant A was the best fit in 38% of the cases and Implant B the best fit in 3% of the cases. This method shows promise in aiding a surgeon to select the optimal prosthesis type and size from an array of different conventional total knee replacements.
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Affiliation(s)
- Dawie van den Heever
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, Corner of Banghoek and Joubert Street, Mechanical Engineering Building, Room M616, Stellenbosch, 7600, South Africa.
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Smith J, Finnoff JT, Santaella-Sante B, Henning T, Levy BA, Lai JK. Sonographically guided popliteus tendon sheath injection: techniques and accuracy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:775-782. [PMID: 20427790 DOI: 10.7863/jum.2010.29.5.775] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this investigation was to describe two sonographically guided popliteus tendon sheath injection techniques and determine their accuracy in a cadaveric model. METHODS A single experienced operator completed 24 sonographically guided popliteus tendon sheath injections, 12 using a longitudinal approach and 12 using a transverse approach relative to the tendon. The injection order was randomized, and all injections were completed with diluted colored latex. Coinvestigators blinded to the injection technique dissected each specimen and graded the colored latex location as accurate (in the sheath), accurate with overflow (within the sheath but also in other regions), or inaccurate (no latex in the sheath). RESULTS All 12 sonographically guided popliteus sheath injections using the longitudinal approach placed latex into the sheath. Eight of these injections (67%) also resulted in overflow into the knee joint. Ten of 12 transverse approach injections placed latex into the sheath (83%), with 7 of these (70%) also producing overflow into the knee joint. Two of 12 transverse injections (17%) placed latex only into the knee joint and were therefore inaccurate. CONCLUSIONS Sonographic guidance can be used to inject the popliteus tendon sheath with a high degree of accuracy. Although the longitudinal approach is potentially more accurate, both approaches may result in injectate overflow into the knee joint, likely through the popliteus hiatus.
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Affiliation(s)
- Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, MN 55905, USA.
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Peters CL, Severson E, Crofoot C, Allen B, Erickson J. Popliteus tendon release in the varus or neutral knee: prevalence and potential etiology. J Bone Joint Surg Am 2008; 90 Suppl 4:40-6. [PMID: 18984717 DOI: 10.2106/jbjs.h.00687] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Christopher L Peters
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Rosenstein AD, Veazey B, Shephard D, Xu KT. Gender Differences in the Distal Femur Dimensions and Variation Patterns in Relation to TKA Component Sizing. Orthopedics 2008. [PMID: 19292386 DOI: 10.3928/01477447-20110505-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Affiliation(s)
- Alexander D Rosenstein
- Department of Orthopedic Surgery, University of Texas Health Science Center, 6431 Fannin St, MSB 6.136, Houston, TX 77030, USA
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Mandalia V, Eyres K, Schranz P, Toms AD. Evaluation of patients with a painful total knee replacement. ACTA ACUST UNITED AC 2008; 90:265-71. [PMID: 18310744 DOI: 10.1302/0301-620x.90b3.20140] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Evaluation of patients with painful total knee replacement requires a thorough clinical examination and relevant investigations in order to reach a diagnosis. Awareness of the common and uncommon problems leading to painful total knee replacement is useful in the diagnostic approach. This review article aims to act as a guide to the evaluation of patients with painful total knee replacement.
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Affiliation(s)
- V Mandalia
- 1Princess Elizabeth Orthopaedic Centre, Exeter Knee Reconstruction Unit, Royal Devon & Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK
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Abstract
STUDY DESIGN Case report. BACKGROUND Determining the cause of painful snapping on the lateral aspect of the knee can be a challenge. The differential diagnosis includes iliotibial band friction syndrome, lateral meniscus tear, intra-articular loose body, discoid lateral meniscus, snapping biceps femoris tendon, degenerative joint disease, proximal tibiofibular joint instability, and snapping popliteus tendon. CASE DESCRIPTION A 21-year-old female presented with a 7-year history of a painful snapping on the lateral aspect of her left knee. She reported the snapping occurred with all activities involving knee flexion and extension, including running and walking. With a diagnosis of snapping iliotibial band, she had received a variety of physical therapy interventions, including various lower extremity stretching and strengthening exercises. Nonsteroidal anti-inflammatory medications were also prescribed by her physician. Conservative and pharmoclogical interventions were unsuccessful in improving her symptoms. Similarly, our attempt with conservative treatment consisting of ice, taping, and a short period of immobilization was not successful. OUTCOMES The patient underwent a surgical procedure consisting of removal of a prominent tubercle on the lateral femoral condyle and tenodesis of the popliteus tendon to the proximal aspect of the fibular (lateral) collateral ligament, followed by a postoperative program of physical therapy including range-of-motion and progressive strengthening exercises. At 6 weeks following surgery, the patient had returned to all activities with complete resolution of her symptoms. DISCUSSION Painful snapping at the lateral aspect of the knee may be caused by a variety of disorders, including the popliteus tendon. Clinical diagnosis is challenging. Clinical suspicion of a snapping popliteus tendon as a source of the signs and symptoms of the condition is important for inclusion in the differential diagnosis. LEVEL OF EVIDENCE Differential diagnosis, level 4.
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Abstract
Numerous conditions exist that may cause pain following total knee arthroplasty (TKA) that can be categorized into articular versus nonarticular etiologies. To critically evaluate the painful TKA, the treating physician must perform a thorough history and physical examination, as well as both laboratory and radiographic testing. Laboratory analysis is directed to differentiate septic versus aseptic etiologies of knee pain and commonly includes assessment of white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and knee aspiration for cell count and cultures. Available radiographic tools include plain radiographs, stress views, arthrography, nuclear scanning, ultrasonography, and magnetic resonance imaging. In cases of unexplained pain, reoperation is unwise and frequently associated with suboptimal results. Periodic repeat evaluations are recommended until the etiology of pain is clearly determined.
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Affiliation(s)
- Douglas A Dennis
- Department of Biomedical Engineering, University of Tennessee, and Oak Ridge National Laboratory/University of Tennessee Center of Musculoskeletal Research, Knoxville, Tennessee, USA
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Abstract
Three cases of symptomatic popliteus tendon impingement on an osteophyte are presented. In only one case did the patient complain of a painful 'snapping' on flexing and extending the knee. Diagnosis was made when tenderness was elicited on palpating the osteophyte during flexion and extension with varus stress on the knee. It may be difficult to determine whether such a prominence represents an osteophyte or an exaggerated normal lower border of the popliteus groove. Two cases were successfully treated by arthroscopic excision of the osteophyte and the remaining case by resection of the popliteus tendon.
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Affiliation(s)
- William J Gaine
- The Hip Centre, Wrightington Hospital NHS Trust, Appley Bridge, Lancashire WN6 9EP, UK.
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Affiliation(s)
- D R McAllister
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, OH 44195, USA
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Otani T, Fujii K, Ozawa M, Kaechi K, Funaki K, Matsuba T, Ueno H. Impingement after total knee arthroplasty caused by cement extrusion and proximal tibiofibular instability. J Arthroplasty 1998; 13:589-91. [PMID: 9726327 DOI: 10.1016/s0883-5403(98)90061-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A 57-year-old patient with rheumatoid arthritis showed posterolateral impingement after total knee arthroplasty. The radiographs showed bone cement extrusion posterolateral to the tibial tray. Arthrotomy through a posterolateral approach revealed that the impingement was caused not only by cement extrusion against the fibular head but also by proximal tibiofibular joint instability. It was speculated that rheumatoid arthritis had caused proximal tibiofibular instability, active knee motion had caused fibular head shift by tension of biceps femoris and the fibular head had been impinged on the extruded cement. In cementing the tibial tray, especially in a rheumatoid patient, it is of paramount importance to take caution against posterolateral cement extrusion in order to minimize the risk of fibular head impingement during total knee arthroplasty.
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Affiliation(s)
- T Otani
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Allardyce TJ, Scuderi GR, Insall JN. Arthroscopic treatment of popliteus tendon dysfunction following total knee arthroplasty. J Arthroplasty 1997; 12:353-5. [PMID: 9113555 DOI: 10.1016/s0883-5403(97)90037-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Following total knee arthoplasty, the popliteus tendon may cause a "snap" when it rolls over a retained lateral femoral condylar osteophyte or when it subluxates over the posterior condyle of the femoral component. When this condition is painful and fails to respond to conservative treatment, arthroscopic release of the popliteus tendon has been beneficial.
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Affiliation(s)
- T J Allardyce
- Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, New York 10128, USA
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