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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Georgaklis VA, Karachalios T, Makridis KG, Badras SL, Palaiochorlidis IS, Malizos KN, Badras LS. Genesis 1 posterior cruciate-retaining total knee arthroplasty with asymmetric tibial tray: An 18-to-26-year long-term clinical outcome study. Knee 2019; 26:838-846. [PMID: 31118135 DOI: 10.1016/j.knee.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 02/10/2019] [Accepted: 04/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To present the long-term clinical and radiological outcomes of the Genesis I posterior cruciate-retaining total knee arthroplasty (TKA) (Smith & Nephew Orthopaedics, Memphis, TN, USA) (one of the first designed with an asymmetric tibial tray). METHODS Prospectively collected data from 117 cemented TKAs performed on 95 patients were evaluated using this design, with a mean follow-up of 21.5 years (range, 18-26). Failures, complication rates, and clinical (both subjective and objective) and radiological outcomes were assessed for all patients. RESULTS Seven failures occurred (wear and structural failure of the polyethylene insert) and six revision surgeries were performed at a mean of 10 years (range, three to 14) from the index operation. No revision of either the femoral or tibial components for aseptic loosening was performed. Survivorship analysis showed a cumulative success rate of 93.53% (95% CI, 92.75-94.32%) at 20 and 25 years, with revision for any reason as an end point. All patients showed a statistically significant improvement (P = 0.001) in the Knee Society and Oxford knee rating scores. CONCLUSIONS This study demonstrated satisfactory long-term clinical outcomes for this TKA design, with revisions being related to polyethylene wear structural failure.
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Affiliation(s)
| | - Theofilos Karachalios
- Orthopaedic Department, University General Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessalia, Larissa, Hellenic Republic.
| | | | - Stelios L Badras
- Orthopaedic Department, University General Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessalia, Larissa, Hellenic Republic
| | | | - Konstantinos N Malizos
- Orthopaedic Department, University General Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessalia, Larissa, Hellenic Republic
| | - Leonidas S Badras
- Orthopaedic Department, General State Hospital of Volos, Thessalia, Hellenic Republic
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3
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Durig N, Pace T, Broome B, Osuji O, Harman MK. Clinical Outcomes of Tibial Components with Modular Stems Used in Primary TKA. Adv Orthop 2014; 2014:651279. [PMID: 24669319 PMCID: PMC3941588 DOI: 10.1155/2014/651279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/14/2013] [Accepted: 12/16/2013] [Indexed: 11/17/2022] Open
Abstract
Due to the known potential for fretting and corrosion at modular junctions in orthopaedic implants, this retrospective study evaluated radiographic and clinical outcomes of 85 primary TKA patients implanted with modular stemmed tibial components and followed up for an average of 82 months. There was low incidence of tibial radiolucent lines, excellent functional outcomes, and no complications associated with stem modularity. The findings were comparable to the historical control study involving 107 TKA with a nonmodular tibial stem design. When using surface cemented tibial components combined with a constrained polyethylene bearing, modular stems appear to be a viable option for primary TKA when adequate fixation and rotational stability are maintained.
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Affiliation(s)
- Nicole Durig
- Department of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634, USA
| | - Thomas Pace
- University of South Carolina, School of Medicine Greenville, 607 Grove Road, Greenville, SC 29605, USA
| | - Brandon Broome
- Steadman Hawkins Clinic of the Carolinas, 200 Patewood Drive, Suite C100, Greenville, SC 29615, USA
| | - Obi Osuji
- Steadman Hawkins Clinic of the Carolinas, 200 Patewood Drive, Suite C100, Greenville, SC 29615, USA
| | - Melinda K. Harman
- Department of Bioengineering, 301 Rhodes Engineering Research Center, Clemson University, Clemson, SC 29634, USA
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Chalidis BE, Sachinis NP, Papadopoulos P, Petsatodis E, Christodoulou AG, Petsatodis G. Long-term results of posterior-cruciate-retaining Genesis I total knee arthroplasty. J Orthop Sci 2011; 16:726-31. [PMID: 21909722 DOI: 10.1007/s00776-011-0152-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 08/15/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term results of Genesis I modular total knee system are not well known. METHODS We analyzed data from 345 patients with 393 primary total knee arthroplasties (TKA) using the Genesis I prosthesis. In all cases, the posterior cruciate ligament (PCL) was retained, and the patella was not resurfaced. The minimum follow-up was 10 (range 10-16) years. RESULTS Preoperative range of motion improved from 89° preoperatively to 105° at the time of the most recent follow-up (p < 0.001). Mean preoperative Knee Society pain and function scores increased from 29 and 25 points to 91 and 85 points, respectively (p < 0.001). Tibiofemoral angle shifted from 2.40° of varus before to 4.8° of valgus after the operation (p < 0.001). Early postoperative complications occurred in 34 knees (8.6%). Manipulation under general anesthesia was done in six knees (1.5%). Nonprogressive radiolucent lines were seen around the femoral component in 16 knees (4%) and at the tibial bone-cement interface in 101 knees (25%). However, in only five cases (1.3%) was there significant progression leading to implant loosening and revision surgery. Eight more revisions were performed due to infection (three knees), stiffness (three knees), excessive wear and fracture of polyethylene liner (one knee), and instability (one knee). The overall survivorship of knee replacement reached 96.7%. CONCLUSIONS In the long term (up to 16 years), PCL-retaining Genesis I total knee prosthesis is associated with good functional outcomes and low failure rates.
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Affiliation(s)
- Byron E Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, G.Papanikolaou Hospital, Exochi, 57010, Thessaloniki, Greece.
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Woo YK, Kim KW, Chung JW, Lee HS. Average 10.1-year follow-up of cementless total knee arthroplasty in patients with rheumatoid arthritis. Can J Surg 2011; 54:179-84. [PMID: 21609517 DOI: 10.1503/cjs.000910] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) using a cemented technique has been recommended in patients with rheumatoid arthritis owing to the initial stability of the fixation and long-term durability of the components; however, similar long-term follow-up results have been reported in patients who have undergone cementless TKA. The purpose of this study was to evaluate the radiologic and clinical outcomes of cementless TKA in patients with rheumatoid arthritis. METHODS We enrolled patients undergoing cementless TKA from March 1990 to February 2000. Clinical and radiologic evaluations were performed using the Knee Society clinical rating system and radiographic evaluation and scoring system. RESULTS We included the cases of 112 patients who underwent 179 cementless TKA procedures in our analysis. Their mean age was 62.3 years, and the mean follow-up period was 10.1 years. The final survival rate was 0.968 at the 15.5-year follow-up. Regarding radiologic results after surgery, the mean total valgus angle was 6.7°, the mean femoral flexion angle was 97.5° and the mean tibial angle was 89.2° on the anteroposterior radiographs. On the lateral films, the mean femoral flexion angle was 1.6° and the mean tibial angle was 89.2°. At the last follow-up, the mean total valgus angle was 6.5°, the mean femoral flexion angle was 97.4° and the mean tibial angle was 89.1°, as seen on the anteroposterior view. On the lateral views, the mean femoral flexion angle was 1.4° and the mean tibial angle was 89.0°. Regarding the clinical outcome, the mean knee score and function score on the Knee Society clinical rating system were also enhanced from 47.5 and 43.6, respectively, before the operation to 91.2 and 82.3, respectively, at the last follow-up. CONCLUSION On radiologic and clinical follow-up of cementless TKA for patients with rheumatoid arthritis, there were no serious complications, and the results of the operation were satisfactory with improvement in range of motion and clinical symptoms.
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Affiliation(s)
- Young Kyun Woo
- Department of Orthopedic Surgery, St. Mary's Hospital, the Catholic University of Korea, Seoul, Korea
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6
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Lenssen AF, Crijns YHF, Waltjé EMH, van Steyn MJA, Geesink RJT, van den Brandt PA, de Bie RA. Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: an RCT. BMC Musculoskelet Disord 2006; 7:71. [PMID: 16942627 PMCID: PMC1579215 DOI: 10.1186/1471-2474-7-71] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 08/31/2006] [Indexed: 11/17/2022] Open
Abstract
Background The main goal of physical therapy treatment (PT) in the clinical stage following total knee arthroplasty (TKA) is to prepare patients for discharge from the hospital as soon as possible after their operation. Although aggressive rehabilitation is believed to be important, evidence of effects of different exercise programmes following TKA is limited. This led to the question whether the intensity of PT (once versus twice daily) following TKA affects short-term recovery, measured as range of motion. Methods A randomised controlled trial compared an exercise regimen of two sessions per day with a similar programme administered once daily. Primary outcome measure was ROM. Results At the time of hospital discharge, there was no difference between the experimental and control groups in range of motion. Conclusion This study shows that in our setting twice daily PT sessions do not produce different results as daily PT sessions. It may be questioned whether multiple daily therapy sessions are needed as an in-hospital PT regimen in OA total knee patients.
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Affiliation(s)
- Anton F Lenssen
- University Hospital Maastricht, Department of Physical Therapy, Maastricht, The Netherlands
| | - Yvonne HF Crijns
- University Hospital Maastricht, Department of Physical therapy, Maastricht, The Netherlands
| | - Eddie MH Waltjé
- University Hospital Maastricht, Department of Physical therapy, Maastricht, The Netherlands
| | - Mike JA van Steyn
- University Hospital Maastricht, Department of Orthopaedics, Maastricht, The Netherlands
| | - Ruud JT Geesink
- University Hospital Maastricht, Department of Orthopaedics, Maastricht, The Netherlands
| | | | - Rob A de Bie
- Maastricht University, Department of Epidemiology, Maastricht, The Netherlands
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Ishii Y, Matsuda Y. Perioperative blood loss in cementless or hybrid total knee arthroplasty without patellar resurfacing: a prospective, randomized study. J Arthroplasty 2005; 20:972-6. [PMID: 16376250 DOI: 10.1016/j.arth.2004.12.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2004] [Accepted: 12/29/2004] [Indexed: 02/01/2023] Open
Abstract
The use of cement is considered as an important way to control perioperative blood loss in knee arthroplasty. We prospectively randomized 57 patients (60 knees) who underwent total knee arthroplasty with (30 knees) or without (30 knees) tibial cement to evaluate perioperative blood loss. The measured total blood loss did not differ significantly between the 2 groups (with tibial cement, 731 +/- 288 mL; without cement, 731 +/- 331 mL; P = .9117). The red blood cell count, hemoglobin level, and hematocrit returned to the preoperative levels within 3 months in both groups. Therefore, tibial cement does not appear to affect perioperative blood loss. This finding has implications when planning blood replacement in cementless and hybrid-type arthroplasties.
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Ishii Y, Matsuda Y, Sakata S, Onda N, Omori G. Primary total knee arthroplasty using the Genesis I total knee prosthesis: a 5- to 10-year follow-up study. Knee 2005; 12:341-5. [PMID: 16146625 DOI: 10.1016/j.knee.2004.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Revised: 12/21/2004] [Accepted: 12/29/2004] [Indexed: 02/02/2023]
Abstract
This study analyzed the data from 82 primary total knee arthroplasties performed in 74 patients using the Genesis Total Knee Arthroplasty System. Ten men and 64 women with a mean age of 78 years were evaluated at a mean follow-up of 7 years. Seventy procedures used cemented femoral and tibial components, and 12 used cementless femoral and tibial components. The preoperative mean HSS score was 39. At the most recent follow-up, the mean HSS score increased to 92. The mean preoperative range of motion was 82 degrees and increased to 108 at the most recent follow-up. Clinically, there were 63 excellent (77%), 14 good (17%), 4 fair (5%), and 1 poor (1%) result.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, Gyoda, Saitama 361-0037, Japan.
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9
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Abstract
UNLABELLED Enthusiasm for metal-backed patella has waned because of the high incidence of complications. Considering that perhaps all metal-backed patellae may not be the same, 256 primary consecutive metal-backed mobile bearing TKAs done between May 1985 and January 1989 were retrospectively reviewed to evaluate the results of a unique mobile bearing metal-backed patella. There were four complications (1.6%). Three patella were revised for polyethylene complications and one well-functioning component was removed at the time of revision of the tibial polyethylene to facilitate range of motion and wound closure. No patella was revised for loosening, subluxation, or dislocation. Our results show that all metal-backed patella are not the same and that compared with the high incidence of failure of fixed bearing metal-backed patellae, the use of the anatomic mobile bearing metal-backed patella can produce excellent, durable long-term clinical and radiographic results with a low incidence (1.6%) of complications. Life table survivorship using revision for any reason as the end point was 97% (95% confidence interval, 93%-100%) at a maximum of 19 years. LEVEL OF EVIDENCE Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
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Ishii Y, Matsuda Y, Ishii R, Sakata S, Omori G. Sagittal laxity in vivo after total knee arthroplasty. Arch Orthop Trauma Surg 2005; 125:249-53. [PMID: 15316826 DOI: 10.1007/s00402-004-0712-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2003] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A stress arthrometry study of 77 knees undergoing total knee arthroplasty was performed to determine the difference in anteroposterior (AP) laxity between posterior cruciate ligament (PCL)-retaining (PCLR) and PCL-substituting (PCLS) prostheses using the Genesis I TKA. MATERIALS AND METHODS Fifty-three knees had PCLR and 24 had PCLS prostheses. The selected patients had successful arthroplasties after a minimum follow-up of 5 years. AP laxity was measured with a KT-2000 arthrometer (Medmetric, San Diego, CA, USA) using standard protocols. RESULTS At 30 degrees of flexion, there was no statistical difference in anterior (PCLR: 4.7 mm, PCLS: 4.5 mm), posterior (PCLR: 1.1 mm, PCLS: 0.7 mm), or total (PCLR: 5.8 mm, PCLS: 5.3 mm) displacement. At 75 degrees , significant differences were seen in both anterior (PCLR: 3.3 mm, PCLS: 2.3 mm) and total (PCLR: 4.8 mm, PCLS: 3.4 mm) displacement (p=0.001 and p=0.009, respectively), although there was no statistical difference in posterior displacement (PCLR: 1.5 mm, PCLS: 1.1 mm). CONCLUSION The above values are considered the suitable degree of AP laxity in total knee arthroplasty for a satisfactory clinical outcome 5-9 years after surgery. The PCL in a PCLR prosthesis and the central tibial spine and femoral cam in a PCLS prosthesis might play comparable roles in determining the laxity in the posterior direction in these prostheses.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 361-0037 Gyoda, Saitama, Japan.
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Ishii Y, Matsuda Y. Effect of tourniquet pressure on perioperative blood loss associated with cementless total knee arthroplasty: a prospective, randomized study. J Arthroplasty 2005; 20:325-30. [PMID: 15809950 DOI: 10.1016/j.arth.2004.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Perioperative blood loss is an issue of concern in cementless total knee arthroplasty (TKA). We randomly assigned 57 patients (60 knees) who underwent cementless TKA treatment to 2 groups with tourniquet pressure (TP) of either 350 mm Hg (30 knees) or systolic blood pressure (SBP) plus 100 mm Hg (30 knees) to assess the effect of TP on blood loss. The mean TP in the SBP plus 100 mm Hg group was 238 +/- 13 mm Hg. There was no significant difference between groups. Red blood cell count, hemoglobin levels, and hematocrit recovered to preoperative levels by 3 months after surgery in both groups. In conclusion, we recommend using a TP of 100 mm Hg above SBP during TKA, rather than using the conventional TP of 350 mm Hg.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, Gyoda, Saitama 361-0037, Japan
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12
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Ishii Y, Matsuda Y, Ishii R, Sakata S, Omori G. Coronal laxity in extension in vivo after total knee arthroplasty. J Orthop Sci 2003; 8:538-42. [PMID: 12898307 DOI: 10.1007/s00776-003-0668-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2002] [Accepted: 03/19/2003] [Indexed: 12/31/2022]
Abstract
We performed stress arthrometric studies on 77 knees (71 patients) with total knee arthroplasty to determine the presence and magnitude of femoral abduction and adduction in knee extension. A total of 53 knees (49 patients) had posterior cruciate ligament-retaining (PCLR) prostheses, and 24 (22 patients) had PCL-substituting (PCLS) prostheses. The selected patients had successful arthroplasties with no clinical complications a minimum of 5 years after primary surgery. Each patient was subjected to a successive abduction and adduction stress test at 0 degrees -20 degrees of flexion using a Telos arthrometer. The mean values for abduction and adduction were 4.8 degrees and 4.5 degrees with a PCLR prosthesis, respectively, and 4.6 degrees and 4.0 degrees with a PCLS prosthesis. There were no statistical differences between PCLR and PCLS knees. The results suggest that approximately 4 degrees of laxity in these directions is suitable in total knee arthroplasty for a satisfactory clinical outcome 5-9 years after surgery.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, 361-0037, Japan
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Bach CM, Nogler M, Steingruber IE, Ogon M, Wimmer C, Göbel G, Krismer M. Scoring systems in total knee arthroplasty. Clin Orthop Relat Res 2002:184-96. [PMID: 12011708 DOI: 10.1097/00003086-200206000-00022] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
For assessment of total knee arthroplasty outcome, various scoring systems have been introduced. The current study assessed the interobserver correlation of four commonly used total knee arthroplasty outcome scores. One hundred eighteen total knee arthroplasties were investigated by two independent observers, using the Hungerford score, the Hospital for Special Surgery score, the Knee Society score, and the Bristol score. Each score consisted of three subscores: pain, knee, and function. For the highest interobserver correlation was computed for the Bristol score (interobserver correlation coefficient, 0.88). For knee range of motion, flexion contracture, and extension lag there was high interobserver correlation (interobserver correlation coefficient > 0.8 each). For walking distance and walking aids, there also was a high interobserver correlation (interobserver correlation coefficient > 0.7 each). For clinical assessment of total knee arthroplasty, pain should be measured on a four-step system, the knee should be assessed by measurement of range of motion, extension lag, and flexion contracture, and function should be measured on a separate score assessing walking distance and walking aids.
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Affiliation(s)
- Christian Michael Bach
- Department of Orthopaedic Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI. Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994-2000. ACTA ORTHOPAEDICA SCANDINAVICA 2002; 73:117-29. [PMID: 12079006 DOI: 10.1080/000164702753671678] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We studied primary total knee replacements (TKRs), reported to the Norwegian Arthroplasty Register, operated on between 1994 and 2000. A Cox multiple regression model was used to evaluate differences in survival among the prosthesis brands, their types of fixation, and whether or not the patella was resurfaced. In Norway in 1999, the incidence of knee prosthesis operations was 35 per 100,000 inhabitants. Cement was used as fixation in 87% of the knees, 10% were hybrid and 2% uncemented implants. Bicompartmental (not resurfaced patella) prostheses were used in 65% of the knees. With all revisions as endpoint, no statistically significant differences in the 5-year survival were found among the cemented tricompartmental prostheses brands: AGC 97% (n 279), Duracon 99% (n 101), Genesis I 95% (n 654), Kinemax 98% (n 213) and Tricon 96% (n 454). The bicompartmental LCS prostheses had a 5-year survival of 97% (n 476). The type of meniscal bearing in LCS knees had no effect on survival. Survival with revision for all causes as endpoint showed no differences among types of fixation, or bi- or tricompartmental prostheses. Pain alone was the commonest reason for revision of cemented bicompartmental prostheses. The risk of revision because of pain was 5.7 times higher (p < 0.001) in cemented bicompartmental prostheses than cemented tricompartmental ones, but the revisions mainly involved insertion of a patellar component. In tricompartmental prostheses the risk of revision because of infection was 2.5 times higher than in bicompartmental ones (p = 0.03). Young age (< 60) and the sequelae after a fracture increased the risk of revision. The 5-year survival of the 6 most used cemented tricompartmental knee prostheses brands varied between 95% and 99%, but the differences were not statistically significant. There were more revisions because of pain in bicompartmental than in tricompartmental knees. In tricompartmental knees, however, there were more revisions because of an infection. The relatively few patients with uncemented and hybrid implants showed no improvements in results compared to cemented knee prostheses.
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Affiliation(s)
- Ove Furnes
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
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15
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Jordan LR, Dowd JE, Olivo JL, Voorhorst PE. The clinical history of mobile-bearing patella components in total knee arthroplasty. Orthopedics 2002; 25:s247-50. [PMID: 11866161 DOI: 10.3928/0147-7447-20020202-09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two hundred fifty-six primary cementless meniscal-bearing total knee arthroplasties were performed between May 1985 and January 1989. All knees were replaced with a low contact stress metal-backed anatomic mobile patella. The average patient follow-up was 11.5 years. No patellae were revised for failure of fixation and no dislocations or subluxations were reported. One patella was revised for polyethylene wear, and one well-functioning component was removed at the time of revision to facilitate range of motion and wound closure. The survival estimate at 12 years was 99.5%. Compared to the high incidence of failure of metal-backed fixed-bearing patellae components, the anatomic rotating patella provides durable long-term results with a low incidence of complications.
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Chen AL, Mujtaba M, Zuckerman JD, Jeong GK, Joseph TN, Wright K, Di Cesare PE. Midterm clinical and radiographic results with the genesis I total knee prosthesis. J Arthroplasty 2001; 16:1055-62. [PMID: 11740763 DOI: 10.1054/arth.2001.27667] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The midterm results of primary posterior cruciate ligament-retaining, minimally conforming, cemented modular total knee arthroplasties using the Genesis I prosthesis in 110 knees in 72 patients were reviewed. Patients were evaluated at a mean follow-up of 7.3 years by Knee Society pain and functional scores, radiographic and survivorship analysis, and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) health status questionnaire. Range of motion increased from an average of 96.3 degrees to 112.5 degrees. Knee Society pain and functional scores increased from preoperative averages of 55 and 44 to 92 and 88, respectively. There were 91 excellent, 16 good, 1 fair, and 2 poor results. WOMAC scores were increased significantly in each subcategory examined (pain, stiffness, and physical function). Kaplan-Meier survivorship was 97% at 10 years. An increase in loosening as a result of eccentric stress concentration secondary to the nonconforming design of this prosthesis, theoretically a matter of some clinical concern, was not shown in this investigation.
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Affiliation(s)
- A L Chen
- Department of Orthopaedic Surgery, NYU-Hospital for Joint Diseases, New York, New York 10003, USA
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17
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Hartford JM, Hunt T, Kaufer H. Low contact stress mobile bearing total knee arthroplasty: results at 5 to 13 years. J Arthroplasty 2001; 16:977-83. [PMID: 11740751 DOI: 10.1054/arth.2001.27670] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A total of 139 mobile bearing knee arthroplasties in 104 patients were evaluated at a mean follow-up of 7.8 years (range, 5-13 years). There were 80 cemented knees, 50 uncemented, and 9 hybrid (cemented tibia, uncemented femur). Ten knees were revised. Four knees were revised for aseptic loosening of an uncemented tibial component, and 1 knee was revised for loosening of an uncemented femoral component. One knee was revised for a recurrent dislocating bearing, and 1 knee was revised for instability. No mechanical loosening occurred in the cemented components. Three knee arthroplasties were revised for infection. A total of 66 patients (92 knees) were evaluated clinically and radiographically. Radiographic evaluation showed a 27% incidence of radiolucent lines for the femur and a 31% incidence of radiolucent lines for the tibia. No components were considered radiographically loose. The survivorship of mobile bearing knee arthroplasties was 93% at an average follow-up of 7.8 years. Aseptic loosening was statistically higher in uncemented components (P=.0051).
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Affiliation(s)
- J M Hartford
- Division of Orthopaedic Surgery, Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
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18
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Mont MA, Yoon TR, Krackow KA, Hungerford DS. Eliminating patellofemoral complications in total knee arthroplasty: clinical and radiographic results of 121 consecutive cases using the Duracon system. J Arthroplasty 1999; 14:446-55. [PMID: 10428225 DOI: 10.1016/s0883-5403(99)90100-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This study reports the minimum 5-year follow-up of our experience with the Duracon Total Knee Arthroplasty System. A total of 121 consecutive total knee replacements using the Duracon system (Howmedica, Rutherford, NJ) were performed in 104 patients. Three patients died before the 5-year follow-up and were excluded from the final evaluation. The remaining 118 knees (101 patients) were assessed at a mean follow-up of 65 months (range, 60-80 months). The knee diagnoses were osteoarthritis in 97 patients, rheumatoid arthritis in 2 patients, osteonecrosis in 1 patient, and pigmented villonodular synovitis in 1 patient. The mean age was 70 years (range, 28-85 years). There were no reoperations for aseptic loosening, and there have been no reoperations for patellofemoral problems. At final follow-up evaluation, 112 knees (96%) had good or excellent results, and 6 knees (4%) had poor clinical results or went on to revision. For the surviving knees, the preoperative Knee Society objective score improved from a mean of 52 points (range, 20-72 points) to a final follow-up mean of 94 points (range, 66-100 points). Five knees needed reoperations: 2 knees in 1 patient because of acute hematogenous infection at 12 months, 1 knee because of a supracondylar femur fracture, 1 because of a patellar tendon rupture, and 1 to increase polyethylene thickness because of instability. The lack of aseptic loosening at the minimum 5-year follow-up compares favorably with any cemented or cementless series of knee replacement. The almost complete absence of patellofemoral complications in this series also indicates that the design changes, with particular attention to the trochlea design and patellofemoral contact throughout full flexion, have achieved their intended purpose. The results are encouraging at midterm, awaiting true long-term (15-20 years) follow-up.
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Affiliation(s)
- M A Mont
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, The Good Samaritan Hospital, Baltimore, Maryland 21239, USA
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19
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Ikezawa Y, Gustilo RB. Clinical outcome of revision of the patellar component in total knee arthroplasty. A 2- to 7-year follow-up study. J Orthop Sci 1999; 4:83-8. [PMID: 10199985 DOI: 10.1007/s007760050079] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The objectives of this study were to determine the relationship between the thickness of the residual patellar bone and the composite patella-patellar component, and the clinical outcome in patients who had undergone revision total knee arthroplasty (TKA) with a biconvex patellar component. Clinical outcome after at least a 2-year follow-up was determined using the Knee Society pain and functional scores, and radiographically, with the thicknesses of the patellar bone and composite measured in 23 knees (22 patients). The thickness of the patellar bone after preparation for a biconvex patellar component was significantly less for revised patellae (average, 5.0 mm) than the primary patellae (average, 7.9 mm; P < 0. 01). Differences in thickness between preoperative patellae, primary composites, and revision composites did not significantly affect postoperative results. There were no patellar fractures, despite the relatively thin bone remnant in the revision patients. Radiolucency was observed in 8% of the revisions. A patella with a thickness of residual bone of as little as 5 mm can provide favorable clinical results in revision TKA with restoration of the composite thickness of the patella achieved using a thick but small-diameter biconvex patellar component.
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Affiliation(s)
- Y Ikezawa
- Minneapolis Orthopaedic and Arthritis Institute and Midwest Orthopaedic Research Foundation, Minneapolis, Minnesota, USA
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Ishii Y, Terajima K, Koga Y, Takahashi HE, Bechtold JE, Gustilo RB. Gait analysis after total knee arthroplasty. Comparison of posterior cruciate retention and substitution. J Orthop Sci 1998; 3:310-7. [PMID: 9811982 DOI: 10.1007/s007760050058] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
: The objective of this study was to measure three-dimensional knee motion during gait in patients with total knee replacements which either retained the posterior cruciate ligament (n = 11), or required sacrifice of the posterior cruciate ligament and replacement of its function with a posterior stabilizing articular surface (n = 9). Clinically meaningful translations (anterior and posterior, medial and lateral, proximal and distal) and rotations (flexion and extension, internal and external rotation, abduction and adduction) were measured using an instrumented spatial linkage. Although patients from both groups were able to achieve passive full extension and a minimum of 95 degrees flexion, some of their translations and rotations during free speed walking were consistently less than those in a group of healthy controls. Motion during the swing phase of gait was similar for both knee replacement groups. However, abduction and adduction and proximal and distal translation were larger (but neither difference was significant) for the patients with implants with a posterior stabilizing surface, which suggests that the stabilizing surface may not reliably provide as much stability in these directions as does retention of the posterior cruciate ligament.
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Affiliation(s)
- Y Ishii
- Department of Orthopaedic Surgery, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8510, Japan
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