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Sim CHS, Chen JDY, Pang HN, Yeo SJ, Lo NN, Liow MHL. Novel morphogenic knee implant delivers comparable mid-term outcomes as compared to conventional non-morphogenic implants. Arch Orthop Trauma Surg 2023; 143:7159-7167. [PMID: 37566132 DOI: 10.1007/s00402-023-04990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Conventional total knee arthroplasty (C-TKA) implants have well-established mid- and long-term outcomes. The novel TKA (N-TKA) implants provide morphogenic implant components with smaller size increments to facilitate anatomical replication. The aim of the study is to evaluate if these advantages provides better clinical outcomes. MATERIALS AND METHODS Registry data prospectively collected within a single institution from 2014 to 2018 was reviewed and propensity score matching was performed to match C-TKA to N-TKA. 70 pairs of cruciate retaining (CR) TKA and 116 pairs of posterior stabilized (PS) TKA were identified. Range of motion, SF-36, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS) and Oxford Knee Score (OKS) were assessed preoperatively, 6 and 24 months postoperatively. Satisfaction was assessed 6 and 24 months postoperatively. Independent T test was performed for parametric data, whereas Wilcoxon rank-sum analysis was performed for non-parametric data. RESULTS Both C-TKA and N-TKA cohorts demonstrated statistically significant improvement for KSKS, KSFS, OKS and SF-36 at 6 and 24 months postoperatively. C-TKA CR patients had better flexion at 6 months as compared to N-TKA CR (108.7° versus 98.3°, respectively, p = 0.046). At 24 months, there was no difference between C-TKA and N-TKA for range of motion, KSKS, KSFS, OKS and SF-36 PCS, regardless of insert type (p > 0.05). CONCLUSIONS Both models showed great postoperative improvements in KSFS, KSKS, OKS and SF-36 and have comparable early and mid-term outcomes, suggesting that N-TKAs are suitable substitutes for C-TKA. Longer follow-up studies are required to evaluate the long-term outcomes of N-TKAs. LEVEL OF EVIDENCE lll.
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Affiliation(s)
- Craigven Hao Sheng Sim
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169856, Singapore
| | - Jerry Delphi Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169856, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169856, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169856, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169856, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169856, Singapore.
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Pander P, Fransen BL, Hagemans FJA, Keijser LCM. Functional outcome of total knee arthroplasty following tibial plateau fractures: a systematic review. Arch Orthop Trauma Surg 2023; 143:1265-1274. [PMID: 34800157 DOI: 10.1007/s00402-021-04188-1] [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: 05/12/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) following a tibial plateau fracture (TPF) is a debilitating disease which often affects a young and active patient population for whom good knee function is essential. Frequently, total knee arthroplasty (TKA) is the only surgical option. The aim of this systematic review was to evaluate functional outcome for TKA in PTOA patients, together with several secondary outcome parameters. METHODS A systematic review according to the PRISMA guidelines was conducted. Studies were included that reported on patient-reported outcome measures, range of motion or objective functional analysis after TKA because of PTOA following TPF. RESULTS After analyzing 105 studies, 5 were included for the final review. In total, 162 patients with a TKA for PTOA were included of whom 125 (77%) were managed operatively for their TPF. All studies reported improvements in functional outcome after TKA, with two studies showing no significant differences between PTOA patients and a matched cohort of primary OA patients. Reported complication and re-intervention rates were higher for TKA patients with PTOA. CONCLUSION The results of this review indicate the TKA for PTOA after a TPF provides satisfactory functional outcome, with results similar to those of matched primary OA patients. TKA should, therefore, be considered a viable treatment option to improve function, but both patients and orthopedic surgeons should be aware of the higher complication rates in this patient population.
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Affiliation(s)
- Pieter Pander
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
| | - Bas Lennart Fransen
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Frans Johan Alexander Hagemans
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Lucien Cornelis Marie Keijser
- CORAL - Centre for Orthopaedic Research Alkmaar, Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
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Malhotra R, Jain A, Gupta S, Gautam D. Outcomes of Total Knee Arthroplasty in Patients with Prior Hardware: A Case-Control Study Using Handheld Navigation. J Knee Surg 2022; 35:1474-1483. [PMID: 33853153 DOI: 10.1055/s-0041-1726419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Presence of hardware in juxta-articular location poses challenge during total knee arthroplasty (TKA). When present in distal femur, it precludes the use of an intramedullary femoral jig during TKA often necessitating removal of hardware leading to prolonged surgery, higher risk of complications, and inferior results. We conducted a case-control study to assess the outcome of TKA among patients with post-traumatic arthritis using a handheld navigation system to perform bone cuts allowing retention of hardware in situ. In 15 patients with post-traumatic arthritis and hardware around the knee (Group A), none or part(s) of hardware were removed while performing TKA. These patients were matched to 15 patients who underwent TKA with handheld navigation for primary OA knee (Group B). The perioperative outcomes assessed were operative time, intraoperative blood loss, length of hospital stay, complications, and 30 days reoperation rate. Clinical outcomes were assessed by using Knee Society Score (KSS) and radiological outcomes using mechanical axis and coronal and sagittal component angles. Mean age of patients at surgery were 65.67 years (Group A) and 66.73 years (Group B). Mean operative time and blood loss were significantly higher in Group A as compared with Group B. At the mean follow-up of 34 months, KSS significantly improved in both the groups. However, there was no statistically significant difference in the clinical and radiological outcomes between the two groups. One patient in Group A developed wound dehiscence and had to undergo debridement and flap coverage within 30 days. The use of navigation helps surgeons in gaining proper limb alignment and implant positioning without complete removal of hardware.
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Affiliation(s)
- Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gautam
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Bhaskaran S, Gadod LL. Post-traumatic Arthritic Stiff Knee in a Malunited Distal Femur Fracture Treated with Total Knee Arthroplasty - A Case Report. J Orthop Case Rep 2022; 12:85-88. [PMID: 36687476 PMCID: PMC9831217 DOI: 10.13107/jocr.2022.v12.i08.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/27/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Post-traumatic knee arthritis is defined as any structural osteochondral damage to the knee after an injury. About 12% cases of symptomatic osteoarthritis of the knee mainly due to post-traumatic arthritis. Primary total knee arthroplasty in a post-traumatic arthritic stiff knee with a malunited distal femur fracture is a technically difficult procedure due to secondary deformity, poor bone quality, bone loss, ligament incompetence, tissue adhesion, and stiffness. Case Report A 65-year-old male presented with chief complaints of pain and stiffness in the left knee for 15 years. On inspection no scar, sinuses, and dilated veins on palpation, tenderness was present over both the medial and lateral joint lines. Radiographs of the left knee in anteroposterior and lateral views were taken, which showed united distal femur fracture with Grade 4 Kellegren Lawrence knee arthritis. Due to severe knee stiffness and with the patient demanding early mobilization and functional knee ROM, total knee arthroplasty with intra-articular and extra-articular adhesion release was planned for the patient. Conclusion In cases of post-traumatic arthritis with severe stiffness, total knee arthroplasty is a viable option in providing good pain relief with excellent functional improvement; however, the procedure is technically more demanding.
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Affiliation(s)
- Sinukumar Bhaskaran
- Department of Orthopaedics, Manipal Hospital Kharadi, Pune, Maharashtra, India
| | - Lalkar Laxman Gadod
- Department of Orthopaedics, Adinarayan Hospital, Sathe Chowk, Nanded, Maharashtra, India,Address of Correspondence: Dr. Lalkar Laxman Gadod, Department of Orthopaedics, Adinarayan Hospital, Sathe Chowk, Nanded, Maharashtra, India. E-mail:
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van Rensch PJH, Heesterbeek PJC, van Loon CJ. Tibial metaphyseal sleeves in primary total knee arthroplasty following high tibial osteotomy and tibial plateau fracture; preliminary mid-term survival and outcome. Knee 2022; 35:98-104. [PMID: 35276553 DOI: 10.1016/j.knee.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 01/02/2022] [Accepted: 02/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous high tibial osteotomy (HTO), and tibial plateau fractures (TPF) may cause problems in subsequent total knee arthroplasty (TKA) due to altered metaphyseal bone structure. Higher rates of loosening of the tibial component have been described. In post-HTO and TPF cases, a more durable fixation could be achieved by tibial sleeves. This study investigates the preliminary short-to-midterm clinical and radiographic results in a cohort of these cases. METHODS A cohort of 28 patients was selected, 11 following HTO, and 17 following TPF. Standard clinical and radiologic follow-up was performed at 6 weeks, and one and two years. Revision with removal of primary prosthesis for any reason was the primary outcome. Patient reported pre- and postoperative pain, satisfaction and general health scores were collected at one and two years. Postoperative radiographs were analyzed for radiolucent lines. RESULTS There were no cases of aseptic loosening. Survival for all reasons was 96.4% (CI 77.2%-99.5%). One progressive radiolucent line was seen. Numerical rating scale (NRS) for pain with and without weightbearing at 2-year follow-up improved from 8 to 3 and from 5 to 2 points respectively. Overall general health scores improved with a median of 70 at ≥ 2 years, compared to 63 pre-operatively. CONCLUSION With no revision for aseptic loosening the use of tibial sleeves in primary TKA seems a safe and reliable method for fixation of the tibial component in metaphyseal bone with altered bone structure at short and mid-term follow-up. LEVEL OF EVIDENCE Level IV, cohort study.
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Affiliation(s)
- P J H van Rensch
- Department of Orthopedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AG Arnhem, the Netherlands; Currently Employed at CortoClinics, Beatrixstraat 31, 6031 BB, Nederweert, the Netherlands.
| | - P J C Heesterbeek
- Department of Research, Sint Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, the Netherlands.
| | - C J van Loon
- Department of Orthopedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AG Arnhem, the Netherlands.
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Li Z, Chen Z, Wang X, Li J, Jing L, Li Z, Cao X. Locking Plate Alone or in Combination with Cannulated Screws for Hoffa Fractures: A Retrospective Study. Orthop Surg 2022; 14:492-500. [PMID: 35098693 PMCID: PMC8926976 DOI: 10.1111/os.13201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Zhen Li
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine Guangzhou China
| | - Zhenyue Chen
- The First Clinical Medical College of Guangzhou University of Chinese Medicine Guangzhou China
| | - Xiaotan Wang
- The First Clinical School, Shandong University of Traditional Chinese Medicine Jinan China
| | - Jingyin Li
- Department of Orthopaedics the First Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan China
| | - Lizhong Jing
- Department of Orthopaedics the First Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan China
| | - Zehui Li
- Department of Orthopaedic Surgery Guangdong Provincial Hospital of Traditional Chinese Medicine Guangzhou China
| | - Xuewei Cao
- Department of Orthopaedic Surgery Guangdong Provincial Hospital of Traditional Chinese Medicine Guangzhou China
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Cerny J, Soukup J, Novotny T. A Successful Case of TKA With Complex Deformity And Retained Hardware Using Computer Navigation. Arthroplast Today 2021; 13:29-34. [PMID: 34917718 PMCID: PMC8666612 DOI: 10.1016/j.artd.2021.11.005] [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: 09/12/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022] Open
Abstract
We present a case report of a 60-year-old Caucasian female patient, who had undergone a series of procedures for a periprosthetic (after total hip arthroplasty) Vancouver C type diaphyseal fracture of the right femur (reverse distal femoral locking compression plate [LCP] osteosynthesis, then a corrective osteotomy with another distal femoral LCP osteosynthesis). Subsequently, she developed high-grade osteoarthrosis of the right knee, indicated for a total knee arthroplasty. Considering the extent of previous procedures, which had significantly compromised the bone quality of the femur and therefore increased the risk of a refracture after an eventual hardware removal, we decided to retain the LCP plate. We concluded that the optimal solution would be the use of a computer-navigated total knee arthroplasty. This procedure obviated the need for intramedullary guiding, while ensuring optimal joint alignment. No postoperative complications emerged.
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Affiliation(s)
| | | | - Tomas Novotny
- Corresponding author. Department of Orthopaedics, University J.E. Purkinje, Masaryk Hospital, Usti nad Labem, 40113, Czech Republic. Tel: +420477113060.
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Ramamurti P, Fassihi SC, Stake S, Stadecker M, Whiting Z, Thakkar SC. Conversion Total Knee Arthroplasty. JBJS Rev 2021; 9:01874474-202109000-00007. [PMID: 34812774 DOI: 10.2106/jbjs.rvw.20.00198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Conversion total knee arthroplasty (TKA) represents a heterogeneous group of procedures and most commonly includes TKA performed after ligamentous reconstruction, periarticular open reduction and internal fixation (ORIF), high tibial osteotomy (HTO), and unicompartmental knee arthroplasty (UKA). » Relative to patients undergoing primary TKA, patients undergoing conversion TKA often have longer operative times and higher surgical complexity, which may translate into higher postoperative complication rates. » There is mixed evidence on implant survivorship and patient-reported outcome measures when comparing conversion TKA and primary TKA, with some studies noting no differences between the procedures and others finding decreased survivorship and outcome scores for conversion TKA. » By gaining an improved understanding of the unique challenges facing patients undergoing conversion TKA, clinicians may better set patient expectations, make intraoperative adjustments, and guide postoperative care.
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Affiliation(s)
- Pradip Ramamurti
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Seth Stake
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Monica Stadecker
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Zachariah Whiting
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, Columbia, Maryland
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Yang QF, Lin ZM, Yang S, Wang PK, Chen R, Wang J. Incidence and Risk Factors of In-Hospital Prosthesis-Related Complications Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study. Orthop Surg 2021; 13:1579-1586. [PMID: 34109750 PMCID: PMC8313154 DOI: 10.1111/os.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/13/2021] [Accepted: 03/11/2021] [Indexed: 01/28/2023] Open
Abstract
Objective To examine the incidence and risk factors of in‐hospital prosthesis‐related complications (PRCs) following total knee arthroplasty (TKA) using a large‐scale national database. Methods A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005–2014. Patients who underwent TKA were included. The recruited cases were divided into two groups according to the occurrence of PRCs. Patient demographics (age, sex, and race), hospital characteristics (type of admission and payer, and bedsize, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in‐hospital mortality, comorbidities, and perioperative complications were analyzed. Results A total of 1,227,244 TKAs were captured from the NIS database. There were 8484 cases of in‐hospital PRCs after TKA and the overall incidence was 0.69%, with a slight downward trend annually. Periprosthetic joint infection (PJI) was the main category among PRCs (0.20%), followed by mechanical loosening (0.04%), dislocation (0.02%), and periprosthetic fracture (PPF) (0.01%). Patients suffered from in‐hospital PRCs were 3 years younger (64 years vs 67 years) and 6.51% more likely to be male (43.60% vs 37.09%) compared to the nonaffected population (P < 0.0001). Additionally, patients experiencing in‐hospital PRCs after TKA were 2.11% less likely through elective admission (92.07% vs 94.18%) while 2.34% more likely in teaching hospital (45.53% vs 43.19%) than those without these complications (P < 0.0001). Furthermore, the occurrence of in‐hospital PRCs was associated with longer LOS (4 days vs 3 days; P < 0.0001), more total charges ($53,418 vs $41,204, P < 0.0001), and higher in‐hospital mortality (0.30% vs 0.07%; P < 0.0001). Multivariate logistic regression was performed to identify independent risk factors of in‐hospital PRCs after TKA which included younger age, male, non‐elective admission, teaching hospital, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, depression, diabetes with chronic complications, fluid and electrolyte disorders, pulmonary circulation disorders, metastatic cancer, and weight loss. Besides, in‐hospital PRCs after TKA were associated with secondary osteoarthritis, inflammatory arthritis, prior knee arthroscopy, acute renal failure, acute myocardial infarction, deep vein thrombosis, sepsis, transfusion, and wound dehiscence. Conclusion It is beneficial to study the risk factors of in‐hospital PRCs after TKA to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.
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Affiliation(s)
- Qin-Feng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ze-Ming Lin
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pin-Kai Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Chen
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Li M, Chang H, Wei N, Chang W, Yan Y, Jin Z, Chen W. Biomechanical Study on the Stress Distribution of the Knee Joint After Tibial Fracture Malunion with Residual Varus-Valgus Deformity. Orthop Surg 2020; 12:983-989. [PMID: 32462810 PMCID: PMC7307236 DOI: 10.1111/os.12668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the effect of residual varus and valgus deformity on the stress distribution of the knee joint after tibial fracture malunion. METHODS Fourteen adult cadaver specimens were selected to establish the models of tibial fractures, which were fixed subsequently at neutral position (anatomical reduction) and malunion positions (at 5°, 10°, and 15° valgus positions, and 5°, 10°, and 15° varus positions). The stress distribution on the medial and lateral plateau of the tibia was quantitatively measured using ultra-low-pressure sensitive film technology. The changes in the stress distribution of the knee joint after tibial fracture malunion and the relationship between the stress values and the residual varus or valgus deformity were analyzed. RESULTS Under 400 N vertical load, the stress values on the medial and lateral plateau of the tibia at the neutral position were 1.137 ± 0.139 MPa and 1.041 ± 0.117 MPa, respectively. When compared with the stress values measured at the neutral position, the stress on the medial plateau of the tibia was significantly higher at varus deformities and lower at valgus deformities, and the stress on the lateral plateau was significantly higher at valgus deformities and lower at varus deformities (all P < 0.05). The stress values on the medial plateau of the tibia were significantly higher than the corresponding data on the lateral plateau at neutral and 5°, 10°, and 15° varus deformities, respectively (all P < 0.05), and significantly lower than the corresponding data on the lateral plateau at 5°, 10°, and 15° valgus deformities, respectively (all P < 0.05). CONCLUSION Residual varus and valgus deformity after tibial fracture malunion can lead to obvious changes of the stress distribution of the knee joint. Therefore, tibial fractures should be reduced anatomically and fixed rigidly to avoid residual varus-valgus deformity and malalignment of lower limbs.
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Affiliation(s)
- Ming Li
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hengrui Chang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Wei
- Department of Orthopedic Surgery, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Wenli Chang
- Department of Orthopedic Surgery, Cangzhou Hospital of Integrated TCM-WM Hebei, Cangzhou, China
| | - Ying Yan
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zeyue Jin
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
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