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Chen TLW, Shimizu MR, Buddhiraju A, Seo HH, Subih MA, Chen SF, Kwon YM. Predicting 30-day unplanned hospital readmission after revision total knee arthroplasty: machine learning model analysis of a national patient cohort. Med Biol Eng Comput 2024; 62:2073-2086. [PMID: 38451418 DOI: 10.1007/s11517-024-03054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
Revision total knee arthroplasty (TKA) is associated with a higher risk of readmission than primary TKA. Identifying individual patients predisposed to readmission can facilitate proactive optimization and increase care efficiency. This study developed machine learning (ML) models to predict unplanned readmission following revision TKA using a national-scale patient dataset. A total of 17,443 revision TKA cases (2013-2020) were acquired from the ACS NSQIP database. Four ML models (artificial neural networks, random forest, histogram-based gradient boosting, and k-nearest neighbor) were developed on relevant patient variables to predict readmission following revision TKA. The length of stay, operation time, body mass index (BMI), and laboratory test results were the strongest predictors of readmission. Histogram-based gradient boosting was the best performer in distinguishing readmission (AUC: 0.95) and estimating the readmission probability for individual patients (calibration slope: 1.13; calibration intercept: -0.00; Brier score: 0.064). All models produced higher net benefit than the default strategies of treating all or no patients, supporting the clinical utility of the models. ML demonstrated excellent performance for the prediction of readmission following revision TKA. Optimization of important predictors highlighted by our model may decrease preventable hospital readmission following surgery, thereby leading to reduced financial burden and improved patient satisfaction.
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Affiliation(s)
- Tony Lin-Wei Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Michelle Riyo Shimizu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Hojoon Seo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Murad Abdullah Subih
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shane Fei Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Kim CH, Park YB, Baek SH. Clinical and Radiological Outcomes of Computer-Assisted Navigation in Primary Total Knee Arthroplasty for Patients with Extra-articular Deformity: Systematic Review and Meta-Analysis. Clin Orthop Surg 2024; 16:430-440. [PMID: 38827763 PMCID: PMC11130617 DOI: 10.4055/cios23261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 06/05/2024] Open
Abstract
Background Computer-assisted navigation surgery (CAS) during primary total knee arthroplasty (TKA) may help improve outcomes for patients with extra-articular deformity (EAD); however, this has not been extensively studied. Therefore, we aimed to investigate the clinical and radiological outcomes following primary TKA using CAS in patients with EAD. Methods We searched Medline, Embase, and the Cochrane Library up to March 3, 2023 for studies investigating surgical outcomes of using the navigation system for TKA to treat patients with EAD. From 14 studies, 539 knees with EAD that underwent navigation TKA were enrolled. We investigated the knee range of motion (ROM), outcome scores at final follow-up (Knee Society Score [KSS] and Knee Functional Score [KFS]), and pre- and postoperative mechanical hip-knee-ankle (mHKA) angle using lower extremity scanogram. The meta-analysis was based on the single-arm method, and all data were pooled using a random-effects model. Results Following our meta-analyses, the mean knee ROM changed from 87.0° (95% confidence interval [CI], 75.9°-98.1°) preoperatively to 109.4° (95% CI, 97.9°-120.8°) postoperatively. The adjusted KSS was 93.45 points (95% CI, 88.36-98.54 points), and the adjusted KFS was 91.57 points (95% CI, 86.80-96.33 points) in knees with EAD that underwent CAS-TKA. As a radiological outcome, the mHKA angle changed from 169.53° (95% CI, 166.90°-172.16°) preoperatively to 178.81° (95% CI, 178.31°-179.30°) postoperatively. Conclusions CAS-TKA yielded positive clinical results and demonstrated a satisfactory alignment of the lower limb's mechanical axis. CAS-TKA showed promise for primary TKA procedures, demonstrating favorable clinical and radiological outcomes even in complex cases involving EAD.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Suk Ho Baek
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
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Gurusamy P, Liu JW, Sullivan TC, Clyburn TA, Lambert BS, Incavo SJ. Alignment in Total Knee Arthroplasty: Avoid Crossing Over From Varus to Valgus. J Arthroplasty 2024:S0883-5403(24)00380-2. [PMID: 38679348 DOI: 10.1016/j.arth.2024.04.057] [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: 01/19/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Ideal target limb alignment remains a debated topic in total knee arthroplasty (TKA). We aimed to determine the effect of limb alignment correction on patient-reported outcomes and knee range of motion (ROM) following TKA. METHODS In this retrospective analysis, patients (N = 409) undergoing primary TKA at a single institution were studied. Using full leg-length radiographs, limb alignment was measured preoperatively and postoperatively. Patients were categorized by preoperative (Preop) alignment (varus > 0°; valgus < 0°). Preop varus patients were then divided as follows based on postoperative alignment: neutral (VAR-NEUT, 0°± 2), remaining in varus (VAR-rVAR, ≥3°), and cross-over to valgus (VAR-CO, ≤-3°). Similarly, Preop valgus patients were divided as follows for postoperative alignment: neutral (VAL-NEUT, 0°± 2), remaining in valgus (VAL-rVAL, ≤-3°), and cross-over to varus (VAL-CO, ≥3°). The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement survey scores were collected at preoperatively as well as at 6 weeks, 3, 6, and 12 months postoperatively. Knee ROM was collected at 2 weeks, 6 to 12 weeks, and >6 months postoperatively. An analysis of variance repeated on time followed by a Bonferroni post hoc test was used to compare outcomes for the postoperative alignment subgroups. RESULTS Preop Varus patients: Those in the VAR-CO group (overcorrected to -4.03° ± 1.95valgus) were observed to have lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at 3, 6, and 12 months postoperatively compared to those in the NEUT group (P < .05). This finding was paired with reduced ROM at 6 to 12 weeks postoperatively in the VAR-CO group compared to VAR-NEUT and VAR-rVAR (P < .05). Preop Valgus patients: Those in the VAL-rVal group (left in -4.39° ± 1.39valgus) were observed to have reduced knee flexion at 6 to 12 weeks postoperatively compared to VAL-NEUT and VAL-CO. CONCLUSIONS These findings indicate that postoperative valgus alignment via either crossing over to valgus (VAR-CO) or remaining in valgus (VAL-rVAL) alignment may result in less preferable outcomes than correction to neutral or slightly varus alignment.
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Affiliation(s)
- Pradyumna Gurusamy
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas
| | - Jennifer W Liu
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas
| | - Thomas C Sullivan
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas
| | - Terry A Clyburn
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas
| | - Bradley S Lambert
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas
| | - Stephen J Incavo
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas
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Alrajeb R, Zarti M, Shuia Z, Alzobi O, Ahmed G, Elmhiregh A. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1333-1343. [PMID: 38133653 PMCID: PMC10980635 DOI: 10.1007/s00590-023-03798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Robotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes. METHODS We searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS Our search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR - 0.82; 95% CI, - 1.027 to - 0.58, p value < 0.00001) and mechanical restoration (OR - 0.95; 95% CI, - 1.49 to - 0.41, p value < 0.0006). While knee range of motion (OR - 2.23; 95% CI - 4.89-0.43, p value 0.1) and femoral prosthesis position (OR - 0.98; 95% CI, - 2.03-0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries. CONCLUSION This meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | | | | | - Osama Alzobi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Ghalib Ahmed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Sterneder CM, Faschingbauer M, Haralambiev L, Kasparek MF, Boettner F. Why Kinematic Alignment Makes Little Sense in Valgus Osteoarthritis of the Knee: A Narrative Review. J Clin Med 2024; 13:1302. [PMID: 38592153 PMCID: PMC10932440 DOI: 10.3390/jcm13051302] [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: 01/28/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the aim of restoring the patient's native alignment and minimizing the need for soft tissue releases. Our previous studies showed that MA with standardized soft tissue release produces reproducible results, and that the preoperative phenotype does not influence the results of patients with valgus osteoarthritis. These data suggest that there is no functional advantage to preserving valgus alignment in patients with valgus osteoarthritis. Many patients with valgus osteoarthritis present with a compromised medial collateral ligament and leaving the knee in valgus could increase the risk of secondary instability. The current literature supports MA TKA with soft tissue release as the gold standard. While using more sophisticated enabling technologies like robotic surgery might allow for aiming for very slight (1-2°) valgus alignment on the femoral side, any valgus alignment outside this range should be avoided. This review paper summarizes our current knowledge on the surgical techniques of TKA in patients with valgus osteoarthritis.
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Affiliation(s)
- Christian Manuel Sterneder
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Maximilian F. Kasparek
- Department of Orthopedics, Evangelisches Krankenhaus, Hans-Sachs Gasse 10-12, 1180 Vienna, Austria
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Aunan E, Alhaug E, Schuller SG, Rundfloen JE. 3-dimensional computer tomography is more accurate than traditional long-leg radiographs in the planning and evaluation of coronal alignment in total knee arthroplasty: a prospective study on 121 knees. Acta Orthop 2023; 94:530-536. [PMID: 37882334 PMCID: PMC10601491 DOI: 10.2340/17453674.2023.19695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Accurate measuring tools are essential in preoperative planning and for the study of the association between postoperative alignment and clinical outcome in total knee arthroplasty (TKA). We aimed to describe a simple method to measure preoperative hip-knee-femoral shaft (HKFS) angle and postoperative coronal alignment in TKA with the use of standard 3D CT and to compare preoperative HKFS angles and postoperative coronal alignment measured with the 3D CT technique and with standing long-leg hip-knee-ankle (HKA) radiographs. PATIENTS AND METHODS HKA radiographs and 3D CT were taken preoperatively and 3 months after the operation in 121 knees. The interrater reliability for the 3D CT method was calculated with intra-class correlation coefficient (ICC). The preoperative HKFS angles and the postoperative deformity measured with the 2 methods were compared and illustrated on Bland-Altman plots, frequency tables, and by Cohen's kappa coefficients (k). RESULTS The 3D CT method was feasible in all knees and the ICC was excellent. Mean (SD, range) difference in HKFS angle measured on HKA radiographs and on 3D CT was -0.3° (0.9°, -4.1° to 2.4°). Mean (SD, range) difference in postoperative deformity was 0.1° (1.6°, -5° to 6°). The 95% limits of agreement were 1.4° and -2° for HKFS and ±3° for postoperative alignment. The agreement in outlier (≥ 3°) identification was moderate with a k (95% confidence interval) of 0.48 (0.32-0.64). CONCLUSION 3-dimensional computer tomography was feasible and was shown to be more accurate than traditional long-leg radiographs.
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Affiliation(s)
- Eirik Aunan
- Department of Orthopaedic Surgery, Sykehuset Innlandet Hospital Trust, Lillehammer.
| | - Eivind Alhaug
- Department of Radiology, Sykehuset Innlandet Hospital Trust, Lillehammer, Norway
| | - Siri G Schuller
- Department of Radiology, Sykehuset Innlandet Hospital Trust, Lillehammer, Norway
| | - Jan E Rundfloen
- Department of Radiology, Sykehuset Innlandet Hospital Trust, Lillehammer, Norway
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Streck LE, Faschingbauer M, Brenneis M, Boettner CS, List K, Kasparek MF, Boettner F. Individual Phenotype Does Not Impact the Outcome of Mechanical Aligned Total Knee Arthroplasties for Valgus Osteoarthritis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1852. [PMID: 37893570 PMCID: PMC10608527 DOI: 10.3390/medicina59101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: There is an ongoing discussion about the best alignment targets in total knee arthroplasty (TKA). Mechanical alignment has been the standard in TKA for years. Alongside the development of various classification systems to describe the native alignment of the knee (knee phenotype), kinematic alignment restoring the individual phenotype of the knee has been advocated more recently. Alignment in TKA becomes even more challenging in knees with preoperative deformities such as valgus osteoarthritis. Materials and Methods: The study retrospectively evaluated 158 knees in 135 patients who underwent TKA with a mechanical alignment target for valgus osteoarthritis. Pre- and postoperative hip knee angle, lateral distal femur angle, and medial proximal tibial angle/tibial plate angle (pre-/postoperative) were measured on standing hip-to-ankle radiographs. Knees were grouped according to the coronal plane alignment of the knee (CPAK) classification. Preoperative and postoperative range of motion and patient-related outcome measures (WOMAC, UCLA, SF-12, pain) were assessed. Results: There was no difference in outcome for mechanically aligned TKA between the different CPAK phenotypes, suggesting that mechanical alignment is an appropriate target for the different phenotypes analyzed in the study. Remaining valgus alignment was associated with decreased postoperative UCLA scores and decreased improvement in SF-12 scores (p = 0.011/p = 0.028). Within CPAK III, mechanical aligned TKA showed better postoperative UCLA Scores than TKA with valgus alignment (p = 0.015). The individual knee phenotype in patients with valgus osteoarthritis did not influence the outcome of mechanical aligned TKA operated with standardized soft-tissue release.
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Affiliation(s)
- Laura E. Streck
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Marco Brenneis
- The Complex Joint Reconstruction Centre at Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
| | - Cosima S. Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Kilian List
- Department of Orthopedics, University of Wuerzburg, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Maximilian F. Kasparek
- Department of Orthopedics, Evangelisches Krankenhaus, Hans-Sachs Gasse 10-12, 1180 Vienna, Austria
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Luyckx T, Moreels R, Geernaert H, Scheys L, Vandenneucker H. Valgus alignment of the femoral component is associated with higher revision rates 10 years after TKA. Knee Surg Sports Traumatol Arthrosc 2023; 31:4171-4178. [PMID: 37154911 DOI: 10.1007/s00167-023-07448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Appropriate positioning and alignment of tibial and femoral component in primary total knee arthroplasty (TKA) are factors of major importance directly related to patient satisfaction and implant survival. Most literature works elaborate on overall post-operative alignment and its correlation to implant survival. However, less is known about the impact of individual component alignment. The purpose of this study was to investigate the effect of undercorrection of overall alignment as well as the effect of individual tibial and femoral component alignment on the post-operative failure rate after total knee arthroplasty. METHODS Clinical and radiographic data of primary TKA cases from 2002 to 2004, with a minimum of 10-year follow-up, were retrospectively reviewed. The pre- and post-operative hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were measured on weight-bearing, full-length antero-posterior lower limb radiographs. Statistical analysis was performed to establish the correlation between both overall and implant alignment and revision rate. RESULTS In total, 379 primary TKA cases were evaluated. The mean time of follow-up was 12.9 years (range 10.3-15.9 years, SD = 1.8). Nine out of 379 cases were revised due to aseptic loosening; the mean time to revision was 5.5 years (range 1.0-15.5 years, SD = 4.6). Varus undercorrection of overall alignment was not associated with a higher rate of revision (p = 0.316). Post-operative valgus femoral alignment (mLDFA < 87°) contributed to a significant decreased prosthesis survival in contrast to neutral femoral alignment (revision rate valgus group: 10.7% and neutral group: 1.7%; p = 0.003). Post-operative tibial mechanical alignment was not identified as a significant predictor for implant survival (revision rate varus group: 2.9% and neutral group: 2.4%; p = 0.855). CONCLUSIONS Primary TKA showed significantly higher revision rates when the femoral component was placed in > 3° of valgus (mLDFA < 87°). In contrast, postoperative overall residual varus alignment (HKA) and varus alignment of the tibial component were not related to higher revision rates at a minimum 10-year follow-up after TKA. These findings should be considered when choosing component position in individualised TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T Luyckx
- Department of Orthopaedic Surgery and Traumatology, AZ Delta Roeselare, Roeselare, Belgium
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - R Moreels
- Department of Orthopaedic Surgery and Traumatology, AZ Delta Roeselare, Roeselare, Belgium.
| | - H Geernaert
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - L Scheys
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, Leuven, Belgium
| | - H Vandenneucker
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
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Functional Alignment Philosophy in Total Knee Arthroplasty-Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning. J Pers Med 2023; 13:jpm13020212. [PMID: 36836446 PMCID: PMC9961945 DOI: 10.3390/jpm13020212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
Functional alignment (FA) is a novel philosophy to deliver a total knee arthroplasty (TKA) that respects individual bony and soft tissue phenotypes within defined limitations. The purpose of this paper is to describe the rationale and technique of FA in the valgus morphotype with the use of an image-based robotic-platform. For the valgus phenotype the principles are personalized pre-operative planning, reconstitution of native coronal alignment without residual varus or valgus of more than 3°, restoration of dynamic sagittal alignment within 5° of neutral, implant sizing to match anatomy, and achievement of defined soft tissue laxity in extension and flexion through implant manipulation within the defined boundaries. An individualized plan is created from pre-operative imaging. Next, a reproducible and quantifiable assessment of soft tissue laxity is performed in extension and flexion. Implant positioning is then manipulated in all three planes if necessary to achieve target gap measurements and a final limb position within a defined coronal and sagittal range. FA is a novel TKA technique that aims to restore constitutional bony alignment and balance the laxity of the soft tissues by placing and sizing implants in a manner that respects variations in individual anatomy and soft tissues within defined limits.
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Hao K, Wei M, Ji G, Jia Y, Wang F. Comparison of the Imaging and Clinical Outcomes among the Measured Resection, Gap Balancing, and Hybrid Techniques in Primary Total Knee Arthroplasty. Orthop Surg 2022; 15:93-102. [PMID: 36377906 PMCID: PMC9837215 DOI: 10.1111/os.13525] [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: 07/07/2021] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although many studies have compared the measured resection (MR) technique to the gap balancing (GB) technique, few studies have investigated the hybrid technique. In this study, we compared imaging and clinical outcomes of the MR, GB, and hybrid techniques in primary total knee arthroplasty (TKA). METHODS From January 2016 to January 2019, we conducted a retrospective study on 90 patients who underwent unilateral primary TKA; 30 received the MR technique, 30 received the GB technique, and 30 received the hybrid technique. Radiological outcomes, including joint line level, mechanical alignment of the lower limb, positions of the femoral and tibial components, and rotation of the femoral component, and clinical outcomes, including the visual analog scale score for pain, the Knee Society Score, and the range of motion, were assessed among the three groups. One-way analysis of variance and Dunnett's test were performed for normally distributed data. Kruskal-Wallis H test and Dunn-Bonferroni test were conducted for non-normally distributed data. RESULTS No significant difference in the mechanical alignment (p = 0.151) and the positions of the tibial and femoral components (p = 0.230 for α angle, p = 0.517 for β angle, p = 0.686 for femoral flexion angle, and p = 0.918 for tibial slope angle) was found among the three groups. No significant difference in the elevation of the joint line between the MR and the hybrid groups was found (2.1 ± 0.3 mm vs 2.1 ± 0.1 mm, p = 0.627), but the GB group (2.8 ± 0.2 mm) differed significantly from the other two groups (p < 0.001). Although rotation of the femoral component in the GB group was larger than that of the MR and hybrid groups, the difference was not significant (1.8° ± 0.2° vs 1.7° ± 0.3° vs. 1.7° ± 0.2°, p = 0.101). The clinical outcomes were not significantly different (p > 0.05), although the results in the hybrid group were slightly higher. CONCLUSION The hybrid technique helped to restore the mechanical alignment of the lower limb and realize optimal positions of the femoral and tibial components without significant differences relative to the MR and GB techniques. The hybrid technique was more helpful for maintaining the original height of the joint line, which was similar to the MR technique. Additionally, although the improvement in the clinical outcomes in the hybrid group was slightly higher, it was not significantly different among the three groups.
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Affiliation(s)
- Kuo Hao
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Maozheng Wei
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Gang Ji
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Yanfeng Jia
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Fei Wang
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
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Geng L, Fu J, Xu C, Ren P, Wang YM, Ji QB, Xin P, Zheng QY, Ni M, Zhang GQ. The Comparison between Mini-Subvastus Approach and Medial Parapatellar Approach in TKA: A Prospective Double-Blinded Randomized Controlled Trial. Orthop Surg 2022; 14:2878-2887. [PMID: 36127866 PMCID: PMC9627057 DOI: 10.1111/os.13494] [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: 12/04/2021] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Minimal invasive approach has been increasingly used in total knee arthroplasty (TKA) and more is expected of early rehabilitation in terms of pain release and recovery of knee function. The approach type is one of the major factors that determines the early rehabilitation after TKA. The purpose of this study is to determine whether mini‐subvastus approach (MSVA) is superior to the traditional medial parapatellar approach (MPA) in TKA. Methods From 2018 to 2019, a randomized double‐blinded prospective study was conducted on 58 patients who underwent simultaneous bilateral TKA. The subjects included eight men and 50 women, with an average age of 65 years. One side was randomized using MSVA and the other side using MPA. Visual analog scale (VAS), operative duration, recovery time to straight leg raising (SLR), range of motion (ROM), HSS score, release rate of lateral retinaculum, satisfaction rate were recorded and compared. Paired‐samples T test were used for quantitative data and chi‐square test for qualitative data. Results There was no statistical difference in the ratio of left and right sides, preoperative ROM, VAS, HSS score, muscular strength of lower limbs, KL grade, operative order, and operative duration between the two groups. The average ROM (118.91 ± 8.21 vs. 107.60 ± 7.99, t = 14.320, p = 0.0000) and HSS score (72.03 ± 4.55 vs. 61.22 ± 4.36, t = 13.095, p = 0.0000) on POD 3, VAS in rest and motion on POD 1 and 3, the recovery time to SLR (1.17 ± 0.38 vs. 3.09 ± 0.76, t = 19.902, p = 0.0000), and the satisfaction rate on POD 1 (96.55% vs. 74.14%, χ2 = 9.9251, p = 0.0016) were superior in the MSVA group over MPA group. ROM in rest and motion and HSS score on POD 30 had no difference. The release rate of lateral retinaculum was less in the MSVA group than in the MPA group. The mean value of HKA, FFC, and FTC and the proportion of outliers did not differ significantly between the two groups. Conclusions Compared with MPA, MSVA can make ROM of knee and SLR recover earlier, reduce postoperative pain after TKA, improve the early postoperative satisfaction and reduce the lateral release rate. MSVA can be used as a favorable measure in the concept of enhanced recovery after surgery (ERAS).
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Affiliation(s)
- Lei Geng
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Fu
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Chi Xu
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Peng Ren
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yi-Ming Wang
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Quan-Bo Ji
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Peng Xin
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Qing-Yuan Zheng
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ming Ni
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Guo-Qiang Zhang
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
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