1
|
Baba R, Ohkoshi Y, Maeda T, Suzuki K, Iwadate A, Iwasaki K, Onodera T, Kondo E, Iwasaki N. The Influence of Patello-Femoral Overstuffing After Modular Unlinked Bicompartmental Knee Arthroplasty (BiKA) for Medial Tibio-Femoral and Patello-Femoral Osteoarthritis of the Knee. J Arthroplasty 2024; 39:638-644. [PMID: 37633506 DOI: 10.1016/j.arth.2023.08.069] [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: 04/26/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The factors affecting results after bicompartmental knee arthroplasty (BiKA) have not been fully elucidated. This major ligament-preserving procedure may be more susceptible to overstuffing of the patello-femoral (PF) joint than the major ligament-sacrificing total knee arthroplasty. Currently, we investigated the effect of PF overstuffing after BiKA on its clinical outcome. METHODS There were 71 patients (74 knees) who underwent modular unlinked BiKA at our clinic who had a follow-up of 5 to 9 years. Final follow-up results were assessed by evaluating knee range of motion, the 2011 Knee Society Score (2011KSS), Japanese Knee Osteoarthritis Measure, and radiological findings. The degree of postoperative PF overstuffing was evaluated by computed tomography and magnetic resonance images for 55 knees, and the correlation between the degree of overstuffing and postoperative clinical results were examined. RESULTS Overall clinical results improved significantly after surgery without any revision cases. The X-ray measurements showed the improved coronal alignments and the appropriate implant installation angles. Higher degree of postoperative PF overstuffing caused by insufficient amount of osteotomy on the anterior surface of the femur correlated with worse postoperative total 2011KSS at 2 years after surgery (Spearman's rank correlation coefficient (rs) = -0.387, P = .004), as opposed to no correlation at the time of the final follow-up (Spearman's rank correlation coefficient = 0.068, P = .623). CONCLUSION Modular unlinked BiKA provided patients with a high level of satisfaction and functional improvement over 5 to 9 years postoperatively. However, because PF overstuffing affects initial patient satisfaction, the amount of osteotomy should be determined carefully during the surgery.
Collapse
Affiliation(s)
- Rikiya Baba
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasumitsu Ohkoshi
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Tatsunori Maeda
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Ko Suzuki
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Akane Iwadate
- Department of Orthopedic Surgery, Hakodate Orthopedics Clinic, Hakodate, Japan
| | - Koji Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
2
|
Peng Y, Lin W, Zhang Y, Wang F. Patellofemoral arthroplasty in combination with high tibial osteotomy can achieve good outcome for patients with medial-patellofemoral osteoarthritis. Front Surg 2022; 9:999208. [PMID: 36317169 PMCID: PMC9616691 DOI: 10.3389/fsurg.2022.999208] [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: 07/20/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of our study is to report on the clinical outcomes of patients who undergoing patellofemoral arthroplasty (PFA) in combination with a high tibial osteotomy (HTO). Due to this procedure's conservative and kinematics-preserving characteristics, we hypothesized that PFA in combination with HTO would result in good clinical outcomes in patients with medial and patellofemoral compartment osteoarthritis (MPFOA). Methods Patients who underwent PFA in combination with HTO for MPFOA from January 2018 to April 2020 were included in the study. Clinical outcomes were analyzed by comparing the Knee Society Score, Oxford Knee Score, Range of Motion, and Forgotten Joint Score before and after the procedure. Radiological evaluations were also performed to assess the tibiofemoral osteoarthritis progression and implant loosening. For all tests, the value of p < 0.05 was considered statistically significant. Results A total of nine consecutive patients who underwent PFA in combination with HTO were included. Two were males, seven were females. The average follow-up period was 2.6 ± 0.4 years. Clinical outcomes showed a significant improvement in the Knee Society Score (clinical score: 90.3 ± 8.5 and function score: 90.8 ± 7.8), Oxford Knee Score (43.6 ± 3.6), Forgotten Joint Score (71.2 ± 10.2), and knee Range of Motion (130.4 ± 8.1°) at the final follow-up. Additionally, hip-knee-ankle angle significantly decreased from -9.3 ± 2.1° preoperatively to 2.2 ± 1.2° at the final follow-up (p < 0.05). There were no complications for any patient during the follow-up time. Conclusion This study shows that patients who underwent PFA in combination with HTO for the treatment of MPFOA achieved good clinical and radiological outcomes. This combined surgery could be an effective alternative to treat MPFOA in well-selected patients.
Collapse
|
3
|
Ozer A. Computational wear of knee implant polyethylene insert surface under continuous dynamic loading and posterior tibial slope variation based on cadaver experiments with comparative verification. BMC Musculoskelet Disord 2022; 23:871. [PMID: 36123647 PMCID: PMC9484235 DOI: 10.1186/s12891-022-05828-2] [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: 03/15/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background The effect of posterior tibial slope on the maximum contact pressure and wear volume of polyethylene (PE) insert were not given special attention. The effects of flexion angle, Anterior-Posterior (AP) Translation, and Tibial slope on the max contact pressure and wear of PE insert of TKR were investigated under loadings which were obtained in cadaver experiments by using Archard’s wear law. This study uses not only loads obtained from cadaver experiments but also dynamic flexion starting from 0 to 90 degrees. Method Wear on knee implant PE insert was investigated using a 2.5 size 3 dimensional (3D) cruciate sacrificing total knee replacement model and Finite Element Method (FEM) under loadings and AP Translation data ranging from 0 to 90 flexion angles validated by cadaver experiments. Two types of analyses were done to measure the wear effect on knee implant PE insert. The first set of analyses included the flexion angles dynamically changing with the knee rotating from 0 to 90 angles according to the femur axis and the transient analyses for loadings changing with a certain angle and duration. Results It is seen that the contact pressure on the PE insert decreases as the cycle increases for both Flexion and Flexion+AP Translation. It is clear that as the cycle increases, the wear obtained for both cases increases. The loadings acting on the PE insert cannot create sufficient pressure due to the AP Translation effect at low speeds and have an effect to reduce the wear, while the effect increases with the wear as the cycle increases, and the AP Translation now contributes to the wear at high speeds. It is seen that as the posterior tibial slope angle increases, the maximum contact pressure values slightly decrease for the same cycle. Conclusions This study indicated that AP Translation, which changes direction during flexion, had a significant effect on both contact pressure and wear. Unlike previous similar studies, it was seen that the amount of wear continues to increase as the cycle increases. This situation strengthens the argument that loading and AP Translation values that change with flexion shape the wear effects on PE Insert.
Collapse
Affiliation(s)
- Alaettin Ozer
- Department of Mechanical Engineering, Yozgat Bozok University, Yozgat, Turkey.
| |
Collapse
|
4
|
Yamagami R, Inui H, Taketomi S, Kono K, Kawaguchi K, Sameshima S, Kage T, Tanaka S. Proximal tibial morphology is associated with risk of trauma to the posteromedial structures during tibial bone resection reproducing the anatomical posterior tibial slope in bicruciate-retaining total knee arthroplasty. Knee 2022; 36:1-8. [PMID: 35381571 DOI: 10.1016/j.knee.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 07/23/2021] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A tibial cut with the native posterior tibial slope (PTS) is a theoretical prerequisite in bicruciate-retaining total knee arthroplasty (BCRTKA) to regain physiological knee kinematics. The present study reveals tibial morphological risk factors of trauma to the posteromedial structures of the knee during tibial bone resection in BCRTKA. METHODS Fifty patients undergoing BCRTKA for varus knee osteoarthritis were analyzed. A three-dimensional tibial bone model was reconstructed using a computed tomography-based preoperative planning system, and the coronal tibial slope (CTS) and medial PTS (MPTS) were measured. Then, we set the simulated tibial cutting plane neutral on the coronal plane, posteriorly inclined in accordance with the MPTS on the sagittal plane, and 9 mm below the surface of the subchondral cortical bone (i.e., 11 mm below the surface of the cartilage) of the lateral tibial plateau. The association between the tibial morphology and the distance from the simulated cutting plane to the semimembranosus (SM) insertion (Dsm) was analyzed. RESULTS Of the 50 patients, 19 (38%) had negative Dsm values, indicating a cut into the SM (namely, below the posterior oblique ligament) insertion. The MPTS was negatively correlated with Dsm (r = -0.396, p = 0.004), whereas the CTS was positively correlated with Dsm (r = 0.619, p < 0.001). On multivariate linear regression analysis, the MPTS and CTS were independent predictors of Dsm. CONCLUSION In the setting of tibial cuts reproducing the native MPTS in BCRTKA, patients with larger PTS and smaller CTS had more risk of trauma to the posteromedial structures.
Collapse
Affiliation(s)
- Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
5
|
Gaudiani MA, Samuel LT, Diana JN, DeBattista JL, Coon TM, Moore RE, Kamath AF. Robotic-arm assisted bicompartmental knee arthroplasty: Durable results up to 7-year follow-up. Int J Med Robot 2021; 18:e2338. [PMID: 34665485 DOI: 10.1002/rcs.2338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/04/2021] [Accepted: 10/08/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of our study was to investigate the mid-term clinical and functional outcomes of robotic-arm assisted Bicompartmental knee arthroplasty (BiKA). METHODS This study reviewed a single-centre prospectively maintained cohort of 50 patients (53 knees) who underwent BiKA (patellofemoral and medial compartment) at 5- and 7-year postoperative follow-up. RESULTS Mean follow-up was 7.1 ± 0.1 years (range, 7.0-7.3). Kaplan-Meier survivorship rates at 5 and 7 years were 96% and 93%, respectively. At 7-year follow-up, patient satisfaction was 76% satisfied, 13% neutral, and 11% not satisfied. Mean KSS-FS was 80.5 ± 15.8 (range, 30-100) with 82% of patients reporting walking more than 10 blocks, 89% reporting walking without support, and 100% able to go up and down stairs with 61% requiring use of a rail. Three patients (four knees) underwent revision surgery. CONCLUSIONS Our study reported excellent survivorship and functional outcomes, and good-excellent satisfaction at mid-term follow-up for robotic-arm assisted BiKA.
Collapse
Affiliation(s)
- Michael A Gaudiani
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - John N Diana
- Coon Joint Replacement Institute, St. Helena, California, USA
| | | | - Thomas M Coon
- Coon Joint Replacement Institute, St. Helena, California, USA
| | - Ryan E Moore
- Coon Joint Replacement Institute, St. Helena, California, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
6
|
Koh YG, Hong HT, Lee HY, Kim HJ, Kang KT. Influence of Variation in Sagittal Placement of the Femoral Component after Cruciate-Retaining Total Knee Arthroplasty. J Knee Surg 2021; 34:444-451. [PMID: 31499566 DOI: 10.1055/s-0039-1696958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Prosthetic alignment is an important factor for long-term survival in cruciate-retaining (CR) total knee arthroplasty (TKA). The purpose of this study is to investigate the influence of sagittal placement of the femoral component on tibiofemoral (TF) kinematics and kinetics in CR-TKA. Five sagittal placements of femoral component models with -3, 0, 3, 5, and 7 degrees of flexion are developed. The TF joint kinematics, quadriceps force, patellofemoral contact force, and posterior cruciate ligament force are evaluated using the models under deep knee-bend loading. The kinematics of posterior TF translation is found to occur with the increase in femoral-component flexion. The quadriceps force and patellofemoral contact force decrease with the femoral-component flexion increase. In addition, extension of the femoral component increases with the increase in posterior cruciate ligament force. The flexed femoral component in CR-TKA provides a positive biomechanical effect compared with a neutral position. Slight flexion could be an effective alternative technique to enable positive biomechanical effects with TKA prostheses.
Collapse
Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
| | - Hyoung-Taek Hong
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
| |
Collapse
|
7
|
Arnout N, Victor J, Vermue H, Pringels L, Bellemans J, Verstraete MA. Knee joint laxity is restored in a bi-cruciate retaining TKA-design. Knee Surg Sports Traumatol Arthrosc 2020; 28:2863-2871. [PMID: 31377826 DOI: 10.1007/s00167-019-05639-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The goal is to evaluate the passive stability of a bicruciate retaining, cruciate retaining and bicruciate substituting TKA design in relation to the native knee stability in terms of the laxity envelope. A bicruciate retaining knee prosthesis was hypothesized to offer a closer to normal knee stability in vitro. METHODS Fourteen cadaveric knee specimens have been tested under passive conditions with and without external loads, involving a varus/valgus and an external/internal rotational torque, distraction/compression force and an anteroposterior shear force. Subsequently, the native knee, bicruciate retaining, cruciate retaining and finally a bicruciate substituting total knee arthroplasty were tested. RESULTS Through the range of motion, the width of the varus/valgus and internal/external laxity envelope for the native knee and the bicruciate retaining knee were almost equivalent, whereas the cruciate retaining and the bicruciate substituting knee displayed less laxity and more joint distraction. In all prosthetic knees, an equal anteroposterior laxity was seen for the lateral and medial side whereas in the native knee, a difference in laxity was seen between the stable medial side and the more mobile lateral side. CONCLUSION Bicruciate retaining knee prostheses can restore normal laxity and thus have the potential to offer more normal knee function. Restoration of natural peri-articular soft-tissue tension is clinically important because of its obvious effects on joint stability and range of motion. Furthermore, the results of this study could help to establish the ideal ligament tension and laxity in more conventional implants by approaching the normal values for passive knee evaluation as presented here.
Collapse
Affiliation(s)
- N Arnout
- University Hospital Ghent, Corneel Heymanslaan 10, 9000, Gent, Belgium.
- Ghent University, Gent, Belgium.
| | - J Victor
- University Hospital Ghent, Corneel Heymanslaan 10, 9000, Gent, Belgium
- Ghent University, Gent, Belgium
| | - H Vermue
- University Hospital Ghent, Corneel Heymanslaan 10, 9000, Gent, Belgium
- Ghent University, Gent, Belgium
| | - L Pringels
- University Hospital Ghent, Corneel Heymanslaan 10, 9000, Gent, Belgium
- Ghent University, Gent, Belgium
| | | | | |
Collapse
|
8
|
Al-Dadah O, Hawes G, Chapman-Sheath PJ, Tice JW, Barrett DS. Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes. Knee Surg Relat Res 2020; 32:47. [PMID: 32867858 PMCID: PMC7457474 DOI: 10.1186/s43019-020-00065-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Combined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively. Materials and methods This prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively. Results Significant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p < 0.001) and TKR (16.6 to 34.5, p < 0.001). Significant improvement was also found for the WOMAC sub-scores for all three groups during this time period. After 6 months, there was no further statistically significant improvement in either outcome score in any of the groups up to the 2-year follow-up results. There was no significant difference in either outcome score post-operatively between the three groups. Conclusion The magnitude of clinical improvement following knee replacement is greatest at 6 months; thereafter, only modest improvements continue to occur. This study also found no significant differences of outcomes at 2 years after surgery among UKR, BKR and TKR. BKR is a good alternative option for combined symptomatic medial and patellofemoral arthritis of the knee.
Collapse
Affiliation(s)
- Oday Al-Dadah
- Translational and Clinical Research Institute, Newcastle University, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, UK. .,Department of Trauma and Orthopaedic Surgery, South Tyneside Hospital, Harton Lane, South Tyneside, NE34 0PL, UK.
| | - Georgina Hawes
- Department of Trauma and Orthopaedic Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Philip J Chapman-Sheath
- Department of Trauma and Orthopaedic Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - John William Tice
- Department of Trauma and Orthopaedic Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - David S Barrett
- Department of Trauma and Orthopaedic Surgery, University Hospital Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK.,School of Engineering Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| |
Collapse
|
9
|
Meier M, Lüring C, Best R, Köck FX, Beckmann J. [Indications, tips and tricks in individualized bicompartmental replacement]. DER ORTHOPADE 2020; 49:390-395. [PMID: 32219468 DOI: 10.1007/s00132-020-03902-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Meier
- Department Endoprothetik untere Extremität und Fußchirurgie, Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland
| | - C Lüring
- Klinikum Dortmund, Dortmund, Deutschland
| | - R Best
- Department Endoprothetik untere Extremität und Fußchirurgie, Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland
| | - F X Köck
- MedArtes, Neutraubling, Deutschland
| | - J Beckmann
- Department Endoprothetik untere Extremität und Fußchirurgie, Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
| |
Collapse
|
10
|
Abstract
AIMS There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology used to describe these procedures leads to confusion and ambiguity in communication between surgeons, allied health professionals, and patients. A standardized classification system is required for patient safety, accurate clinical record-keeping, clear communication, correct coding for appropriate remuneration, and joint registry data collection. MATERIALS AND METHODS An advanced PubMed search was conducted, using medical subject headings (MeSH) to identify terms and abbreviations used to describe knee arthroplasty procedures. The search related to TKA, unicompartmental (UKA), patellofemoral (PFA), and combined PKA procedures. Surveys were conducted of orthopaedic surgeons, trainees, and biomechanical engineers, who were asked which of the descriptive terms and abbreviations identified from the literature search they found most intuitive and appropriate to describe each procedure. The results were used to determine a popular consensus. RESULTS Survey participants preferred "bi-unicondylar arthroplasty" (Bi-UKA) to describe ipsilateral medial and lateral unicompartmental arthroplasty; "medial bi-compartmental arthroplasty" (BCA-M) to describe ipsilateral medial unicompartmental arthroplasty with patellofemoral arthroplasty; "lateral bi-compartmental arthroplasty" (BCA-L) to describe ipsilateral lateral unicompartmental arthroplasty with patellofemoral arthroplasty; and tri-compartmental arthroplasty (TCA) to describe ipsilateral patellofemoral and medial and lateral unicompartmental arthroplasties. "Combined partial knee arthroplasty" (CPKA) was the favoured umbrella term. CONCLUSION We recommend bi-unicondylar arthroplasty (Bi-UKA), medial bicompartmental arthroplasty (BCA-M), lateral bicompartmental arthroplasty (BCA-L), and tricompartmental arthroplasty (TCA) as the preferred terms to classify CPKA procedures. Cite this article: Bone Joint J 2019;101-B:922-928.
Collapse
Affiliation(s)
- A Garner
- Imperial College London, MSk Lab, Imperial College London, London, UK.,Royal College of Surgeons of England, London, UK.,Health Education Kent, Surrey and Sussex, London, UK
| | - R J van Arkel
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - J Cobb
- MSk Lab, Imperial College London, London, UK
| |
Collapse
|
11
|
Tang BYH, Cheung CN, Tsui HF, Wong HL. Early promising result of bicompartmental knee replacement in middle-aged patients. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2019. [DOI: 10.1177/2210491719848758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Partial knee replacement (PKR) is one of the treatment options in middle-aged patients with less extensive knee osteoarthritis, with unicompartmental knee replacement (UKR) most commonly done for medial osteoarthritis. There are numerous advantages like bone/ligament preserving and faster recovery. However, the indications of UKR remain controversial, as most patients have some patellofemoral joint (PFJ) osteoarthritis. We performed modular bicruciate-retaining bicompartmental knee replacement (BKR) in this group of patients and compared the outcome with total knee replacement (TKR). Materials and Methods: From 2016 to 2017, 14 BKR were performed in patients with medial and PFJ osteoarthritis. They were retrospectively compared with 14 TKR performed in patients with similar age and severity. The incision length, operative time, blood loss (in terms of hemoglobin drop), and length of stay were recorded. Pre- and postoperative range of motion and Knee Society knee score at 1-year follow-up were compared. Results: The mean incision length for BKR was shorter than TKR (130.1 vs. 185.1 mm), but the mean operative time was also longer (152.6 vs. 88.1 min). There was also less mean hemoglobin drop (1.8 vs. 2.6 g/dL) and shorter length of stay (7.4 vs. 9.2 days). The mean postoperative function score is better in BKR group (90.4 vs. 77.5), and the mean postoperative knee score (87.2 vs 88.9) and flexion (115.7° vs. 111.4°) were similar for both groups. Discussion: In selected patients, BKR is a good alternative to TKR. It preserves advantages of UKR while also tackle the PFJ which is the most controversial aspect of UKR. The early clinical outcome in our study is promising. However, there is a learning curve. Longer follow-up is necessary to study on the performance and survivorship as compared with UKR and TKR.
Collapse
Affiliation(s)
- Bruce Yan Ho Tang
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong
| | - Chi Nok Cheung
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong
| | - Hon For Tsui
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong
| | - Hok Leung Wong
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong
| |
Collapse
|
12
|
Koh YG, Park KM, Kang KT. The biomechanical effect of tibiofemoral conformity design for patient-specific cruciate retainging total knee arthroplasty using computational simulation. J Exp Orthop 2019; 6:23. [PMID: 31161463 PMCID: PMC6546798 DOI: 10.1186/s40634-019-0192-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022] Open
Abstract
Background Alterations to normal knee kinematics performed during conventional total knee arthroplasty (TKA) focus on the nonanatomic articular surface. Patient-specific TKA was introduced to provide better normal knee kinematics than conventional TKA. However, no study on tibiofemoral conformity has been performed after patient-specific TKA. The purpose of this study was to compare the biomechanical effect of cruciate-retaining (CR) implants after patient-specific TKA and conventional TKA under gait and deep-knee-bend conditions. Methods The examples of patient-specific TKA were categorized into conforming patient-specific TKA, medial pivot patient-specific TKA and anatomy mimetic articular surface patient-specific TKA. We investigated kinematics and quadriceps force of three patient-specific TKA and conventional TKA using validated computational model. The femoral component designs in patient specific TKA were all identical. Results The anatomy mimetic articular surface patient-specific TKA provided knee kinematics that was closer to normal than the others under the gait and deep-knee-bend conditions. However, the other two patient-specific TKA designs could not preserve the normal knee kinematics. In addition, the closest normal quadriceps force was found for the anatomic articular surface patient-specific TKA. Conclusions Our results showed that the anatomy mimetic articular surface patient-specific TKA provided close-to-normal knee mechanics. Other clinical and biomechanical studies are required to determine whether anatomy mimetic articular surface patient-specific TKA restores more normal knee mechanics and provides improved patient satisfaction.
Collapse
Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Kyoung-Mi Park
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
13
|
A high level of satisfaction after bicompartmental individualized knee arthroplasty with patient-specific implants and instruments. Knee Surg Sports Traumatol Arthrosc 2019; 27:1487-1496. [PMID: 30291399 PMCID: PMC6527787 DOI: 10.1007/s00167-018-5155-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Customized Individually Made (CIM) Bicompartmental Knee Arthroplasty (BKA) implants and three-dimensional printed customized instruments are available to fit to each patient's unique anatomy, medial or lateral with patellofemoral. This study aimed to evaluate the clinical outcomes after CIM-BKA. METHODS Fifty-five patients [59 knees; average age, 51 years; standard deviation (SD), 6.8; range 37-65 years] who underwent CIM-BKA were evaluated over an average of 3.8-year follow-up (SD 1.6; range 1-6 years). Forty-one knees underwent BKA combined medial and patellofemoral replacement (BKA-MP) and 18 knees underwent BKA combined lateral with patellofemoral replacement (BKA-LP). Survival rates, the modified Cincinnati Knee Rating Scale, WOMAC, VAS, SF-36, a satisfaction survey, and radiographic evaluation were used to evaluate outcomes. RESULTS Overall, survival rates were 98% and 92% at 2 and 5 years, respectively. Of 56 knees (95%) that did not fail, all patient-reported functional scores significantly improved post-operatively (P < 0.01), regardless of the previous surgeries, with a high level of satisfaction (51/56 knees, 91%). Radiographically, all the femoral components fit perfectly and 56 knees (95%) of the tibial components fit with less than 2 mm of undercoverage or overhang. Three knees (5%) required the conversion to TKA and 17 knees (29%) required subsequent surgical procedures, of which multiply operated knees had higher rate than virgin knee [14/40 (35%) vs. 3/16 (19%)]. CONCLUSION CIM-BKA allowed precise fit of the components and provided a significant improvement post-operatively with a high level of satisfaction over short- to mid-term follow-up. This novel CIM-BKA is resurfacing, and does not require 10-mm faceted cuts, being only 3-mm-thick, which preserves bone stock for the future. It may be a promising option for relatively young active patients with bicompartmental osteoarthritis with a longer term follow-up being necessary. LEVEL OF EVIDENCE IV.
Collapse
|
14
|
de Sousa CS, de Jesus FLA, Machado MB, Ferreira G, Ayres IGT, de Aquino LM, Fukuda TY, Gomes-Neto M. Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2019; 19:69-78. [PMID: 30839305 PMCID: PMC6454257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To systematically review the published studies that compare lower limb muscle strength in patients with low back pain to matched healthy controls. METHODS We searched Medline, SciELO, Cumulative Index to Nursing and Allied Health (CINAHL), and Scopus up until December 2017. Studies comparing lower limb muscle strength in people diagnosed with low back pain to healthy control participants were included in the systematic review. RESULTS 14 studies, which included 951 healthy controls and 919 patients with low back pain, fulfilled the inclusion criteria. Meta-analysis revealed a lower muscle strength of hip abductor/extensors and knee extensors in patients with low back pain in comparison to healthy controls. The average strength of hip abductors (Five studies, SMD=0.7 95% CI: 0.49 to 0.9) and hip extensors (Two studies, SMD=0.93, 95% CI: 0.62 to 1.23) was significantly lower in patients with low back pain compared to that of healthy controls. Knee extensor muscle strength was significantly lower in patients with low back pain compared to healthy controls (Three studies, WMD=0.31 Nm/kg, 95% CI: 0.1 to 0.5). The meta-analysis indicated a no significant difference in knee flexor muscle strength in patients with low back pain compared to healthy controls. CONCLUSIONS Lower limb muscle is impaired in patients with low back pain.
Collapse
Affiliation(s)
- Camila Santana de Sousa
- Programa de Pós-Graduação em Medicina e Saúde - UFBA Salvador - BA, Brazil,Trata Institute – Knee and Hip Rehabilitation, Brazil,Physiotherapy Research Group, UFBA, Salvador, BA, Brazil
| | - Fabio Luciano Arcanjo de Jesus
- Programa de Pós-Graduação em Medicina e Saúde - UFBA Salvador - BA, Brazil,Trata Institute – Knee and Hip Rehabilitation, Brazil
| | | | | | | | | | | | - Mansueto Gomes-Neto
- Programa de Pós-Graduação em Medicina e Saúde - UFBA Salvador - BA, Brazil,Trata Institute – Knee and Hip Rehabilitation, Brazil,Physiotherapy Research Group, UFBA, Salvador, BA, Brazil,Phisical Therapy Department, Curso de Fisioterapia da Universidade Federal da Bahia - UFBA,Corresponding author: Prof. Mansueto Gomes Neto, Phisical Therapy Department, Curso de Fisioterapia – Federal University of Bahia, UFBA. Instituto de Ciências da Saúde. Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, BA, Brazil E-mail:
| |
Collapse
|
15
|
Kang KT, Kwon SK, Kwon OR, Lee JS, Koh YG. Comparison of the biomechanical effect of posterior condylar offset and kinematics between posterior cruciate-retaining and posterior-stabilized total knee arthroplasty. Knee 2019; 26:250-257. [PMID: 30577956 DOI: 10.1016/j.knee.2018.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 07/26/2018] [Accepted: 11/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effect of the changes in the femoral posterior condylar offset (PCO) on anterior-posterior (AP) translation and internal-external (IE) rotation in cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) remains unknown. The purpose of this study was to compare the kinematics in CR and PS TKA with respect to the difference in prosthetic design and PCO change through a computational simulation. METHODS We developed three-dimensional finite element models with the different PCOs of ±1, ±2 and ±3 mm in the posterior direction using CR and PS TKA. We performed the simulation with different PCOs under a deep knee bend condition and evaluated the kinematics for the AP and IE in CR and PS TKA. RESULTS The more tibiofemoral (TF) translation in the posterior direction was found as PCO translated in posterior direction for both CR and PS TKA compared to the neutral position. However, the change of the AP translation with respect to the PCO change in CR TKA was greater than PS TKA. The more TF external rotation was found as PCO translated in the anterior direction for both CR and PS TKA compared to the neutral position. However, unlike the TF translation, the TF rotation was not influenced by the PCO change in both CR and PS TKA. CONCLUSION The PCO magnitude was influenced by a postoperative change in the kinematics in CR TKA although a relatively smaller effect was observed in PS TKA. Hence, surgeons should be aware of the PCO change, especially for CR TKA.
Collapse
Affiliation(s)
- Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
| | - Sae Kwang Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
| | - Oh-Ryong Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
| | - Jun-Sang Lee
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea.
| |
Collapse
|
16
|
Koh YG, Lee JA, Chung PK, Kang KT. Computational analysis of customized cruciate retaining total knee arthroplasty restoration of native knee joint biomechanics. Artif Organs 2018; 43:504-514. [PMID: 30375662 DOI: 10.1111/aor.13382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/17/2018] [Accepted: 10/25/2018] [Indexed: 01/20/2023]
Abstract
The purpose of this study was to verify if customized prosthesis better preserves the native knee joint kinematics and provides lower contact stress on the polyethylene (PE) insert owing to the wider bone preservation than that of standard off-the-shelf prosthesis in posterior cruciate-retaining type total knee arthroplasty (TKA). Validated finite element (FE) models for were developed to evaluate the knee joint kinematics and contact stress on the PE insert after TKA with customized and standard off-the-shelf (OTS) prostheses as well as in normal healthy knee through FE analysis under dynamic loading conditions. The contact stresses on the customized prosthesis decreased by 18% and 8% under gait cycle loading conditions, and 24% and 9% under deep-knee-bend loading conditions, in the medial and lateral sides of the PE insert, respectively, compared with the standard OTS prosthesis. The anterior-posterior translation and internal-external (IE) rotation in customized TKA were more similar to native knee joint behaviors compared with standard OTS TKA under gait loading conditions. The difference from normal knee kinematics was lower for femoral rollback and IE rotation in customized TKA than in standard OTS TKA in the deep-knee-bend condition. In general, customized prostheses achieve kinematics that are close to those of the native healthy knee joint and have better contact stresses than standard OTS prostheses in gait and deep-knee-bend loading conditions.
Collapse
Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Pill Ku Chung
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
17
|
Abstract
Background Patellofemoral arthritis is a common cause of anterior knee pain and limits flexion-related activities of daily living and exercise. While frequently present in bicompartmental and tricompartmental osteoarthritis, patellofemoral arthritis can occur in isolation. Patellofemoral arthroplasty as a treatment option is gaining in popularity, especially with new implant designs. We report a case in which new inlay implants were used to resurface the patellofemoral joint in a patient with contralateral compromise secondary to a previous below-knee amputation. Case Report A 37-year-old female with a contralateral right below-knee amputation and progressive left patellofemoral arthritis had failed multiple conservative treatment modalities. She underwent isolated patellofemoral arthroplasty using an inlay-designed implant. The patient was followed for 2 years postoperatively. She noticed an immediate increase in her knee range of motion and her pain scores improved. Two years postoperatively, she demonstrated drastic improvement in all outcome measures: International Knee Documentation Committee score (16.1 to 88.5), Lysholm Knee Scoring Scale (22 to 100), Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms (7.14 to 96.43), KOOS Pain (2.78 to 100), KOOS Activities of Daily Living (0 to 100), KOOS Sports (0 to 100), and KOOS Quality of Life (12.5 to 93.75). Conclusion Inlay patellofemoral arthroplasty is a valid treatment option for isolated patellofemoral arthritis. Successful results can be achieved with this procedure after failure of conservative measures in patients with limited or no evidence of tibiofemoral arthritis.
Collapse
|
18
|
Comparison of Kinematics in Cruciate Retaining and Posterior Stabilized for Fixed and Rotating Platform Mobile-Bearing Total Knee Arthroplasty with respect to Different Posterior Tibial Slope. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5139074. [PMID: 29992149 PMCID: PMC6016153 DOI: 10.1155/2018/5139074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022]
Abstract
Reconstructed posterior tibial slope (PTS) plays a significant role in kinematics restoration after total knee arthroplasty (TKA). However, the effect of increased and decreased PTS on prosthetic type and design has not yet been investigated. We used a finite element model, validated using in vitro data, to evaluate the effect of PTS on knee kinematics in cruciate-retaining (CR) and posterior-stabilized (PS) fixed TKA and rotating platform mobile-bearing TKA. Anterior-posterior tibial translation and internal-external tibial rotation were investigated for PTS ranging from -3° to 15°, with increments of 1°, for three different designs of TKA. Tibial posterior translation and external rotation increased as the PTS increased in both CR and PS TKAs. In addition, there was no remarkable difference in external rotation between CR and PS TKAs. However, for the mobile-bearing TKA, PTS had less effect on the kinematics. Based on our computational simulation, PTS is the critical factor that influences kinematics in TKA, especially in the CR TKA. Therefore, the surgeon should be careful in choosing the PTS in CR TKAs.
Collapse
|
19
|
Biazzo A, Silvestrini F, Manzotti A, Confalonieri N. Bicompartmental (uni plus patellofemoral) versus total knee arthroplasty: a match-paired study. Musculoskelet Surg 2018; 103:63-68. [PMID: 29654550 DOI: 10.1007/s12306-018-0540-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Osteoarthritis (OA) of the knee, whether primary or post-traumatic, does not always involve all three compartments (tibiofemoral medial and lateral and the patellofemoral ones). Bicompartmental knee arthroplasty (BKA) was proposed as a good alternative to total knee arthroplasty when two of the three knee compartments were affected. MATERIALS AND METHODS We performed a retrospective comparative study collecting all BKAs performed between March 2010 and January 2016. During this period, we treated 27 patients with BKA for medial or lateral and patellofemoral OA. Seven of them were lost to follow-up and were not included in the study. Group A (BKA group) was compared to a homogeneous group of 20 patients who underwent TKA during the same period (group B). RESULTS Patients treated with TKA were younger than those treated with BKA (mean age 65 vs. 67.2; p = 0.2149). BKA resulted in longer mean operating time (87 vs. 82.4 min; p = 0.2983), less blood loss (413 vs. 458 ml; p = 0.0052) but higher blood transfusion rate (12 vs. 10%). Medium follow-up was 34 months for BKA group and 38 months for TKA group. No statistically significant differences were found in KSS score between the two groups (KSS score 92.3 for BKA, 94.5 for TKA; p = 0.5221; KSS function was 87.2 for BKA and 89.2 for TKA; p = 0.4985). CONCLUSION The most important finding of the present study was that although BKA seemed to be theoretically more favorable in terms of functional recovery and blood loss, patients of group A had lower KSS score and higher transfusion rate than those of group B. Our data confirm that BKA could be proposed as an alternative to TKA, especially in young and high-demanding patients.
Collapse
Affiliation(s)
- A Biazzo
- Orthopaedic Department, Humanitas Gavazzeni, via Gavazzeni 21, Bergamo, Italy.
| | - F Silvestrini
- ASST Gaetano Pini-CTO, via Bignami 1, 20126, Milan, Italy
| | - A Manzotti
- Orthopaedic Department, Ospedale Luigi Sacco, via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - N Confalonieri
- ASST Gaetano Pini-CTO, via Bignami 1, 20126, Milan, Italy
| |
Collapse
|
20
|
Romagnoli S, Marullo M. Mid-Term Clinical, Functional, and Radiographic Outcomes of 105 Gender-Specific Patellofemoral Arthroplasties, With or Without the Association of Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2018; 33:688-695. [PMID: 29129614 DOI: 10.1016/j.arth.2017.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate clinical and radiographic outcomes after gender-specific patellofemoral arthroplasty (PFA) either isolated or combined with unicompartmental knee arthroplasty (UKA). METHODS A total of 105 PFAs in 85 patients were reviewed: 64 knees had isolated patellofemoral osteoarthritis and received an isolated PFA, and 41 knees with bicompartmental osteoarthritis were treated with medial UKA and PFA. Preoperative and postoperative clinical and functional assessment included knee range of motion, Knee Society Score, University of California Los Angeles Activity Score, Tegner Activity Level Scale, and visual analogue scale pain. Preoperative and postoperative radiographs were evaluated for patellofemoral and tibiofemoral compartment osteoarthritis, trochlear dysplasia, changes in patellar height, and signs of osteolysis. RESULTS At a mean follow-up of 5.5 ± 1.6 years, both groups showed improvement in knee joint range of motion (P < .001), clinical and functional Knee Society Score (P < .001), University of California Los Angeles Activity Score (P < .001 in the PFA group and P = .004 in the UKA + PFA group), and visual analogue scale pain (P < .001). There were no statistically significant postoperative differences between the 2 groups. No signs of osteolysis or subsidence were recorded. Survivorship of these 105 implants was 95.2%. CONCLUSION Excellent clinical and radiographic outcomes were achieved after PFA with a gender-specific implant both as isolated replacement and when combined with medial UKA. Bicompartmental replacement with small implants can be considered in patients with bicompartmental osteoarthritis and intact anterior cruciate ligament.
Collapse
Affiliation(s)
- Sergio Romagnoli
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Matteo Marullo
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| |
Collapse
|
21
|
Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. Influence of Increased Posterior Tibial Slope in Total Knee Arthroplasty on Knee Joint Biomechanics: A Computational Simulation Study. J Arthroplasty 2018; 33:572-579. [PMID: 29017801 DOI: 10.1016/j.arth.2017.09.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/28/2017] [Accepted: 09/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The reconstructed posterior tibial slope (PTS) plays a significant role in restoring knee kinematics in cruciate-retaining-total knee arthroplasty (TKA). A few studies have reported the effect of the PTS on biomechanics. METHODS This study investigates the effect of the PTS on tibiofemoral (TF) kinematics, patellofemoral (PF) contact stress, and forces at the quadriceps, posterior cruciate ligament (PCL) and collateral ligament after cruciate-retaining-TKA using computer simulations. The simulation for the validated TKA finite element model was performed under deep knee bend condition. All analyses were repeated from -3° to 15° PTS in increments of 3°. RESULTS The kinematics on the TF joint translated increasingly posteriorly when the PTS increased. Medial and lateral contact points translated in posterior direction in extension and flexion as PTS increased. The maximum contact stress on the PF joint and quadriceps, and collateral ligament force decreased when the PTS increased. An implantation of the tibial plate with increased PTS reduced the PCL load. Physiologic insert movement led to an increasingly posterior position of the femur and reduced quadriceps force especially for knee flexion angles above high flexion (120°) when compared to TKA with a decreased slope of the tibial base plate. CONCLUSION An increase in the PTS increased medial and lateral movements without paradoxical motion. However, an excessive PTS indicated progressive loosening of the TF joint gap due to a reduction in collateral ligament tension during flexion.
Collapse
Affiliation(s)
- Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Juhyun Son
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Oh-Ryong Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Jun-Sang Lee
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Sae-Kwang Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| |
Collapse
|
22
|
Rivière C, Lazic S, Boughton O, Wiart Y, Vïllet L, Cobb J. Current concepts for aligning knee implants: patient-specific or systematic? EFORT Open Rev 2018; 3:1-6. [PMID: 29657839 PMCID: PMC5890125 DOI: 10.1302/2058-5241.3.170021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mechanical or anatomical alignment techniques create a supposedly ‘biomechanically friendly’ but often functionally limited prosthetic knee. Alternative techniques for alignment in total knee arthroplasty (TKA) aim at being more anatomical and patient-specific, aiming to improve functional outcomes after TKA. The kinematic alignment (KA) technique for TKA has shown good early clinical outcomes. Its role in extreme anatomical variation remains to be defined. The restricted KA technique for TKA might be a reasonable option for patients with extreme anatomical variation. While unicompartmental knee arthroplasty (UKA) has many advantages over TKA, the revision rate remains higher compared with TKA. One major explanation is the relative ease with which a UKA can be converted to a TKA, compared with revising a TKA. This can be considered as an additional advantage of UKA. Another reason is that surgeons favour revising a UKA to a TKA in cases of degeneration of the other femorotibial compartment rather than performing a relatively simple re-operation of the knee by doing an additional UKA (staged bi-UKA).
Cite this article: EFORT Open Rev 2018;3:1–6. DOI: 10.1302/2058-5241.3.170021
Collapse
Affiliation(s)
- Charles Rivière
- Imperial College London, UK; South West London Elective Orthopaedic Centre, UK
| | - Stefan Lazic
- South West London Elective Orthopaedic Centre, UK
| | | | | | | | | |
Collapse
|
23
|
Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. A computational simulation study to determine the biomechanical influence of posterior condylar offset and tibial slope in cruciate retaining total knee arthroplasty. Bone Joint Res 2018; 7:69-78. [PMID: 29330345 PMCID: PMC5805829 DOI: 10.1302/2046-3758.71.bjr-2017-0143.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Posterior condylar offset (PCO) and posterior tibial slope (PTS) are critical factors in total knee arthroplasty (TKA). A computational simulation was performed to evaluate the biomechanical effect of PCO and PTS on cruciate retaining TKA. Methods We generated a subject-specific computational model followed by the development of ± 1 mm, ± 2 mm and ± 3 mm PCO models in the posterior direction, and -3°, 0°, 3° and 6° PTS models with each of the PCO models. Using a validated finite element (FE) model, we investigated the influence of the changes in PCO and PTS on the contact stress in the patellar button and the forces on the posterior cruciate ligament (PCL), patellar tendon and quadriceps muscles under the deep knee-bend loading conditions. Results Contact stress on the patellar button increased and decreased as PCO translated to the anterior and posterior directions, respectively. In addition, contact stress on the patellar button decreased as PTS increased. These trends were consistent in the FE models with altered PCO. Higher quadriceps muscle and patellar tendon force are required as PCO translated in the anterior direction with an equivalent flexion angle. However, as PTS increased, quadriceps muscle and patellar tendon force reduced in each PCO condition. The forces exerted on the PCL increased as PCO translated to the posterior direction and decreased as PTS increased. Conclusion The change in PCO alternatively provided positive and negative biomechanical effects, but it led to a reduction in a negative biomechanical effect as PTS increased. Cite this article: K-T. Kang, Y-G. Koh, J. Son, O-R. Kwon, J-S. Lee, S. K. Kwon. A computational simulation study to determine the biomechanical influence of posterior condylar offset and tibial slope in cruciate retaining total knee arthroplasty. Bone Joint Res 2018;7:69–78. DOI: 10.1302/2046-3758.71.BJR-2017-0143.R1.
Collapse
Affiliation(s)
- K-T Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Y-G Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - J Son
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - O-R Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - J-S Lee
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - S K Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| |
Collapse
|
24
|
Biomechanical Effects of Posterior Condylar Offset and Posterior Tibial Slope on Quadriceps Force and Joint Contact Forces in Posterior-Stabilized Total Knee Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4908639. [PMID: 29349074 PMCID: PMC5733759 DOI: 10.1155/2017/4908639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/14/2017] [Accepted: 10/25/2017] [Indexed: 11/24/2022]
Abstract
This study aimed to determine the biomechanical effect of the posterior condylar offset (PCO) and posterior tibial slope (PTS) in posterior-stabilized (PS) fixed-bearing total knee arthroplasty (TKA). We developed ±1, ±2, and ±3 mm PCO models in the posterior direction and −3°, 0°, 3°, and 6° PTS models using a previously validated FE model. The influence of changes in the PCO and PTS on the biomechanical effects under deep-knee-bend loading was investigated. The contact stress on the PE insert increased by 14% and decreased by 7% on average as the PCO increased and decreased, respectively, compared to the neutral position. In addition, the contact stress on post in PE insert increased by 18% on average as PTS increased from −3° to 6°. However, the contact stress on the patellar button decreased by 11% on average as PTS increased from −3° to 6° in all different PCO cases. The quadriceps force decreased by 14% as PTS increased from −3° to 6° in all PCO models. The same trend was found in patellar tendon force. Changes in PCO had adverse biomechanical effects whereas PTS increase had positive biomechanical effects. However, excessive PTS should be avoided to prevent knee instability and subsequent failure.
Collapse
|
25
|
Patellofemoraler Ersatz und Schlittenprothese. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
26
|
Komnik I, Peters M, Funken J, David S, Weiss S, Potthast W. Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients. PLoS One 2016; 11:e0168566. [PMID: 28002437 PMCID: PMC5176302 DOI: 10.1371/journal.pone.0168566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/04/2016] [Indexed: 11/19/2022] Open
Abstract
After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.
Collapse
Affiliation(s)
- Igor Komnik
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Markus Peters
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Johannes Funken
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Sina David
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Pforzheim, Baden-Württemberg, Germany
| | - Wolfgang Potthast
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| |
Collapse
|
27
|
Tibial component considerations in bicruciate-retaining total knee arthroplasty: A 3D MRI evaluation of proximal tibial anatomy. Knee 2016; 23:593-9. [PMID: 27041222 DOI: 10.1016/j.knee.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/15/2015] [Accepted: 12/07/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Restoration of normal anatomy and proper ligament balance are theoretical prerequisites for reproducing physiological kinematics with bicruciate-retaining total knee arthroplasty (TKA). The purpose of this study was to use a 3D MRI technique to evaluate the topography of the proximal tibia and outline considerations in tibial component design for bicruciate-retaining TKA. METHODS We identified 100 consecutive patients (50 males and 50 females) between ages 20 and 40 years with knee MRIs without arthritis, dysplasia, ACL tears, or prior knee surgery. A novel 3D MRI protocol coordinating axial, coronal, and sagittal images was used to measure: 1) medial and lateral posterior tibial slopes; 2) medial and lateral coronal slopes; and 3) distance from the anterior tibia to the ACL footprint. RESULTS There was no overall difference in medial and lateral posterior tibial slopes (5.5° (95% CI 5.0 to 6.0°) vs. 5.4° (95% CI 4.8 to 6.0°), respectively (p=0.80)), but 41 patients had side-to-side differences greater than 3°. The medial coronal slope was greater than the lateral coronal slope (4.6° (95% CI 4.0 to 5.1°) vs. 3.3° (95% CI 2.9 to 3.7°), respectively (p<0.0001)). Females had less clearance between the anterior tibia and ACL footprint than males (10.8mm (95% CI 10.4 to 11.2mm) vs. 13.0mm (95% CI 12.5 to 13.5mm), respectively (p<0.0001)). CONCLUSIONS Due to highly variable proximal tibial topography, a monoblock bicruciate-retaining tibial baseplate may not reproduce normal anatomy in all patients. LEVEL OF EVIDENCE Level IV - Anatomic research study.
Collapse
|
28
|
Dudhniwala AG, Rath NK, Joshy S, Forster MC, White SP. Early failure with the Journey-Deuce bicompartmental knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:517-21. [PMID: 27001223 DOI: 10.1007/s00590-016-1760-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/21/2016] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the early functional outcome and survivorship of a bicompartmental knee arthroplasty implant (Journey-Deuce) in a cohort of patients with combined medial and patellofemoral degenerative osteoarthritis. Fifteen patients with a mean age of 57 years were followed up prospectively and evaluated with clinical examination, Oxford knee score and radiology imaging. Poor pain scores, concerns about the tibial fixation, early aseptic loosening of the tibial component and a revision rate of 60 % at a minimum follow-up of 54 months are reported. Implantation of this prosthesis was stopped at our institution well before the first revision due to an unfavourable early clinical response. This was further endorsed by an unacceptable revision rate. The outcome of the Journey-Deuce bicompartmental knee replacement was considerably worse than the published outcome of total knee replacement.
Collapse
Affiliation(s)
- A G Dudhniwala
- Cardiff & Vale Orthopaedic Centre, University Hospital Llandough, Penlan Road, Penarth, CF64 2XX, UK
| | - N K Rath
- Cardiff & Vale Orthopaedic Centre, University Hospital Llandough, Penlan Road, Penarth, CF64 2XX, UK
| | - S Joshy
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - M C Forster
- Cardiff & Vale Orthopaedic Centre, University Hospital Llandough, Penlan Road, Penarth, CF64 2XX, UK.
| | - S P White
- Cardiff & Vale Orthopaedic Centre, University Hospital Llandough, Penlan Road, Penarth, CF64 2XX, UK
| |
Collapse
|
29
|
Sabatini L, Giachino M, Risitano S, Atzori F. Bicompartmental knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:5. [PMID: 26855941 DOI: 10.3978/j.issn.2305-5839.2015.12.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes.
Collapse
Affiliation(s)
- Luigi Sabatini
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano 10043, Torino, Italy ; 2 University of Turin, Turin, Italy
| | - Matteo Giachino
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano 10043, Torino, Italy ; 2 University of Turin, Turin, Italy
| | - Salvatore Risitano
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano 10043, Torino, Italy ; 2 University of Turin, Turin, Italy
| | - Francesco Atzori
- 1 A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano 10043, Torino, Italy ; 2 University of Turin, Turin, Italy
| |
Collapse
|
30
|
Fracture of the Tibial Baseplate in Bicompartmental Knee Arthroplasty. Case Rep Orthop 2015; 2015:693025. [PMID: 26843998 PMCID: PMC4710956 DOI: 10.1155/2015/693025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Bicompartmental knee arthroplasty (BKA) addresses combined medial and patellofemoral compartment osteoarthritis, which is relatively common, and has been proposed as a bridge between unicompartmental and total knee arthroplasty (TKA). Case Presentation. We present the case report of a young active man treated with BKA after unsuccessful conservative therapy. Four years later, loosening with fracture of the tibial baseplate was identified and the patient was revised to TKA. Discussion. Although our case is only the second fractured tibial baseplate to be reported, we believe that the modular titanium design, with two fixation pegs, is too thin to withstand daily cyclic loading powers. Light daily routine use, rather than high-impact sports, is therefore advised. Failures may also be related to the implant being an early generation and known to be technically complex, with too few implant sizes. We currently use TKA for the treatment of medial and patellofemoral compartment osteoarthritis.
Collapse
|
31
|
Parratte S, Ollivier M, Opsomer G, Lunebourg A, Argenson JN, Thienpont E. Is knee function better with contemporary modular bicompartmental arthroplasty compared to total knee arthroplasty? Short-term outcomes of a prospective matched study including 68 cases. Orthop Traumatol Surg Res 2015; 101:547-52. [PMID: 26047754 DOI: 10.1016/j.otsr.2015.03.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/27/2015] [Accepted: 03/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bicompartmental knee arthroplasty (BKA) was developed to treat medial tibiofemoral and patellofemoral osteoarthritis while preserving the anterior cruciate ligament to optimise knee kinematics. Our objective here was to compare the probability of achieving forgotten knee status and the functional outcomes at least two years after BKA versus total knee arthroplasty (TKA). We hypothesised that contemporary modular BKA produced better functional outcomes than TKA after at least two years, for patients with similar pre-operative osteoarthritic lesions. MATERIAL AND METHODS We conducted a two-centre prospective controlled study of 34consecutive patients who underwent BKA between January 2008 and January 2011. Each patient was matched on age, gender, body mass index, preoperative range of knee flexion, centre, and surgeon to a patient treated with TKA. An independent observer evaluated all 68 patients after six and 12months then once a year. Forgotten knee status was defined as a 100/100 value of the Forgotten Joint Score (FJS-12) and each of the five KOOS subscales. We also compared the two groups for knee range of motion, Knee Society Scores (KSSs), Timed Up-and-Go test (TUG), and UCLA Activity Score. RESULTS At a mean follow-up of 3.8±1.7 years, the probability of forgotten knee status was significantly higher in the BKA group (odds ratio, 4.64; 95% confidence interval, 1.63-13.21; P=0.007, Chi(2) test). Mean post-operative extension was not significantly different between the groups, whereas mean range of knee flexion was significantly greater in the BKA group (130°±6° vs. 125°±8° after TKA; P=0.03). The BKA group had significantly higher mean values for the knee and function KSSs, TUG test, and UCLA score (P<0.04 for all four comparisons). CONCLUSION After at least two years, contemporary unlinked BKA was associated with greater comfort during everyday activities (forgotten knee) and better functional outcomes, compared to TKA. These short-term results require validation in randomised trials with longer follow-ups. LEVEL OF EVIDENCE III, case-control study.
Collapse
Affiliation(s)
- S Parratte
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, CHU Sud, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - M Ollivier
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, CHU Sud, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - G Opsomer
- Département de chirurgie orthopédique, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - A Lunebourg
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, CHU Sud, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - J-N Argenson
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, CHU Sud, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - E Thienpont
- Département de chirurgie orthopédique, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| |
Collapse
|
32
|
Park BH, Leffler J, Franz A, Dunbar NJ, Banks SA. Kinematics of monoblock bicompartmental knee arthroplasty during weight-bearing activities. Knee Surg Sports Traumatol Arthrosc 2015; 23:1756-62. [PMID: 25413593 DOI: 10.1007/s00167-014-3427-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 11/06/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE There is an increased interest in treating arthritis of the medial and patellofemoral compartments without using a total knee arthroplasty. The purpose of this study was to measure kinematics in knees with a monoblock bicompartmental arthroplasty to see whether maintaining the cruciate ligaments and lateral compartment resulted in consistent kinematics more similar to healthy knees than those observed in replaced knees. METHODS The kinematics of ten knees with monoblock bicompartmental arthroplasty were observed using fluoroscopy during three weight-bearing activities. Model-image registration techniques were used to quantify the three-dimensional motions of the knee joints. RESULTS During kneeling, lunging, and stair-step activities, the medial condyle remained relatively close to the centre of the tibial plateau, while the lateral condyle typically moved posteriorly with flexion. Knees generally exhibited motion patterns consistent with retained cruciate ligament function, but individual patterns varied significantly. CONCLUSIONS Bicompartmental knee arthroplasty has the potential to retain more natural knee function. Improved tools for aligning the implants and increased implant sizing options may be required to achieve highly consistent results and realize the clinical benefit of a knee arthroplasty with intact cruciate ligaments. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Brian H Park
- Gary J. Miller PhD Orthopaedic Biomechanics Laboratory, Department of Mechanical and Aerospace Engineering, University of Florida, MAE-A 318, Gainesville, FL, 32611-6250, USA
| | | | | | | | | |
Collapse
|
33
|
ROMAGNOLI SERGIO, MARULLO MATTEO, MASSARO MICHELE, RUSTEMI ENIS, D’AMARIO FEDERICO, CORBELLA MICHELE. Bi-unicompartmental and combined uni plus patellofemoral replacement: indications and surgical technique. JOINTS 2015; 3:42-48. [PMID: 26151039 PMCID: PMC4469043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The anatomy and orientation of the condyles and the trochlea are not standard, but related to morphotype, gender and race. Consequently, the extreme variability in their dimension, and in the distance and angle between the axis of the condyles and of the trochlea, often necessitates a "custom-made" replacement. This may be achieved through the use of small implants. Bicompartmental osteoarthritis with intact ligaments should be addressed with bi-unicompartmental (bi-UKR) or UKR plus patellofemoral replacement (PFR). These options allow selective replacement of the worn compartments and a customised fit of the small implants to the native knee anatomy. Clinical consequences are restoration of the native knee kinematics and overall better function.
Collapse
Affiliation(s)
| | - MATTEO MARULLO
- Corresponding Author: Matteo Marullo, MD, Department of Joint Replacement, IRCCS Galeazzi, Orthopaedic Institute, Via Galeazzi 4, 20161 Milan, Italy, E-mail:
| | | | | | | | | |
Collapse
|
34
|
Increased patellofemoral pressure after TKA: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2014; 22:500-8. [PMID: 23328986 DOI: 10.1007/s00167-013-2372-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Considering the discrepant results of the recent biomechanical studies, the purpose of this study was to simulate dynamic muscle-loaded knee flexion with a large number of specimens and to analyse the influence of total knee arthroplasty (TKA) without and with patellar resurfacing on the patellofemoral pressure distribution. METHODS In 22 cadaver knee specimens, dynamic muscle-loaded knee flexion (15°-90°) was simulated with a specially developed knee simulator applying variable muscle forces on the quadriceps muscles to maintain a constant ankle force. Patellofemoral pressures were measured with flexible, pressure-sensitive sensor foils (TEKSCAN) and patellofemoral offset with an ultrasound motion-tracking system (ZEBRIS). Measurements were taken on the native knee, after total knee arthroplasty and after patellar resurfacing. Correct positioning of the patellar implant was examined radiologically. RESULTS The maximal patellofemoral peak pressure partly increased from the native knee to the knee with TKA with intact patella (35°-90°, p < 0.012) and highly increased (twofold to threefold) after patellar resurfacing (20°-90°, p < 0.001). Concurrently, the patellofemoral contact area decreased and changed from a wide area distribution in the native knee, to a punctate area after TKA with intact patella and a line-shaped area after patellar resurfacing. Patellar resurfacing led to no increase in patellar thickness and patellofemoral offset. CONCLUSIONS Despite correct implantation of the patellar implants and largely unchanged patellofemoral offset, a highly significant increase in pressure after patellar resurfacing was measured. Therefore, from a biomechanical point of view, the preservation of the native patella seems reasonable if there is no higher grade patellar cartilage damage.
Collapse
|
35
|
Heyse TJ, El-Zayat BF, De Corte R, Scheys L, Chevalier Y, Fuchs-Winkelmann S, Labey L. Biomechanics of medial unicondylar in combination with patellofemoral knee arthroplasty. Knee 2014; 21 Suppl 1:S3-9. [PMID: 25382365 DOI: 10.1016/s0968-0160(14)50002-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Modular bicompartmental knee arthroplasty (BKA) for treatment of medio-patellofemoral osteoarthritis (OA) should allow for close to normal kinematics in comparison with unicondylar knee arthroplasty (UKA) and the native knee. There is so far no data to support this. SCOPE Six fresh frozen full leg cadaver specimens were prepared and mounted in a kinematic rig with six degrees of freedom for the knee joint. Three motion patterns were applied with the native knee and after sequential implantation of medial UKA and patellofemoral joint replacement (PFJ): passive flexion-extension, open chain extension, and squatting. During the loaded motions, quadriceps and hamstrings muscle forces were applied. Infrared cameras continuously recorded the trajectories of marker frames rigidly attached to femur, tibia and patella. Prior computer tomography allowed identification of coordinate frames of the bones. Strains in the collateral ligaments were calculated from insertion site distances. RESULTS UKA led to a less adducted and internally rotated tibia and a more strained medial collateral ligament (MCL). Addition of a patellofemoral replacement led to a more posterior position of both femoral condyles, a more dorsally located tibiofemoral contact point and higher MCL strain with squatting. CONCLUSION In comparison to UKA modular BKA leads to a more dorsal tibial contact point, a medial femoral condyle being located more posteriorly, and more MCL strain. Mainly the changes to the trochlear anatomy as introduced by PFJ may account for these differences.
Collapse
Affiliation(s)
- Thomas J Heyse
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Germany.
| | - Bilal F El-Zayat
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Germany
| | | | - Lennart Scheys
- Department of Orthopaedics, Katholieke Universiteit Leuven, Belgium
| | - Yan Chevalier
- Klinikum Großhadern, Orthopädische Klinik und Poliklinik, Labor für Biomechanik und Experimentelle Orthopädie, München, Germany
| | | | - Luc Labey
- Mechanical Engineering Technology TC, KU Leuven, Leuven, Belgium
| |
Collapse
|
36
|
Thienpont E, Price A. Bicompartmental knee arthroplasty of the patellofemoral and medial compartments. Knee Surg Sports Traumatol Arthrosc 2013. [PMID: 23184084 DOI: 10.1007/s00167-012-2303-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Studies have shown that after total knee arthroplasty neither normal biomechanics nor function is obtained. Selective resurfacing of diseased compartments could be a solution. A narrative review of the available literature on bicompartmental arthroplasty is presented. METHODS A literature review of all peer reviewed published articles on bicompartmental arthroplasty of the knee was performed. Bicompartmental arthroplasty is by definition the replacement of the tibiofemoral and the patellofemoral joint. It can be performed with a modular unlinked or a monolithic femoral component. RESULTS Bicompartmental arthroplasty performed with modular components obtains good to excellent results at ± 10 years follow-up. Function and biomechanics are superior to total knee arthroplasty. Modern monolithic femoral components are reported to give early failure and high revision rates and should be avoided. CONCLUSION Modular bicompartmental arthroplasty is an excellent alternative to treat bicompartmental arthritis of the knee leading to good functional results and superior biomechanics in well-selected patients. Caution is needed since only a few peer reviewed articles with small series and old implant designs are available on this type of arthritis treatment. Survivorship in these studies is inferior to total knee arthroplasty.
Collapse
Affiliation(s)
- Emmanuel Thienpont
- Department of Orthopaedic Surgery, University Hospital Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium,
| | | |
Collapse
|
37
|
Belvedere C, Tamarri S, Notarangelo DP, Ensini A, Feliciangeli A, Leardini A. Three-dimensional motion analysis of the human knee joint: comparison between intra- and post-operative measurements. Knee Surg Sports Traumatol Arthrosc 2013; 21:2375-83. [PMID: 23114867 DOI: 10.1007/s00167-012-2271-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 10/19/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare intra-operative knee joint kinematic measurements immediately after total knee replacement with those of the same patients post-operatively at 6-month follow-up. METHODS Fifteen patients who underwent total knee arthroplasty were analysed retrospectively. Eight were implanted with one prosthesis design and seven with another. The intra-operative measurements were performed by using a standard knee navigation system. This provided accurate three-dimensional positions and orientations for the femur and tibia by corresponding trackers pinned into the bones. At 6-month follow-up, the patients were analysed by standard three-dimensional video-fluoroscopy of the replaced knee during stair climbing, chair rising and step-up. Relevant three-dimensional positions and orientations were obtained by an iterative shape-matching procedure between the silhouette contours and the CAD-model projections. A number of traditional kinematic parameters were calculated from both measurements to represent the joint motion. RESULTS Good post-operative replication of the intra-operative measurements was observed for most of the variables analysed. The statistical analysis also supported the good consistency between the intra- and post-operative measurements. CONCLUSIONS Intra-operative kinematic measurements, accessible by a surgical navigation system, are predictive of the following motion performance of the replaced knees as experienced in typical activities of daily living. LEVEL OF EVIDENCE Prognostic studies--investigating natural history and evaluating the effect of a patient characteristic, Level II.
Collapse
Affiliation(s)
- C Belvedere
- Movement Analysis Laboratory, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy,
| | | | | | | | | | | |
Collapse
|
38
|
Yamabe E, Ueno T, Miyagi R, Watanabe A, Guenzi C, Yoshioka H. Study of surgical indication for knee arthroplasty by cartilage analysis in three compartments using data from Osteoarthritis Initiative (OAI). BMC Musculoskelet Disord 2013; 14:194. [PMID: 23800392 PMCID: PMC3695763 DOI: 10.1186/1471-2474-14-194] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 06/18/2013] [Indexed: 01/14/2023] Open
Abstract
Background Bicompartmental or unicompartmental knee arthroplasty (BKA, UKA) is currently advocated as an alternative solution to conventional total knee arthroplasty (TKA) in order to preserve bone stock and ligaments for limited osteoarthritis (OA) with intact anterior and posterior cruciate ligaments (ACL, PCL). However, the actual rate of UKA or BKA compared to TKA procedures in OA patients has not been reported. In this study, we retrospectively analyzed preoperative MRI of the knee in subjects who underwent knee arthroplasty and assessed the potential for UKA or BKA as an alternative treatment. Methods Data were extracted from the Osteoarthritis Initiative (OAI) public use data set, which included 4,796 subjects, ages 45–79. 3.0 Tesla MRI scanners were dedicated to imaging the knees of OAI participants annually from February 2004 to March 2010. Extensive quantitative measurements of the knee MRI were performed on 87 patients who underwent knee arthroplasty during follow-up visits. We assessed the cartilage thickness and defect size in the medial femorotibial joint (FTJ), lateral FTJ, and patellofemoral joint (PFJ) as well as ligamentous injury, bone marrow edema, and subchondral cyst size from 2D coronal turbo spin echo (TSE), 2D sagittal TSE, 3D coronal T1-weighted water-excitation fast low angle shot (FLASH), and 3D sagittal water-excitation double echo steady-state (DESS) with axial and coronal reformat images. Results Eighty-five subjects (97.7%) were subjected to TKA, while only 2 subjects (2.3%) received UKA from the OAI database. Based on the preoperative MRI findings criteria, 51 of 87 subjects (58.6%) met the indication for TKA including the 2 UKA subjects above. This rate was significantly lower (p<0.001) than the actual TKA rate received. Among 85 subjects who actually underwent TKA, 31 subjects (36.5%) and 5 subjects (5.9%) met the indication for BKA and UKA, respectively. Conclusions Many medial or lateral compartmental OA subjects, with or without patellar compartment defects have undergone TKA. The results of this study suggest the indication for partial arthroplasty, such as UKA or BKA, may increase when cartilage in each compartment, as well as ligaments and subchondral bone status are comprehensively evaluated.
Collapse
Affiliation(s)
- Eiko Yamabe
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, USA
| | | | | | | | | | | |
Collapse
|