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Broberg JS, Naudie DDR, Howard JL, Lanting BA, Vasarhelyi EM, Teeter MG. Effect of Surgical Technique, Implant Design, and Time of Examination on Contact Kinematics: A Study of Bicruciate-Stabilized and Posterior-Stabilized Total Knee Arthroplasty. J Arthroplasty 2024; 39:2111-2115. [PMID: 38522799 DOI: 10.1016/j.arth.2024.03.040] [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: 09/22/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Bicruciate-stabilized (BCS) total knee arthroplasty (TKA) designs attempt to approximate natural knee mechanics. Multiple surgical techniques, including gap balancing (GB) and measured resection (MR), have been developed to provide optimal implant positioning and soft-tissue balance. The goal of this study was to determine the effect of surgical technique on BCS TKA contact kinematics. Secondary goals included investigating the change of kinematics over time and comparing BCS TKA kinematics to a posterior-stabilized (PS) design. METHODS The study included the BCS-GB, BCS-MR, and PS-MR groups. The BCS-GB and BCS-MR groups underwent weight-bearing radiostereometric analysis for multiple knee flexion angles at 3 months and 1 year postoperatively, whereas the PS-MR group was imaged at 1 year postoperatively. The medial and lateral contact kinematics were determined from implant poses. RESULTS There were no differences in BCS TKA kinematics between the GB and MR techniques. There were differences in the mid-flexion ranges when comparing the 3-month and 1-year kinematics of the BCS design; however, they were less than 1.5 mm. Differences existed between the kinematics of the BCS and PS designs at all flexion angles for the medial condyle (P < .0006) and at 0° of flexion on the lateral condyle (P < .0001). CONCLUSIONS Contact kinematics for a BCS design were similar for both surgical techniques, suggesting both are appropriate for this design. Small, likely clinically insignificant differences were found between 3-month and 1-year kinematics. The BCS TKA kinematics differed from the PS design; however, it is unclear whether these differences improve clinical outcomes.
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Affiliation(s)
- Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Douglas D R Naudie
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Edward M Vasarhelyi
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada; Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Maciąg BM, Kordyaczny T, Jegierski D, Łapiński M, Dorocińska M, Żarnovsky K, Maciąg GJ, Adamska O, Stolarczyk A. Differences in joint line level and posterior condylar offset during total knee replacement with use of gap-balancing and measured resection techniques-matched cohort study. BMC Musculoskelet Disord 2023; 24:610. [PMID: 37491199 PMCID: PMC10367383 DOI: 10.1186/s12891-023-06722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Total knee replacement (TKR) is considered one of the most common elective orthopaedic procedures. The main focus of TKR is to offer patient's symptomatic relief from persistent knee pain. To achieve this it is crucial to restore joint biomechanics by performing proper bone cuts. Some surgeons favor the measured resection technique, others prefer gap balancing technique. The researchers of the presented study performed TKR using these two techniques. The aim of this study was to compare the postoperative change in joint line and posterior condylar offset after TKR with use of anatomic knee design implants between gap balancing and measured resection techniques. METHODS Two hundred twenty-five X-rays of patients who underwent TKR performed by a single surgeon between 2020 and 2021 were analyzed. The first group of patients (101) was operated with the use of gap balancing technique and the second group (124) was operated with the use of measured resection technique. Patients included in the study were > 50 years of age, had confirmed primary knee osteoarthritis, underwent primary TKR with a PS (posterior stabilized) knee implants without patella resurfacing and had at least 15 degree flexion contracture. T-student test and U Mann-Whitney test were used in statistical analysis of results, according to the normality of distribution examined with the Shapiro-Wilk test. Post-hoc analysis was performed using the Dwass-Steel-Crichtlow-Fligner test (DSCF). RESULTS The postoperative analysis showed a significantly elevated joint line level in the gap balancing group (-2.6 ± 4.1 vs -0.7 ± 4.8, p < 0.0005). In the gap balancing group significantly more patients had joint lines elevated > 2 mm comparing to measured resection technique. The difference between pre- and postoperative PCO (posterior condylar offset) and PCOR (posterior condylar offset ratio) results had no significant differences (100.8 ± 11.8 vs 101 ± 12.5, p > 0.05) between the groups. CONCLUSIONS The results of the study suggest that when it comes to restoring joint line level measured resection technique seems to be superior in comparison to the gap balancing technique. What is more, results indicate measured resection is equal in terms of restoring posterior condylar offset to the gap balancing technique. TRIAL REGISTRATION NCT04164147, date of registration: November 14, 2019.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland.
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Monika Dorocińska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Olga Adamska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
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Broberg JS, Vasarhelyi EM, Lanting BA, Howard JL, Teeter MG, Naudie DDR. Migration and Inducible Displacement of the Bicruciate-Stabilized Total Knee Arthroplasty: A Randomized Controlled Trial of Gap Balancing and Measured Resection Techniques. J Arthroplasty 2022; 37:252-258. [PMID: 34710566 DOI: 10.1016/j.arth.2021.10.010] [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: 08/11/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The goal of this study is to investigate the migration and inducible displacement of a bicruciate-stabilized (BCS) total knee arthroplasty implanted using gap balancing (GB) or measured resection (MR) surgical techniques. We hypothesized equal migration and displacement between the techniques. METHODS The study is a single-blinded, prospective, randomized controlled trial, with allocation of 71 patients to either GB or MR groups. Fifteen patients were withdrawn, resulting in 31 patients in the GB group and 25 in the MR group. Patients received the JOURNEY II™ BCS implant. Migration and inducible displacement were evaluated using radiostereometric analysis and patient examinations were performed at a 2-week baseline, and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperation. RESULTS No differences (P > .05) existed between GB and MR groups for any measurement of tibial or femoral migration. Both groups had tibial migrations below 0.5 mm from baseline to 6 months, and below 0.2 mm from both 6 months to 1 year and 1-2 years postoperation. No differences (P > .05) were found between GB and MR groups for inducible displacement. CONCLUSION No differences were found in implant migration or inducible displacement between GB and MR groups. The BCS implant can be expected to have migration risks on par with industry standards and both surgical techniques are safe and effective options for implantation of this implant design.
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Affiliation(s)
- Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Edward M Vasarhelyi
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Douglas D R Naudie
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
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