1
|
Nagarkatti A, Strecker S, Nagarkatti D, Witmer D. The Role of Imageless Computer-Assisted Navigation During Total Knee Arthroplasty on Femoral Component Sagittal Alignment and Outcomes. Arthroplast Today 2024; 28:101455. [PMID: 39100414 PMCID: PMC11295699 DOI: 10.1016/j.artd.2024.101455] [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: 04/02/2024] [Revised: 05/13/2024] [Accepted: 06/08/2024] [Indexed: 08/06/2024] Open
Abstract
Background While total knee arthroplasty (TKA) is highly successful, 15%-20% of patients are not satisfied postoperatively, which may be due to alignment of the TKA components. Imageless computer navigation was developed to increase implant alignment accuracy and precision, but controversy surrounds the patient benefit of this technology. The target of femoral sagittal alignment and its role in patient-reported outcomes (PROMs) after TKA using assistive technology has not been well-defined. Methods Femoral sagittal alignment, 30-day complications, and PROMs through 1 year were collected retrospectively from unilateral elective TKA patients who underwent surgery between July 2020 and February 2023. Two surgeons equally versed in conventional and imageless navigation techniques participated in patient record identification. Students t-tests and chi-square tests of proportion were used to compare outcomes, 30-day complications, and alignment. Results Completed PROMs were available for 387 patients; 181 in the computer navigation group and 206 in the conventional arthroplasty group. PROMs were statistically significantly different between groups, favoring computer navigation (P = .014 at 12 months). Lateral femoral angle measurements were greater in females who underwent TKA with computer navigation (P < .001). Of note, 14 patients in the conventional technique group returned to the emergency department within 30 days, as compared to 4 in the navigation group (P = .033). Conclusions PROMs are improved in the navigation group compared to the conventional technique group. Fewer patients in the navigation group returned to the emergency department. Navigation appeared to provide a small benefit compared to conventional techniques, though final lateral femoral angle was not predictive of outcomes. Additional surgical characteristics may need to be examined to determine the reasons for the differences in outcomes between these techniques.
Collapse
Affiliation(s)
| | - Sara Strecker
- Orthopedics, Bone & Joint Institute, Hartford Hospital, Hartford, CT, USA
| | - Durgesh Nagarkatti
- Orthopedics, Bone & Joint Institute, Hartford Hospital, Hartford, CT, USA
| | - Dan Witmer
- Orthopedics, Bone & Joint Institute, Hartford Hospital, Hartford, CT, USA
| |
Collapse
|
2
|
Pagan CA, Karasavvidis T, Cohen-Rosenblum AR, Hannon CP, Lombardi AV, Vigdorchik JM. Technology in Total Knee Arthroplasty in 2023. J Arthroplasty 2024:S0883-5403(24)00751-4. [PMID: 39053667 DOI: 10.1016/j.arth.2024.07.028] [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: 12/20/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
Over the past few decades, instrumentation and techniques for total knee arthroplasty have evolved from conventional manual tools to a wide range of technologies, including calibrated guides for accurate bone cuts and alignment, smart tools, dynamic intraoperative sensors for soft tissue balancing, patient-specific guides, computer navigation, and robotics. This review is intended to provide an overview of the latest advancements in total knee arthroplasty technology, address potential challenges and solutions related to the application of these technologies, and explore their limitations.
Collapse
Affiliation(s)
- Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Charles P Hannon
- Deparment of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| |
Collapse
|
3
|
Alling TE, Conteh‐Meijer M, Boerboom AL, Stevens M, Reininga IF. Computer-assisted revision total knee arthroplasty does not improve postoperative knee prosthesis alignment compared to the conventional technique. J Exp Orthop 2024; 11:e12064. [PMID: 39021891 PMCID: PMC11252016 DOI: 10.1002/jeo2.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose Computer-assisted surgery (CAS) during primary total knee arthroplasty (TKA) prosthesis alignment. However, literature on its use during revision TKA (rTKA) is scarce. Moreover, the effect of CAS during rTKA on rotational alignment of the prosthesis has not been described yet. The purpose of this study was to assess the effect of CAS during rTKA, focusing on the number of outliers and coronal, sagittal and rotational prosthetic alignment compared to conventional rTKA. Methods A prospective cohort study comparing CAS-rTKA with a historical control group (CON-rTKA). The CAS-rTKA group (54 patients/62 knees) underwent rTKA using imageless CAS between 2012 and 2017. The CON-rTKA group (13 patients/23 knees) was operated using the conventional technique between 2002 and 2012. Postoperative alignment was measured using the EOS-2D/3D system (coronal and sagittal planes) and computed tomography scan (rotation). Results No significant differences between the CAS-rTKA and CON-rTKA groups were found for coronal and sagittal alignment regarding the mechanical angle of the leg (p = 0.08), mechanical lateral distal femoral angle (p = 0.87), mechanical medial proximal tibial angle (p = 0.40), anatomical proximal posterior tibial angle (p = 0.43) nor femoral (p = 0.80) and tibial rotation (p = 0.15). For the proportions of coronal, sagittal and rotational outliers, no significant differences were found either. Conclusion This study showed no evidence that use of CAS during rTKA leads to improved coronal, sagittal or rotational alignment of knee prostheses or a difference of outliers between the groups. Level of Evidence Level III, therapeutic.
Collapse
Affiliation(s)
- Triine E. Alling
- Department of Orthopaedics, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Marrigje F. Conteh‐Meijer
- Department of Orthopaedics, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of OrthopaedicsMartini Hospital GroningenGroningenThe Netherlands
| | - Alexander L. Boerboom
- Department of Orthopaedics, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Inge H. F. Reininga
- Department of Trauma Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| |
Collapse
|
4
|
Lee HJ, Park KK, Park YB, Choi SW, Kim BO, Kim SH. Accuracy of Advanced Active Robot for Total Knee Arthroplasty: A Cadaveric Study. J Knee Surg 2024; 37:135-141. [PMID: 36638805 DOI: 10.1055/s-0042-1760391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although the accuracy of other types of robotic systems for total knee arthroplasty (TKA) has been assessed in cadaveric studies, no investigations have been performed to evaluate this newly advanced active robotic system. Therefore, the authors aimed to analyze the accuracy of bone resection in terms of thickness and alignment in a cadaveric study. Three cadaveric specimens (six knees) and an active robotic system (CUVIS Joint, CUREXO) were used in the study. Three surgeons with different experiences in robotic TKAs performed this cadaveric study using the same robotic protocol with two different implant designs. The thickness and angle of bone resection planes obtained from the optical tracking system and the difference between resection planes and the planning data were assessed to determine accuracy. With respect to the overall resection accuracy compared to the plan, the cutting depth accuracy was within 1.0 mm mean of root mean square (RMS), and the resection angle accuracy in terms of sagittal, coronal, and axial planes was within 1.0 degree mean RMS. In contrast, no significant differences were observed between the planned and measured values in terms of the resection angles and cutting thickness. The hip-knee-ankle angle at postoperative evaluation was 0.7 degrees ± 0.7 degrees (RMS 1.0 degrees). This in vivo study suggests that the use of this newly advanced active robotic system for TKA demonstrates a high degree of accuracy in terms of resection thickness and alignment. This finding supports the clinical application of this advanced robotic system. LEVEL OF EVIDENCE: Cadaveric study, Level V.
Collapse
Affiliation(s)
- Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Gyeonggi-do, South Korea
| | - Sung Wook Choi
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Bong-Oh Kim
- R & D center, Curexo Inc., Seoul, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| |
Collapse
|
5
|
Song SJ, Lee HW, Park CH. Predictors of Recurrent Flexion Contracture after Total Knee Arthroplasty in Osteoarthritic Knees with Greater Than 15° Flexion Contracture. Clin Orthop Surg 2023; 15:770-780. [PMID: 37811511 PMCID: PMC10551682 DOI: 10.4055/cios22207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 10/10/2023] Open
Abstract
Background This study aimed to analyze the risk factors that predict recurrent flexion contracture (FC) after total knee arthroplasty (TKA) in osteoarthritic knees with FC ≥ 15°. Methods Data from a consecutive cohort comprising 237 TKAs in 187 patients with degenerative osteoarthritis, preoperative FC ≥ 15°, and a minimum follow-up period of 2 years were retrospectively reviewed. Preoperative FC was corrected intraoperatively from 0° to 5°. The incidence of recurrent FC (FC ≥ 10°) at 2 years postoperatively was investigated. Potential risk factors predicting recurrent FC including age, sex, body mass index, unilateral TKA, severity of preoperative FC, 3-month postoperative residual FC, γ angle, change in posterior femoral offset ratio, and lumbar degenerative kyphosis (LDK) were analyzed using logistic regression analysis. The post-hoc powers for the identified factors were then determined. Results Forty-one knees (17.3%) with recurrent FC were identified. Risk factors with sufficient power for recurrent FC were unilateral TKA, severity of preoperative FC, residual FC at 3 months postoperatively, and LDK (odds ratios of 3.579, 1.115, 1.274, and 3.096, respectively; p < 0.05; power ≥ 86.1). Conclusions Recurrent FC can occur in TKAs with the risk factors including unilateral TKA, severe preoperative FC, residual FC at 3 months postoperative, and LDK despite appropriate intraoperative correction. Surgical strategies and rehabilitation protocols used in managing FC should be applied in TKA cases with risk factors for recurrent FC.
Collapse
Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
6
|
Jung HJ, Kang MW, Lee JH, Kim JI. Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in asian patients: a prospective study. BMC Musculoskelet Disord 2023; 24:332. [PMID: 37106353 PMCID: PMC10134614 DOI: 10.1186/s12891-023-06422-w] [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: 08/07/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Robot-assisted total knee arthroplasty (r-TKA) can reportedly achieve more accurate implant positioning than conventional total knee arthroplasty (c-TKA), although its learning curve is controversial. Moreover, few studies have investigated r-TKA in Asians, who have different anatomical characteristics. This study aimed to determine the learning curve for r-TKA and compare implant positions between r-TKA and c-TKA according to the learning curve in Asian patients. METHODS This prospective study included 50 consecutive c-TKAs (group C), followed by 50 consecutive r-TKAs conducted using the MAKO robotic system (Stryker, USA). Cumulative summation analyses were performed to assess the learning curve for operative time in r-TKA. Accordingly, the r-TKA cases were divided into the initial (group I) and proficiency cases (group P). The femoral and tibial component positions in the coronal, sagittal, and axial planes and lower limb alignment were compared among the three groups. RESULTS r-TKA was associated with a learning curve for operative time in 18 cases. The operative time was significantly shorter in groups C and P than that in group I, with no significant difference between groups C and P. Groups I and P demonstrated fewer outliers with respect to lower limb alignment, femoral component coronal position, axial position, and tibial component sagittal position than those in group C, with no significant difference between groups I and P. CONCLUSION The operative time did not differ significantly between r-TKA and c-TKA after the learning curve. Surgeons could expect more accurate and reproducible lower limb alignment and implant positioning with r-TKA in Asian patients, irrespective of the learning curve.
Collapse
Affiliation(s)
- Ho Jung Jung
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min Wook Kang
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Hwa Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joong Il Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| |
Collapse
|
7
|
Effects of Severe Varus Deformity on Soft Tissue Balancing in Total Knee Arthroplasty. J Clin Med 2022; 12:jcm12010263. [PMID: 36615063 PMCID: PMC9821530 DOI: 10.3390/jcm12010263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
This study aimed to establish the effect of severe varus deformity on soft tissue balance in total knee arthroplasty (TKA), which is not yet well established. We retrospectively enrolled 205 patients (270 knees) who underwent primary TKA using the measured resection technique. Four intraoperatively measured TKA gaps and gap differences were compared between the severe varus deformity group (Hip-knee-ankle [HKA] varus angle ≥ 10°) and the mild varus deformity group (HKA varus angle < 10°). Pearson’s correlation analysis and multiple linear regression analysis were used to investigate the factors affecting flexion and extension gap differences (FGD and EGD). A receiver operating characteristic curve was applied to assess the cut-off value of the HKA varus angle to discriminate the rectangular gap. The FGD (1.42 ± 1.35 mm vs. 1.05 ± 1.16 mm, p = 0.019) and the EGD (1.45 ± 1.32 mm vs. 0.97 ± 1.53 mm, p = 0.006) were significantly larger in severe varus deformity group than in mild varus deformity group. The HKA varus angle was positively correlated with both FGD (r = 0.264, p < 0.001) and EGD (r = 0.319, p < 0.001) and was an influencing factor for FGD (β = 0.232, p = 0.040) and EGD (β = 0.229, p = 0.037). A preoperative HKA angle of 12.4° was selected as the cutoff value to discriminate between rectangular and trapezoidal gaps. Thus, the severity of varus deformity (HKA varus angle) was found to be a significant factor affecting the mediolateral gap difference in TKA. When performing TKA in a knee with an HKA varus angle ≥ 12.4°, a trapezoidal gap is more likely to be expected. Level of evidence III, case−control study.
Collapse
|
8
|
Lee SS, Seo MK, Kim IS, Moon YW. Comparison of Survival Rate and Outcomes Between Conventional and Navigation-Assisted Primary Total Knee Arthroplasty in Severe Varus Knees: A Minimum 10-Year Follow-Up. J Arthroplasty 2022; 37:2164-2170. [PMID: 35618215 DOI: 10.1016/j.arth.2022.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to compare the long-term clinical and radiographic outcomes and survival rates between navigation-assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA in patients with preoperative severe varus deformity. METHODS From January 2005 to December 2011, 152 TKAs and 62 TKAs with preoperative hip-knee-ankle (HKA) angles more than 15° were enrolled in the CON-TKA and NAV-TKA group with 135.7 months follow-up. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (HKA, α, β, γ, and δ angles), and survivorship were compared between the groups. RESULTS The mean value of radiographic outcomes was not statistically different; however, outliers of the HKA angle were significantly higher in the CON-TKA group (18.4% versus 8.1%, P = .04). However, long-term clinical outcomes were similar between both groups. The cumulative survival rate was 96.1% in the CON-TKA group and 96.8% in the NAV-TKA group, with no difference between the groups (P = .962). CONCLUSION NAV-TKA showed fewer outliers in the HKA angle for severe preoperative varus deformity compared with CON-TKA. The long-term clinical outcomes and survival rates were similar between the 2 techniques. A survival rate of more than 96% was observed in both groups. STUDY DESIGN Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, South Korea
| | - Min Kyu Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Il Su Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
9
|
Kim KI, Kim JH, Lee SH, Song SJ, Jo MG. Mid- to Long-Term Outcomes After Medial Open-Wedge High Tibial Osteotomy in Patients With Radiological Kissing Lesion. Orthop J Sports Med 2022; 10:23259671221101875. [PMID: 35859646 PMCID: PMC9289913 DOI: 10.1177/23259671221101875] [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: 02/03/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Although medial open-wedge high tibial osteotomy (MOWHTO) is the treatment of
choice for patients with mild to moderate osteoarthritis with varus
malalignment, concerns about inferior outcomes in patients with preoperative
radiological kissing lesion (RKL) remain. Purpose: To compare the mid- to long-term clinical and radiological results and
survivorship after MOWHTO in patients with versus without preoperative
RKL. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 122 knees in patients who underwent MOWHTO with a medial locked
plate and had minimum 5-year follow-up data. The mean age at surgery was
55.9 years (range, 38-65 years), and the mean follow-up was 7.5 years
(range, 5-12.8 years). All patients had undergone second-look arthroscopy
around 2 years after MOWHTO. The knees were divided into an RKL group (n =
17) and no-RKL group (n = 105) based on preoperative standing radiographs.
The authors compared postoperative American Knee Society (AKS) knee and
function scores, range of motion, and improvements in AKS scores between
groups, as well as hip-knee-ankle angle, medial proximal tibial angle, and
joint-line convergence angle from preoperatively to postoperatively. Also
compared were the degree of cartilage regeneration between first- and
second-look arthroscopy and the survival rate after index surgery. Results: Preoperative AKS scores were significantly lower in the RKL group versus the
no-RKL group (AKS knee, 79.6 ± 7.5 vs 83.8 ± 3.9, P = .037;
AKS function, 68.8 ± 9.3 vs 76.0 ± 5.1, P = .006).
Likewise, postoperative AKS scores were significantly lower in the RKL group
versus the no-RKL group (AKS knee: 91.3 ± 4.2 vs 94.4 ± 1.6, respectively,
P = .008; AKS function: 90.0 ± 10.0 vs 97.6 ± 4.5,
respectively, P = .007). However, all patients had
excellent postoperative AKS knee and function scores (>80). Moreover,
there were no between-group differences in pre- to postoperative improvement
in AKS scores, postoperative radiological changes, or grade of cartilage
regeneration. The survival rates in the RKL and no-RKL groups were 100% and
97.1%, respectively (P ≥ .999). Conclusion: Although the latest clinical scores were lower in the RKL group than in the
no-RKL group, comparable results in postoperative clinical improvement,
cartilage regeneration, and survivorship were observed in patients with RKL
at mid- to long-term follow-up.
Collapse
Affiliation(s)
- Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Myeong-Guk Jo
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| |
Collapse
|
10
|
Kim JH, Kim KI, Yoon WK, Song SJ, Jin W. Intra-articular Injection of Mesenchymal Stem Cells After High Tibial Osteotomy in Osteoarthritic Knee: Two-Year Follow-up of Randomized Control Trial. Stem Cells Transl Med 2022; 11:572-585. [PMID: 35674255 PMCID: PMC9216209 DOI: 10.1093/stcltm/szac023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/20/2022] [Indexed: 02/02/2023] Open
Abstract
Intra-articular injection of adipose-derived mesenchymal stem cell (ADMSC) after medial open-wedge high tibial osteotomy (MOWHTO) would be a promising disease-modifying treatment by correcting biomechanical and biochemical environment for arthritic knee with varus malalignment. However, there is a paucity of clinical evidence of the treatment. This randomized controlled trial (RCT) was aimed to assess regeneration of cartilage defect, functional improvement, and safety of intra-articular injection of ADMSCs after MOWHTO compared with MOWHTO alone for osteoarthritic knee with varus malalignment. This RCT allocated 26 patients into the MOWHTO with ADMSC-injection group (n = 13) and control (MOWHTO-alone) group (n = 13). The primary outcome was the serial changes of cartilage defect on periodic magnetic resonance imaging (MRI) evaluation using valid measurements until postoperative 24 months. Secondary outcomes were the 2-stage arthroscopic evaluation for macroscopic cartilage status and the postoperative functional improvements of patient-reported outcome measures until the latest follow-up. Furthermore, safety profiles after the treatment were evaluated. Cartilage regeneration on serial MRIs showed significantly better in the ADMSC group than in the control group. The arthroscopic assessment revealed that total cartilage regeneration was significantly better in the ADMSC group. Although it was not significant, functional improvements after the treatment showed a tendency to be greater in the ADMSC group than in the control group from 18 months after the treatment. No treatment-related adverse events, serious adverse events, and postoperative complications occurred in all cases. Concomitant intra-articular injection of ADMSCs with MOWHTO had advantages over MOWHTO alone in terms of cartilage regeneration with safety at 2-year follow-up, suggesting potential disease-modifying treatment for knee OA with varus malalignment.
Collapse
Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Corresponding author: Kang-Il Kim, M.D., Ph D., Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Republic of Korea. Tel: +82 2 440 6151;
| | - Wan Keun Yoon
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gandong, Seoul, Republic of Korea
| |
Collapse
|