1
|
Tanariyakul Y, Kanitnate S, Tammachote N. Cementless and Cemented Total Knee Arthroplasties Have Similar Outcomes but Cementless Patellar Component Migration was Observed in a Paired Randomized Control Trial. J Arthroplasty 2024; 39:1266-1272. [PMID: 37924989 DOI: 10.1016/j.arth.2023.10.055] [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: 06/12/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) has become increasingly popular. Some surgeons are concerned about pain, implant stability, and metal-backed patellar component survivorship. This study investigated the outcomes of cementless compared with cemented TKA in bilateral cases. METHODS We randomized 80 knees in 40 osteoarthritic knee patients who underwent bilateral TKA with patellar resurfacing under one anesthesia. All participants received cementless prostheses in one knee and cemented prostheses in the other. The outcomes were knee function measured by the forgotten joint scores, modified Western Ontario and McMaster Universities Osteoarthritis Index, knee ranges of motion, pain levels, operative times, radiographic outcomes, and complications. All knees were followed for a minimum of 2 years (2 to 3 years). RESULTS Cementless and cemented TKA had similar functional outcomes in forgotten joint score (97 ± 5 versus 98 ± 3 points, P = .52), modified Western Ontario and McMaster Universities Osteoarthritis Index score (3 ± 4 versus 3 ± 2 points, P = .96), and ranges of motion (134 ± 7° versus 134 ± 7°, P = .16). The postoperative pain was also similar (P > .05). There were 4 cementless patellar components had superior migration for an average of 3.5 mm (range, 1.77 to 4.16) without loosening. The mean time of migration was 4 (range, 2 to 6) weeks. CONCLUSIONS Cementless TKA had similar functional outcomes and recovery patterns compared with cemented TKA. However, there was concern of cementless component migration at patellae.
Collapse
Affiliation(s)
- Yot Tanariyakul
- Department of Orthopaedics, Thammasat University, Pathumthani, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Thammasat University, Pathumthani, Thailand
| | | |
Collapse
|
2
|
Williams J, Albuquerque Ii JBD, Nuelle CW, Stannard JP, Cook JL. Impacts of Knee Arthroplasty on Activity Level and Knee Function in Young Patients: A Systematic Review. J Knee Surg 2024; 37:452-459. [PMID: 37714214 DOI: 10.1055/a-2176-4688] [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: 09/17/2023]
Abstract
The annual demand for knee arthroplasty has been steadily rising, particularly in younger patients. The primary objective of this systematic review was to determine the impact of knee arthroplasties on knee function and activity levels in young (≤55 years) patients. A PubMed search from inception (1977) to March 2022 to identify eligible studies produced 640 peer-reviewed studies for consideration. A total of 18 studies including 4,186 knee arthroplasties in 3,200 patients (mean patient age at the time of surgery: 47.4 years, range: 18-55 years) were ultimately included for analysis. Mean final follow-up (FFU) duration was 5.8 years (range: 2-25.1 years). Mean FFU improvement in Knee Society Clinical Score was 48.0 (1,625 knees, range: 20.9-69.0), Knee Society Function Score was 37.4 (1,284 knees, range: 20-65). Mean FFU for the Tegner and Lysholm activity scale was 2.8 (4 studies, 548 knees, range: 0.7-4.2); University of California Los Angeles Physical Activity Questionnaire score was 2.8 (3 studies, 387 knees, range: 1.2-5); lower extremity activity scale was 1.84 (529 knees). The available evidence suggest that young patients typically realize sustained improvements in knee function compared to preoperative levels; however, these improvements do not typically translate into a return to desired activity levels or quality of life, and this patient population should expect a higher and earlier risk for revision than their older counterparts. Further research, including robust registry data, is needed to establish evidence-based indications, expectations, and prognoses for outcomes after knee arthroplasty in young and active patients.
Collapse
Affiliation(s)
- Jonathan Williams
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - João B de Albuquerque Ii
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Clayton W Nuelle
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, Mizzou Joint and Limb Preservation Center, Missouri Orthopaedic Institute, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, Mizzou Joint and Limb Preservation Center, Missouri Orthopaedic Institute, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, Mizzou Joint and Limb Preservation Center, Missouri Orthopaedic Institute, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
3
|
Monarrez R, Dubin J, Bains SS, Hameed D, Moore MC, Chen Z, Mont MA, Delanois RE, Nace J. Cemented is not superior to cementless total knee arthroplasty for complications: a propensity score matched analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1825-1830. [PMID: 38429555 DOI: 10.1007/s00590-024-03847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION There is continued debate regarding the survivorship and revision rate of cementless versus cemented total knee arthroplasty (TKA) prostheses. This includes the assessment of early revision surgery due to aseptic loosenings and periprosthetic joint infections (PJIs). Studies have not always taken into account the impact of comorbidities, such as diabetes, obesity, and tobacco. Therefore, we compared revisions in a large population of patients undergoing cemented or cementless TKAs at 90 days, 1 year, and 2 years. METHODS A review of an administrative claims database was used to identify patients undergoing primary TKA, either cementless (n = 8,890) or cemented (n = 215,460), from October 1, 2015 to October 31, 2020. Revision surgery for PJI and aseptic loosening were identified with diagnosis and associated procedural codes at 90 days, 1 year, and 2 years and then compared between groups. A propensity matched-analysis was performed for age, sex, Charles Comorbidity Index (CCI) > 3, alcohol abuse, tobacco use, obesity, and diabetes. Chi square tests assessed statistical significance of differences in the matched cohorts using odds ratios (ORs) with 95% confidence intervals (CIs). A P < 0.05 was defined as statistically significant. RESULTS Cementless TKA was associated with similar revisions rates due to PJIs at 90 days (OR, 1.04, 95% CI 0.79-1.38, p = 0.83), 1 year (OR, 0.93, 95% CI 0.75-1.14, p = 0.53, and 2 years (OR, 0.87, 95% CI 0.73-1.05, p = 0.17) in comparison to the cemented TKA cohort. The odds ratio of revision due to aseptic loosening was similar as well at 90 days (OR, 0.67, 95% CI 0.34-1.31, 0.31), 1 year (OR, 1.09, 95% CI 0.73-1.61, p = 0.76), and 2 years (OR, 1.00, 95% CI 0.73-1.61, p = 0.99). CONCLUSIONS This study found a comparable risk of PJI and aseptic loosening in cementless and cemented TKA when controlling for several comorbidities, such as tobacco, diabetes, and alcohol. Therefore, with proper patient selection, cementless TKAs can be performed with expectation of low risks of infections and aseptic loosenings.
Collapse
Affiliation(s)
- Ruben Monarrez
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep S Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Mallory C Moore
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael A Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Ronald E Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| |
Collapse
|
4
|
Singh J, Rassir R, Sierevelt IN, van Geene OFF, Rademakers MV, Spekenbrink-Spooren A, Nolte PA. Total Knee Arthroplasty in the Post-Traumatic Knee: Revision Risks and Functional Outcomes Compared to Osteoarthritic Knees. A Report of Primary Procedures From the Dutch Arthroplasty Register. J Arthroplasty 2024; 39:363-367. [PMID: 37598781 DOI: 10.1016/j.arth.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) for post-traumatic arthritis (PTA) poses higher challenges and increased risks of complications compared to TKA for osteoarthritis (OA). This study aimed to compare implant survivorships, reasons for revision, and patient-reported outcome measures between OA and PTA as indications for TKA. METHODS We selected all primary TKAs for PTA or OA between 2007 and 2020 from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies). The study included 3,897 TKA procedures for PTA (median follow-up 4.6 years; interquartile range: 2.2, 7.3) and 255,259 procedures for OA (median follow-up 4.7 years; interquartile range 2.2, 7.6). A total of 10,480 revision procedures were performed across both groups (238 in PTA knees; 10,242 in OA knees). We analyzed the prevalence of preoperative comorbidities and postoperative complications, as well as the reasons for revision, and calculated the implant survival rates. RESULTS The survival revision rate in the OA group was significantly lower at both follow-up moments (5- and 10- years). The likelihood for revision was increased in TKA for PTA compared to TKA for OA (hazards ratio: 1.16 [95% confidence interval 1.02 to 1.33], P = .03). The most common reason for a revision was instability and arthrofibrosis in the PTA group compared to patellar pain for the OA group. CONCLUSION This study demonstrated an increased risk for revision for any reason in TKA for PTA compared to OA. Revision for instability and arthrofibrosis were more prevalent in the PTA group, while revision for patellar pain was less prevalent compared to TKA for OA.
Collapse
Affiliation(s)
- Jiwanjot Singh
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Rachid Rassir
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands; Orthopedic Department, Xpert Clinics, Amsterdam, The Netherlands
| | | | | | - Anneke Spekenbrink-Spooren
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), s-Hertogenbosch, The Netherlands
| | - Peter A Nolte
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| |
Collapse
|
5
|
Desmarais J, Dalury D, Bernasek TL, Fisher DA, Nunley RM, Fickenscher MC, Gorab RS. A Short-Term Multicenter Analysis of Radiolucent Lines in a Single Uncemented Rotating Platform Implant for Total Knee Arthroplasty. Arthroplast Today 2022; 15:34-39. [PMID: 35392363 PMCID: PMC8980437 DOI: 10.1016/j.artd.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/18/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Uncemented total knee arthroplasty is increasing as a potential solution for aseptic loosening via biologic fixation and to increase operative efficiency. However, postoperative radiolucent lines (RLLs) remain a concern for some clinicians. We report on a multicenter analysis of these RLLs over a 2-year period to identify their incidence, progression, and clinical significance. Material and methods Institutional review board approval was obtained for this retrospective, multicenter case series. A total of 312 patients treated with a single cruciate-retaining, fully porous coated femoral and tibial component design were included in the study. All patients were evaluated clinically and radiographically in the early postoperative period and at final follow-up (average 2.0 years). Average age of the study group was 58.2 years, and average body mass index was 30.7. Of the total, 66% were male, and 34% were female. Two independent surgeons evaluated the radiographs at the initial postoperative visit and at the most recent follow-up for RLLs. Knee Society Scores and range of motion (ROM) were collected at each visit. Results We identified RLLs in 25% of patients. All RLLs were less than 1 mm in size and located at the periphery of the tibial implant. None of the RLLs were progressive. At the final follow-up, compared with early postoperative imaging, no new RLLs were identified. Average ROM in flexion was 124 degrees, and the average Knee Society Scores at the most recent clinical follow-up was 96. Conclusion RLLs are commonly seen following cementless TKA, most commonly underneath the tibial tray. Based on this data set, there does not appear to be progression of these RLLs with time, and they do not appear to have an effect on ROM or clinical outcome at 2 years.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Robert S. Gorab
- Hoag Orthopedic Institute, Irvine, CA, USA
- Corresponding author. Hoag Orthopedic Institute, 16300 Sand Canyon Ave, Suite 511, Irvine, CA 92618, USA. Tel.: +1 714 318 7716.
| |
Collapse
|
6
|
Paul RW, Osman A, Clements A, Tjoumakaris FP, Lonner JH, Freedman KB. What Are the All-Cause Survivorship Rates and Functional Outcomes in Patients Younger Than 55 Years Undergoing Primary Knee Arthroplasty? A Systematic Review. Clin Orthop Relat Res 2022; 480:507-522. [PMID: 34846307 PMCID: PMC8846274 DOI: 10.1097/corr.0000000000002023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/04/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Approximately one-fourth of TKAs will be performed in patients 55 years or younger within the next decade. Postoperative outcomes for younger patients who had a knee arthroplasty were systematically reviewed in 2011; however, numerous studies evaluating young patients who had both a TKA and unicompartmental knee arthroplasty (UKA) have been reported in the past decade. Therefore, to better counsel this growing population of young patients undergoing knee arthroplasty, an updated understanding of their expected postoperative outcomes is warranted. QUESTIONS/PURPOSES In this systematic review, we evaluated (1) all-cause survivorship, (2) reasons for revision, (3) patient-reported outcomes, and (4) return to physical activity and sport in patients 55 years or younger undergoing primary TKA or UKA. METHODS A comprehensive search of PubMed, Medline, SportDiscus, and CINAHL was performed to identify all original studies evaluating outcomes after primary knee arthroplasty for young patients (55 years of age or younger) from inception until March 2021. The following keywords were used: knee, arthroplasty, replacement, pain, function, revision, survivorship, sport, physical activity, and return to play. Only original research studies that were related to knee arthroplasty and reported postoperative outcomes with a minimum 1-year follow-up for patients 55 years or younger were included. Unpublished materials, publications not available in English, and studies with a primary diagnosis of rheumatoid arthritis were excluded. The Methodological Index for Non-Randomized Studies (MINORS) score was used to evaluate the study quality of case series and comparative studies, while the Cochrane Risk of Bias tool and the Jadad scale were used for randomized studies. The primary outcomes of interest for this study were all-cause survivorship rate, reasons for all-cause revision, Knee Society and Knee Society Function scores (minimum clinically important difference [MCID] 7.2 and 9.7, respectively), WOMAC scores (MCID 10), Tegner scores (no reported MCID for knee arthroplasty), and return to physical activity or sport. Knee Society and Knee Society Function scores range from 0 to 100, with scores from 85 to 100 considered excellent and below 60 representing poor outcomes. All-cause survivorship rate and reasons for revision were both reported in 17 total studies. Knee Society scores were presented in 19 and Knee Society Function scores were reported in 18 included studies. WOMAC scores and Tegner scores were each found in four included studies, and return to physical activity and return to sport analyses were performed in seven studies. Overall, 21 TKA studies and five UKA studies were included in this analysis, featuring 3095 TKA knees and 482 UKA knees. RESULTS Kaplan-Meier estimates of all-cause survivorship ranged from 90% to 98% at 5 to 10 years of follow-up after TKA and from 84% to 99% (95% CI 93% to 98%) at 10 years to 20 years post-TKA. All-cause UKA survivorship was 90% at 10 years and 75% at 19 years in the largest Kaplan-Meier estimate of survivorship for patients younger than 55 who underwent UKA. Common reasons for revision in TKA patients were polyethylene wear/loosening, aseptic tibial loosening, and infection, and in UKA patients the common reasons for revision were knee pain, aseptic loosening, progression of knee osteoarthritis, and polyethylene wear/loosening. Knee Society scores ranged from 85 to 98 for 5-year to 10-year follow-up and ranged from 86 to 97 at 10-year to 20-year follow-up in TKA patients. Knee Society Function scores ranged from 70 to 95 for 5-year to 10-year follow-up and ranged from 79 to 86 at 10-year to 20-year follow-up. Return to physical activity and sport was reported variably; however, most patients younger than 55 have improved physical activity levels after knee arthroplasty relative to preoperative levels. CONCLUSION Although all-cause survivorship rates were frequently above 90% and patient-reported outcome scores were generally in the good to excellent range, several studies reported long-term survivorship rates from 70% to 85% and fair patient-reported outcome scores, which must be factored into any preoperative counseling with patients. We could not control for surgeon volume in this report, and prior research suggests that increasing volume is associated with less frequent complications; in addition, the studies we included were variably affected by selection bias, transfer bias, and assessment bias, which makes it likely that the findings of our review represent best-case estimates. To limit the frequency of revision in patients younger than 55 years undergoing TKA, clinicians should be cautious of polyethylene wear/loosening, aseptic tibial loosening, and infection, while knee pain and progression of knee osteoarthritis are also common reasons for revision in patients younger than 55 undergoing UKA. Further research should isolate younger knee arthroplasty patients and evaluate postoperative activity levels while accounting for preoperative physical activity and sport participation. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Alim Osman
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ari Clements
- Sidney Kimmel Medical College, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
7
|
Uivaraseanu B, Vesa CM, Tit DM, Maghiar O, Maghiar TA, Hozan C, Nechifor AC, Behl T, Andronie-Cioara FL, Patrascu JM, Bungau S. Highlighting the advantages and benefits of cementless total knee arthroplasty (Review). Exp Ther Med 2022; 23:58. [PMID: 34917184 PMCID: PMC8630446 DOI: 10.3892/etm.2021.10980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
In the field of orthopedic surgery, cemented total knee arthroplasty (TKA) is considered to be one of the gold standards. However, there are categories of patients (i.e., obese and morbidly obese patients, younger than 65 years old) among whom cemented TKA has however a high failure rate. Moreover, the frequency of using uncemented TKA is increasing due to the potential benefits of long-term biological fixation, being an innovative field that addresses a new generation orthopedic surgical treatment which is more suitable for young patients who have good bone quality (good to very good, in terms of density). The survival rates and functional results of the latest generation of cementless TKAs may be similar to functional results and survival rates of cemented prosthesis. In conclusion, this review-type article can be considered a powerful database, extremely informative, dense, and focused on the topic mentioned above, in the interest of all medical professionals and all interested individuals.
Collapse
Affiliation(s)
- Bogdan Uivaraseanu
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Octavian Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Teodor Andrei Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Calin Hozan
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Aurelia Cristina Nechifor
- Analytical Chemistry and Environmental Engineering Department, Polytechnic University of Bucharest, 011061 Bucharest, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Chandigarh, Punjab 140401, India
| | - Felicia Liana Andronie-Cioara
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania
| | - Jenel Marian Patrascu
- Department of Orthopedics, Urology and Medical Imaging, Faculty of Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| |
Collapse
|
8
|
Mainine S, Marinho JA, Oliveira BGPD, Zanon EM, Pereira BM, Souza RFRD. Radiographic Study in Patients Submitted to Cementless Total Knee Arthroplasties: Minimum Follow-Up of 2 Years. Rev Bras Ortop 2021; 56:628-633. [PMID: 34733435 PMCID: PMC8558939 DOI: 10.1055/s-0041-1731355] [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: 04/03/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022] Open
Abstract
Objective
Radiographic evaluate if there are signs of early loosening of the cementless total knee arthroplasties Amplitude-Score® (Amplitude Surgical SAS, Valence, France), checking with a follow-up time ranging from 2 to 5.75 years (mean of 3.75 years).
Methods
Descriptive longitudinal investigation of observational nature, non-comparative, through a static radiographic study of annual control, of a case series, in a single center, all operated on by the same surgeon (S.M.). All cementless arthroplasties that met the inclusion and exclusion criteria performed from March 2012 to October 2014 were included.
Results
Among the 46 cementless knee arthroplasties evaluated in 40 patients, no radiographic signs of early loosening were verified.
Conclusion
Cementless arthroplasty promotes optimal osteointegration, with no early release, and it is essential that the surgical technique is perfectly respected.
Collapse
Affiliation(s)
- Sérgio Mainine
- Grupo de Cirurgia do Joelho, Instituto de Fraturas, Ortopedia e Reabilitação (IFOR), São Bernardo do Campo, SP, Brasil
| | - José Antônio Marinho
- Grupo de Cirurgia do Joelho, Instituto de Fraturas, Ortopedia e Reabilitação (IFOR), São Bernardo do Campo, SP, Brasil
| | | | - Enrico Montorsi Zanon
- Grupo de Cirurgia do Joelho, Instituto de Fraturas, Ortopedia e Reabilitação (IFOR), São Bernardo do Campo, SP, Brasil
| | - Bruno Machado Pereira
- Grupo de Cirurgia do Joelho, Instituto de Fraturas, Ortopedia e Reabilitação (IFOR), São Bernardo do Campo, SP, Brasil
| | | |
Collapse
|
9
|
Rajgopal A, Kumar S, Aggarwal K. Evaluating Long Term Outcomes and Survivorship of Cruciate Retaining and Sacrificing Knee Replacements Done for Degenerative Arthritis in Patients Under 55 Years. Indian J Orthop 2021; 55:1180-1185. [PMID: 34824718 PMCID: PMC8586379 DOI: 10.1007/s43465-021-00460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total Knee Arthroplasty (TKA) is the gold standard of treatment for end stage arthritis not responding to conservative treatment. With a recent increase in the younger population presenting with osteoarthritis (OA) we undertook this study to evaluate long-term outcomes and survivorship of TKA in this cohort. MATERIALS AND METHODS Our study cohort included 328 patients, < 55 years, with OA, who underwent TKA using Cruciate Retaining (CR), and Posterior Stabilized (PS) implants with a minimum follow up of 15 years. Revision surgery was the end point of our analysis and Kaplan-Meier evaluation of survivorship was measured. Knee Society Scores (KSS) and Range of Motion (ROM) were assessed to evaluate outcomes. RESULTS Survivorship of the CR and PS implants with revision as end point, for aseptic loosening was 97.3% and 96%, and revision for all causes was 89.7% and 86.1%, respectively, at 15 years. The outcomes of CR implants were better than the PS cohort in terms of function and survivorship. CONCLUSION Long term survivorship and outcome analysis of TKA in patients < 55 years showed good results with excellent survivorship, with both CR and PS implants. The CR cohort demonstrated better long-term survivorship, though the difference was not statistically significant. Deep infection and aseptic loosening were the commonest causes for failure.
Collapse
Affiliation(s)
- Ashok Rajgopal
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta-The Medicity Hospital Gurugram, Haryana, 122001 India
| | - Sumit Kumar
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta-The Medicity Hospital Gurugram, Haryana, 122001 India
| | - Kalpana Aggarwal
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta-The Medicity Hospital Gurugram, Haryana, 122001 India
| |
Collapse
|
10
|
Rassir R, Sierevelt IN, Schager M, Nolte PA. Design and rationale of the ATtune Knee Outcome Study (ATKOS): multicenter prospective evaluation of a novel uncemented rotating platform knee system. BMC Musculoskelet Disord 2021; 22:622. [PMID: 34266444 PMCID: PMC8283948 DOI: 10.1186/s12891-021-04493-1] [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: 03/09/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Total Knee Arthroplasty (TKA) remains the gold standard for treatment of debilitating symptoms of knee osteoarthritis (OA). Even though providing satisfactory results for the majority of patients, some studies report dissatisfaction after TKA to be as high as 20%. Among other things, pain catastrophising and self-efficacy are thought to compromise results of TKA. Implant manufacturers keep improving upon their designs in an attempt to improve functional outcomes. One of these novel knee systems is the Attune. To our knowledge, there are no clinical follow-up studies reporting results of the uncemented version. The main objective of this multicentre prospective observational study is to evaluate revision rate, complications, radiographic outcomes (i.e. alignment and radiolucent lines) and patient reported outcomes of the uncemented Attune mobile bearing TKA. Secondary objectives are (1) to assess physical function, return to sport and return to work after TKA and (2) to evaluate the long-term effect of preoperative psychological factors on satisfaction after TKA. Methods All patients presenting in the participating centres with knee pathology warranting joint replacement therapy will be considered for inclusion, an absolute indication for cemented fixation is the only exclusion criterium. Evaluation of clinical and radiographic performance (e.g. radiolucent lines) is done at 6 weeks, 6 months, 1 year, 5 years and 10 years after surgery using validated patient reported outcome measures. Cumulative revision rates are calculated after 5 and 10 years using Kaplan–Meier methods. Physical function is assessed with performance based measurements before and 1 year after surgery. Return to sports is assessed using the Tegner and University of California Los Angeles (UCLA) activity rating scale before and 1 year after surgery. Return to work is evaluated by inviting patients of working age to complete a short questionnaire 1 year after surgery. Psychologic factors are assessed using questionnaires for pain catastrophising, pain self-efficacy and mental health before, 5 years and 10 years after surgery. Preoperative psychologic scores are correlated to functional outcomes. Discussion The current study aims to report the clinical performance of a novel implant and can help provide insight in factors that play a role in satisfaction after TKA. Trial registration ClinicalTrials.gov identifier: NCT04247672 (January 30, 2020)
Collapse
Affiliation(s)
- Rachid Rassir
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | - Inger N Sierevelt
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.,Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands
| | - Marjolein Schager
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Peter A Nolte
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | | |
Collapse
|
11
|
Cementless Fixation in Primary Total Knee Arthroplasty: Historical Perspective to Contemporary Application. J Am Acad Orthop Surg 2021; 29:e363-e379. [PMID: 33399290 DOI: 10.5435/jaaos-d-20-00569] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023] Open
Abstract
Cemented total knee arthroplasty (TKA) has been considered the benchmark, with excellent clinical outcomes and low rates of aseptic loosening at the long-term follow-up. However, alterations of the bone/cement interface leading to aseptic loosening, particularly in younger and obese patients, along with increased life expectancy have led to a renewed interest in noncemented TKA fixation. Certain early noncemented designs exhibited higher rates of subsidence and component failure. Improvements in designs, materials, and surgical technique offer promise for improved results with contemporary noncemented TKA applications. In an increasing cost-conscious healthcare environment, implant cost is important to consider because press-fit prostheses are generally more expensive. However, this cost may be offset by shorter surgical times, cement costs, and the potential for osseous integration. Technological advances have improved the manufacturing of porous metals, with reported excellent midterm survivorship. Future prospective, randomized trials, and registry data are needed to delineate differences between cemented and noncemented fixation, survivorship, and patient-reported outcomes, especially in young, functionally active, and/or obese populations.
Collapse
|
12
|
Patient-Reported Outcomes Following Total Knee Replacement in Patients <65 Years of Age-A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9103150. [PMID: 33003394 PMCID: PMC7600907 DOI: 10.3390/jcm9103150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022] Open
Abstract
An increasing number of total knee replacements (TKRs) are being performed in response to the growing burden of osteoarthritis. Patients <65 years of age represent the fastest growing group of TKR recipients and are expected to account for an increasing number of primary and revision procedures. Concerns have been raised about the outcomes that can be expected by this age demographic who are more active, physically demanding, and have longer life expectancies compared to older TKR recipients. This systematic review and meta-analysis evaluated the effectiveness of TKR for osteoarthritis in patients <65 years of age, compared to older individuals. A systematic search of Embase and Medline was conducted to identify studies which examined patient-reported outcomes measured using disease-specific and generic health-related quality of life instruments. Ten studies met our inclusion criteria and were included in this review. These studies comprised 1747 TKRs performed between 1977 and 2014. In the meta-analysis of two prospective studies (288 TKRs), patients <65 years of age were able to attain large and clinically meaningful improvements in pain, function, and quality of life. One of these studies (61 TKRs) suggested that patients <55 years of age attained a larger degree of improvement compared to older individuals. Results into the second postoperative decade were less certain, with some data suggesting a high prevalence of pain and patterns of functional decline. Further research is required to investigate longer-term outcomes following TKR for osteoarthritis in younger patients.
Collapse
|
13
|
Bingham JS, Salib CG, Hanssen AD, Taunton MJ, Pagnano MW, Abdel MP. Clinical Outcomes and Survivorship of Contemporary Cementless Primary Total Knee Arthroplasties. JBJS Rev 2020; 8:e2000026. [PMID: 32960025 DOI: 10.2106/jbjs.rvw.20.00026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Total knee arthroplasties (TKAs) with cementless fixation have been studied in multiple series with varying success. The aim of this study was to prepare a systematic review of the literature to evaluate clinical outcomes and revtpdelision rates of patients undergoing contemporary cementless TKA. METHODS A search of PubMed and MEDLINE was conducted for English-language articles published between 2005 and 2018 to identify studies examining survivorship and clinical outcomes of cementless TKAs. Studies that reported clinical and/or radiographic outcomes were included. Data collected included the number of TKAs, implant utilized, primary diagnosis, mean age and follow-up, implant survivorship, complications, revisions, and clinical outcome scores. All hybrid constructs and revision TKAs were excluded. Poisson regression analysis was used to determine the revision incidence rates per 1,000 person-years. RESULTS Forty-three studies with 10,447 TKAs met inclusion criteria, of which 8,187 were primary cementless TKAs. The mean follow-up was 7 years. The revision incidence per 1,000 person-years was 4.8 for all cementless designs. The complication rate for all cementless TKAs was 6%, with deep venous thrombosis being the most common complication. The mean postoperative Knee Society Score and Functional Score were 92 and 83, respectively. CONCLUSIONS While newer-generation cementless designs have shown improved survivorship and clinical outcomes compared with earlier-generation cementless designs, the literature for cementless designs remains limited when compared with cemented designs. Further studies are needed to determine if cementless TKA can achieve the same benefits that have been realized with cementless total hip arthroplasty. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Joshua S Bingham
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 2Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona
| | | | | | | | | | | |
Collapse
|
14
|
Rassir R, Nolte PA, van der Lugt JCT, Nelissen RGHH, Sierevelt IN, Verra WC. No differences in cost-effectiveness and short-term functional outcomes between cemented and uncemented total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:448. [PMID: 32646453 PMCID: PMC7350734 DOI: 10.1186/s12891-020-03477-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background There is an ongoing debate regarding optimal fixation of total knee arthroplasty (TKA), however cost has not been addressed as profoundly. Therefore, the current study primarily aimed to compare costs and cost-effectiveness 1 year after cemented or uncemented TKA. A secondary objective was to compare short-term functional outcomes between both groups. Methods A posthoc prospective observational multicenter cohort study of 60 cemented and 50 uncemented Low Contact Stress (LCS) knee systems. Outcome was evaluated using the EuroQol5D-3 L (EQ5D) index, in order to calculate quality adjusted life years (QALYs). Total costs were calculated considering direct costs within the hospital setting (inpatient cost) as well as direct and indirect costs outside the hospital. Cost-effectiveness (total costs per QALY), Oxford Knee Score (OKS) and Numeric Rating Scale (NRS) were compared between cemented and uncemented cases at 1 year after surgery. HealthBASKET project, a micro-costing approach, represents the Dutch costs and situation and was used to calculate hospital stay. (In) direct costs outside the healthcare (medical cost and productivity cost) were determined using two validated questionnaires. Results Median costs per QALY were similar between cemented and uncemented TKA patients (€16,269 and €17,727 respectively; p = 0.50). Median OKS (44 and 42; p = 0.79), EQ5D (0.88 and 0.90; p = 0.82) and NRS for pain (1.0 and 1.0; p = 0.48) and satisfaction (9.0 and 9.0; p = 0.15) were also comparable between both groups. Conclusion For this type of knee implant (LCS), inpatient hospital costs and costs after hospitalization were comparable between groups.
Collapse
Affiliation(s)
- R Rassir
- Department of Orthopaedic Surgery, Spaarne Hospital, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands.
| | - P A Nolte
- Department of Orthopaedic Surgery, Spaarne Hospital, Spaarnepoort 1, 2134, TM, Hoofddorp, the Netherlands
| | - J C T van der Lugt
- Department of Orthopaedic Surgery, Haga Hospital, The Hague, the Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - I N Sierevelt
- Spaarne Academy, Department of Epidemiology, Spaarne Hospital, Hoofddorp, the Netherlands
| | - W C Verra
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| |
Collapse
|
15
|
Li JQ, Hao-Xu, Sun ZG, Huang QS, Yao XD. The outcomes of post-traumatic arthritis vs osteoarthritis following primary total knee arthroplasty: A protocol of matched cohort study. Medicine (Baltimore) 2020; 99:e20077. [PMID: 32384476 PMCID: PMC7220653 DOI: 10.1097/md.0000000000020077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) for treatment of end-stage post-traumatic arthritis (PTA) has specific technical difficulties and complications. The aim of this study was to examine the outcome of TKA after PTA and to compare it with a cohort osteoarthritis (OA). METHODS A retrospective review of patients undergoing primary TKA at a single university hospital from 2013 to 2016 was performed. A minimum follow-up of 4 years was required. Patients in the study group were matched 1:2 with patients in the cohort group based on the following criteria: age at time of TKA (±3 years), body mass index (±3 points), sex, and American Society of Anesthesiologists score (±1 point). Outcome measures included surgical time, intraoperative complications, Oxford Knee Score, range of motion, postoperative complications, and revision. RESULTS This clinical trial is expected to determine whether PTA is associated with increased risks of complications and revision or reduced functional outcomes following TKA. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5455).
Collapse
|
16
|
Liu Y, Zhao XD, Zou C. Lingering risk: A meta-analysis of outcomes following primary total knee arthroplasty for patients with post-traumatic arthritis. Int J Surg 2020; 77:163-172. [PMID: 32247846 DOI: 10.1016/j.ijsu.2020.03.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Currently, no meta-analysis exists to elucidate the outcomes of primary total knee arthroplasty (TKA) in patients with post-traumatic arthritis (PTA). The primary aim of this meta-analysis was to compare revision and complication rates for patients with PTA versus osteoarthritis (OA). METHODS The following databases were used for searching existing literature (from their inception to October 2019): PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science. The primary outcomes were the incidences of revision and complications, Secondary outcomes included operative time and patient-reported outcomes (PRO) scores. RESULTS Nine studies with a total of 6,783,990 patients were included. This study found that there was a statistically significant difference in the rates of superficial wound infection, periprosthetic infection, stiffness, wound complications, and revision, with these outcomes occurring more frequently in patients with PTA. However, PTA did not increase the risks for periprosthetic fracture, aseptic loosening or instability, and VTE. Moreover, PTA was associated with increased operative time, worse postoperative PRO scores, and similar changes in PRO scores. CONCLUSIONS This meta-analysis highlight the complexity of PTA and demonstrates increased risks of infection, wound complications, stiffness, and revision. Surgeons can use this information to help aid in counseling patients preoperatively.
Collapse
Affiliation(s)
- Yang Liu
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, 610041, PR China.
| | - Xiao-Dan Zhao
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, 610041, PR China.
| | - Chang Zou
- Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| |
Collapse
|
17
|
Kim YH, Yoon SH, Park JW. Does Robotic-assisted TKA Result in Better Outcome Scores or Long-Term Survivorship Than Conventional TKA? A Randomized, Controlled Trial. Clin Orthop Relat Res 2020; 478:266-275. [PMID: 31389889 PMCID: PMC7438149 DOI: 10.1097/corr.0000000000000916] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/09/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Robotic-assisted TKA was introduced to enhance the precision of bone preparation and component alignment with the goal of improving the clinical results and survivorship of TKA. Although numerous reports suggest that bone preparation and knee component alignment may be improved using robotic assistance, no long-term randomized trials of robotic-assisted TKA have shown whether this results in improved clinical function or survivorship of the TKA. QUESTIONS/PURPOSES In this randomized trial, we compared robotic-assisted TKA to manual-alignment techniques at long-term follow-up in terms of (1) functional results based on Knee Society, WOMAC, and UCLA Activity scores; (2) numerous radiographic parameters, including component and limb alignment; (3) Kaplan-Meier survivorship; and (4) complications specific to robotic-assistance, including pin-tract infection, peroneal nerve palsy, pin-site fracture, or patellar complications. METHODS This study was a registered prospective, randomized, controlled trial. From January 2002 to February 2008, one surgeon performed 975 robotic-assisted TKAs in 850 patients and 990 conventional TKAs in 849 patients. Among these patients 1406 patients were eligible for participation in this study based on prespecified inclusion criteria. Of those, 100% (1406) patients agreed to participate and were randomized, with 700 patients (750 knees) receiving robotic-assisted TKA and 706 patients (766 knees) receiving conventional TKA. Of those, 96% (674 patients) in the robotic-assisted TKA group and 95% (674 patients) in the conventional TKA group were available for follow-up at a mean of 13 (± 5) years. In both groups, no patient older than 65 years was randomized because we anticipated long-term follow-up. We evaluated 674 patients (724 knees) in each group for clinical and radiographic outcomes, and we examined Kaplan-Meier survivorship for the endpoint of aseptic loosening or revision. Clinical evaluation was performed using the original Knee Society knee score, the WOMAC score, and the UCLA activity score preoperatively and at latest follow-up visit. We also assessed loosening (defined as change in the position of the components) using plain radiographs, osteolysis using CT scans at the latest follow-up visit, and component, and limb alignment on mechanical axis radiographs. To minimize the chance of type-2 error and increase the power of our study, we assumed the difference in the Knee Society score to be 25 points to match the MCID of the Knee Society score with a SD of 5; to be able to detect a difference of this size, we calculated that a total of 628 patients would be needed in each group in order to achieve 80% power at the α = 0.05 level. RESULTS Clinical parameters at the latest follow-up including the Knee Society knee scores (93 ± 5 points in the robotic-assisted TKA group versus 92 ± 6 points in the conventional TKA group [95% confidence interval 90 to 98]; p = 0.321) and Knee Society knee function scores (83 ± 7 points in the robotic-assisted TKA group versus 85 ± 6 points in the conventional TKA group [95% CI 75 to 88]; p = 0.992), WOMAC scores (18 ± 14 points in the robotic-assisted TKA group versus 19 ± 15 points in the conventional TKA group [95% CI 16 to 22]; p = 0.981), range of knee motion (125 ± 6° in the robotic-assisted TKA group versus 128 ± 7° in the conventional TKA group [95% CI 121 to 135]; p = 0.321), and UCLA patient activity scores (7 points versus 7 points in each group [95% CI 5 to 10]; p = 1.000) were not different between the two groups at a mean of 13 years' follow-up. Radiographic parameters such as the femorotibial angle (mean 2° ± 2° valgus in the robotic-assisted TKA group versus 3° ± 3° valgus in the conventional TKA group [95% CI 1 to 5]; p = 0.897), femoral component position (coronal plane: mean 98° in the robotic-assisted TKA group versus 97° in the conventional TKA group [95% CI 96 to 99]; p = 0.953; sagittal plane: mean 3° in the robotic-assisted TKA group versus 2° in the conventional TKA group [95% CI 1 to 4]; p = 0.612) and tibial component position (coronal plane: mean 90° in the robotic-assisted TKA group versus 89° in the conventional TKA group [95% CI 87 to 92]; p = 0.721; sagittal plane: 87° in the robotic-assisted TKA group versus 86° in the conventional TKA group [95% CI 84 to 89]; p = 0.792), joint line (16 mm in the robotic-assisted TKA group versus 16 mm in the conventional TKA group [95% CI 14 to 18]; p = 0.512), and posterior femoral condylar offset (24 mm in the robotic-assisted TKA group versus 24 mm in the conventional TKA group [95% CI 21 to 27 ]; p = 0.817) also were not different between the two groups (p > 0.05). The aseptic loosening rate was 2% in each group, and this was not different between the two groups. With the endpoint of revision or aseptic loosening of the components, Kaplan-Meier survivorship of the TKA components was 98% in both groups (95% CI 94 to 100) at 15 years (p = 0.972). There were no between-group differences in terms of the frequency with which complications occurred. In all, 0.6% of knees (four) in each group had a superficial infection, and they were treated with intravenous antibiotics for 2 weeks [corrected]. No deep infection occurred in these knees. In the conventional TKA group, 0.6% of knees (four) had motion limitation (< 60°) [corrected]. CONCLUSIONS At a minimum follow-up of 10 years, we found no differences between robotic-assisted TKA and conventional TKA in terms of functional outcome scores, aseptic loosening, overall survivorship, and complications. Considering the additional time and expense associated with robotic-assisted TKA, we cannot recommend its widespread use. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
Affiliation(s)
- Young-Hoo Kim
- Y.-H. Kim, The Joint Replacement Center, Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Sung-Hwan Yoon
- S.-H. Yoon, The Joint Replacement Center, Lee Chun Teck Hospital, Suwon, Seoul, Republic of Korea
| | - Jang-Won Park
- J.-W. Park, The Joint Replacement Center, Ewha Womans University Ewha Seoul Hospital, Seoul, Republic of Korea
| |
Collapse
|
18
|
Wang K, Sun H, Zhang K, Li S, Wu G, Zhou J, Sun X. Better outcomes are associated with cementless fixation in primary total knee arthroplasty in young patients: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e18750. [PMID: 32011458 PMCID: PMC7220050 DOI: 10.1097/md.0000000000018750] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of cemented and cementless fixations in primary total knee arthroplasty (TKA) in young patients is controversial. Previous reviews predominantly relied on data from retrospective studies. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the optimal fixation mode in TKA for young patients. METHODS The PubMed, Embase, Medline, Web of Science, and full Cochrane Library electronic databases were searched from inception to July 2018. The outcome measurements consisted of functional outcomes (Knee Society Score [KSS], range of motion [ROM]), radiolucent lines, aseptic loosening, total complications, and reoperation rate. Study data were pooled using a random-effects model. RESULTS Six RCTs were included in the systematic review and meta-analysis. The mean follow-up period was 12 years (range, 2-16.6 years). Cementless TKA was associated with higher KSS-function (P < .0001), higher KSS-pain (P = .005), better ROM recovery (P = .01), and fewer radiolucent lines (<1 mm) (P = .04) compared with cemented TKA. No significant intergroup differences were observed for KSS-knee, total complications, aseptic loosening, or reoperation rate. These results based on a random-effects model were unchanged by sensitivity analysis assumptions. CONCLUSION Cementless TKA was substantially superior to cemented TKA in young patients. Although the complication and survival rates were similar between groups, better clinical outcomes were obtained with cementless fixation. Further well-designed studies with long follow-up durations are necessary to confirm our findings.
Collapse
|
19
|
Horsager K, Madsen F, Odgaard A, Fink Jepsen C, Rømer L, Kristensen PW, Kaptein BL, Søballe K, Stilling M. Similar polyethylene wear between cemented and cementless Oxford medial UKA: a 5-year follow-up randomized controlled trial on 79 patients using radiostereometry. Acta Orthop 2019; 90:67-73. [PMID: 30526183 PMCID: PMC6366473 DOI: 10.1080/17453674.2018.1543757] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hydroxyapatite (HA)-coated implants have been associated with high polyethylene wear in hip arthroplasties. HA coating as a promoter of wear in knee arthroplasties has not been investigated. We compared the wear-rate of the polyethylene bearing for cemented and cementless HA-coated Oxford medial unicondylar knee arthroplasties (UKA). Secondarily, we investigated whether wear-rates were influenced by overhang or impingement of the bearing. Patients and methods - 80 patients (mean age 64 years), treatment-blinded, were randomized to 1 of 3 Oxford medial UKA versions: cemented with double-pegged or single-pegged femoral component or cementless HA-coated with double-pegged femoral component (ratios 1:1:1). We compared wear between the cemented (n = 55) and cementless group (n = 25) (ratio 2:1). Wear, impingement, and overhang were quantified between surgery and 5-year follow-up using radiostereometry. Clinical outcome was evaluated with the Oxford Knee Score. Results - The mean wear-rate for patients without bearing overhang was 0.04 mm/year (95% CI 0.02-0.07) for the cemented group and 0.05 mm/year (CI 0.02-0.08) for the cementless group. The mean difference in wear was 0.008 mm/year (CI -0.04 to 0.03). No impingement was identified. Half of the patients had medial bearing overhang, mean 2.5 mm (1-5). Wear increased by 0.014 mm/year for each mm increment in overhang. The mean Oxford Knee Score was 39 for the cementless group and 38 for the cemented group at the 5-year follow-up. Interpretation - The wear-rates were similar for the 2 fixation methods, which supports further use of the cementless Oxford medial UKA. However, a caveat is a relatively large 95% CI of the mean difference in wear-rate. Component size and position is important as half of the patients presented with an additional increase in wear-rate due to medial bearing overhang.
Collapse
Affiliation(s)
- Kristian Horsager
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Frank Madsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Odgaard
- Department of Orthopaedics, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - Claus Fink Jepsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bart L Kaptein
- Department of Orthopedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, Netherlands
| | - Kjeld Søballe
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark
| |
Collapse
|
20
|
Haruta Y, Kawahara S, Tsuchimochi K, Hamasaki A, Hara T. Deviation of femoral intramedullary alignment rod influences coronal and sagittal alignment during total knee arthroplasty. Knee 2018; 25:644-649. [PMID: 29778655 DOI: 10.1016/j.knee.2018.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/18/2018] [Accepted: 04/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND An intramedullary (IM) rod is used to resect the distal femur vertically to the femoral mechanical axis in the coronal plane in many cases of total knee arthroplasties (TKA). The valgus angle between the mechanical axis and the anatomical axis of the distal femur is estimated preoperatively. It is known the deviation of the IM rod in the femoral canal could influence the femoral component alignment. However, there is no published data regarding how many degrees of deviation to make with the IM rod. The purpose of this study is to measure each deviation of the IM rod using three-dimensional (3D) computer simulations. METHODS Preoperative CT scans on 30 knees undergoing TKA were studied. The line connecting central points at 10 and 20 cm proximal from the intercondylar notch was defined as the anatomical axis and the point at which the anatomical axis intersects the surface of the distal femur was considered as the entry point of the IM rod. The medio-lateral (ML) and antero-posterior (AP) deviations between the anatomical axis and the IM rod were measured. RESULTS The ML and AP deviations were 0.8 and 1.1° on average. The IM rod was deviated medio-laterally more than 1.0° in three knees (10%). CONCLUSION Surgeons should note the ML difference of the resection thickness of the distal femur for coronal alignment. If the ML difference varies greatly from the preoperative planning, they need to adjust at most 1.0° of valgus angle to achieve the appropriate coronal alignment. Level of evidence III, Therapeutic.
Collapse
Affiliation(s)
- Yohei Haruta
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan
| | - Shinya Kawahara
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan.
| | - Kanenobu Tsuchimochi
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan
| | - Akihiko Hamasaki
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan
| | - Toshihiko Hara
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan
| |
Collapse
|
21
|
Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26:1811-1822. [PMID: 29185005 DOI: 10.1007/s00167-017-4817-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Due to the lack of comparative studies, a systematic review was conducted to determine revision rates of unicompartmental and total knee arthroplasty (UKA and TKA), and compare functional outcomes, range of motion and activity scores in patients less than 65 years of age. METHODS A literature search was performed using PubMed, Embase, and Cochrane systems since 2000. 27 UKA and 33 TKA studies were identified and included. Annual revision rate (ARR), functional outcomes, and return to activity were assessed for both types of arthroplasty using independent t tests. RESULTS Four level I studies, 12 level II, 16 level III, and 29 level IV were included, which reported on outcomes in 2224 UKAs and 4737 TKAs. UKA studies reported 183 revisions, yielding an ARR of 1.00 and extrapolated 10-year survivorship of 90.0%. TKA studies reported 324 TKA revisions, resulting in an ARR of 0.53 and extrapolated 10-year survivorship of 94.7%. Functional outcomes scores following UKA and TKA were equivalent, however, following UKA larger ROM (125° versus 114°, p = 0.004) and higher UCLA scores were observed compared to TKA (6.9 versus 6.0, n.s.). CONCLUSION These results show that good-to-excellent outcomes can be achieved following UKA and TKA in patients less than 65 years of age. A higher ARR was noted following UKA compared to TKA. However, improved functional outcomes, ROM and return to activity were found after UKA than TKA in this young population. Comparative studies are needed to confirm these findings and assess factors contributing to failure at the younger patient population. Outcomes of UKA and TKA in patients younger than 65 years are both satisfying, and therefore, both procedures are not contraindicated at younger age. UKA has several important advantages over TKA in this young and frequently more active population. LEVEL OF EVIDENCE IV.
Collapse
|
22
|
Miller AJ, Stimac JD, Smith LS, Feher AW, Yakkanti MR, Malkani AL. Results of Cemented vs Cementless Primary Total Knee Arthroplasty Using the Same Implant Design. J Arthroplasty 2018; 33:1089-1093. [PMID: 29275115 DOI: 10.1016/j.arth.2017.11.048] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although cemented total knee arthroplasty (TKA) continues to be the gold standard, there are patient populations with higher failure rates with cemented TKAs such as the obese, morbidly obese, and younger active males. Cementless TKA usage continues to increase because of the potential benefits of long-term biologic fixation similar to the rise in cementless total hip arthroplasty. The purpose of this study was to evaluate the clinical and radiographic results of cementless TKA using a novel highly porous cementless tibial baseplate. METHODS This was a retrospective matched case-control study of 400 primary TKAs comparing cementless vs cemented TKAs using the same implant design (Stryker Triathlon; Stryker Inc, Mahwah, NJ). Two-hundred patients with a mean age of 64 years (range 42-88 years) and body mass index (BMI) of 33.9 kg/m2 (range 19.7-57.1 kg/m2) were matched to 200 primary cemented TKA patients with a mean age of 64 years (range 43-87 years) and BMI of 33.1 kg/m2 (range 22.2-53.2 kg/m2). The mean follow-up in the cementless group was 2.4 years (range 2-3.5 years) and in the cemented group was 5.3 years (range 2-10.9 years). Clinical and radiographic analyses were evaluated. Statistical analysis was performed using the Microsoft Excel, version 15.21.1. RESULTS There was no statistical difference in age, BMI, and preoperative Knee Society Scores between the 2 groups (P = .22, P = .82, and P = .43, respectively). Patients in both groups had a similar incidence of postoperative complications (P = .90). Cementless group had 7 revisions with one aseptic loosening of the tibial component (0.5%). Cementless tibial baseplates demonstrated areas of increased bone density at the pegs of the tibial baseplate. The cemented group had 8 total revisions with 5 cases of aseptic loosening (2.5%). CONCLUSION Early results of cementless TKA using a highly porous tibial baseplate designed with a keel and 4 pegs appear promising with one case of aseptic loosening at minimum 2-year follow-up. As the demographics of patients undergoing TKA change to include younger, obese, and more active patients, along with increased life expectancy, the use of a highly porous cementless tibial baseplate may be beneficial in providing long-term durable biologic fixation similar to the success of cementless total hip arthroplasty.
Collapse
Affiliation(s)
- Adam J Miller
- University of Louisville School of Medicine, Louisville, Kentucky
| | | | | | - Anthony W Feher
- Franciscan Health Total Joint Reconstruction, Carmel, Indiana
| | | | - Arthur L Malkani
- Department of Orthopaedic Surgery, University of Louisville Adult Reconstruction Program, Louisville, Kentucky
| |
Collapse
|
23
|
Kim YH, Park JW, Kim JS. Comparison of High-Flexion Fixed-Bearing and High-Flexion Mobile-Bearing Total Knee Arthroplasties-A Prospective Randomized Study. J Arthroplasty 2018; 33:130-135. [PMID: 28844767 DOI: 10.1016/j.arth.2017.07.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is none, to our knowledge, about comparison of high-flexion fixed-bearing and high-flexion mobile-bearing total knee arthroplasties (TKAs) in the same patients. The purpose of this study was to determine whether clinical results; radiographic and computed tomographic scan results; and the survival rate of a high-flexion mobile-bearing TKA is better than that of a high-flexion fixed-bearing TKA. METHODS The present study consisted of 92 patients (184 knees) who underwent same-day bilateral TKA. Of those, 17 were men and 75 were women. The mean age at the time of index arthroplasty was 61.5 ± 8.3 years (range 52-65 years). The mean body mass index was 26.2 ± 3.3 kg/m2 (range 23-34 kg/m2). The mean follow-up was 11.2 years (range 10-12 years). RESULTS The Knee Society knee scores (93 vs 92 points; P = .531) and function scores (80 vs 80 points; P = 1.000), WOMAC scores (14 vs 15 points; P = .972), and UCLA activity scores (6 vs 6 points; P = 1.000) were not different between the 2 groups at 12 years follow-up. There were no differences in any radiographic and CT scan parameters between the 2 groups. Kaplan-Meier survivorship of the TKA component was 98% (95% confidence interval, 93-100) in the high-flexion fixed-bearing TKA group and 99% (95% confidence interval, 94-100) in the high-flexion mobile-bearing TKA group 12 years after the operation. CONCLUSION We found no benefit to mobile-bearing TKA in terms of pain, function, radiographic and CT scan results, and survivorship. Longer-term follow-up is necessary to prove the benefit of the high-flexion mobile-bearing TKA over the high-flexion fixed-bearing TKA.
Collapse
Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Centers, Ewha Womans University, SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Centers, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Centers, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
| |
Collapse
|
24
|
Kim YH, Park JW, Kim JS. 2017 Chitranjan S. Ranawat Award: Does Computer Navigation in Knee Arthroplasty Improve Functional Outcomes in Young Patients? A Randomized Study. Clin Orthop Relat Res 2018; 476:6-15. [PMID: 29389753 PMCID: PMC5919243 DOI: 10.1007/s11999.0000000000000000] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Proponents of computer-assisted TKA suggest that better alignment of the TKAs will lead to improved long-term patient functional outcome and survivorship of the implants. However, there is little evidence about whether the improved position and alignment of the knee components obtained using computer navigation improve patient function and the longevity of the TKA. QUESTIONS/PURPOSES The purpose of this study was to determine whether (1) clinical results; (2) radiographic and CT scan results; and (3) the survival rate of TKA components would be better in patients having computer-assisted TKA than results of patients having TKA without computer-assisted TKA. In addition, we determined whether (4) complication rates would be less in the patients with computer-assisted TKA than those in patients with conventional TKA. METHODS We performed a randomized trial between October 2000 and October 2002 in patients undergoing same-day bilateral TKA; in this trial, one knee was operated on using navigation, and the other knee was operated on without navigation. All 296 patients who underwent same-day bilateral TKA during that period were enrolled. Of those, 282 patients (95%) were accounted for at a mean of 15 years (range, 14-16 years). A total of 79% (223 of 282) were women and the mean age of the patients at the time of index arthroplasty was 59 ± 7 years (range, 48-64 years). Knee Society knee score, WOMAC score, and UCLA activity score were obtained preoperatively and at latest followup. Radiographic measurements were performed including femorotibial angle, position of femoral and tibial components, level of joint line, and posterior condylar offset. Aseptic loosening was defined as a complete radiolucent line > 1 mm in width around any component or migration of any component. Assessors and patients were blind to treatment assignment. RESULTS The Knee Society knee (92 ± 8 versus 93 ± 7 points; 95% confidence interval [CI], 92-98; p = 0.461) and function scores (80 ± 11 versus 80 ± 11 points; 95% CI, 73-87; p = 1.000), WOMAC score (14 ± 7 versus 15 ± 8 points; 95% CI, 14-18; p = 0.991), range of knee motion (128° ± 9° versus 127° ± 10°; 95% CI, 100-140; p = 0.780), and UCLA patient activity score (6 versus 6 points; 95% CI, 4-8; p = 1.000) were not different between the two groups at 15 years followup. There were no differences in any radiographic parameters of alignment (on radiography or CT scan) between the two groups. The frequency of aseptic loosening was not different between the two groups (p = 0.918). Kaplan-Meier survivorship of the TKA components was 99% in both groups (95% CI, 93-100) at 15 years as the endpoint of revision or aseptic loosening (p = 0.982). Anterior femoral notching was observed in 11 knees (4%) in the computer-assisted TKA group and none in the conventional TKA group (p = 0.046). CONCLUSIONS In this randomized trial, with data presented at a minimum of 14 years of followup, we found no benefit to computer navigation in TKA in terms of pain, function, or survivorship. Unless another study at long-term followup identifies an advantage to survivorship, pain, and function, we do not recommend the widespread use of computer navigation in TKA because of its risks (in this series, we observed femoral notching; others have observed pin site fractures) and attendant costs. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
MESH Headings
- Age Factors
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/instrumentation
- Arthroplasty, Replacement, Knee/methods
- Awards and Prizes
- Biomechanical Phenomena
- Female
- Humans
- Knee Joint/diagnostic imaging
- Knee Joint/physiopathology
- Knee Joint/surgery
- Knee Prosthesis
- Male
- Middle Aged
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Postoperative Complications/etiology
- Prosthesis Failure
- Range of Motion, Articular
- Recovery of Function
- Risk Factors
- Seoul
- Surgery, Computer-Assisted/adverse effects
- Surgery, Computer-Assisted/instrumentation
- Surgery, Computer-Assisted/methods
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
Collapse
Affiliation(s)
- Young-Hoo Kim
- Y.-H. Kim The Joint Replacement Center, Ewha Womans University, SeoNam Hospital, Seoul, Republic of Korea J.-W. Park, J.-S. Kim The Joint Replacement Center, MokDong Hospital, Seoul, Republic of Korea
| | | | | |
Collapse
|
25
|
Prudhon JL, Verdier R. Cemented or cementless total knee arthroplasty? - Comparative results of 200 cases at a minimum follow-up of 11 years. SICOT J 2017; 3:70. [PMID: 29232186 PMCID: PMC5726856 DOI: 10.1051/sicotj/2017046] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Since 1996 we have been using cementless fixation with hydroxyapatite (HA) coating. The purpose of this paper is to compare survivorship of a series of 100 cemented Total Knee Arthroplasty (TKA) to a similar series of 100 cementless with a follow up of 11-16 years. Material methods: Both TKA are mobile bearing total knee postero-stabilized. They can be used with cement or without cement. Among 1030 New Wave TKATM implanted from 2002 to 2015 we have identified 100 cemented TKAs and 100 cementless TKAs. All these cases were primary replacement. Differences in survival probability were determined using log-rank test. RESULTS Survival probabilities at 11 years of follow-up were: Cemented group: 90.2% CI95% [81.9-94.8]; Cementless group: 95.4% CI95% [88.1-98.2]. Comparison between both group showed significant difference, p = 0.32. DISCUSSION The advantages of cementless TKA are bone stock preservation, cement debris protection and the potential to achieve biologic fixation. Cementless implants rely on a porous or roughened surface to facilitate bone formation. HA has been shown to accelerate bone integration and to decrease micro motion of the components and to increase fixation. With a survival probability of 90.2% (cemented version) and 95.4% (cementless version), this total knee prosthesis performs as intended in primary total knee arthroplasty. No statistical differences could be found between cemented and cementless implants.
Collapse
Affiliation(s)
| | - Régis Verdier
- Groupe Lépine, 175 rue Jacquard, CS 50307, 69727 Genay Cedex, France
| |
Collapse
|
26
|
Singh A, Singh KK. Clinical Evaluation of Efficacy and Performance of All-Poly Tibial Freedom ® Total Knee System for Treating Osteoarthritis Patients: Three-Year Follow Up Study. J Clin Diagn Res 2017; 11:RC01-RC05. [PMID: 29207792 DOI: 10.7860/jcdr/2017/26418.10671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 07/22/2017] [Indexed: 11/24/2022]
Abstract
Introduction Advancement in technology in terms of design and building materials has made Total Knee Replacement (TKR) a highly effective, safe, and predictable orthopedic procedure. Aim To review the clinical outcomes for efficacy and performance of Freedom Total Knee System for the management of Osteoarthritis (OA), at a minimum of three years follow up. Materials and Methods For this retrospective, post-marketing study, clinical data of patients treated with Freedom Total Knee System was retrieved from the clinical records after approval from the Institutional Ethics Committee . All the patients above the age of 18 years who completed at least three years after TKR were observed for the study purpose. Patients treated for OA were included while the patients who received the implant for treatment of rheumatoid arthritis and traumatic injury were excluded. Factors such as aseptic loosening, implant failure, and need for revision surgery were observed to evaluate implant performance. Cases were recruited for clinical assessment of primary efficacy endpoint in terms of post-surgery maximun range of motion. Secondary efficacy endpoint was to determine the clinical and social quality of life as per the American Knee Society Score (AKSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores. Results A total of 158 patients who had 191 TKR were observed for performance. The mean age of the patients was 67.67 years; mean BMI was 28.97±3.33, and the group comprised of 43% men and 57% women. Telephonic follow up at three years of 158 patients identified that none of them required revision surgery or had aseptic loosening suggesting excellent performance. Final clinical follow up at three years was available for only 35 patients (41 knee implants). The range of motion significantly improved from preoperative 104°±5.67° (range, 85°-119°) to 119.8°±11.05° (98°-123°) at follow-up (p<0.05). There was a significant improvement in clinical and functional AKSS score and WOMAC score at follow-up. Conclusion The evaluation of Freedom Total Knee System for TKR in treating OA, at a minimum of three years follow up showed excellent outcomes in terms of performance, range of motion, reduced postoperative stiffness and pain, and improved functionality.
Collapse
Affiliation(s)
- Avatar Singh
- Head, Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Kanwar Kulwinder Singh
- Senior Consultant, Department of Orthopaedic and Rheumatology, Amandeep Hospital, Amritsar, Punjab, India
| |
Collapse
|
27
|
Mont MA, Gwam C, Newman JM, Chughtai M, Khlopas A, Ramkumar PN, Harwin SF. Outcomes of a newer-generation cementless total knee arthroplasty design in patients less than 50 years of age. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:S24. [PMID: 29299471 DOI: 10.21037/atm.2017.08.20] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Younger patients undergoing cemented total knee arthroplasty (TKA) may be at risk for lower implant survivorship and higher revision rates due to the historical increased prevalence of aseptic loosening and instability in this cohort. The recent advances of cementless TKAs may mitigate some of these complications. However, there is a paucity of studies reporting on patients who are under 50 years who have undergone a cementless TKA. Therefore, this study evaluated: (I) implant survivorship; (II) functional outcomes and complications; and (III) radiographic outcomes in patients who were less than 50 years of age and underwent cementless TKA. Methods A total of 29 patients (31 knees) younger than 50 years who underwent primary TKA at a single institution (Mount Sinai Beth Israel, New York, New York, USA) from June 2008 to May 2014 were included. Their mean follow-up was 4 years (range, 2 to 6 years). The cohort included 20 women and 9 men who had a mean age of 45 years (range, 34 to 49 years), and a mean body mass index (BMI) of 33 kg/m2 (range, 22 to 54 kg/m2). The preoperative knee diagnoses were osteoarthritis (n=24), osteonecrosis (n=5), and rheumatoid arthritis (n=2). A Kaplan-Meier analysis was used to calculate the all cause implant survivorship. Functional outcomes and all complications were recorded for each patient. Additionally, radiographic evaluation using the new Knee Society Radiographic Evaluation and Scoring System was performed. Results The overall implant survivorship was 100%; there were no failures or revision surgeries performed as of the latest follow-up visit. At the latest follow-up, the mean Knee Society pain score was 92 points (range, 80 to 95 points) and the mean Knee Society function score was 84 points (range, 70 to 90 points). Additionally, the mean knee extension was 1 degree (range, 0 to 5 degrees) and the mean knee flexion was 125 degrees (range, 95 to 140 degrees). Furthermore, at the latest follow-up, on radiographic evaluation, there was no evidence of component loosening, subsidence, radiolucency, gap formation, or reactive changes, and there were no postoperative complications. Conclusions Cementless fixation of TKAs had excellent survivorship and functional and radiographic outcomes at midterm follow-up in patients younger than 50 years. Although longer follow-up is needed, these cementless TKA implants appear to provide promising results in younger patient populations.
Collapse
Affiliation(s)
- Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chukwuweike Gwam
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Jared M Newman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Prem N Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven F Harwin
- Center for Reconstructive Joint Surgery, Mount Sinai Beth Israel, New York, New York, USA
| |
Collapse
|
28
|
Bilgen MS, Eken G, Guney N. Short-term results of the management of severe bone defects in primary TKA with cement and K-wires. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:388-392. [PMID: 28768575 PMCID: PMC6197322 DOI: 10.1016/j.aott.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 11/24/2022]
Abstract
Objective The aim of this study was to evaluate the results of cement and kirschner wire augmentation in the management of bone defects in primary TKA. Methods Twenty-four patients (10 male, 14 female; mean age: 66 years) with uncontained unilateral medial tibial articular bone defect who underwent TKA between 2010 and 2014 were included in this study. The average follow up time was 33.7 months. Patients were divided to two groups according to the size of the bone defect (Group 1: <20 mm, Group 2: >20 mm). The tibial defect was reconstructed by using cement and K-wires. We used posterior stabilized prosthesis with no tibial stem extension. Results The preoperative and postoperative lower extremity mechanical axis in Group I was in a mean varus of 15° and mean varus of 3°, respectively (p < 0.001). The preoperative and postoperative lower extremity mechanical axis in Group 2 was in a mean varus of 20° and mean varus of 3° respectively in Group II (p < 0.001). None of the patients neither suffered from failure of K-wires nor loosening. Conclusion The use of cement and K-wires augmentation appears to be a simple and cost-effective treatment option for the tibial bone defects in primary TKA. Level of evidence Level IV, Therapeutic study.
Collapse
|
29
|
Good long-term results following cementless TKA with a titanium plasma coating. Knee Surg Sports Traumatol Arthrosc 2017; 25:2801-2808. [PMID: 26334884 DOI: 10.1007/s00167-015-3769-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE While cemented total knee arthroplasty (TKA) is currently the gold standard for primary osteoarthritis, cementless component fixation has achieved increasingly comparable outcomes due to improvements in both implant designs and surgical technique. Long-term outcomes and survivorship with the TC-Plus cementless, titanium plasma-coated TKA system without patella resurfacing were evaluated. METHODS A homogenous population of 171 consecutive patients who received 206 primary TC-Plus TKAs without patella resurfacing over a 19-year period was retrospectively reviewed. Knee Society Clinical Rating System (KSCRS) scores were obtained, and radiographic evaluation was performed after a mean follow-up of 13.2 ± 8.4 years. Survivorship analysis was made with endpoints revision for any reason and aseptic loss of biological fixation. RESULTS One hundred and thirty-six TKAs implanted in 113 patients were available for analysis. Mean KSCRS clinical and functional scores improved significantly versus preoperative values. No radiological loss of biological fixation of femoral and tibial components was observed. Survival with aseptic revision of any component as the endpoint was 95.7 % (95 % confidence interval (CI) 91.7-97.9 %) and 93.6 % (95 % CI 87.8-96.6 %) at 10 and 15 years, respectively. CONCLUSION Titanium plasma-coated cementless TKA without patella resurfacing showed excellent long-term results, with high 10- and 15-year component survival rates. The clinical and radiological results were comparable to those of other cementless TKAs, providing further evidence for the non-cemented resurfacing of the osteoarthritic knee. LEVEL OF EVIDENCE IV.
Collapse
|
30
|
Total Knee Arthroplasty for Osteoarthritis in Patients Less Than Fifty-Five Years of Age: A Systematic Review. J Arthroplasty 2017; 32:2598-2603.e1. [PMID: 28456563 DOI: 10.1016/j.arth.2017.02.069] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/09/2017] [Accepted: 02/22/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The proportion of younger patients undergoing total knee arthroplasty (TKA) is increasing and predictions state that the <55 age group will be the fastest growing group by 2030. We aim to collate data across studies to assess functional outcomes following TKA in patients <55 years of age using a systematic review. METHODS The search identified 980 studies for title and abstract review. Forty-three full texts were then assessed. Thirteen studies underwent quality assessment and data extraction. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed throughout. Outcomes extracted included pre-operative and post-operative functional scores, range of motion, and patient satisfaction. Clinical complications and survival were also recorded. RESULTS Across 13 studies we were able to demonstrate 54-point improvement in clinical Knee Society Score and a 46-point improvement on functional Knee Society Score. A 2.9° improvement in range of motion was found at final follow-up. Satisfaction rate was 85.5%. Cumulative percentage all-cause revision rate was 5.4% across 1283 TKAs at a mean 10.8 years of follow-up. Ten-year survival, for aseptic loosening alone, was 98.2%. CONCLUSION TKA is an excellent treatment option for the young osteoarthritic knee with a >50% improvement in functional knee scores. Satisfaction is high and the revision rate remains 0.5% per year.
Collapse
|
31
|
Goh GSH, Liow MHL, Bin Abd Razak HR, Tay DKJ, Lo NN, Yeo SJ. Patient-Reported Outcomes, Quality of Life, and Satisfaction Rates in Young Patients Aged 50 Years or Younger After Total Knee Arthroplasty. J Arthroplasty 2017; 32:419-425. [PMID: 27593732 DOI: 10.1016/j.arth.2016.07.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/19/2016] [Accepted: 07/14/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recent studies have shown a discrepancy between traditional functional outcomes and patient satisfaction, with some reporting less than 85% satisfaction in older patients undergoing total knee arthroplasty (TKA). As native knee biomechanics are not completely replicated, the resulting functional limitations may cause dissatisfaction in higher-demand individuals. Few studies have recorded patient-reported outcomes, health-related quality of life scores, and patient satisfaction in a young population undergoing TKA. METHODS One hundred thirty-six primary TKAs were performed in 114 patients aged 50 years or younger (mean age, 47.0 years; range, 30-50 years) at a single institution. The main diagnoses were osteoarthritis (85%) and rheumatoid arthritis (10%). RESULTS The range of motion, Knee Society Score, Oxford Knee Score, and Physical and Mental Component Scores of Short Form-36 increased significantly (P < .001). At 2 years, 85.3% of patients had good/excellent knee scores, 71.3% had good/excellent function scores, 94.9% met the minimal clinically important difference for the Oxford Knee Score, and 84.6% met the minimal clinically important difference for the Physical Component Score. We found that 88.8% of patients were satisfied with their surgeries, whereas 86.8% had their expectations fulfilled. Survivorship using revision as an end point was 97.8% at a mean of 7 years (range, 3-16 years). CONCLUSION Patients aged 50 years or younger undergoing TKA can experience significant improvements in their quality of life, have their expectations met, and be satisfied with their surgeries, at rates similar to those of non-age-restricted populations. Surgeons should inform them of these benefits and the potential risk of revision surgery in the future, albeit increasingly shown to be low.
Collapse
Affiliation(s)
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
32
|
Bianchi G, Sambri A, Sebastiani E, Caldari E, Donati D. Is unicondylar osteoarticular allograft still a viable option for reconstructions around the knee? Knee 2016; 23:692-7. [PMID: 27156870 DOI: 10.1016/j.knee.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/27/2016] [Accepted: 03/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicondylar osteoarticular allografts (UOAs) represent a possible technique for reconstructing massive bone defects around the knee when only one condyle is affected. The aim of this retrospective study is to evaluate the outcome of UOAs and describe the possible salvage procedures in case of graft failure. METHODS Twenty-five deep-frozen UOAs were implanted at Rizzoli Orthopedic Institute (Bologna, Italy). Twenty-two followed bone tumor resection, two cases were post-traumatic defects and one case followed UOA failure. Mean age at surgery was 33years (range: 15 to 63). Eighteen UOAs were in distal femur, seven in proximal tibia. RESULTS Three patients died (only one because of the tumor). One UOA was removed for chondrosarcoma relapse and one for allograft fracture. Mean overall survival with UOA failure as a primary endpoint was 129months (range 12 to 302), with differences in the femur (85%) and in the tibia (40%) at 150months. Six UOAs had to be converted into knee prostheses due to osteoarthritis after a mean follow-up of 146months. No complications were recorded in UOAs converted into knee prostheses after a mean three year follow-up. Fourteen patients with UOAs still in place at the last follow-up (mean 123months) were radiologically and functionally evaluated: no correlation was found between function and the degree of osteoarthritis. CONCLUSIONS In selected cases, UOAs offer good clinical results and postpone the need for knee prosthesis. Despite short-term encouraging results, longer-term follow-up is needed in order to evaluate the outcome of knee prosthesis after UOA.
Collapse
Affiliation(s)
- Giuseppe Bianchi
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy
| | - Andrea Sambri
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy.
| | - Elisa Sebastiani
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy
| | - Emilia Caldari
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy
| | - Davide Donati
- Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy
| |
Collapse
|
33
|
Abstract
As the number of younger and more active patients treated with total knee arthroplasty (TKA) continues to increase, consideration of better fixation as a means of improving implant longevity is required. Cemented TKA remains the reference standard with the largest body of evidence and the longest follow-up to support its use. However, cementless TKA, may offer the opportunity of a more bone-sparing procedure with long lasting biological fixation to the bone. We undertook a review of the literature examining advances of cementless TKA and the reported results. Cite this article: Bone Joint J 2016;98-B:867–73.
Collapse
Affiliation(s)
- D. F. Dalury
- University of Maryland St. Joseph Medical
Center, Towson Orthopaedic Associates, Ruxton
Professional Center, 8322 Bellona Avenue, Suite
100, Towson, MD, 21204, USA
| |
Collapse
|
34
|
Motififard M, Pesteh M, Etemadifar MR, Shirazinejad S. Causes and rates of revision total knee arthroplasty: Local results from Isfahan, Iran. Adv Biomed Res 2015; 4:111. [PMID: 26261813 PMCID: PMC4513314 DOI: 10.4103/2277-9175.157829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 12/16/2014] [Indexed: 01/17/2023] Open
Abstract
Background: Knee replacement is one of the most frequently performed surgical procedures in the world. Local data on revision total knee arthroplasty (TKA) are limited. This study aims to assess the rates and causes of revision TKA in Kashani Hospital (Isfahan, Iran) from 2011 to 2013. Materials and Methods: We assessed all primary TKA and revision TKA procedures performed from 2011 to 2013 for the rate and causes of failures. Demographic data, duration from primary TKA to revision TKA and underlying diagnosis for primary TKA were also assessed. Results: Overall, 353 primary TKA procedures carried out in this period. The overall revisions following primary TKA in this period was 24 cases, indicating a revision burden of 6.8%. The most common cause of revision TKA was infection, which was in 16 cases (44.4%). Other causes included patellar complications, mechanical loosening of both tibia and femur, mechanical loosening of tibia, instability, and periprosthetic fracture. The main revision procedures were all component revision, tibial component revision, isolated tibial insert exchange and patellar tendon repair. The most common revision procedure was two stage all component revision, which was carried out in 13 subjects (36.1%). Conclusion: Local indications for revision TKA are mainly similar to those in other large centers. As compared with other centers, with considering the follow-up time, revision burden is relatively higher in this center.
Collapse
Affiliation(s)
- Mehdi Motififard
- Department of Orthopedy, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohamad Pesteh
- Department of Orthopedy, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Etemadifar
- Department of Orthopedy, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Shirazinejad
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
35
|
Lunebourg A, Parratte S, Gay A, Ollivier M, Garcia-Parra K, Argenson JN. Lower function, quality of life, and survival rate after total knee arthroplasty for posttraumatic arthritis than for primary arthritis. Acta Orthop 2015; 86:189-94. [PMID: 25350612 PMCID: PMC4404769 DOI: 10.3109/17453674.2014.979723] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Total knee arthroplasty (TKA) for treatment of end-stage posttraumatic arthritis (PTA) has specific technical difficulties and complications. We compared clinical outcome, postoperative quality of life (QOL), and survivorship after TKA done for PTA with those after TKA performed for primary arthritis (PA). PATIENTS AND METHODS We retrospectively reviewed patients who were operated on at our institution for PTA between 1998 and 2005 (33 knees), and compared them to a matched group of patients who were operated on for PA during the same period (407 knees). Clinical outcomes and postoperative QOL were compared in the 2 groups using Knee Society score (KSS), range of motion (ROM) of the knee, and the knee osteoarthritis outcomes score (KOOS). Implant survival rate was calculated using Kaplan-Meier analysis. RESULTS At a mean follow-up of 11 (5-15) years, KSS knee increased from mean 39 (SD 18) to 87 (SD 16) in the PA group (p = 0.003), and from 31 (SD 11) to 77 (SD 15) in the PTA group (p = 0.003). KSS function increased from 55 (12) to 89 (25) in the PA group (p = 0.008) and from 44 (SD 14) to 81 (SD 10) in the PTA group (p = 0.008). Postoperative ROM also improved in both groups, from 83° to 108° in the PTA group (p < 0.001) as opposed to 116° to 127° in the PA group (p = 0.001), with lower results in the PTA group (p < 0.001). KOOS was lower in the PTA group (p < 0.001). The survival rate of TKA at 10 years with an endpoint defined as "any surgery on the operated knee" showed better results in the PA group (99%, CI: 98-100 vs. 79%, CI: 69-89; p < 0.001). INTERPRETATION Patients and surgeons should be aware that clinical outcome and implant survival after TKA for PTA are lower than after TKA done for PA.
Collapse
Affiliation(s)
- Alexandre Lunebourg
- Department of Orthopedic Surgery APHM, IML, Sainte Marguerite Hospital,Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Sebastien Parratte
- Department of Orthopedic Surgery APHM, IML, Sainte Marguerite Hospital,Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - André Gay
- Department of Plastic Surgery APHM, IML, Sainte Marguerite Hospital,Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopedic Surgery APHM, IML, Sainte Marguerite Hospital,Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | | | - Jean-Noël Argenson
- Department of Orthopedic Surgery APHM, IML, Sainte Marguerite Hospital,Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| |
Collapse
|
36
|
Long WJ, Bryce CD, Hollenbeak CS, Benner RW, Scott WN. Total knee replacement in young, active patients: long-term follow-up and functional outcome: a concise follow-up of a previous report. J Bone Joint Surg Am 2014; 96:e159. [PMID: 25232089 DOI: 10.2106/jbjs.m.01259] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Concern exists regarding the long-term durability and effectiveness of total knee arthroplasty in young patients. We reviewed our experience with total knee arthroplasty in patients fifty-five years old and younger with severe osteoarthritis to determine the long-term outcomes. One hundred and fourteen total knee arthroplasties were performed in eighty-eight patients at an average patient age of fifty-one years. Clinical outcomes, survival analysis, and radiographs were all reviewed at the most recent follow-up. One hundred and eight knees (eighty-four patients) were followed up from May 2011 to 2012. At thirty years, survivorship without revision for any cause was 70.1% (twenty-five revisions) and survivorship with failure defined as aseptic revision of the tibial or femoral components was 82.5%. At thirty years, a significant difference existed in the survivorship free from tibial or femoral aseptic revision (p = 0.003) between the non-modular Insall-Burstein I component (92.3%) and the modular Insall-Burstein II component (68.3%). All patients were evaluated at an average time from the index total knee arthroplasty to the latest follow-up of 25.1 years (range, twenty to thirty-five years). Clinical evaluation was obtained in thirty-six patients with forty-five total knee arthroplasties. The average Hospital for Special Surgery score had improved from 57.9 points preoperatively to 85.3 points. The average Knee Society score was 87.4 points and the average Knee Society functional score was 62.1 points; the average knee motion was 110°. The mean Tegner and Lysholm activity score improved from 1.5 points preoperatively to 3.0 points. Radiographic review of forty-two knees that had undergone total knee arthroplasty demonstrated a mean 3.2° of valgus, with no cases of radiographically loose components. Total knee arthroplasty with use of a cemented posterior stabilized system, particularly a non-modular Insall-Burstein I design, was an effective treatment option with durable results for end-stage symptomatic osteoarthritis in this young cohort. These data should provide comparison for modern total knee arthroplasties and alternative procedures in young patients.
Collapse
Affiliation(s)
- William J Long
- Insall Scott Kelly Institute, 210 East 64th Street, New York, NY 10065. E-mail address for W.J. Long: . E-mail address for W.N. Scott:
| | - Christopher D Bryce
- Mezona Orthopaedic, Canyon Springs Medical Plaza, 2940 East Banner Gateway Drive, Suite 200, Gilbert, AZ 85234. E-mail address:
| | | | - Rodney W Benner
- The Shelborne Knee Center, 1815 North Capitol Avenue, Suite 600, Indianapolis, IN 46202. E-mail address:
| | - W Norman Scott
- Insall Scott Kelly Institute, 210 East 64th Street, New York, NY 10065. E-mail address for W.J. Long: . E-mail address for W.N. Scott:
| |
Collapse
|
37
|
Similar survival between screw cementless and cemented tibial components in young patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2014; 22:1585-90. [PMID: 23135413 DOI: 10.1007/s00167-012-2291-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/29/2012] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to compare the outcomes of tibial fixation with either a cemented or cementless with screw augmentation component in young patients with non-inflammatory arthritis. METHODS Ninety-three patients aged 55 or younger with non-inflammatory arthritis were randomized to compare outcomes between cemented tibial fixation (48 patients) and cementless fixation with screw augmentation (45 patients). The femoral component was cementless in both groups. Post-operative evaluation was assessed by the clinical and radiological criteria of The Knee Society and WOMAC questionnaire. RESULTS The median follow-up was 6.7 (5-12) years. Significant differences were found for knee score (p = 0.02), range of motion (p = 0.04), and WOMAC score (p = 0.03). In the cemented group, there was one deep wound infection, four tibial aseptic loosening, and one polyethylene wear, all of which were revised. In the cementless group there was one tibial aseptic loosening and one polyethylene wear, both being revised. There was no difference in revision rate, and the cumulative survival at 9-year for aseptic reason was 93.7 % (95 % CI, 82-100 %) in the cementless group and 90.0 % (95 % CI, 80-100 %) in the cemented group (n.s.). CONCLUSIONS Cementless total knee arthroplasty was found to be a reliable option in younger patients with osteoarthritis. Although the revision rate and survival were similar in both groups, better clinical outcomes were obtained with cementless tibial components.
Collapse
|
38
|
Sun ZH, Liu YJ, Li H. Femoral stress and strain changes post-hip, -knee and -ipsilateral hip/knee arthroplasties: a finite element analysis. Orthop Surg 2014; 6:137-44. [PMID: 24890296 DOI: 10.1111/os.12105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/19/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To identify the optimal ratio of free femur for minimizing the risks of periprosthetic fracture. METHODS Three dimensional models of the femur with hip and knee stem elongation were constructed. With the distal femoral condylar surface fixed in a three dimensional model, the femoral head loading was performed according to the methods described by Huiskes and van Rietbergen in the models of hip replacement, knee replacement with or without hip stem or knee stem elongation. The maximum principal stress (MPS) and maximum principal elastic strain (MPES) of the femur were recorded and their relationships to the free femur ratio were analyzed using Pearson's correlation analysis. RESULTS There were no obvious changes in MPS and MPES with hip stem elongation from 100 to 180 mm. In ipsilateral hip and knee replacement, the MPS and MPES had a tendency to decrease with knee and hip stem elongation. The MPS and MPES were mainly located in the anterior medial side of the middle to distal femur post-hip replacement and distalized with stem elongation. When the knee stem had been elongated more than 120 mm, the stress and strain concentrated strongly in the middle of the femoral shaft. There was a positive correlation between MPS and MPES to the free femur ratio (P < 0.01); however, no optimal ratio of free femur that would minimize the risks of periprosthetic fracture was identified. CONCLUSION Positive correlations were found between implant free femur and stress and strain changes in total knee arthroplasty, total hip arthroplasty and ipsilateral hip and knee replacement.
Collapse
Affiliation(s)
- Zhen-hui Sun
- Center for Joint Diseases, Tianjin People's Hospital, Tianjin, China
| | | | | |
Collapse
|
39
|
Keeney JA, Nunley RM, Wright RW, Barrack RL, Clohisy JC. Are younger patients undergoing TKAs appropriately characterized as active? Clin Orthop Relat Res 2014; 472:1210-6. [PMID: 24249533 PMCID: PMC3940741 DOI: 10.1007/s11999-013-3376-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 11/01/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of TKAs in young patients is increasing. Demographic characteristics and activity levels among this patient group may affect implant selection, performance, and survivorship. Patient age (≤ 55 years) and preoperative diagnosis have been used to define this patient group, with the presumption that these patients are more active than older patients with similar indications for TKA. QUESTIONS/PURPOSES We questioned whether (1) demographic features of young patients support high activity expectations after TKA, and (2) preoperative or postoperative functional activity measures support projections that young patients are active after TKA. METHODS We retrospectively compared demographic characteristics (gender, BMI, diagnosis) and functional activity profile (as determined by preoperative and postoperative UCLA activity score and functional subscores of The Knee Society and WOMAC instruments) for 150 patients 55 years old or younger (181 TKAs) and 262 patients who were between 65 to 75 years old (314 TKAs) at the time of surgery. RESULTS Younger patients having TKAs were significantly more likely than older patients to be female (74% versus 60%, p < 0.001) and to have diagnoses other than osteoarthritis (18% versus 3%, p < 0.001). BMI was significantly greater among younger female patients than among other age and gender combinations (35 kg/m(2) versus 31 kg/m(2), p < 0.001). Male patients had higher mean postoperative UCLA activity scores (5.5 versus 4.4, p < 0.001), Knee Society function subscores (80.2 versus 66.4, p < 0.001), and WOMAC function subscores (82.8 versus 74.2, p < 0.01) compared with female patients, but these were not different in older versus younger patients. CONCLUSIONS Sustained high activity levels are not likely to be a principal cause of revision TKAs among younger patients when considering age and diagnosis alone. Determining the effect of activity on survivorship of prosthetic designs and techniques should be based on measured functional activity instead of using age and diagnosis as surrogates for activity. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- James A. Keeney
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid, CB 8233, St Louis, MO 63110 USA
| | - Ryan M. Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid, CB 8233, St Louis, MO 63110 USA
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid, CB 8233, St Louis, MO 63110 USA
| | - Robert L. Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid, CB 8233, St Louis, MO 63110 USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid, CB 8233, St Louis, MO 63110 USA
| |
Collapse
|
40
|
Minimally invasive total knee arthroplasty; a pragmatic randomised controlled trial reporting outcomes up to 2 year follow up. Knee 2014; 21:189-93. [PMID: 23972565 DOI: 10.1016/j.knee.2013.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 06/25/2013] [Accepted: 07/25/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND We present a prospective, randomised, multi-surgeon, controlled trial comparing minimally invasive (MIS) and standard approach total knee arthroplasty (TKA). METHODS Participants underwent unilateral TKA. Patients were randomised to Bristol, quadriceps sparing MIS or standard medial parapatellar approaches. Length of stay with secondary outcome measures including knee range of movement, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) and American Knee Society Score (KSS) up to 2 years. Radiographic and post operative assessment was blinded. RESULTS 86 patients (92 knees) participated in the study. Mean operative time between MIS and control groups was 95.5 (95% CI 90.0-101.0) and 94.8 (95% CI 88.2-101.4) minutes respectively. Mean readiness for discharge was shorter in the MIS group 4.5±1.5 (95% CI, 4.1-4.9) days versus 5.9±2.7 (95% CI, 5.1-6.7) days amongst controls (p=0.004). Patients in the MIS group had fewer complications (p=0.003). One patient developed a deep vein thrombosis (DVT) and one required revision surgery, both in the control group. 83 patients completed follow up to 2 years (40 MIS, 43 controls). Range of movement and other outcome measures improved up to 1 year post-operatively with no statistically significant differences between MIS and controls. We found no evidence of radiographic loosening in either group at the 2 year follow up. CONCLUSIONS MIS offers reduced length of stay and fewer complications for patients following TKR without evidence of component mal-alignment. Our findings of fewer systemic complications in MIS TKR patients warrant further future study. LEVEL OF EVIDENCE Level 1.
Collapse
|
41
|
Abstract
As a result of reading this article, physicians should be able to :1. Understand the rationale behind using uncemented fixation in total knee arthroplasty.2.Discuss the current literature comparing cemented and uncemented total knee arthroplasty3. Describe the value of radiostereographic analysis in assessing implant stability.4. Appreciate the limitations in the available literature advocating 1 mode of fixation in total knee arthroplasty. Total knee arthroplasty performed worldwide uses either cemented, cementless, or hybrid (cementless femur with a cemented tibia) fixation of the components. No recent literature review concerning the outcomes of cemented vs noncemented components has been performed. Noncemented components offer the potential advantage of a biologic interface between the bone and implants, which could demonstrate the greatest advantage in long-term durable fixation in the follow-up of young patients undergoing arthroplasty. Several advances have been made in the backing of the tibial components that have not been available long enough to yield long-term comparative follow-up studies. Short-term radiostereographic analysis studies have yielded differing results. Although long-term, high-quality studies are still needed, material advances in biologic fixation surfaces, such as trabecular metal and hydroxyapatite, may offer promising results for young and active patients undergoing total knee arthroplasty when compared with traditional cemented options.
Collapse
Affiliation(s)
- Thomas E Brown
- Division of Adult Reconstruction, Department of Orthopaedics, University of Virginia, Charlottesville, Virginia 22903, USA.
| | | | | |
Collapse
|
42
|
Drexler M, Dwyer T, Marmor M, Abolghasemian M, Sternheim A, Cameron HU. Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams - opposes. ACTA ACUST UNITED AC 2013; 94:85-9. [PMID: 23118390 DOI: 10.1302/0301-620x.94b11.30827] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this study we present our experience with four generations of uncemented total knee arthroplasty (TKA) from Smith & Nephew: Tricon M, Tricon LS, Tricon II and Profix, focusing on the failure rates correlating with each design change. Beginning in 1984, 380 Tricon M, 435 Tricon LS, 305 Tricon 2 and 588 Profix were implanted by the senior author. The rate of revision for loosening was 1.1% for the Tricon M, 1.1% for the Tricon LS, 0.5% for the Tricon 2 with a HA coated tibial component, and 1.3% for the Profix TKA. No loosening of the femoral component was seen with the Tricon M, Tricon LS or Tricon 2, with no loosening seen of the tibial component with the Profix TKA. Regarding revision for wear, the incidence was 13.1% for the Tricon M, 6.6% for the Tricon LS, 2.3% for the Tricon 2, and 0% for the Profix. These results demonstrate that improvements in the design of uncemented components, including increased polyethylene thickness, improved polyethylene quality, and the introduction of hydroxyapatite coating, has improved the outcomes of uncemented TKA over time.
Collapse
Affiliation(s)
- M Drexler
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Holland Orthopaedic & Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario M4Y 1H1, Canada.
| | | | | | | | | | | |
Collapse
|
43
|
Williams DP, Price AJ, Beard DJ, Hadfield SG, Arden NK, Murray DW, Field RE. The effects of age on patient-reported outcome measures in total knee replacements. Bone Joint J 2013; 95-B:38-44. [PMID: 23307671 DOI: 10.1302/0301-620x.95b1.28061] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a comparison of patient-reported outcomes (PROMs) in relation to patient age, in patients who had received a total (TKR) or unicompartmental knee replacement (UKR). The outcome was evaluated using the Oxford knee score (OKS), EuroQol (EQ-5D) and satisfaction scores. Patients aged 65 to 84 years demonstrated better pre-operative function scores than those aged < 65 years (OKS, p = 0.03; EQ-5D, p = 0.048) and those aged ≥ 85 years (OKS, p = 0.03). Post-operative scores were comparable across age groups, but a linear trend for greater post-operative improvement in OKS and EQ-5D was seen with decreasing age (p < 0.033). The overall mean satisfaction score at six months was 84.9, but those aged < 55 years exhibited a lower mean level of satisfaction (78.3) compared with all other age groups (all p < 0.031). The cumulative overall two-year revision rate was 1.3%. This study demonstrates that good early outcomes, as measured by the OKS and EQ-5D, can be anticipated following knee replacement regardless of the patient's age, although younger patients gain greater improvement. However, the lower satisfaction in those aged < 55 years is a concern, and suggests that outcome is not fully encapsulated by the OKS and EQ-5D evaluation, and raises the question whether the OKS alone is an appropriate measure of pain and function in younger, more active individuals.
Collapse
Affiliation(s)
- D P Williams
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Windmill Road, Oxford OX3 7LD, UK.
| | | | | | | | | | | | | |
Collapse
|
44
|
Long-term results of Alpina Postero-stabilized total knee replacement: 10- to 16-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 22:695-701. [PMID: 27526072 DOI: 10.1007/s00590-011-0903-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 10/26/2011] [Indexed: 10/15/2022]
Abstract
One hundred and ninety-four primary knee arthroplasties were done between 1992 and 1998 with Alpina Postero-Stabilized prosthesis. Eighty-eight knees were available for the long-term follow-up at a mean of 12 years. The mean IKS score improved from 103.1 ± 21.9 points preoperatively to 161.5 ± 25.6 at the latest follow-up (P < 0.001). Eighty-four percent of the knees were rated good and excellent. The mean flexion significantly improved from 110° preoperatively to 117.5° at the latest follow-up (P < 0.001). Two knees were revised: 1 due to infection and 1 due to femorotibial malalignment. Eight other knees were revised: 7 for isolated patella addition, 1 for patella replacement. Excluding patella failure, the 12-year Kaplan-Meier survivorship for the entire cohort was 98.8 (95% CI, 97.2-100%). Alpina Postero-Stabilized TKA showed good long-term results.
Collapse
|
45
|
Melton JTK, Mayahi R, Baxter SE, Facek M, Glezos C. Long-term outcome in an uncemented, hydroxyapatite-coated total knee replacement. ACTA ACUST UNITED AC 2012; 94:1067-70. [DOI: 10.1302/0301-620x.94b8.28350] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A consecutive series of patients with a hydroxyapatite-coated uncemented total knee replacement (TKR) performed by a single surgeon between 1992 and 1995 was analysed. All patients were invited for clinical review and radiological assessment. Revision for aseptic loosening was the primary outcome. Assessment was based on the Knee Society clinical score (KSS) and an independent radiological analysis. Of 471 TKRs performed in 356 patients, 432 TKRs in 325 patients were followed for a mean of 16.4 years (15 to 18). The 39 TKRs in 31 patients lost to follow-up had a mean KSS of 176 (148 to 198) at a mean of ten years. There were revisions in 26 TKRs (5.5%), of which 11 (2.3%) were for aseptic loosening. Other further surgery was carried out on 49 TKRs (10.4%) including patellar resurfacing in 20, arthrolysis in 19, manipulation under anaesthetic in nine and extensor mechanism reconstruction in one. Survivorship at up to 18 years without aseptic loosening was 96% (95% confidence interval 91.9 to 98.1), at which point the mean KSS was 176 (134 to 200). Of 110 knees that underwent radiological evaluation, osteolysis was observed in five (4.5%), one of which was revised. These data indicate that uncemented hydroxyapatite-coated TKR can achieve favourable long-term survivorship, at least as good as that of cemented designs.
Collapse
Affiliation(s)
| | - R. Mayahi
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - S. E. Baxter
- Notre Dame Medical School, 160
Oxford Street, Darlinghurst, Sydney, New
South Wales 2010, Australia
| | - M. Facek
- Australian Institute of Musculoskeletal
Research, Unit 2/12 Fredrick Street, St Leonards, Sydney, New
South Wales, Australia
| | | |
Collapse
|
46
|
Bercovy M, Beldame J, Lefebvre B, Duron A. A prospective clinical and radiological study comparing hydroxyapatite-coated with cemented tibial components in total knee replacement. ACTA ACUST UNITED AC 2012; 94:497-503. [PMID: 22434466 DOI: 10.1302/0301-620x.94b4.27496] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This prospective study compares the outcome of 157 hydroxyapatite (HA)-coated tibial components with 164 cemented components in the ROCC Rotating Platform total knee replacement in 291 patients. The mean follow-up was 7.6 years (5.2 to 11). There were two revisions for loosening: one for an HA-coated and one for a cemented tibial component. Radiological evaluation demonstrated no radiolucent lines with the HA-coated femoral components. A total of three HA-coated tibial components exhibited radiolucent lines at three months post-operatively and these disappeared after three further months of protected weight-bearing. With HA-coated components the operating time was shorter (p < 0.006) and the radiological assessment of the tibial interface was more stable (p < 0.01). Using revision for aseptic loosening of the tibial component as the end point, the survival rates at nine years was identical for both groups at 99.1%. Our results suggest that HA-coated components perform at least as well as the same design with cemented components and compare favourably with those of series describing cemented or porous-coated knee replacements, suggesting that fixation of both components with hydroxyapatite is a reliable option in primary total knee replacement.
Collapse
Affiliation(s)
- M Bercovy
- Centre Médical Vauban, 2A Avenue de Ségur, Paris 75007, France.
| | | | | | | |
Collapse
|
47
|
Tírico LEP, Pasqualin T, Pécora JO, Gobbi RG, Pécora JR, Demange MK. Study on implant stability in cementless total knee arthroplasty. ACTA ORTOPEDICA BRASILEIRA 2012; 20:230-4. [PMID: 24453609 PMCID: PMC3718400 DOI: 10.1590/s1413-78522012000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 05/25/2010] [Indexed: 11/26/2022]
Abstract
Objectives Determine the stability of tibial and femoral components of 20 cementless knee
arthroplasties with rotating platform. Methods The 20 patients (20 knees) underwent an analysis of dynamic radiographs with an image
amplifier and maneuvers of varus and valgus which were compared to static frontal and
lateral radiographs of the knees and analyzed by two experienced surgeons in a
double-blind way. Results We could observe in this study that both methods showed very similar results for the
stability of the tibial and femoral components (p<0.001) using the Kappa method
for comparison. Conclusion The tibial component was more unstable in relation to the femoral component in both
static and dynamic studies. Level of Evidence IV, Case
Series.
Collapse
|
48
|
Klatt BA, Lopez HL, Segal NA, Chimes GP. Treatment options in knee osteoarthritis: total knee arthroplasty versus platelet-rich plasma. PM R 2011; 3:377-86. [PMID: 21497325 DOI: 10.1016/j.pmrj.2011.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 03/10/2011] [Indexed: 11/18/2022]
|
49
|
O'Flynn KP, Stanton KT. Optimisation of the enamelling of an apatite-mullite glass-ceramic coating on Ti6Al4V. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:2035-2044. [PMID: 21773840 DOI: 10.1007/s10856-011-4392-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 07/09/2011] [Indexed: 05/31/2023]
Abstract
Apatite-mullite glass-ceramics (AMGCs) are under investigation as a potential alternative to hydroxyapatite (HA) as a coating for cementless fixation of orthopaedic implants. These materials have tailorable mechanical and chemical properties that make them attractive for use as bioactive coatings. Here, AMGC coatings on Ti(6)Al(4)V were investigated to determine an improved heat treatment regime using a systematic examination of the different inputs: composition of glass, nucleation hold and crystallisation hold. An upper limit to the heat treatment temperature was determined by the α + β --> β of Ti(6)Al(4)V at 970°C. The glass composition was modified to produce different crystallisation temperatures and sintering characteristics. A glass was found that is fully crystalline below 970°C and has good sinterability. The effects of different heat treatment time and temperature combinations on the coating and substrate morphologies were examined and the most suitable combination determined. This sample was further investigated and was found to have qualitatively good adhesion and evidence of an interfacial reaction region between the coating and substrate indicating that a chemical reaction had occurred. Oxygen infiltration into the substrate was quantified and the new route was shown to result in a 63% reduction in penetration depth.
Collapse
Affiliation(s)
- Kevin P O'Flynn
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | | |
Collapse
|
50
|
Voigt JD, Mosier M. Hydroxyapatite (HA) coating appears to be of benefit for implant durability of tibial components in primary total knee arthroplasty. Acta Orthop 2011; 82:448-59. [PMID: 21657975 PMCID: PMC3237036 DOI: 10.3109/17453674.2011.590762] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND It is unclear whether there is a clinical benefit to adding hydroxyapatite (HA) coatings to total knee implants, especially with the tibial component, where failure of the implant more often occurs. A systematic review of the literature was undertaken to identify all prospective randomized trials for determining whether the overall clinical results (as a function of durability, function, and adverse events) favored HA-coated tibial components. METHODS A comprehensive literature search was performed for the years 1990 to September 16, 2010. We restricted our search to randomized controlled trials involving participants receiving either an HA-coated tibia or other forms of tibial fixation. The primary outcome measures evaluated were durability, function, and acute adverse events. RESULTS Data from 926 evaluable primary total knee implants in 14 studies were analyzed. Using an RSA definition for durability, HA-coated tibial components (porous or press-fit) without screw fixation were less likely to be unstable at 2 years than porous and cemented metal-backed tibial components (RR = 0.58, 95% CI: 0.34-0.98; p = 0.04, I(2) = 39%, M-H random effects model). There was no significant difference in durability, as measured from revision and evaluated at 2 and 8-10 years, between groups. Also, functional status using different validated measures showed no significant difference at 2 and 5 years, no matter what measure was used. Lastly, there was no significant difference in adverse events. Limitations included small numbers of evaluable patients (≤ 50) in 7 of the 14 trials identified, and a lack of "hard" evidence of durability with need for replacement (i.e. frank failure, pain, or loss of functionality). INTERPRETATION In patients > 65 years of age, an HA-coated tibial implant may provide better durability than other forms of tibial fixation. Larger trials should be undertaken comparing the long-term durability, function, and adverse events of HA-coated implants with those of other porous-coated tibial implants in younger, more active OA patients.
Collapse
Affiliation(s)
- Jeffrey D Voigt
- 99 Glenwood Rd., Ridgewood, NJ; Washburn University, Topeka, KS, USA
| | - Michael Mosier
- 99 Glenwood Rd., Ridgewood, NJ; Washburn University, Topeka, KS, USA
| |
Collapse
|