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Kim MS, Choi KY, Hur JH, In Y. A high-flexion design total knee prosthesis: a ten to twelve-year follow-up study. J Orthop Surg Res 2024; 19:599. [PMID: 39342376 PMCID: PMC11438381 DOI: 10.1186/s13018-024-05082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate the clinical and radiographic outcomes and to determine the survivorship of a high-flexion design total knee arthroplasty (TKA) prosthesis, the LOSPA knee system, over a follow-up period of 10-12 years. METHODS The study included 386 patients (503 TKAs) who were treated with TKA from 2011 to 2013 (follow-up period 10-12 years).The patients were assessed clinically using range of motion (ROM) of the knee, the Knee Society scoring system (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For radiographic analysis, the positions of femoral and tibial implants as α, β, γ, and δ angles, hip knee ankle (HKA) angle, and radiolucent lines were used. Kaplan-Meier survival analysis was performed. RESULTS Mean ROM improved significantly from the preoperative baseline of 117.3° to 126.5° at the final follow-up (p < 0.001). The mean KSS and WOMAC scores also both showed significant improvement after surgery (all p < 0.001). A non-progressive radiolucent line less than 2 mm was observed in 23 cases (4.7%). Nine patients underwent revision surgery on the knee during the follow-up period. Revision surgery was performed on four patients due to aseptic loosening, three patients due to infection, one patient due to ankylosis, and one patient due to instability. When the endpoint of survival was the entire surgical cases, the survival rate was 96.2%. The survival rate, with revision for any reason as the endpoint, was 97.2%, and 97.8% for aseptic causes. CONCLUSIONS The LOSPA knee system, a high-flexion design total knee prosthesis, showed excellent long-term survivorship and improvements in clinical outcomes at 10- to 12-year follow-up.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jae Hyeong Hur
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Lee CR, Park DH, Heo KS, Jo SM, Seo KJ, Seo SS. Long-Term Outcomes of High-Flexion Design Total Knee Arthroplasty with a Short Posterior Flange. Clin Orthop Surg 2024; 16:251-258. [PMID: 38562641 PMCID: PMC10973616 DOI: 10.4055/cios23133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/06/2023] [Accepted: 08/06/2023] [Indexed: 04/04/2024] Open
Abstract
Background The purpose of this study was to evaluate the clinical and radiological outcomes of high-flexion total knee arthroplasty (TKA) using Vega Knee System (B. Braun, Aesculap) at a long-term follow-up and to analyze the implant survivorship. Methods We enrolled 165 patients (232 knees) with a minimum 7-year follow-up after TKA (VEGA Knee System). For clinical assessment, range of motion (ROM), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used. For radiologic assessment, hip-knee-ankle angle, component position, and the existence of radiolucent lines and loosening were used. Survival analysis was conducted using the Kaplan-Meier method. Results The mean follow-up period was 9.8 years. The mean ROM increased from 124.4° to 131.4° at the final follow-up. The WOMAC score decreased from 38.5 to 17.4 at the final follow-up (p < 0.001). All 5 subscales of the KOOS improved at the final follow-up (all subscales, p < 0.001). Revision TKA was performed in 10 cases (4.3%), which included 9 cases of aseptic loosing and 1 case of periprostatic joint infection. Of the 9 aseptic loosening cases (3.9%), 8 cases (3.4%) were loosening of the femoral component and 1 case (0.4%) was loosening of the tibial component. When revision for any reason was considered an endpoint, the 10-year survivorship was 96.2% (95% confidence interval [CI], 93.9%-98.5%). On the other hand, when revision for aseptic loosening was considered the endpoint, the 10-year survivorship was 96.6% (95% CI, 94.4%-98.8%). Conclusions The Vega Knee System provided good clinical results in the long-term follow-up period. Although the VEGA Knee System showed acceptable implant survivorship, loosening of the femoral component occurred in about 3.4% of the patients. For more accurate evaluation of the survivorship of high-flexion design TKA with a short posterior flange, it is necessary to conduct more long-term follow-up studies targeting diverse races, especially Asians who frequently perform high-flexion activities.
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Affiliation(s)
- Chang-Rack Lee
- Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Dae-Hyun Park
- Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Ki-Seong Heo
- Department of Orthopaedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Se-Myoung Jo
- Department of Orthopaedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Kyung-Jae Seo
- Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Seung-Suk Seo
- Department of Orthopaedic Surgery, Haeundae Bumin Hospital, Busan, Korea
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Tille E, Beyer F, Lützner C, Postler A, Lützner J. Better Flexion but Unaffected Satisfaction After Treatment With Posterior Stabilized Versus Cruciate Retaining Total Knee Arthroplasty - 2-year Results of a Prospective, Randomized Trial. J Arthroplasty 2024; 39:368-373. [PMID: 37598783 DOI: 10.1016/j.arth.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Both the cruciate-retaining (CR) and posterior-stabilized (PS) implant systems are commonplace in modern total knee arthroplasty (TKA) practice. However, there is controversy regarding functional outcomes and survivorship. The aim of the underlying study was to evaluate differences between CR and PS TKA regarding knee function, patient-reported outcome measures (PROMs) as well as complication rates. METHODS 140 patients with knee osteoarthritis scheduled for an unconstrained TKA were enrolled in a prospective, randomized study. Patients received either a CR or PS implant. Range of motion and PROMs (Oxford Knee Score, Knee Society Score, European Quality of Life 5 Dimensions 3 Level, University of California Los Angeles Activity scale and subjective satisfaction) were assessed prior to, 3 months, 1 and 2 years after surgery. RESULTS We found minor differences between treatment groups regarding demographic factors. Within the PS group duration of surgery was longer (mean PS 81.4 min vs CR 76.0 min, P = .006). We observed better flexion (median PS 120.0° vs CR 115°, P = .017) and an overall better range of motion (median PS 120.0° vs CR 115.0°, P = .008) for the PS group. PROMs did not differ between groups. At 2-year follow-up there were no revisions in either cohort. Five patients needed reoperations. Three patients needed manipulation under anesthesia, 2 in the CR and one in the PS group. CONCLUSION While PS TKA achieved a better flexion capability, PROMs were similar in CR and PS TKA. The CR implant design continues to be a reliable option for patients with an intact posterior cruciate ligament.
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Affiliation(s)
- Eric Tille
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany; Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Anne Postler
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
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Kim YH, Park JW, Jang YS, Kim EJ. Is Highly Cross-Linked Polyethylene Safe for Use in High-Flexion Posterior Stabilized Total Knee Arthroplasty? J Arthroplasty 2023; 38:286-292. [PMID: 36028177 DOI: 10.1016/j.arth.2022.08.025] [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: 06/23/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Application of highly cross-linked polyethylene (HXLPE) to a posterior cruciate-substituting total knee arthroplasty (TKA) might add the risk of fracture and failure of the tibial polyethylene insert. The purpose of this study is to evaluate the long-term (up to 19 years) clinical and radiographic results of posterior cruciate-substituting TKAs with HXLPE or conventional polyethylene. METHODS This study analyzed the results of 1,217 patients (444 men and 773 women; mean age of 65 ± 7 years, range, 31-85) (2,434 knees) who had received a NexGen LPS-Flex prosthesis with a conventional tibial insert in one knee and the same prosthesis with an HXLPE tibial insert in the contralateral knee. The mean duration of follow-up was 17 years (range, 15-19). RESULTS The 2 groups did not differ significantly (P > .05) with regard to the clinical and radiographic results. No knee in either group had a fracture of the tibial polyethylene post or failure of the locking mechanism of the tibial polyethylene insert or osteolysis. Twenty-eight knees (2.3%) in the HXLPE group and 26 knees (2.1%) in the conventional polyethylene group were revised. The estimated survival rate at 17 years was 97.7% in the HXLPE group and 97.9% in the conventional polyethylene group. CONCLUSION The data suggest that clinical and radiographic findings at a mean of 17 years after posterior cruciate-substituting TKA are the same for patients treated with HXLPE and those treated with conventional polyethylene.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- Department of Orthopeadic Surgery, Ewha Womans University, Seoul Hospital, Seoul, Republic of Korea
| | - Young-Soo Jang
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Eun-Jung Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
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Malahias MA, Iacobelli DA, Torres L, Rojas Marcos C, Nocon AA, Wright TM, Sculco PK, Sculco TP. Early Aseptic Loosening with Increased Presence and Severity of Backside Burnishing in the Optetrak Logic Posterior-Stabilized Total Knee Arthroplasty Femoral Component. J Knee Surg 2022; 35:1595-1603. [PMID: 33930899 DOI: 10.1055/s-0041-1729549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Concerns persist that the Optetrak Logic posterior-stabilized (PS) total knee arthroplasty (TKA) femoral component might correlate with early failures due to aseptic loosening. The primary aim of this study was to examine if the use of the Optetrak Logic PS femoral component is associated with early (<5 years) and more extensive aseptic loosening compared with other PS femoral components. This is a single-institution retrieval analysis and revision registry study (based on prospectively collected data) of 27 failed primary PS TKA patients with loose femoral components that underwent revision TKAs between 2016 and 2019. Patients were stratified by components type: Group A (n = 16) received the Optetrak Logic PS femoral component, while Group B (n = 11) received other PS femoral components. Burnishing (macroscopic polishing of the component's backside) was observed and graded as a marker for relative motion at the cement-implant interface. No significant differences were found between the two groups regarding the baseline demographic, radiographic, and clinical characteristics. Mean length of implantation for Group A (3.8 ± 2.9 years) was significantly shorter (p < 0.001) than that of Group B (12.0 ± 6.7 years). A significant difference (p = 0.009) was found in presence of backside femoral burnishing between Group A (15 of 16 patients; 93.8%) and group B (5 of 11 patients; 45.6%). Furthermore, we found a significant difference (p < 0.001) in the severity of burnishing between Group A (13 of 16 patients with severe degree of burnishing; 81.3%) and Group B (1 of 11 patients with severe degree of burnishing; 9.1%). In contrast to Group B, a distinctive macroscopic pattern found in Logic retrieved femoral components (Group A) was the total absence of cement in the backside surface. The use of the Optetrak Logic PS TKA femoral component was associated with early aseptic loosening and increased presence and severity of backside burnishing with early cement-implant interface debonding compared with other commercially available types of PS TKA femoral components. The earlier failure rate with this implant is of concern.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
| | - David A Iacobelli
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York City, New York
| | - Lisa Torres
- Department of Biomechanics, Hospital for Special Surgery, New York City, New York
| | - Carolena Rojas Marcos
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
| | - Allina A Nocon
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York City, New York
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
| | - Thomas P Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
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Sasaki R, Nagashima M, Otani T, Okada Y, Aibara N, Takeshima K, Ishii K. Pressurized carbon dioxide lavage reduces the incidence of a radiolucent line around the tibial component two years after total knee arthroplasty. J Orthop Surg Res 2022; 17:349. [PMID: 35841041 PMCID: PMC9284780 DOI: 10.1186/s13018-022-03204-3] [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: 11/11/2021] [Accepted: 06/02/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction In cemented total knee arthroplasty (TKA), pressurized carbon dioxide (CO2) lavage prior to cement fixation can eliminate debris at the bone-cement interface and is considered effective for increasing cement penetration and preventing aseptic loosening. Regarding the risk of a preliminary diagnosis of implant loosening, a radiolucent line (RLL) is a valuable sign. The purpose of this study was to compare the incidence of a tibial RLL at 2 years after TKA with and without pressurized CO2 lavage. Methods This is a retrospective study. One hundred knees from 98 patients were enrolled in this study. TKA was performed without pressurized CO2 lavage (CO2− group) for the first 47 knees, and with pressurized CO2 lavage (CO2+ group) for the next 53 knees. The depth of cement penetration was measured just after surgery, and the incidence of tibial RLL > 2 mm at 2 years after TKA was determined. Results Significant differences between groups were not seen regarding pre- and postoperative clinical factors. The depth of cement penetration in each area was significantly higher in the CO2+ group. The frequency of knees with RLL > 2 mm was significantly lower in the CO2+ group than in the CO2− group (p < 0.001). Conclusions Pressurized CO2 lavage improved cement penetration and decreased the incidence of tibial RLL > 2 mm at 2 years after TKA.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan. .,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan. .,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan.
| | - Toshiro Otani
- Department of Orthopaedic Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kōnodai, Ichikawa City, Chiba, 272-0827, Japan
| | - Yoshifumi Okada
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Noriyuki Aibara
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita City, Chiba, 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
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Maniar AR, Gajjar A, Bhatnagar N, Mishra A, Maniar RN. Ten- to 14-Year Results of a High-Flex Rotating Platform Knee Implant: A Follow-Up Report of a Prospective Cohort. Indian J Orthop 2021; 56:256-262. [PMID: 35140856 PMCID: PMC8789968 DOI: 10.1007/s43465-021-00441-2] [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: 03/25/2021] [Accepted: 06/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND High-flex posterior stabilised rotating platform (PSRP) implant was introduced to provide for deep knee flexion. Few short-term results have been reported, but there are no long-term outcomes reported. METHODS We prospectively followed 48 patients (53 knees) implanted with one such design. Inclusion criteria for implantation were patients with good pre-operative flexion and wishing to perform activities requiring deep knee flexion post-operatively, with femorotibial varus angle < 15° and having good flexion stability at trialling stage. Previously, we reported their outcomes at 2-6 years (FU-1). We now report their functional and radiological results at a minimum follow-up of 10 years (FU-2) in 39 patients (43 knees); 5 patients having died and 4 lost to follow-up. RESULTS The mean pre-operative flexion of 124° improved to 130° at FU-1 and to 134° at FU-2. Flexion of 130° or more was seen in 59.6% knees at FU-1 and 74.42% knees at FU-2. At FU-2 mean Knee score was 90.5 and Function score was 67.8. Incidence of patellofemoral symptoms increased from 7.7% at FU-1 to 11.36% at FU-2. There were no cases of bearing spin out, osteolysis or revision surgeries. CONCLUSION At a minimum 10-year follow-up, high-flexion PSRP design in selected patients yielded 100% survival. We recorded good knee flexion and knee society scores, with no case of spin out, implant loosening, osteolysis or revision surgery. Although deep knee flexion improved at longer follow-up, its use in ADL had reduced due to other age-related factors. There was increased incidence of patellofemoral symptoms.
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Affiliation(s)
- Adit R. Maniar
- grid.415923.80000 0004 1766 8592Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, India ,grid.414597.a0000 0004 1799 5016Breach Candy Hospital Trust, 60 A, Bhulabhai Desai, Marg, Mumbai 400026 India
| | - Arpit Gajjar
- Shanku Medicity, Near Shankus Waterpark Ahmedabad-Mehsana Highway, Baliyasan, Gujarat 384435 India
| | - Nishit Bhatnagar
- grid.414612.40000 0004 1804 700XDepartment of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110076 India
| | - Abhinav Mishra
- Department of Orthopaedics, Shriram Care Hospital, Shriram Care Hospital Ameri Road, Nehru Nagar, Bilaspur, Chhattisgarh 495001 India ,Sky Hospital Seepat Rd, Near Suryavihar Colony, Surya Vihar Colony, Sarkanda, Lingiadih, Chhattisgarh 495006 India
| | - Rajesh N. Maniar
- grid.415923.80000 0004 1766 8592Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, India ,grid.414597.a0000 0004 1799 5016Breach Candy Hospital Trust, 60 A, Bhulabhai Desai, Marg, Mumbai 400026 India
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Is high flexion total knee arthroplasty a rewarding procedure? An updated meta-analysis of prospective randomized controlled trials. Arch Orthop Trauma Surg 2021; 141:783-793. [PMID: 32448929 DOI: 10.1007/s00402-020-03481-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this study is to provide an updated meta-analysis comparing the benefits and clinical outcomes between high flexion (HF)-TKA and standard (S)-TKA. MATERIALS AND METHODS A detailed database analysis was carried out using Web of Science, PubMed, EMBASE, Cochrane Library, MEDLINE and Clinicaltrial.gov, to identify eligible studies. The meta-analysis and sensitivity analysis were performed using Review Manager 5.3 software and STATA 12.0. RESULTS Twenty-two randomized control trials (RCTs), including 2841 patients and 4268 knees, were eligible for the meta-analysis. The pooled results of subgroup analysis reveal that there was significant difference between HF-TKA and S-TKA in each subgroup in terms of postoperative ROM, with a higher degree of knee flexion for HF-TKA than S-TKA. However, no statistical difference was identified between HF-TKA and S-TKA in other clinical outcomes including various functional scores and complications. CONCLUSIONS On the basis of this meta-analysis, we can recommended HF-TKA as an alternative choice to S-TKA for patients requiring higher knee flexion in their daily activities.
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Kim YH, Park JW, Jang YS. 20-Year Minimum Outcomes and Survival Rate of High-Flexion Versus Standard Total Knee Arthroplasty. J Arthroplasty 2021; 36:560-565. [PMID: 32854994 DOI: 10.1016/j.arth.2020.07.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are conflicting reports of early and mid-term results of the high-flexion total knee arthroplasties (TKAs). The purpose of the present long-term follow-up study was to determine the long-term (minimum 20 years) clinical and radiographic and CT scan results, and the survival rates of high-flexion versus standard TKAs. METHODS Ninety-five patients (190 knees) were included (mean age, 65 ± 6.5 years). The mean follow-up was 20.3 years (range, 20 to 20.6 years). RESULTS Revision of the TKA was performed in 5 knees (5.2%) with high-flexion TKA and in 3 knees (3.2%) with standard TKA. The rate of survival at 20 years was 94.8% (95% CI, 91%-98%) in the high-flexion TKA group and 96.8% (95% CI, 92%-100%) in the standard TKA group with reoperation for any reason. No knee had osteolysis in either group. CONCLUSIONS At this length of follow-up, high-flexion TKA has comparable outcomes and survivorship to standard TKA.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center of Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Young-Soo Jang
- The Joint Replacement Center of Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
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10
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de Ruiter L, Cowie RM, Jennings LM, Briscoe A, Janssen D, Verdonschot N. The Effects of Cyclic Loading and Motion on the Implant-Cement Interface and Cement Mantle of PEEK and Cobalt-Chromium Femoral Total Knee Arthroplasty Implants: A Preliminary Study. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E3323. [PMID: 32722599 PMCID: PMC7435552 DOI: 10.3390/ma13153323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022]
Abstract
This study investigated the fixation of a cemented PEEK femoral TKA component. PEEK and CoCr implants were subjected to a walking gait cycle for 10 million cycles (MC), 100,000 cycles or 0 cycles (unloaded control). A method was developed to assess the fixation at the cement-implant interface, which exposed the implants to a fluorescent penetrant dye solution. The lateral condyles of the implants were then sectioned and viewed under fluorescence to investigate bonding at the cement-implant interface and cracking of the cement mantle. When tested for 100,000 cycles, debonding of the cement-implant interface occurred in both PEEK (61%) and CoCr (13%) implants. When the duration of testing was extended (10 MC), the percentage debonding was further increased for both materials to 88% and 61% for PEEK and CoCr, respectively. The unloaded PEEK specimens were 79% debonded, which suggests that, when PEEK femoral components are cemented, complete bonding may never occur. Analysis of cracks in the cement mantle showed an absence of full-thickness cracks in the unloaded control group. For the 100,000-cycle samples, on average, 1.3 and 0.7 cracks were observed for PEEK and CoCr specimens, respectively. After 10 MC, these increased to 24 for PEEK and 19 for CoCr. This was a preliminary study with a limited number of samples investigated, but shows that, after 10 MC under a walking gait, substantial debonding was visible for both PEEK and CoCr implants at the cement-implant interface and no significant difference in the number of cement cracks was found between the two materials.
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Affiliation(s)
- Lennert de Ruiter
- Orthopaedic Research Laboratory, Radboud university medical center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; (L.d.R.); (N.V.)
| | - Raelene M. Cowie
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK; (R.M.C.); (L.M.J.)
| | - Louise M. Jennings
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK; (R.M.C.); (L.M.J.)
| | | | - Dennis Janssen
- Orthopaedic Research Laboratory, Radboud university medical center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; (L.d.R.); (N.V.)
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud university medical center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; (L.d.R.); (N.V.)
- Laboratory of Biomechanical Engineering, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
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11
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de Ruiter L, Janssen D, Briscoe A, Verdonschot N. The mechanical response of a polyetheretherketone femoral knee implant under a deep squatting loading condition. Proc Inst Mech Eng H 2017; 231:1204-1212. [PMID: 29105568 PMCID: PMC5703027 DOI: 10.1177/0954411917738805] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The current study was designed to investigate the mechanical response of a polyetheretherketone-on-polyethylene total knee replacement device during a deep squat. Application of this high-demand loading condition can identify weaknesses of the polyetheretherketone relative to cobalt-chromium. This study investigated whether the implant is strong enough for this type of loading, whether cement stresses are considerably changed and whether a polyetheretherketone femoral component is likely to lead to reduced periprosthetic bone loss as compared to a cobalt-chromium component. A finite element model of a total knee arthroplasty subjected to a deep squat loading condition, which was previously published, was adapted with an alternative total knee arthroplasty design made of either polyetheretherketone or cobalt-chromium. The maximum tensile and compressive stresses within the implant and cement mantle were analysed against their yield and fatigue stress levels. The amount of stress shielding within the bone was compared between the polyetheretherketone and cobalt-chromium cases. Relative to its material strength, tensile peak stresses were higher in the cobalt-chromium implant; compressive peak stresses were higher in the polyetheretherketone implant. The stress patterns differed substantially between polyetheretherketone and cobalt-chromium. The tensile stresses in the cement mantle supporting the polyetheretherketone implant were up to 33% lower than with the cobalt-chromium component, but twice as high for compression. Stress shielding was reduced to a median of 1% for the polyetheretherketone implant versus 56% for the cobalt-chromium implant. Both the polyetheretherketone implant and the underlying cement mantle should be able to cope with the stress levels present during a deep squat. Relative to the cobalt-chromium component, stress shielding of the periprosthetic femur was substantially less with a polyetheretherketone femoral component.
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Affiliation(s)
- Lennert de Ruiter
- 1 Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dennis Janssen
- 1 Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Nico Verdonschot
- 1 Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,3 Laboratory for Biomechanical Engineering, University of Twente, Enschede, The Netherlands
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12
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Experimental pre-clinical assessment of the primary stability of two cementless femoral knee components. J Mech Behav Biomed Mater 2017; 75:322-329. [DOI: 10.1016/j.jmbbm.2017.07.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/27/2016] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
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13
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de Ruiter L, Janssen D, Briscoe A, Verdonschot N. Fixation strength of a polyetheretherketone femoral component in total knee arthroplasty. Med Eng Phys 2017; 49:157-162. [DOI: 10.1016/j.medengphy.2017.06.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/22/2017] [Accepted: 06/25/2017] [Indexed: 11/27/2022]
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14
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Conlisk N, Howie CR, Pankaj P. Computational modelling of motion at the bone-implant interface after total knee arthroplasty: The role of implant design and surgical fit. Knee 2017; 24:994-1005. [PMID: 28778499 DOI: 10.1016/j.knee.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 05/12/2017] [Accepted: 07/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aseptic loosening, osteolysis, and infection are the most commonly reported reasons for revision total knee arthroplasty (TKA). This study examined the role of implant design features (e.g. condylar box, pegs) and stems in resisting loosening, and also explored the sensitivity of the implants to a loose surgical fit due to saw blade oscillation. METHODS Finite element models of the distal femur implanted with four different implant types: cruciate retaining (CR), posterior stabilising (PS), total stabilising (TS) with short stem (12mm×50mm), and a total stabilising (TS) with long stem (19mm×150mm) were developed and analysed in this study. Two different fit conditions were considered: a normal fit, where the resections on the bone exactly match the internal profile of the implant, and a loose fit due to saw blade oscillation, characterised by removal of one millimetre of bone from the anterior and posterior surfaces of the distal femur. Frictional interfaces were employed at the bone-implant interfaces to allow relative motions to be recorded. RESULTS The results showed that interface motions increased with increasing flexion angle and loose fit. Implant design features were found to greatly influence the surface area under increased motion, while only slightly influencing the values of peak motion. Short uncemented stems behaved similarly to PS implants, while long canal filling stems exhibited the least amount of motion at the interface under any fit condition. CONCLUSION In conclusion, long stemmed prostheses appeared less susceptible to surgical cut errors than short stemmed and stemless implants.
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Affiliation(s)
- Noel Conlisk
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; School of Engineering, The University of Edinburgh, Edinburgh, UK.
| | - Colin R Howie
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; Department of Orthopaedics, New Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh, UK
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, Edinburgh, UK
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15
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Kim YH, Park JW, Kim JS. Do High-Flexion Total Knee Designs Increase the Risk of Femoral Component Loosening? J Arthroplasty 2017; 32:1862-1868. [PMID: 28238582 DOI: 10.1016/j.arth.2017.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of our prospective, randomized, long-term investigation is to compare the aseptic loosening rate of the femoral component of the total knee prosthesis and clinical and radiographic results of high-flexion posterior cruciate-substituting knee prosthesis or standard posterior cruciate-substituting knee prosthesis in the same patients. METHODS There were 960 patients (mean age 71.3 years). The mean follow-up period was 13.2 years (range 10-14). The patients were assessed clinically and radiographically with rating systems of the Knee Society. Furthermore, Western Ontario and McMaster Universities Osteoarthritis questionnaire and ranges of knee motion were determined in both groups. RESULTS In the high-flexion knee group, 2 knees (0.2%) had aseptic loosening of both femoral and tibial components. In the standard knee group, 2 knees (0.2%) had aseptic loosening of the femoral component only. The mean postoperative knee scores (97 vs 97 points), Western Ontario and McMaster Universities Osteoarthritis scores (19 vs 19 points), and range of knee motion (128° vs 129°) were not significantly different between the 2 groups. Two knees (0.2%) in the high-flexion knee group underwent a revision of both femoral and tibial components and 2 knees (0.2%) in the standard knee group had a revision of the femoral component only. CONCLUSION After a mean of 13.2 years of follow-up, this study did not show increased incidence of femoral component loosening in the high-flexion knee group. Furthermore, we found no significant differences between the 2 groups with regard to clinical or radiographic parameters or range of knee motion.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Ewha Womans University, SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
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16
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Jain S, Pathak AC, Kalaivanan K. Minimum 5-year follow-up results and functional outcome of rotating-platform high-flexion total knee arthroplasty: A prospective study of 701 knees. Arthroplast Today 2016; 2:127-132. [PMID: 28326414 PMCID: PMC5045466 DOI: 10.1016/j.artd.2016.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To evaluate the midterm clinical outcome, functional outcome, associated complications, and survivorship of high-flexion posterior-stabilized rotating-platform total knee arthroplasty. METHODS We prospectively analyzed 701 knees in 501 patients, who underwent total knee arthroplasty using high-flexion posterior-stabilized rotating-platform prosthesis. Patients were assessed preoperatively and postoperatively for their ability to kneel, do full squats, do half squats, and sit cross-legged by using a patient-administered questionnaire. RESULTS Significant improvement was seen in patient-reported outcomes at the mean follow-up of 5.5 (range, 5-7) years. Mean flexion achieved postoperatively was 135° (range, 120°-150°) from a mean preoperative flexion of 108.8° (range, 90°-120°). Ninety-five percent of patients were able to sit cross-legged, 90% were able to kneel, 70% were able to perform a half squat, and 20% were able to perform a full squat. CONCLUSIONS Posterior-stabilized, rotating-platform, high-flexion design provides good postoperative flexion, functional outcome, and good midterm survivorship.
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Affiliation(s)
| | - Aditya C. Pathak
- Department of Orthopaedics, Dr LH Hiranandani Hospital, Mumbai, India
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17
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Kim MS, Koh IJ, Jang SW, Jeon NH, In Y. Two- to Four-Year Follow-up Results of Total Knee Arthroplasty Using a New High-Flexion Prosthesis. Knee Surg Relat Res 2016; 28:39-45. [PMID: 26955612 PMCID: PMC4779804 DOI: 10.5792/ksrr.2016.28.1.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/02/2015] [Accepted: 12/15/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose The purpose of this study was to evaluate minimum 2-year follow-up results of total knee arthroplasty (TKA) performed using a new high-flexion
prosthesis design (LOSPA). Materials and Methods The 2- to 4-year results of 191 consecutive TKAs (177 patients) with the LOSPA posterior-stabilized prosthesis were evaluated. The patients were assessed clinically and radiographically using the Knee Society scoring system (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results The mean range of motion (ROM) increased significantly from 117.4° (range, 75° to 140°) preoperatively to 126.7° (range, 80° to 144°) postoperatively (p<0.001). The mean KSS and WOMAC scores improved significantly from 121.4 (range, 42 to 185) and 56.1 (range, 23 to 88) preoperatively to 174.0 (range, 130 to 200) and 16.4 (range, 0 to 85) postoperatively, respectively (both, p<0.001). One knee required revision for deep infection. No knee had aseptic loosening or osteolysis. Radiolucent lines were noted in 15 knees (7.9%). Conclusions The new high-flexion total knee prosthesis resulted in no early aseptic loosening of the component and improved postoperative ROM comparable to other high-flexion TKA prostheses at 2- to 4-year follow-ups.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Won Jang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Neung Han Jeon
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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18
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Ha CW, Ravichandran C, Lee CH, Kim JH, Park YB. Performing high flexion activities does not seem to be crucial in developing early femoral component loosening after high-flexion TKA. BMC Musculoskelet Disord 2015; 16:353. [PMID: 26573935 PMCID: PMC4647493 DOI: 10.1186/s12891-015-0812-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/10/2015] [Indexed: 08/30/2023] Open
Abstract
Background It is still unclear whether high flexion (HF) activities correlated with the early loosening of the femoral component and whether HF activities are possible. We investigated what is the capability for performing various HF activities, and whether high flexion activities increase the chance of aseptic loosening after HF-TKA. Methods We retrospectively analysed 260 patients who underwent HF-TKA using the NexGen LPS Flex between 2001 and 2009. The mean follow-up was 6.7 years (range, 5–13). We evaluated range of motion, Knee Society scores, WOMAC, and serial radiographs for aseptic loosening. Responses to questions on individual HF activities were recorded on 5-point Likert scales based on difficulty (0–4). Patients were divided two groups based on their responses to squatting and kneeling, which were important weight-bearing HF activities in Asian population (HF group vs. non-HF group) for comparisons of aseptic loosening and clinical outcomes. Results More than 80 % of patients positively responded for various HF activities. The capability of HF activities showed that cross-legged sitting, squatting, and kneeling were 97.7, 51.1 and 52.7 % at the latest follow-up, respectively. Aseptic loosening was identified in two tibial components (0.8 %) but none in femoral components in non-HF group. There was no significant difference of aseptic loosening based on HF activities (0.8% vs. 0%, p = 0.063). Conclusions The results of this study suggest that HF activities do not seem to be associated with aseptic loosening of femoral component after HF-TKA.
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Affiliation(s)
- Chul-Won Ha
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Chandramohan Ravichandran
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Choong-Hee Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Jun-Ho Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
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Squatting-related tibiofemoral shear reaction forces and a biomechanical rationale for femoral component loosening. ScientificWorldJournal 2014; 2014:785175. [PMID: 24982995 PMCID: PMC4054786 DOI: 10.1155/2014/785175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/15/2014] [Indexed: 11/18/2022] Open
Abstract
Previous gait studies on squatting have described a rapid reversal in the direction of the tibiofemoral joint shear reaction force when going into a full weight-bearing deep knee flexion squat. The effects of such a shear reversal have not been considered with regard to the loading demand on knee implants in patients whose activities of daily living require frequent squatting. In this paper, the shear reversal effect is discussed and simulated in a finite element knee implant-bone model, to evaluate the possible biomechanical significance of this effect on femoral component loosening of high flexion implants as reported in the literature. The analysis shows that one of the effects of the shear reversal was a switch between large compressive and large tensile principal strains, from knee extension to flexion, respectively, in the region of the anterior flange of the femoral component. Together with the known material limits of cement and bone, this large mismatch in strains as a function of knee position provides new insight into how and why knee implants may fail in patients who perform frequent squatting.
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20
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Namba RS, Inacio MCS, Cafri G. Increased risk of revision for high flexion total knee replacement with thicker tibial liners. Bone Joint J 2014; 96-B:217-23. [PMID: 24493187 DOI: 10.1302/0301-620x.96b2.32625] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The outcome of total knee replacement (TKR) using components designed to increase the range of flexion is not fully understood. The short- to mid-term risk of aseptic revision in high flexion TKR was evaluated. The endpoint of the study was aseptic revision and the following variables were investigated: implant design (high flexion vs non-high flexion), the thickness of the tibial insert (≤ 14 mm vs > 14 mm), cruciate ligament (posterior stabilised (PS) vs cruciate retaining), mobility (fixed vs rotating), and the manufacturer (Zimmer, Smith & Nephew and DePuy). Covariates included patient, implant, surgeon and hospital factors. Marginal Cox proportional hazard models were used. In a cohort of 64 000 TKRs, high flexion components were used in 8035 (12.5%). The high flexion knees with tibial liners of thickness > 14 mm had a density of revision of 1.45/100 years of observation, compared with 0.37/100 in non-high flexion TKR with liners ≤ 14 mm thick. Relative to a standard fixed PS TKR, the NexGen (Zimmer, Warsaw, Indiana) Gender Specific Female high flexion fixed PS TKR had an increased risk of revision (hazard ratio (HR) 2.27 (95% confidence interval (CI) 1.48 to 3.50)), an effect that was magnified when a thicker tibial insert was used (HR 8.10 (95% CI 4.41 to 14.89)). Surgeons should be cautious when choosing high flexion TKRs, particularly when thicker tibial liners might be required.
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Affiliation(s)
- R S Namba
- Kaiser Permanente, 6670 Alton Parkway, Irvine, California 92618, USA
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21
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Song SJ. CORR Insights ®: Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study. Clin Orthop Relat Res 2014; 472:327-8. [PMID: 24061846 PMCID: PMC3889404 DOI: 10.1007/s11999-013-3286-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/05/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701 Korea
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22
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Belvedere C, Tamarri S, Notarangelo DP, Ensini A, Feliciangeli A, Leardini A. Three-dimensional motion analysis of the human knee joint: comparison between intra- and post-operative measurements. Knee Surg Sports Traumatol Arthrosc 2013; 21:2375-83. [PMID: 23114867 DOI: 10.1007/s00167-012-2271-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 10/19/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare intra-operative knee joint kinematic measurements immediately after total knee replacement with those of the same patients post-operatively at 6-month follow-up. METHODS Fifteen patients who underwent total knee arthroplasty were analysed retrospectively. Eight were implanted with one prosthesis design and seven with another. The intra-operative measurements were performed by using a standard knee navigation system. This provided accurate three-dimensional positions and orientations for the femur and tibia by corresponding trackers pinned into the bones. At 6-month follow-up, the patients were analysed by standard three-dimensional video-fluoroscopy of the replaced knee during stair climbing, chair rising and step-up. Relevant three-dimensional positions and orientations were obtained by an iterative shape-matching procedure between the silhouette contours and the CAD-model projections. A number of traditional kinematic parameters were calculated from both measurements to represent the joint motion. RESULTS Good post-operative replication of the intra-operative measurements was observed for most of the variables analysed. The statistical analysis also supported the good consistency between the intra- and post-operative measurements. CONCLUSIONS Intra-operative kinematic measurements, accessible by a surgical navigation system, are predictive of the following motion performance of the replaced knees as experienced in typical activities of daily living. LEVEL OF EVIDENCE Prognostic studies--investigating natural history and evaluating the effect of a patient characteristic, Level II.
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Affiliation(s)
- C Belvedere
- Movement Analysis Laboratory, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy,
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Namba RS, Cafri G, Khatod M, Inacio MCS, Brox TW, Paxton EW. Risk factors for total knee arthroplasty aseptic revision. J Arthroplasty 2013; 28:122-7. [PMID: 23953394 DOI: 10.1016/j.arth.2013.04.050] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 03/04/2013] [Accepted: 04/07/2013] [Indexed: 02/01/2023] Open
Abstract
Using a Total Joint Replacement Registry, patient, operative, implant, surgeon, and hospital risk factors associated with aseptic revision after primary total knee arthroplasty (TKA) were evaluated. From 04/2001 to 12/31/2010 64,017 primary TKA cases, followed for a median time of 2.9 years, were registered and included in the analysis. Patients were predominantly female, white, with osteoarthritis, and obese. The crude aseptic revision rate is 1.3% (N=826). The cumulative survival for aseptic revision at 8 years is 97.6% (95% CI 97.3%-97.8%). Adjusted models revealed that age, race, body mass index, diabetic status, bilateral procedures, high-flex implants, and the LCS mobile bearing knee are associated with risk of revision. Gender, general health status, diagnosis, surgeon fellowship training, surgeon volume, hospital volume, fixation, and bearing surface material were not associated with risk of aseptic revision. Recognition of surgical factors associated with TKA failures can help the surgeons with their choices of surgical techniques and implants.
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Affiliation(s)
- Robert S Namba
- Department of Orthopedic Surgery, Kaiser Permanente, Orange County, Irvine, California
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Jain S, Pathak AC, Kanniyan K, Kulkarni S, Tawar S, Mane P. High-flexion posterior-stabilized total knee prosthesis: is it worth the hype? Knee Surg Relat Res 2013; 25:100-5. [PMID: 24032097 PMCID: PMC3767894 DOI: 10.5792/ksrr.2013.25.3.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/07/2013] [Accepted: 07/20/2013] [Indexed: 11/07/2022] Open
Abstract
High-flexion knee prosthesis was introduced with the aim of obtaining higher degree of flexion and good survivorship in patients with high functional demands or those requiring squatting, kneeling, etc., which is more common in Asians. Based on all the research and experience with this prosthesis, it was concluded that high flexion designs meet the need of deeper degrees of flexion in selected sets of patients only. Results were equal and comparable to the traditional standard posterior-stabilized total knee arthroplasty design and superior to it in terms of gaining more flexion and fulfilling activities, such as squatting, kneeling, and sitting cross-legged.
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Affiliation(s)
- Sanjeev Jain
- Department of Orthopaedics, Dr LH Hiranandani Hospital, Mumbai, India
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25
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Influence of preparation techniques to the strength of the bone-cement interface behind the flange in total knee arthroplasty. Knee 2013; 20:186-90. [PMID: 22999642 DOI: 10.1016/j.knee.2012.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 08/14/2012] [Accepted: 08/16/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Recent clinical studies show an increased risk of femoral loosening in high-flexion TKA. Loosening seems to occur behind the anterior flange, which is covering both cancellous bone and cortical bone. It is important to optimize the interface strength between cement and both bone types to increase femoral component fixation. This study was performed to determine the cement-cortical bone interface strength for different preparation techniques. MATERIAL AND METHODS A pure tensile and shear force was applied to interface specimens. The cortical surface area was prepared in three different ways: (1) Unprepared cortical bone with periosteum; (2) Periosteum removed and cortical bone roughened with a rasp; (3) Periosteum removed and three Ø 3.2mm holes drilled through the cortex. A reference group was added with a cancellous bone surface. RESULTS The interface tensile strength of Group 1 was 0.06 MPa and the shear strength was 0.05 MPa. For Group 2, respectively 0.22 MPa and 1.12 MPa. For Group 3, respectively 1.15 MPa and 1.77 MPa. For cancellous bone a tensile strength of 1.79 MPa and a shear strength of 3.85 MPa were measured. CONCLUSION The strength of the cement-cancellous bone interface is superior to the cement-cortical bone interface. The preferred preparation technique of the cortical bone is to remove all the periosteum and drill holes through the cortex within the footprint of the anterior flange, to prevent cortical weakening. CLINICAL RELEVANCE Ultimately, the proposed preparation technique will lead to longer implant survival, particularly for prostheses which are used in the high-flexion range.
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Lee BS, Chung JW, Kim JM, Kim KA, Bin SI. High-flexion prosthesis improves function of TKA in Asian patients without decreasing early survivorship. Clin Orthop Relat Res 2013; 471:1504-11. [PMID: 23104044 PMCID: PMC3613537 DOI: 10.1007/s11999-012-2661-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Two previous studies recently raised the possibility of a high risk of early femoral components loosening with high-flexion (HF) prostheses in Asian populations and suggested that the high failure rate of HF TKAs was associated with HF ability. However, these findings are controversial given other studies reporting a low incidence of aseptic failures in HF prostheses. QUESTIONS/PURPOSES We therefore determined (1) the rate of achieving postoperative HF after HF TKA; (2) whether the aseptic loosening rate of HF prostheses is high; and (3) whether the survivorship was worsened in patients who achieved postoperative deep knee flexion in our cohort of Korean patients. METHODS We retrospectively reviewed 488 patients who had 698 primary TKAs using the NexGen(®) Legacy Posterior-Stabilized Flex system implanted from 2003 to 2010. There were 40 men and 448 women with a mean age of 68 years. We obtained Hospital for Special Surgery scores, maximal flexion, and radiographs. The minimum followup for functional and radiographic evaluations was 2 years (median, 4.8 years; range, 2-8.7 years). We performed a survival analysis on all patients for aseptic loosening. RESULTS Three hundred sixty knees (52%) could achieve ≥ 135° maximum flexion. Six of the 698 knees (0.9%) developed aseptic loosening (three femoral and three tibial). The survival at 5 years for aseptic loosening was 99.1%. The overall survival for aseptic failure did not differ between knees that achieved HF and those that did not. CONCLUSIONS We observed a low incidence of early aseptic loosening of HF designs in this series. Our findings suggest HF TKAs have high survival in Asian patients at 5 years although half of the patients attained maximum flexion more than 135° postoperatively.
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Affiliation(s)
- Bum-Sik Lee
- />Department of Orthopedic Surgery, College of Medicine, Catholic University, Incheon St Mary’s Hospital, Bupyeong-gu, Incheon, Korea
| | - Jong-Won Chung
- />Barun Joint Orthopedics, Geumgwang-dong, Jungwon-gu, Seongnam-si, Gyeonggi-do Korea
| | - Jong-Min Kim
- />Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736 Korea
| | - Kyung-Ah Kim
- />Department of Biomedical Engineering, College of Medicine, Chungbuk National University, Gaesin-dong, Heungdeok-gu, Cheongju-si,
Chungcheongbuk-do Korea
| | - Seong-Il Bin
- />Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736 Korea
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Han HS, Kang SB. Brief followup report: Does high-flexion total knee arthroplasty allow deep flexion safely in Asian patients? Clin Orthop Relat Res 2013; 471:1492-7. [PMID: 23054521 PMCID: PMC3613521 DOI: 10.1007/s11999-012-2628-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The long-term survivorship of TKA in Asian countries is comparable to that in Western countries. High-flexion TKA designs were introduced to improve flexion after TKA. However, several studies suggest high-flexion designs are at greater risk of femoral component loosening compared with conventional TKA designs. We previously reported a revision rate of 21% at 11 to 45 months; this report is intended as a followup to that study. QUESTIONS/PURPOSES Do implant survival and function decrease with time and do high-flexion activities increase the risk of premature failure? METHODS We prospectively followed 72 Nexgen LPS-flex fixed TKAs in 47 patients implanted by a single surgeon between March 2003 and September 2004. We determined the probability of survival using revision as an end point and compared survival between those who could and those who could not perform high-flexion activities. Minimum followup was 0.9 years (median, 6.5 years; range, 0.9-8.6 years). RESULTS Twenty-five patients (33 knees) underwent revision for aseptic loosening of the femoral component at a mean of 4 years (range, 1-8 years). The probability of revision-free survival for aseptic loosening was 67% and 52% at 5 and 8 years, respectively. Eight-year cumulative survivorship was lower in patients capable of squatting, kneeling, or sitting crosslegged (31% compared with 78%). There were no differences in the pre- and postoperative mean Hospital for Special Surgery scores and maximum knee flexion degrees whether or not high-flexion activities could be achieved. CONCLUSIONS Overall midterm high-flexion TKA survival in our Asian cohort was lower than that of conventional and other high-flexion designs. This unusually high rate of femoral component loosening was associated with postoperative high-flexion activities.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Boramae Medical Center, 20, Boramae 5th Road, Seoul, 156-707 South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Boramae Medical Center, 20, Boramae 5th Road, Seoul, 156-707 South Korea
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Bini SA, Chen Y, Khatod M, Paxton EW. Does pre-coating total knee tibial implants affect the risk of aseptic revision? Bone Joint J 2013; 95-B:367-70. [PMID: 23450022 DOI: 10.1302/0301-620x.95b3.27585] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated the impact of pre-coating the tibial component with polymethylmethacrylate (PMMA) on implant survival in a cohort of 16 548 primary NexGen total knee replacements (TKRs) in 14 113 patients. In 13 835 TKRs a pre-coated tray was used while in 2713 TKRs the non-pre-coated version of the same tray was used. All the TKRs were performed between 2001 and 2009 and were cemented. TKRs implanted with a pre-coated tibial component had a lower cumulative survival than those with a non-pre-coated tibial component (p = 0.01). After adjusting for diagnosis, age, gender, body mass index, American Society of Anesthesiologists grade, femoral coupling design, surgeon volume and hospital volume, pre-coating was an independent risk factor for all-cause aseptic revision (hazard ratio 2.75, p = 0.006). Revision for aseptic loosening was uncommon for both pre-coated and non-pre-coated trays (rates of 0.12% and 0%, respectively). Pre-coating with PMMA does not appear to be protective of revision for this tibial tray design at short-term follow-up.
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Affiliation(s)
- S A Bini
- Kaiser Permanente, 280 West MacArthur Blvd, Oakland, California 94611, USA.
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Tikhilov RM, Kornilov NN, Kulyaba TA, Saraev AV, Ignatenko VL. MODERN TRENDS IN ORTHOPEDICS: THE KNEE ARTHROPLASTY. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2012. [DOI: 10.21823/2311-2905-2012--2-5-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Using PubMed the authors analyzed publications dedicated to knee arthroplasty that were published in 2011. The modern trends of knee joint replacement include improvement of implants and instruments; partial knee replacement as alternative to TKA; reducing of surgical trauma due to less-invasive approaches; achieving of deep flexion after TKA; using of computer navigation and individual cutting blocks to make surgery more precise; optimization of rehabilitation process in pre-, intra-and postoperative period; including multimodal pain control; development of complex strategies for prevention of intra- and postoperative complications. In this review the attention was attracted to the most discussed in 2011 subjects: development of new designs and materials of knee implants; navigation, robotics and individualized resection blocks; partial knee replacement; infection, blood loss and venous thromboembolism after TKA; influence of different factors on arthroplasty outcomes, especially components and leg alignment, patella resurfacing, PCL retention or substitution, uncemented fixation, mobility of PE insert, severe pre-op deformities or stiffness, previous intra-articular fractures and tibia or femur osteotomies, soft tissue deficit etc.
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