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Rattanaprichavej P, Laoruengthana A. Accelerometer-Based Navigation versus Conventional Total Knee Arthroplasty for Posttraumatic Knee Osteoarthritis. Clin Orthop Surg 2022; 14:522-529. [PMID: 36518940 PMCID: PMC9715931 DOI: 10.4055/cios21147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/06/2021] [Accepted: 11/06/2021] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) frequently comprises femoral or tibial deformity, which makes it difficult to perform total knee arthroplasty (TKA). Accelerometer-based navigation (ABN) could be effective in restoring a neutral mechanical axis (MA) in TKA, but a limited number of studies have been reported in association with PTOA. Therefore, we aimed to compare the lower limb MA between ABN-assisted TKA (ABN-TKA) and conventional TKA in patients with PTOA. METHODS We conducted a retrospective analysis of 28 PTOA patients who underwent TKA using a conventional system (cTKA group, n = 16) and the ABN system (iTKA group, n = 12). Standing long-leg radiographs were assessed for MA and prosthesis alignment as primary outcomes. A postoperative MA deviating beyond ± 3° was defined as an outlier. Perioperative outcomes, Oxford Knee Score (OKS) at 2-year follow-up, and complications were also assessed. RESULTS The cTKA group and the iTKA group had a mean age of 63.07 years and 65.25 years, respectively. The iTKA group had significantly better MA accuracy when compared to the cTKA group (1.60° ± 2.09° vs. 3.59° ± 1.34°, p = 0.01). The iTKA group showed significantly less MA outlier than the cTKA group (78.6% vs. 25.0%, p = 0.02). The prosthesis alignment and OKS were comparable between the groups. There were 2 periprosthetic joint infections in the cTKA group and 1 periprosthetic fracture of the distal femur in the iTKA group. CONCLUSIONS For PTOA of the knee, both conventional TKA and ABN-TKA significantly improved the postoperative mechanical alignment and functional outcomes. The ABN-TKA seemed to offer higher accuracy and less MA outlier when compared to conventional TKA, and thus ABN could be a good alternative option.
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Affiliation(s)
- Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
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Rosso F, Rossi R, Benazzo F, Ghiara M, Bonasia DE, Rossi SMP. Primary TKA in patients with major deformities and ligament laxities: promising results of an intermediate constrained implant at mid-term follow-up. Arch Orthop Trauma Surg 2022; 143:2675-2681. [PMID: 35819516 DOI: 10.1007/s00402-022-04527-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/16/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) in major deformities with ligament insufficiency may require a higher constraint, with bone sacrifice and concerns about long-term survivorship. Mid-level constraint liners have been recently introduced, but few studies described their outcomes. The aim of this study is to evaluate the short to mid-term outcomes of a constrained postero-stabilized (CPS) insert for primary TKA in moderate to severe deformities. METHODS All patients who underwent TKA using a CPS liner in two centers between 2015 and 2017 were included in the study. The indications were: (1) valgus deformity type 2-3 partially correctable; (2) severe varus deformity with varus thrust; (3) post-traumatic deformity with major ligamentous insufficiency and any case of intra-operative ligament insufficiency. Patients were evaluated according to the Knee Society Scoring System (KSS), the Hospital for Special Surgery score (HSS), the Western Ontario and Mc Master University (WOMAC) and the Oxford Knee score (OKS). X-rays were evaluated according to the Knee Society Roentgenographic Evaluation System. RESULTS Forty-seven TKA were included, with an average age of 66.1 ± 10.3 years and an average follow-up of 68.4 ± 6 months. All patients demonstrated a moderate to severe pre-operative mediolateral instability. All the scores significantly improved (p < 0.0001). In 71.4% of cases, the outcomes were excellent or very good. There were no failures due to aseptic loosening but one failure due to a traumatic ligament rupture. The cumulative survivorship was 97.9% ± 2.1% at 84 months. CONCLUSIONS This mid-range constraint total knee replacement demonstrated promising outcomes and survival at mid-term follow-up. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
- Federica Rosso
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy
| | - Roberto Rossi
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy.,Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Via Po 8, 10100, Turin, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy.,IUSS, Istituto Universitario di Studi Superiori, Pavia, Italy
| | - Matteo Ghiara
- Clinica Ortopedica e Traumatologia, Università degli Studi di Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Davide Edoardo Bonasia
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy.
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Rossi SMP, Medetti M, Perticarini L, Ghiara M, Benazzo F. Customized intraoperatively molded articulating cement spacers for two-stage revisions TKA with major bone defects. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1121-1128. [PMID: 33417052 DOI: 10.1007/s00590-020-02844-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of articulating spacers, molded or prefabricated, becomes difficult in case of severe bone losses. Our idea was to customize the Molded Articulating Cement Spacers with cement stem extensions and if necessary metaphyseal cement augmentations in order to use them also in case of major bone defects. METHODS Fifty-four knees in fifty-three patients undergoing 2-stage exchange arthroplasty were divided in 4 groups, treated with 4 different types of spacers (Static, articulating molded, customized molded and metal on Poly) and evaluated in terms of Range of Motion (ROM), Knee Society Score (KSS), patients' related outcome measures (PROMs), rate of complication and ease of the surgical exposure at the time of reimplantation. RESULTS At final follow-up, no statistical differences in terms of ROM and KSS were found between the articulating groups. Static Spacers showed statistically significant lower results both in terms of ROM and KSS comparing to the other 3 groups (P < 0.05). Considering PROMs, statistically better outcomes for all articulating spacers were found both when spacer was in place and at final follow-up comparing to the static spacers group (P < 0.05). No statistically significant difference was found between the 3 articulating spacers groups. Radiographic analysis did not show signs of loosening, migration or major bone loss. CONCLUSIONS Customized Intraoperatively Molded Articulating Cement Spacers are a safe solution for two-stage revisions TKA with major bone defects and may provide a better quality of life for patients when in place comparing to static ones.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy.
| | - Marta Medetti
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, Pavia, Italy
| | - Loris Perticarini
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Matteo Ghiara
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, Pavia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
- Università degli Studi di Pavia, Pavia, Italy
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Putman S, Argenson JN, Bonnevialle P, Ehlinger M, Vie P, Leclercq S, Bizot P, Lustig S, Parratte S, Ramdane N, Colmar M. Ten-year survival and complications of total knee arthroplasty for osteoarthritis secondary to trauma or surgery: A French multicentre study of 263 patients. Orthop Traumatol Surg Res 2018; 104:161-164. [PMID: 29292123 DOI: 10.1016/j.otsr.2017.11.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous surgical procedures raise technical challenges in performing total knee arthroplasty (TKA) and may affect TKA outcomes. Survival rates of TKA done after trauma or surgery to the knee have not been accurately determined in large populations. The objectives of this retrospective study in 263 patients with TKA after knee trauma or surgery and a follow-up of 10 years were to assess survival, functional outcomes, and the nature and frequency of complications. HYPOTHESIS Knee trauma or surgery before TKA increases the risk of complications and decreases implant survival. MATERIAL AND METHODS Two hundred and sixty-three patients (122 [47%] females and 141 [53%] males) underwent TKA between 2005 and 2009 at nine centres in France. Mean age at surgery was 61 years. The patients had knee osteoarthritis secondary to a fracture (n=66), osteotomy (n=131), or ligament injury (n=66). Mean time from trauma or surgery to TKA was 145 months (range, 72-219 months). RESULTS Major complications were infection (n=12, 4.5%), skin problems (n=8, 3%), and stiffness (n=8, 3%). Ten-year survival to implant exchange for any reason was 89%±2.8%. Flexion range increased by 2.5°±17° (p=0.02) to a mean of 110° (range, 30° to 140°); extension range increased by 4°±7° (p<0.001) to a mean of -1.19 (range, -20° to 0°). Of the 263 patients, 157 (60%) reported little or no pain at last follow-up. Mean postoperative hip-knee-ankle angle was 179°±3.2° (range, 171°-188°). CONCLUSION TKA performed after knee injury or surgery carries a risk of specific complications (infection, skin problems, and stiffness) and may have a lower survival rate compared to primary TKA. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- S Putman
- Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, rue Emile-laine, 59037 Lille, France.
| | - J-N Argenson
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - P Bonnevialle
- Département d'orthopédie et de traumatologie, hôpital P.P.-Riquet, place Baylac, 31052 Toulouse cedex, France
| | - M Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - P Vie
- Clinique du Cèdre, 950, rue de la Haie, 76230 Bois-Guillaume, France
| | - S Leclercq
- CHP Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - P Bizot
- Service de chirurgie orthopédique et traumatologique, hôpital Lariboisière, université Paris Diderot, 3, rue Amboise-Paré, 75010 Paris, France
| | - S Lustig
- Département de chirurgie orthopédique, centre Albert-Trillat, hôpital de la Croix-Rousse, 103, boulevard de la Croix-Rousse, 69004 Lyon, France
| | - S Parratte
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - N Ramdane
- EA 2694 - Santé publique : épidémiologie et qualité des soins, université de Lille, CHU de Lille, 59000 Lille, France
| | - M Colmar
- Hôpital privé des Côtes-d'Armor, 12, rue François-Jacob, 22198 Plerin, France
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- 56, rue Boissonade, 75014 Paris cedex, France
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