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Adkar N, Patil M, Vaidya S, Kumbar R, Kerhalkar R, Mote G, Thareja S, Sadalagi P, Bajwa S. Correlation Between Planned and Executed Bone Cuts Using Robotics in Total Knee Arthroplasty: A Prospective Study of 500 Patients. Indian J Orthop 2024; 58:1103-1108. [PMID: 39087031 PMCID: PMC11286900 DOI: 10.1007/s43465-024-01196-2] [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: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 08/02/2024]
Abstract
Objective This study evaluated the precision of robotic-arm-assisted total knee arthroplasty (RATKA) in performing bone resection, predicting component size, managing soft tissue tension, and determining postoperative range of motion (ROM). Methods A total of 500 participants were enrolled in this prospective cohort research. The procedures were conducted at a single facility, with a uniform method and implant design. The Cuvis system, a fully automated robot, was utilized for the study. The precise removal of bone at both the tibial and femur sites, the positioning of the implant, and the release of soft tissue were documented and then compared to the preoperative plan. Results The distal (medial and lateral) femoral cuts had a mean absolute deviation from the plan of 0.23 mm, while the posterior (medial and lateral) femoral cuts had a mean absolute difference of 1 mm and 1.4 mm, respectively. The absolute discrepancies in the medial and lateral tibial cuts are 0.93 mm and - 0.06 mm, respectively. Out of 1000 bone resections, 980 (98%) were within < 1 mm from the preoperative plan. The predictions for the sizes of the tibial and femoral components had accuracies of 100% and 98.9%, respectively. Conclusion These findings collectively underscore the effectiveness of the fully automated Cuvis robotic system in achieving consistent and accurate results in bone resections and implant sizing, highlighting its potential as a valuable tool in orthopedic surgery.
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Affiliation(s)
- Neeraj Adkar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Mangesh Patil
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Swapnil Vaidya
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Rajendra Kumbar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Ravi Kerhalkar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Girish Mote
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Satwik Thareja
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Prajwal Sadalagi
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Supreet Bajwa
- Department of Orthopedics and Joint Replacement, Wockhardt Hospital, Mumbai Central, Maharashtra India
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Copp EH, Gale TH, Byrapogu VKC, Urish KL, Anderst WJ. Unicompartmental knee arthroplasty approximates healthy knee kinematics more closely than total knee arthroplasty. J Orthop Res 2024. [PMID: 38956422 DOI: 10.1002/jor.25926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/03/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are effective surgeries to treat end-stage knee osteoarthritis. Clinicians assume that TKA alters knee kinematics while UKA preserves native knee kinematics; however, few studies of in vivo kinematics have evaluated this assumption. This study used biplane radiography to compare side-to-side tibiofemoral kinematics during chair rise, stair ascent, and walking in 16 patients who received either TKA or UKA. We hypothesized that TKA knees would have significant kinematic changes and increased asymmetry with the contralateral knee, while UKA knee kinematics would not change after surgery and preoperative knee symmetry would be maintained. Native bone and implant motion were tracked using a volumetric model-based tracking technique. Six degrees of freedom kinematics were calculated throughout each motion. Kinematics were compared between the operated and contralateral knees pre- and post-surgery using a linear mixed-effects model. TKA knees became less varus with the tibia more medial, posterior, and distal relative to the femur. UKA knees became less varus with the tibia less lateral on average. Postoperative TKA knees were in less varus than UKA knees on average and at low flexion angles, with an internally rotated tibia during chair rise and stair ascent. At high flexion angles, the tibia was more medial and posterior after TKA than UKA. Side-to-side kinematic symmetry worsened after TKA but was maintained or improved after UKA. Greater understanding of kinematic differences between operated and contralateral knees after surgery may help surgeons understand why some patients remain unsatisfied with their new knees.
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Affiliation(s)
- Elizabeth H Copp
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tom H Gale
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Kenneth L Urish
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William J Anderst
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Vogel N, Kaelin R, Arnold MP. Custom total knee arthroplasty with personalised alignment showed better 2-year functional outcome compared to off-the-shelf arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38881354 DOI: 10.1002/ksa.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Customised individually made (CIM) total knee arthroplasty (TKA) with personalised alignment is relatively new and evidence is limited. The aim of this study was to compare patient-reported outcome measures between CIM and off-the-shelf (OTS) TKA patients in a matched-pair analysis with a 2-year follow-up. METHODS In this single-centre, prospective cohort study, propensity score matching was performed on 51 CIM and 51 OTS TKA. Data were measured at baseline, at 4 months, 1 and 2 years and included the Forgotten Joint Score (FJS-12), the High Activity Arthroplasty Score (HAAS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the EQ-5D-3L, the EQ-Visual Analogue Scale, satisfaction, overall knee improvement, willingness to undergo the surgery again and the Knee Society Score. RESULTS At 2 years follow-up, the FJS-12 (77 vs. 67, p = .058), HAAS (13 vs. 11, p < .001), KOOS daily living (92 vs. 86, p = .029), KOOS sport (76 vs. 65, p = .019), KOOS quality of life (81 vs. 71, p = .028) and the EQ-5D (.95 vs. .90, p = .030) were higher for CIM TKA compared to OTS TKA. Satisfaction rate was 92% for CIM TKA and 84% for OTS TKA (p = .357). Most patients reported an improvement in the overall knee state (94% CIM and 90% OTS, p = .487) and almost all patients would undergo the surgery again (96% CIM and 98% OTS, p = .999). CONCLUSION The current study found that CIM TKA patients had better functional outcomes at 2 years. Patient satisfaction was high and not statistically significantly different from OTS TKA patients. LEVEL OF EVIDENCE Level II prospective cohort study.
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Affiliation(s)
- Nicole Vogel
- Practice MEIN KNIE, Hirslanden Klinik Birshof, Münchenstein, Switzerland
- Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Kaelin
- Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Markus P Arnold
- Practice MEIN KNIE, Hirslanden Klinik Birshof, Münchenstein, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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LaCour MT, Dessinger GM, Haas SB, Komistek RD. In Vivo Weight-Bearing Kinematics for Constrained Versus Traditional Bicruciate Stabilized Total Knee Arthroplasty Cohorts Compared to the Normal Knee. J Arthroplasty 2024; 39:1589-1594. [PMID: 38040066 DOI: 10.1016/j.arth.2023.11.033] [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: 03/27/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Constrained inserts in total knee arthroplasty (TKA) may offer additional stability, but can this insert type allow unrestricted movements or will the extra conformity cause kinematic conflict with the cam-post mechanism in deeper flexion? The objective of this study was to evaluate the weight-bearing kinematics of both traditional and constrained bicruciate stabilized (BCS) TKA inserts to determine if the rollback induced by the cam-post mechanism will work in unison with the constrained polyethylene insert. METHODS This study used previously published 3-dimensional model fitting techniques to compare weight-bearing flexion and femoro-tibial condylar motion patterns for 20 patients who had a traditional insert, 20 patients who had a constrained insert, and 10 previously published nonimplanted knees, all performing a deep knee bend activity while under fluoroscopic surveillance. RESULTS The results from this study indicate that subjects having a bicruciate stabilized TKA experienced similar postoperative kinematics for both constrained and unconstrained insert options, comparable to normal knees. CONCLUSIONS Subjects in this study having either a constrained or traditional insert experienced progressive rollback of both condyles, with the lateral condyle rolling more posterior than the medial condyle, leading to axial rotation. Although less in magnitude, these results were comparable to the normal knee in pattern, indicating that kinematic conflict did not occur for subjects having a constrained insert.
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Affiliation(s)
- Michael T LaCour
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
| | - Garett M Dessinger
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
| | - Steven B Haas
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
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Nixon J, Tadros BJ, Moreno-Suarez I, Pretty W, Collopy D, Clark G. Functionally aligned total knee arthroplasty: A lateral flexion laxity up to 6 mm is safe! Knee Surg Sports Traumatol Arthrosc 2024; 32:1317-1323. [PMID: 38515265 DOI: 10.1002/ksa.12087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Loose flexion gaps are associated with poor functional outcomes and instability in total knee arthroplasty (TKA). The effect of a trapezoidal flexion gap in a functionally aligned TKA remains unknown. The aim of this study was to investigate the effect of a larger lateral flexion gap in a robotic-assisted (RA), functionally aligned (FA) and cruciate-retaining (CR) TKA on clinical outcomes. METHODS Data from 527 TKA in 478 patients from 2018 to 2020 were collected. All patients underwent an RA (MAKO, Stryker), FA and CR TKA. Gap measurements were collected intraoperatively. Patient-reported outcome measures (PROMs), pain Visual analogue score (VAS) and range of motion were collected postoperatively. Patients were also asked about the ease of stair ascent and descent and kneeling on a 5-point scale. The minimum follow-up was 2 years. Patients were stratified into three groups based on lateral flexion laxity. RESULTS At 2 years postoperatively, the group with a looser gap (3-6 mm) had higher mean PROMs when compared with the group with a gap of 2-3 mm. There were no differences detected in any other outcomes at 2 years. A total of 70.9% of patients in the group with a 3-6 mm gap reported being able to walk down a flight of stairs 'easily', compared with 56.7% in the 2-3 mm group and 54% in the <2 mm group (p = 0.04). CONCLUSION The study shows that a loose lateral flexion gap in functionally aligned CR TKA does not adversely affect outcomes in the short term. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jeremy Nixon
- St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia
| | - Baha John Tadros
- St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia
- Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia
| | | | - William Pretty
- Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia
| | - Dermot Collopy
- St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia
- Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia
| | - Gavin Clark
- St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia
- Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia
- University of Western Australia, Crawley, Western Australia, Australia
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Suneja A, Deshpande SV, Pisulkar G, Taywade S, Awasthi AA, Salwan A, Goel S. Navigating the Divide: A Comprehensive Review of the Mechanical and Anatomical Axis Approaches in Total Knee Replacement. Cureus 2024; 16:e57938. [PMID: 38738158 PMCID: PMC11084915 DOI: 10.7759/cureus.57938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
This comprehensive review explores the mechanical and anatomical axis approaches in total knee replacement (TKR) surgery, addressing the ongoing debate within the orthopedic community. Emphasizing the significance of TKR in alleviating knee-related disorders, this review underscores the pivotal role of accurate alignment in achieving optimal surgical outcomes. The purpose is to navigate the divide between the well-established mechanical axis approach, focusing on a straight-line alignment, and the anatomical axis approach, aligning with natural knee landmarks. The analysis delves into the advantages, disadvantages, and clinical implications of each approach, offering a nuanced perspective on their efficacy. The conclusion emphasizes a patient-centric approach, recommending the adoption of hybrid strategies and the incorporation of emerging technologies for enhanced precision. The future of TKR aligns with personalized medicine, leveraging advancements in computer-assisted navigation, robotics, and patient-specific implants. Ongoing professional development and interdisciplinary collaboration are crucial for surgeons, and as the field evolves, innovations in artificial intelligence, imaging, and 3D printing are expected to shape the trajectory of TKR alignment approaches.
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Affiliation(s)
- Anmol Suneja
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sanjay V Deshpande
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shounak Taywade
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Abhiram A Awasthi
- Orthopedics and Traumatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ankur Salwan
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sachin Goel
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Nogalo C, Farinelli L, Meena A, di Maria F, Abermann E, Fink C. Robotic-assisted total knee arthroplasty is not associated with improved accuracy in implant position and alignment compared to conventional instrumentation in the execution of a preoperative digital plan. J Exp Orthop 2024; 11:e12019. [PMID: 38572393 PMCID: PMC10985632 DOI: 10.1002/jeo2.12019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/04/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose The primary objective of the present study was to evaluate if robotic-assisted total knee arthroplasty (RO-TKA) results in improved accuracy compared to conventional TKA (CO-TKA) with respect to alignment and component positioning executing a preoperative digital plan. The secondary objective was to compare patient-reported outcome measures (PROMs) between the two groups at 6 months of follow-up (FU). Methods Patients who underwent primary TKA using the concept of constitutional alignment were identified from the database. Each patient underwent preoperative digital planning as well as postoperative evaluation of the preoperative plan (alignment and component position) using mediCAD® software (Hectec GmbH). Two groups were formed: (i) The RO-TKA group (n = 30) consisted of patients who underwent TKA with a robotic surgical system (ROSA®, Zimmer Biomet) and (ii) the CO-TKA group (n = 67) consisted of patients who underwent TKA with conventional instrumentation. To assess accuracy, all qualitative variables were analysed using the χ 2 test. Tegner activity scale, Oxford Knee Score and visual analogue scale were assessed preop and at 6-month FU. To assess differences between the two groups, a 2 × 2 repeated measures analysis of variance was performed. Results There was no significant (p > 0.05) difference in the accuracy of alignment as well as tibial and femoral component position between the two groups. At the 6-month FU, there was no significant (p > 0.05) difference in PROMs between the two groups. Conclusion While robotic TKA may have some potential advantages, no significant difference was found between robotic and conventional TKA with respect to limb alignment, clinical outcomes and component positioning. Level of Evidence Level III.
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Affiliation(s)
- Christian Nogalo
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI)UMIT TIROL—Private University For Health Sciences and Health TechnologyHall in TirolAustria
| | - Luca Farinelli
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI)UMIT TIROL—Private University For Health Sciences and Health TechnologyHall in TirolAustria
- Department of Clinical and Molecular SciencesClinical OrthopaedicsAnconaItaly
| | - Amit Meena
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI)UMIT TIROL—Private University For Health Sciences and Health TechnologyHall in TirolAustria
- Division of OrthopedicsShalby HospitalJaipurIndia
| | - Fabrizio di Maria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI)UMIT TIROL—Private University For Health Sciences and Health TechnologyHall in TirolAustria
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico “Rodolico‐San Marco”University of CataniaCataniaItaly
| | - Elisabeth Abermann
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI)UMIT TIROL—Private University For Health Sciences and Health TechnologyHall in TirolAustria
| | - Christian Fink
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI)UMIT TIROL—Private University For Health Sciences and Health TechnologyHall in TirolAustria
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Edelstein AI, Orsi AD, Plaskos C, Coffey S, Suleiman LI. Imageless robotic total knee arthroplasty determines similar coronal plane alignment of the knee (CPAK) parameters to long leg radiographs. ARTHROPLASTY 2024; 6:14. [PMID: 38431650 PMCID: PMC10909262 DOI: 10.1186/s42836-024-00231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/01/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The coronal plane alignment of the knee (CPAK) classification was first developed using long leg radiographs (LLR) and has since been reported using image-based and imageless robotic total knee arthroplasty (TKA) systems. However, the correspondence between imageless robotics and LLR-derived CPAK parameters has yet to be investigated. This study therefore examined the differences in CPAK parameters determined with LLR and imageless robotic navigation using either generic or optimized cartilage wear assumptions. METHODS Medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were determined from the intraoperative registration data of 61 imageless robotic TKAs using either a generic 2 mm literature-based wear assumption (Navlit) or an optimized wear assumption (Navopt) found using an error minimization algorithm. MPTA and LDFA were also measured from preoperative LLR by two observers and intraclass correlation coefficients (ICCs) were calculated. MPTA, LDFA, joint line obliquity (JLO), and arithmetic hip-knee-ankle angle (aHKA) were compared between the robotic and the average LLR measurements over the two observers. RESULTS ICCs between observers for LLR were over 0.95 for MPTA, LDFA, JLO, and aHKA, indicating excellent agreement. Mean CPAK differences were not significant between LLR and Navlit (all differences within 0.6°, P > 0.1) or Navopt (all within 0.1°, P > 0.83). Mean absolute errors (MAE) between LLR and Navlit were: LDFA = 1.4°, MPTA = 2.0°, JLO = 2.1°, and aHKA = 2.7°. Compared to LLR, the generic wear classified 88% and the optimized wear classified 94% of knees within one CPAK group. Bland-Altman comparisons reported good agreement for LLR vs. Navlit and Navopt, with > 95% and > 91.8% of measurements within the limits of agreement across all CPAK parameters, respectively. CONCLUSIONS Imageless robotic navigation data can be used to calculate CPAK parameters for arthritic knees undergoing TKA with good agreement to LLR. Generic wear assumptions determined MPTA and LDFA with MAE within 2° and optimizing wear assumptions showed negligible improvement.
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Affiliation(s)
- Adam I Edelstein
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | | | - Simon Coffey
- Department of Orthopaedics, Nepean Hospital, Penrith, NSW, 2750, Australia
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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Davis KR, Soti V. Effectiveness of Kinematic Alignment-Total Knee Arthroplasty in Treating Preoperative Varus and Valgus Deformities in Patients With Knee Osteoarthritis. Cureus 2024; 16:e53230. [PMID: 38293678 PMCID: PMC10826793 DOI: 10.7759/cureus.53230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/01/2024] Open
Abstract
Knee osteoarthritis (OA) is surgically treated with total knee arthroplasty (TKA). Traditionally, TKA has been performed using a mechanical alignment (MA) philosophy. However, due to significant patient dissatisfaction with surgical outcomes, an alternate alignment approach, kinematic alignment (KA), has gained popularity. KA-TKAs have improved functional patient outcomes by restoring the patient's native joint line orientation and minimizing soft tissue releases compared to neutral alignment in MA-TKAs. This review explores the postoperative effectiveness of utilizing KA-TKA to treat knee OA in patients with preoperative varus and valgus deformities. A comprehensive literature search was conducted on PubMed and Biomed Central databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search focused on studies analyzing the postoperative TKA outcomes in knee OA patients with preoperative varus or valgus deformities whose surgeries followed a KA philosophy and those comparing KA-TKA with MA-TKA. The available clinical evidence indicates that KA-TKA can be a viable treatment option for individuals with knee OA. The alignment of phenotypes has little clinical significance concerning functional outcomes and implant survival rates following KA-TKA. Furthermore, surgery outcomes in patients with preoperative deformities who underwent KA-TKA were similar to those who underwent MA-TKA. KA-TKA produced significantly better functional outcomes than MA-TKA in certain aspects. However, studies with larger sample sizes and more extended follow-up periods that directly compare KA-TKA with MA-TKA in treating knee OA patients are needed to fully demonstrate the efficacy of each technique. Furthermore, further research into the effects of KA-TKA on implant survival rates will provide a better understanding of the benefits of this technique and ultimately lead to improved patient outcomes.
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Affiliation(s)
- Kyle R Davis
- Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Varun Soti
- Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA
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Masilamani ABS, Jayakumar T, Mulpur P, Gandhi V, Kikkuri RR, Reddy AVG. Functional alignment is associated with increased incidence of pre-balance, reduced soft-tissue release, and post-operative pain compared to mechanical alignment in patients undergoing simultaneous bilateral robotic-assisted TKA. J Robot Surg 2023; 17:2919-2927. [PMID: 37831402 DOI: 10.1007/s11701-023-01732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023]
Abstract
This study aimed to compare two alignment strategies in the same patient undergoing simultaneous bilateral robotic-assisted TKA (SB-RATKA): mechanical alignment (MA), the gold-standard, and functional alignment (FA), a balance-driven, personalized alignment strategy. The outcome measures included quantitative assessment of soft-tissue release, incidence of knee balance, and post-operative pain. This was a prospective, self-controlled, randomized-controlled trial involving 72 patients who underwent SB-RATKA using the MAKO® robotic system with comparable grades of deformity and pain in both knees. 65 patients were finally included with one alignment strategy done per knee, with the patients blinded to the strategy used. The study recorded the additional soft-tissue releases required, incidence of pre-balance, and daily post-operative VAS pain scores. The mean age of the study population was 57.95 years, with a female preponderance (N = 53, 81.6%). MA group had significantly more medial compartment tightness in both flexion (MA-15.6 ± 1.8; FA-17 ± 1.3) and extension (MA-14.9 ± 1.9; FA-17 ± 1.1) (p < 0.0001) compared to the FA group after dynamic balancing. 66% of knees in the FA group (N = 43) achieved pre-balance compared to 32.3% in the MA group (N = 21) (p < 0.0001). VAS scores showed a significant reduction in pain in the FA group up to 72 h post-surgery (p < 0.0001). The requirement for posteromedial release (PM), posterior capsular (PC) release, tibial reduction osteotomy (TRO), and superficial MCL pie crusting (sMCL) were significantly lower in FA (PM-22, PC-13, TRO-8, sMCL-2) compared to MA (PM-44, PC-29, TRO-18, sMCL-8). Functional alignment strategy consistently resulted in a higher incidence of knee balance with a significant reduction in soft-tissue releases and immediate post-operative pain when compared to MA in the same patient undergoing SB-RATKA. Therapeutic Level 1.
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Affiliation(s)
| | - Tarun Jayakumar
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India.
| | - Praharsha Mulpur
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Vibhav Gandhi
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
| | | | - A V Gurava Reddy
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
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Karasavvidis T, Pagan Moldenhauer CA, Lustig S, Vigdorchik JM, Hirschmann MT. Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) - there is no winner yet. J Exp Orthop 2023; 10:120. [PMID: 37991599 PMCID: PMC10665290 DOI: 10.1186/s40634-023-00697-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Dissatisfaction following total knee arthroplasty (TKA) has been extensively documented and it was attributed to numerous factors. In recent years, significant focus has been directed towards implant alignment and stability as potential causes and solutions to this issue. Surgeons are now exploring a more personalized approach to TKA, recognizing the importance of thoroughly understanding each individual patient's anatomy and functional morphology. A more comprehensive preoperative analysis of alignment and knee morphology is essential to address the unresolved questions in knee arthroplasty effectively. The crucial task of determining the most appropriate alignment strategy for each patient arises, given the substantial variability in bone resection resulting from the interplay of phenotype and the alignment strategy chosen. This review aims to comprehensively present the definitions of different alignment techniques in all planes and discuss the consequences dependent on knee phenotypes.Level of evidence V.
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Affiliation(s)
- Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Cale A Pagan Moldenhauer
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Sébastien Lustig
- Department of Orthopaedic Surgery and Sports Medicine, Croix-Rousse Hospital, Lyon, 69004, France
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, CH-4101, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, CH-4001, Switzerland
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李 亦, 张 晓, 曹 力, 孙 永, 叶 晔, 谢 杰, 胡 懿, 李 忠, 唐 本. [A multicenter randomized controlled trial of domestic robot-assisted and conventional total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1326-1334. [PMID: 37987040 PMCID: PMC10662400 DOI: 10.7507/1002-1892.202307078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
Objective To investigate the accuracy, safety, and short-term effectiveness of a domestic robot-assisted system in total knee arthroplasty (TKA) by a multicenter randomized controlled trial. Methods Between December 2021 and February 2023, 138 patients with knee osteoarthritis who received TKA in 5 clinical centers were prospectively collected, and 134 patients met the inclusion criteria were randomly assigned to either a trial group ( n=68) or a control group ( n=66). Seven patients had lost follow-up and missing data, so they were excluded and the remaining 127 patients were included for analysis, including 66 patients in the trial group and 61 patients in the control group. There was no significant difference ( P>0.05) in gender, age, body mass index, side, duration of osteoarthritis, Kellgren-Lawrence grading, preoperative Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups. The trial group completed the TKA by domestic robot-assisted osteotomy according to the preoperative CT-based surgical planning. The control group was performed by traditional osteotomy plate combined with soft tissue release. Total operation time, osteotomy time of femoral/tibial side, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. The radiographs were taken at 5 and 90 days after operation, and hip-knee-ankle angle (HKA), lateral distal angle of femur (LDFA), and posterior tibial slope (PTS) were measured. The difference between the measured values of the above indexes at two time points after operation and the preoperative planning target values was calculated, and the absolute value (absolute error) was taken for comparison between the two groups. The postoperative recovery of lower limb alignment was judged and the accuracy was calculated. KSS score and WOMAC score were used to evaluate the knee joint function of patients before operation and at 90 days after operation. The improvement rates of KSS score and WOMAC score were calculated. The function, stability, and convenience of the robot-assisted system were evaluated by the surgeons. Results The total operation time and femoral osteotomy time of the trial group were significantly longer than those of the control group ( P<0.05). There was no significant difference in the tibial osteotomy time and the amount of intraoperative blood loss between the two groups ( P>0.05). The incisions of both groups healed by first intention after operation, and there was no infection around the prosthesis. Nine patients in the trial group and 8 in the control group developed lower extremity vascular thrombosis, all of which were calf intermuscular venous thrombosis, and there was no significant difference in the incidence of complications ( P>0.05). All patients were followed up 90 days. There was no significant difference in KSS score and WOMAC score between the two groups at 90 days after operation ( P>0.05). There was significant difference in the improvement rate of KSS score between the two groups ( P<0.05), while there was no significant difference in the improvement rate of WOMAC score between the two groups ( P>0.05). Radiological results showed that the absolute errors of HKA and LDFA in the trial group were significantly smaller than those in the control group at 5 and 90 days after operation ( P<0.05), and the recovery accuracy of lower limb alignment was significantly higher than that in control group ( P<0.05). The absolute error of PTS in the trial group was significantly smaller than that in the control group at 5 days after operation ( P<0.05), but there was no significant difference at 90 days between the two groups ( P>0.05). The functional satisfaction rate of the robot-assisted system was 98.5% (65/66), and the satisfaction rates of stability and convenience were 100% (66/66). Conclusion Domestic robot-assisted TKA is a safe and effective surgical treatment for knee osteoarthritis, which can achieve favorable lower limb alignment reconstruction, precise implant of prosthesis, and satisfactory functional recovery.
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Affiliation(s)
- 亦丞 李
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 晓岗 张
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 力 曹
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 永强 孙
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 晔 叶
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 杰 谢
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 懿郃 胡
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 忠 李
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 本森 唐
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
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13
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Yu J, Xia Y, Zhou C, Tsai T, Li S, Foster T, Bedair H, Li G. Investigation of Characteristic Motion Patterns of the Knee Joint During a Weightbearing Flexion. Ann Biomed Eng 2023; 51:2237-2244. [PMID: 37261589 DOI: 10.1007/s10439-023-03259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/28/2023] [Indexed: 06/02/2023]
Abstract
This study aimed to develop and validate a novel flexion axis concept by calculating the points on femoral condyles that could maintain constant heights during knee flexion. Twenty-two knees of 22 healthy subjects were investigated when performing a weightbearing single leg lunge. The knee positions were captured using a validated dual fluoroscopic image system. The points on sagittal planes of the femoral condyles that had minimal changes in heights from the tibial plane along the flexion path were calculated. It was found that the points do formulate a medial-lateral flexion axis that was defined as the iso-height axis (IHA). The six degrees of freedom (6DOF) kinematics data calculated using the IHA were compared with those calculated using the conventional transepicondylar axis and geometrical center axis. The IHA measured minimal changes in proximal-distal translations and varus-valgus rotations along the flexion path, indicating that the IHA may have interesting clinical implications. Therefore, identifying the IHA could provide an alternative physiological reference for improvement of contemporary knee surgeries, such as ligament reconstruction and knee replacement surgeries that are aimed to reproduce normal knee kinematics and medial/lateral soft tissue tensions during knee flexion.
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Affiliation(s)
- Jia Yu
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, Newton, MA, 02462, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Orthopaedic Institute, Soochow Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Yulian Xia
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, Newton, MA, 02462, USA
| | - Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, Newton, MA, 02462, USA
| | - Tsungyuan Tsai
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, Newton, MA, 02462, USA
| | - Sophia Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, Newton, MA, 02462, USA
| | - Timothy Foster
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, Newton, MA, 02462, USA
| | - Hany Bedair
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, Newton, MA, 02462, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, Newton, MA, 02462, USA.
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Gieroba TJ, Marasco S, Babazadeh S, Di Bella C, van Bavel D. Arithmetic hip knee angle measurement on long leg radiograph versus computed tomography-inter-observer and intra-observer reliability. ARTHROPLASTY 2023; 5:35. [PMID: 37528475 PMCID: PMC10394810 DOI: 10.1186/s42836-023-00193-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/03/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Pre-operative alignment is important for knee procedures including total knee arthroplasty (TKA), especially when considering alternative alignments. The arithmetic Hip Knee Angle (aHKA) is a measure of coronal alignment calculated using the medial proximal tibial (MPTA) and lateral distal femoral angles (LDFA). Traditionally, aHKA is measured on long leg radiographs (LLR). This study assesses the reproducibility of aHKA measurement on LLR and robotic-assisted TKA planning CT. METHODS Sixty-eight TKA patients with pre-operative LLR and planning CTs were included. Three observers measured the LDFA, MPTA and aHKA three times on each modality and intra-observer and inter-observer reliability was calculated. Statistical analysis was undertaken with Pearson's r and the Bland-Altman test. RESULTS Mean intra-observer coefficient of repeatability (COR) for LLR vs. CT: MPTA 3.50° vs. 1.73°, LDFA 2.93° vs. 2.00° and aHKA 2.88° vs. 2.57° for CT. Inter-observer COR for LLR vs. CT: MPTA 2.74° vs. 1.28°, LDFA 2.31° vs. 1.92°, aHKA 3.56° vs. 2.00°. Mean intra-observer Pearson's r for MPTA was 0.93 for LLR and 0.94 for CT, LDFA 0.90 for LLR and 0.91 for CT and aHKA 0.92 for LLR and 0.94 for CT. Inter-observer Pearson's r for LLR compared to CT: MPTA 0.93 vs. 0.97, LDFA 0.91 vs. 0.90, aHKA 0.91 and 0.95. CONCLUSION When compared to LLR, CT measurements of MPTA, LDFA and aHKA are more reproducible and have a good correlation with LLR measurement. CT overcomes difficulties with positioning, rotation, habitus and contractures when assessing coronal plane alignment and may obviate the need for LLRs.
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Affiliation(s)
- Tom Jan Gieroba
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC, 3065, Australia.
- Discipline of Orthopaedics and Trauma, Adelaide University, Adelaide, SA, 5005, Australia.
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia.
- Sportsmed, Stepney, SA, 5069, Australia.
| | - Sofia Marasco
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC, 3065, Australia
| | - Sina Babazadeh
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC, 3065, Australia
- Australian Orthopaedic Research Group, Kew East, VIC, 3102, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Claudia Di Bella
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC, 3065, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, 3010, Australia
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, VIC, 3065, Australia
| | - Dirk van Bavel
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC, 3065, Australia
- Department of Surgery, Epworth Healthcare, Richmond, VIC, 3121, Australia
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Karasavvidis T, Pagan Moldenhauer CA, Haddad FS, Hirschmann MT, Pagnano MW, Vigdorchik JM. Current Concepts in Alignment in Total Knee Arthroplasty. J Arthroplasty 2023; 38:S29-S37. [PMID: 36773657 DOI: 10.1016/j.arth.2023.01.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND In an effort to increase satisfaction among total knee arthroplasty (TKA) patients, emphasis has been placed on implant positioning and limb alignment. Traditionally, the aim for TKA has been to achieve a neutral mechanical alignment (MA) to maximize implant longevity. However, with the recent spike in interest in individualized alignment techniques and with the advent of new technologies, surgeons are slowly evolving away from classical MA. METHODS This review elucidates the differences in alignment techniques for TKA, describes the concept of knee phenotypes, summarizes comparative studies between MA and individualized alignment, and provides a simple way to incorporate the latter into surgeons' practice. RESULTS In order to manage patients by applying these strategies in day-to-day practice, a basic understanding of the aforementioned concepts is essential. Transition to an individualized alignment technique should be done gradually with caution in a stepwise approach. CONCLUSION Alignment and implant positioning are now at the heart of the debate and surgeons are investigating a more personalized approach to TKA.
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Affiliation(s)
- Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Cale A Pagan Moldenhauer
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospital, London
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Mark W Pagnano
- Deparment of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Balaguer-Castro M, Torner P, Jornet-Gibert M, Martínez-Pastor JC. [Translated article] Current situation of robotics in knee prosthetic surgery: A technology that has come to stay? Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T334-T341. [PMID: 36863515 DOI: 10.1016/j.recot.2023.02.012] [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: 07/01/2022] [Accepted: 10/07/2022] [Indexed: 03/04/2023] Open
Abstract
Robotic surgery is a surgical technique that is on the rise. The goal of robotic-assisted total knee arthroplasty (RA-TKA) is to provide the surgeon with a tool to accurately execute bone cuts according to previous surgical planning to restore knee kinematics and balance of soft tissue, being able to precisely apply the type of alignment that we choose. In addition, RA-TKA is a very useful tool for training. Within the limitations, there is the learning curve, the need for specific equipment, the high cost of the devices, the increase in radiation in some systems and that each robot is linked to a specific type of implant. Current studies show, with RA-TKA, variations in the alignment of the mechanical axis are reduced, postoperative pain is improved and earlier discharge is facilitated. On the other hand, there are no differences in terms of range of motion, alignment, gap balance, complications, surgical time or functional results.
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Affiliation(s)
- M Balaguer-Castro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain.
| | - P Torner
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - M Jornet-Gibert
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - J C Martínez-Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain; Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
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Colyn W, Cleymans A, Bruckers L, Truijen J, Smeets K, Bellemans J. The pre-diseased coronal alignment can be predicted from conventional radiographs taken of the varus arthritic knee. Arch Orthop Trauma Surg 2023; 143:4425-4436. [PMID: 36494462 DOI: 10.1007/s00402-022-04709-6] [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: 10/09/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The concept of restoring the constitutional, pre-diseased alignment has gained lots of interest among knee surgeons. Previous attempts to use the contralateral limb to bridge the gap between the arthritic and the constitutional alignment were unsuccessful. We investigated the usability of a mathematical formula to predict the constitutional (pre-diseased) coronal alignment once arthritis has occurred. It is our hypothesis that by using the KL grade, CPAK classification and four radiographic measurements of the arthritic knee, the pre-diseased coronal alignment could be predicted. MATERIAL AND METHODS Hundred arthritic patients with consecutive X-rays were used to determine a mathematical formula. Five alignment parameters were determined on full-length X-rays: HKA angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and the tibial joint line angle (TJLA). A refinement of the algorithm was implemented based on a reference cohort, consisted of 250 young adults aged between 20 and 27 years. Moreover, all knees were subdivided based on their CPAK-phenotype and the Kellgren-Lawrence scale (KL scale). An independent arthritic cohort of 289 patients scheduled for primary total knee arthroplasty was included to verify the accuracy of the predicted HKAs (HKAPRED). RESULTS In CPAK type 1, the HKAPRED was 3.86° varus (STD 1.39) and the HKAYHA was 4.0° varus. In CPAK type 2, the HKAPRED was 1.68° varus (STD 1.95) compared to a HKAYHA of 1.34° (STD 0.81). The average constitutional HKA is not different in both CPAK 1 (p = 0.61) and CPAK 2 (p = 0.25), and the difference in the mean is estimated to be equal to - 0.14 (95CI - 0.68 to 0.40) in CPAK 1 and 0.35 (95CI - 0.06 to 0.75) in CPAK 2. CONCLUSION Using the KL grade, CPAK classification and four radiographic measurements of the arthritic knee, the pre-diseased coronal alignment can be predicted in 80% of the varus knees with an accuracy of ≤ 0.5°. The predicted HKA (HKAPRED) can be very useful in the current and future clinical practice.
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Affiliation(s)
- William Colyn
- Department of Orthopedic Surgery, AZ Turnhout, Steenweg Op Merksplas 44, 2300, Turnhout, Belgium.
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
- Limburg Clinical Research Center, ZOL Genk, Genk, Belgium.
| | - A Cleymans
- Department of Orthopedic Surgery, AZ Turnhout, Steenweg Op Merksplas 44, 2300, Turnhout, Belgium
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - L Bruckers
- I-BioStat, University Hasselt, Hasselt, Belgium
| | - J Truijen
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Orthopedic Surgery, ZOL Genk, Genk, Belgium
| | - K Smeets
- Department of Orthopedic Surgery, AZ Vesalius, Tongeren, Belgium
- Faculty of Rehabilitation Science, Hasselt University, Diepenbeek, Belgium
- GRIT Belgian Sports Clinic, Leuven, Belgium
| | - J Bellemans
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Orthopedic Surgery, ZOL Genk, Genk, Belgium
- GRIT Belgian Sports Clinic, Leuven, Belgium
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Waterson H, Walker R, Koopmans P, Stroud R, Phillips J, Mandalia V, Eyres K, Toms A. Gap balanced adjusted mechanical alignment versus measured resection mechanical alignment: a randomised controlled trial. Arch Orthop Trauma Surg 2023; 143:2141-2151. [PMID: 35690965 PMCID: PMC10030405 DOI: 10.1007/s00402-022-04487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Alignment goals in total knee replacement (TKR) is a topical subject. This study compares the short-term functional outcomes and patient reported outcome measures (PROMs) of two philosophies for knee arthroplasty alignment: measured resection (MR) and an individualised alignment philosophy, with the tibia mechanically aligned and an instrumented gap balancer (GB) to align the femur in both flexion and extension. PATIENTS AND METHODS 94 knees were enrolled in this randomised controlled trial. The surgical protocol used a MR technique for mechanical alignment or a GB technique for individualised alignment. Primary outcome was quadriceps strength. Secondary outcomes included validated functional tests and PROMs as well as patient satisfaction. Outcomes were assessed pre-operatively, at 6 weeks, 3, 6 and 12 months post-operatively. RESULTS At 12-month follow-up, there was no significant difference in the change from baseline mean quadriceps peak torque between the two groups (p = 0.988). Significant improvement in the change in range of motion (ROM) in the GB group compared to the MR group at 3 months (13° vs 6° p = 0.028) but this improvement was not significant at 1 year (20° vs 17° p = 0.21). The functional test of balance showed statistically significant improvement at 6 weeks (p = 0.03) in the GB group but this difference was not maintained. PROMs favoured the GB group, with the KOOS pain scoring statistically better (p ≤ 0.05) at 6 weeks, 3, 6 and 12 months. CONCLUSIONS Individualised alignment philosophy utilising a GB technique did not demonstrate an improvement in the primary outcome measure quadriceps peak torque. Improvement was seen in the GB group in PROM pain scores that was significant, both statistically and clinically, out to at least 1 year. Gains that were seen in functional assessment with GB, although significant at some time points, were no longer significant at 1 year and no difference was seen in quads strength. Compared to a MR technique, the individualised GB technique appears to confer some improvement in pain, ROM and some functional tests following TKR in the short-term.
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Affiliation(s)
- Hugh Waterson
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK.
| | - Robert Walker
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
| | | | - Rowenna Stroud
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
| | | | - Vipul Mandalia
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
| | - Keith Eyres
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
| | - Andrew Toms
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
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19
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Functional alignment with robotic‑arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:1072-1080. [PMID: 36378291 DOI: 10.1007/s00167-022-07227-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Given the improved accuracy of robot-assisted surgery, robotic-arm assisted functionally aligned total knee arthroplasty (RFA-TKA) aims to preserve the native pre-arthritic knee biomechanics, to achieve balanced flexion-extension gaps. The purpose of this study was to compare the accuracy of the implant position and short-term clinical outcomes of patients who underwent RFA-TKA vs. mechanically aligned total knee arthroplasty with manual technique (MA-TKA). METHODS A prospectively collected database was reviewed retrospectively for patients who underwent primary TKA. Sixty patients who underwent RFA-TKA between February 2020 and July 2020 were included in the RFA-TKA group. Sixty patients who underwent MA-TKA were included via 1:1 matching for age, sex, and body mass index based on the RFA-TKA group. For radiological evaluation, knee X-rays were used to assess the functional knee phenotype and implant position accuracy by measuring the coronal and sagittal alignment, and these measurements were compared between the two groups. Patient demographic characteristics and patient-reported outcomes including Knee Society scores, Western Ontario and McMaster Universities Arthritis Index, and forgotten joint score-12 were compared between the groups. RESULTS Statistically significant differences were observed in postoperative 2-year clinical outcomes in favor of RFA-TKA group which showed greater accuracy in the tibial component sagittal alignment than MA-TKA (1.0 ± 2.3 vs. 0.7 ± 1.6, respectively; P < 0.001). However, outliers in the component positions were more common in the MA-TKA group, which was statistically significant for the femoral coronal and tibial sagittal alignments (P = 0.017 and 0.015, respectively). CONCLUSIONS Functional alignment in TKA could be accurately obtained with the assistance of a robotic arm, and the results showed greater 2 year postoperative patient-reported outcome and satisfaction than mechanically aligned TKA using manual instruments. LEVEL OF EVIDENCE III.
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Gausden EB, Puri S, Chiu YF, Figgie MP, Sculco TP, Westrich G, Sculco PK, Chalmers BP. Mid-term survivorship of primary total knee arthroplasty with a specific implant. Bone Joint J 2023; 105-B:277-283. [PMID: 36854324 DOI: 10.1302/0301-620x.105b3.bjj-2022-0616.r1] [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: 03/02/2023]
Abstract
The purpose of this study was to assess mid-term survivorship following primary total knee arthroplasty (TKA) with Optetrak Logic components and identify the most common revision indications at a single institution. We identified a retrospective cohort of 7,941 Optetrak primary TKAs performed from January 2010 to December 2018. We reviewed the intraoperative findings of 369 TKAs that required revision TKA from January 2010 to December 2021 and the details of the revision implants used. Kaplan-Meier analysis was used to determine survivorship. Cox regression analysis was used to examine the impact of patient variables and year of implantation on survival time. The estimated survivorship free of all-cause revision was 98% (95% confidence interval (CI) 97% to 98%), 95% (95% CI 95% to 96%), and 86% (95% CI 83% to 88%) at two, five, and ten years, respectively. In 209/369 revisions there was a consistent constellation of findings with varying severity that included polyethylene wear and associated synovitis, osteolysis, and component loosening. This failure mode, which we refer to as aseptic mechanical failure, was the most common revision indication. The mean time from primary TKA to revision for aseptic mechanical failure was five years (5 months to 11 years). In this series of nearly 8,000 primary TKAs performed with a specific implant, we identified a lower-than-expected mid-term survivorship and a high number of revisions with a unique presentation. This study, along with the recent recall of the implant, confirms the need for frequent monitoring of patients with Optetrak TKAs given the incidence of polyethylene failure, osteolysis, and component loosening.
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Affiliation(s)
- Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
| | - Simarjeet Puri
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Yu-Fen Chiu
- Biostatistics Core, Hospital for Special Surgery, New York, USA
| | - Mark P Figgie
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
| | - Thomas P Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
| | - Geoffrey Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
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Trends in Computer-Assisted Surgery for Total Knee Arthroplasty in Germany: An Analysis Based on the Operative Procedure Classification System between 2010 to 2021. J Clin Med 2023; 12:jcm12020549. [PMID: 36675478 PMCID: PMC9863460 DOI: 10.3390/jcm12020549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74% per year, while the number of navigated TKAs declined (-3.67% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard.
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Thicker polyethylene inserts (≥ 13 mm) increase the risk for early failure after primary cruciate-retaining total knee arthroplasty (TKA): a single-centre study of 7643 TKAs. Knee Surg Sports Traumatol Arthrosc 2023; 31:1018-1025. [PMID: 36205761 PMCID: PMC9957842 DOI: 10.1007/s00167-022-07189-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/28/2022] [Indexed: 02/14/2023]
Abstract
PURPOSE This study investigates whether thicker (PE) inserts lead to a greater risk for revision after TKA. The differences between the TKA designs of three manufacturers (NexGen, PFC Sigma, Triathlon) are also compared. METHODS A total of 7643 primary TKA surgeries were included. PE inserts were divided into two groups-"thick PE inserts" with a thickness of 13 mm (mm) or more and "standard PE inserts" with a thickness of less than 13 mm. Three cruciate-retaining (CR) TKA designs (NexGen, PFC Sigma, Triathlon) were included in the study. The differences in failure rates between groups were investigated using Kaplan-Meier survival curves and Cox regression model with hazard ratios (HR). Failure rates were investigated short-term (< 2 years) and long-term (the whole follow-up period). The TKA designs were analysed both together and separately. RESULTS During the whole follow-up period, there were 184 (2.4%) aseptic revisions. The thick PE insert group showed an increased risk for revision compared to the standard PE insert group in both short-term (< 2 years; HR 2.0, CI 1.3 to 3.2) and long term (> 2 years; HR 1.6, CI 1.1 to 2.3) follow-up. The highest revision rate was observed in patients who received the Triathlon TKA with a thicker PE insert (HR 2.6, CI 1.2 to 5.7). CONCLUSION The results indicate that thicker PE inserts are associated with increased risk for revision in primary TKA. Further research is required to ascertain whether more conformed PE inserts or constrained knee designs instead of thick CR inserts will ultimately lead to better clinical outcomes. LEVEL OF EVIDENCE III.
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Schelker BL, Moret CS, von Eisenhart-Rothe R, Graichen H, Arnold MP, Leclercq V, Huegli RW, Hirschmann MT. The impact of different alignment strategies on bone cuts for neutral knee phenotypes in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 31:1267-1275. [PMID: 36326877 PMCID: PMC10050061 DOI: 10.1007/s00167-022-07209-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to simulate and visualise the influence of the alignment strategy on bone resection in neutral knee phenotypes. It was hypothesised that different amounts of bone resection would be required depending on the alignment strategy chosen. The hypothesis was that by visualising the corresponding bone cuts, it would be possible to assess which of the different alignment strategies required the least change to the soft tissues for the chosen phenotype but still ensured acceptable component alignment and could, therefore, be considered the most ideal alignment strategy. METHODS Simulations of the different alignment strategies (mechanical, anatomical, restricted kinematic and unrestricted kinematic) regarding their bone resections were performed on four common exemplary neutral knee phenotypes. NEUHKA0° VARFMA 90° VALTMA90°, NEUHKA0° NEUFMA 93° NEUTMA87°, NEUHKA0° VALFMA 96° NEUTMA87° and NEUHKA0° VALFMA 99° VARTMA84°. The phenotype system used categorises knees based on overall limb alignment (i.e. hip knee angle) but also considers joint line obliquity (i.e. TKA and FMA) and has been used globally since its introduction in 2019. These simulations are based on long leg weightbearing radiographs. It is assumed that a change of 1° in the alignment of the joint line corresponds to correspond to 1 mm of distal condyle offset. RESULTS In the most common neutral phenotype NEUHKA0° NEUFMA 93° NEUTMA87°, with a prevalence of 30%, bone cuts remain below 4 mm regardless of alignment strategy. The greatest changes in the obliquity of the joint line can be expected for the mechanical alignment of the phenotype NEUHKA0° VALFMA 99° VARTMA84° where the medial tibia is raised by 6 mm and the lateral femur is shifted distally by 9 mm. In contrast, the NEUHKA0° VARFMA 90° VALTMA90° phenotype requires no change in joint line obliquity if the mechanical alignment strategy is used. CONCLUSION Illustrations of alignment strategies help the treating surgeon to estimate the postoperative joint line obliquity. When considering the alignment strategy, it seems reasonable to prefer a strategy where the joint line obliquity is changed as little as possible. Although for the most common neutral knee phenotype the choice of alignment strategy seems to be of negligible importance, in general, even for neutral phenotypes, large differences in bone cuts can be observed depending on the choice of alignment strategy.
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Affiliation(s)
- Benjamin L Schelker
- Department of Orthopedic Surgery and Traumatology, Head Knee Surgery and DKF Head of Research, Kantonsspital Baselland, Bruderholz, 4101, Bottmingen, Switzerland.,Department of Clinical Research, Regenerative Medicine & Biomechanics, Research Group Michael T. Hirschmann, University of Basel, 4001, Basel, Switzerland
| | - Céline S Moret
- Department of Orthopedic Surgery and Traumatology, Head Knee Surgery and DKF Head of Research, Kantonsspital Baselland, Bruderholz, 4101, Bottmingen, Switzerland.,Department of Clinical Research, Regenerative Medicine & Biomechanics, Research Group Michael T. Hirschmann, University of Basel, 4001, Basel, Switzerland
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Heiko Graichen
- Department of Arthroplasty, Sports Medicine and Traumatology, Orthopaedic Hospital Lindenlohe, Indanone 18, 92421, Schwandorf, Germany
| | - Markus P Arnold
- LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | | | - Rolf W Huegli
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, Bruderholz, 4101, Bottmingen, Switzerland
| | - Michael T Hirschmann
- Department of Orthopedic Surgery and Traumatology, Head Knee Surgery and DKF Head of Research, Kantonsspital Baselland, Bruderholz, 4101, Bottmingen, Switzerland. .,Department of Clinical Research, Regenerative Medicine & Biomechanics, Research Group Michael T. Hirschmann, University of Basel, 4001, Basel, Switzerland.
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Castellarin G, Bori E, Menon A, Innocenti B. The effect of different insert design congruencies on the kinematics of a mobile bearing TKA: A cadaveric study. J Orthop 2022; 34:89-93. [PMID: 36046758 PMCID: PMC9421089 DOI: 10.1016/j.jor.2022.07.018] [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] [Received: 04/12/2022] [Revised: 06/07/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Total knee arthroplasty has proved to be a safe, effective and reproducible surgical treatment for patients with serious/advanced degenerative joint disease of the knee, but the optimal results after these implants can be achieved only if the joint kinematics and kinetics are carefully respected and not significantly altered after the replacement. In order to enhance the capability of matching the healthy configuration, therefore, different prosthesis models in terms of constraints and designs are available for the surgeons to choose among. As an example of this variety, mobile bearing models allow the surgeon to choose among different insert designs in terms of geometry and relative biomechanical approaches, with the relative performances depending on which one is adopted.This article aims to analyse the effect of different levels of congruency of mobile bearing inserts through an experimental activity performed on an ultra-congruent insert design, also referred as deep-dished. Methods The experimental activity followed the same protocol used in a previous study focused on the effect of symmetricity/asymmetricity (in order to allow a comparison among the results obtained), i.e. it analysed passive squat on 5 cadaveric knee specimens; internal-external rotations of femur and tibial insert respect to the tibia tray were thus measured via a motion capture system in order to compare the insert-femur relative rotation among the different congruency configurations. Results The overall knee kinematic (in terms of flexion-extension and internal-external rotation ranges of motion) with an ultra-congruent insert did not differ from the ones found for the other inserts; the insert-femur rotation values, instead, returned to be between the ones obtained with the other two inserts. Conclusion In terms of adaptability to tibio-femoral rotation, therefore, this insert represents a valid option for the surgeon seeking for an intermediate solution among the opposed approaches of the other two.
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Affiliation(s)
| | - Edoardo Bori
- Université Libre de Bruxelles, École Polytechnique de Bruxelles, BEAMS Department (Bio Electro and Mechanical Systems), Brussels, Belgium
| | | | - Bernardo Innocenti
- Université Libre de Bruxelles, École Polytechnique de Bruxelles, BEAMS Department (Bio Electro and Mechanical Systems), Brussels, Belgium
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Hannon CP, Kruckeberg BM, Pagnano MW, Berry DJ, Hanssen AD, Abdel MP. Revision total knee arthroplasty for flexion instability : a concise follow-up of a previous report. Bone Joint J 2022; 104-B:1126-1131. [PMID: 36177638 DOI: 10.1302/0301-620x.104b10.bjj-2022-0358.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS We have previously reported the mid-term outcomes of revision total knee arthroplasty (TKA) for flexion instability. At a mean of four years, there were no re-revisions for instability. The aim of this study was to report the implant survivorship and clinical and radiological outcomes of the same cohort of of patients at a mean follow-up of ten years. METHODS The original publication included 60 revision TKAs in 60 patients which were undertaken between 2000 and 2010. The mean age of the patients at the time of revision TKA was 65 years, and 33 (55%) were female. Since that time, 21 patients died, leaving 39 patients (65%) available for analysis. The cumulative incidence of any re-revision with death as a competing risk was calculated. Knee Society Scores (KSSs) were also recorded, and updated radiographs were reviewed. RESULTS The cumulative incidence of any re-revision was 13% at a mean of ten years. At the most recent-follow-up, eight TKAs had been re-revised: three for recurrent flexion instability (two fully revised to varus-valgus constrained implants (VVCs), and one posterior-stabilized (PS) implant converted to VVC, one for global instability (PS to VVC), two for aseptic loosening of the femoral component, and two for periprosthetic joint infection). The ten-year cumulative incidence of any re-revision for instability was 7%. The median KSS improved significantly from 45 (interquartile range (IQR) 40 to 50) preoperatively to 70 (IQR 45 to 80) at a mean follow-up of ten years (p = 0.031). Radiologically, two patients, who had not undergone revision, had evidence of loosening (one tibial and one patellar). The remaining components were well fixed. CONCLUSION We found fair functional outcomes and implant survivorship at a mean of ten years after revision TKA for flexion instability with a PS implant. Recurrent instability and aseptic loosening were the most common indications for re-revision. Components with increased constraint, such as a VVC or hinged, should be used in these patients in order to reduce the risk of recurrent instability.Cite this article: Bone Joint J 2022;104-B(10):1126-1131.
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Affiliation(s)
- Charles P Hannon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Li J, Zhang Y, Gao X, Dou T, Li X. Accelerometer-based navigation vs. conventional techniques for total knee arthroplasty (TKA): a systematic review and meta-analysis of randomized controlled trials. ARTHROPLASTY 2022; 4:35. [PMID: 36050798 PMCID: PMC9438290 DOI: 10.1186/s42836-022-00135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background The aim of the study was to determine whether accelerometer-based navigation (ABN) can improve radiological and functional outcomes during total knee arthroplasty (TKA) compared with conventional techniques (CONV). Method We comprehensively searched the PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials databases. Only randomized controlled trials were selected for meta-analysis and, ultimately, 10 studies were included. Results The 10 studies involved 1,125 knees, of which 573 were in the ABN group and 552 in the CONV group. The results demonstrated that ABN significantly reduced the number of outliers for mechanical alignment (MA) (RR: 0.38, 95% CI: 0.27 to 0.54, P < 0.00001, I2 = 45%), achieving more accurate MA (RR: –0.78, 95% CI: –0.93 to –0.62, P < 0.00001, I2 = 76%). The results revealed that there was no significant difference in duration of surgery between the ABN and CONV groups (MD: –0.2, 95% CI: –1.45 to 1.05, P = 0.75, I2 = 48%). There was less blood loss through the use of ABN (SMD: –0.49, 95% CI: –0.93 to –0.06, P = 0.03, I2 = 75%). However, ABN group didn’t show better knee function (SMD: 0.13, 95% CI: –0.07 to 0.33, P = 0.20, I2 = 0%), though the incidence of overall complications was significantly lower (RR: 0.69, 95% CI: 0.50 to 0.95, P = 0.02, I2 = 0%). Conclusions The present meta-analysis demonstrated that ABN was superior to CONV in restoring MA of the lower limb. In addition, ABN reduced the loss of blood and the duration of surgery was not prolonged. However, patient-reported outcome measurements (PROMs) were not improved.
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Cherches M, Coss N, Nguyen K, Halvorson R, Allahabadi S, Bini S. No Correlation Between Clinical Outcomes and Changes in the Tibia-Metaphyseal Angle Following Total Knee Arthroplasty: A Retrospective Study. J Arthroplasty 2022; 37:1793-1798. [PMID: 35469985 DOI: 10.1016/j.arth.2022.04.024] [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: 03/04/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite numerous advances in the implant design and surgical technique, improvement in patient satisfaction following total knee arthroplasty (TKA) has plateaued. Various TKA alignment strategies have been introduced that impact the coronal positioning of the tibial component relative to the native joint line. This study aims to analyze if postoperative variance of the joint line from preoperative native alignment is correlated with changes in patient-reported outcomes following primary TKA. METHODS A retrospective review of an academic center's patient population identified all primary TKAs between 2013 and 2021 with full-length, standing radiographs and patient-reported outcome measures (PROMs) data. These measures included the Knee injury and Osteoarthritis Outcome Score for Joint Replacement, Patient-Reported Outcome Measurement Information System, and Veterans RAND 12 scores. Preoperative and postoperative radiographic measurements for hip-knee angle, tibia-metaphyseal angle, tibial-axis orientation angle, and joint-line obliquity angle were recorded. Three-month, 1-year, and 2-year PROM scores were correlated with the change in degrees for each of the angles using a Spearman's correlation. A Mann-Whitney U-test was used to compare angular changes with a change in PROM scores. RESULTS One hundred and ninety nine patients (204 knees) with a mean age of 67 years were included. Average follow-up was 23 months. Three-month, 1-year, and 2-year follow-up rates were 93%, 64%, and 34%, respectively. Improvements were seen across all PROMs regardless of an angular change. CONCLUSION There were no clear correlations between PROMs and variation in joint line obliquity in the coronal plane. These data suggest that the magnitude of the variation in coronal tibial alignment from native alignment does not impact PROMs. Further study is indicated to correlate an angular change with functional measures.
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Affiliation(s)
- Matthew Cherches
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Nathan Coss
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Kevin Nguyen
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Ryan Halvorson
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Stefano Bini
- Department of Orthopaedic Surgery, University of California, San Francisco, California
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Tran T, McEwen P, Peng Y, Trivett A, Steele R, Donnelly W, Clark G. Kinematic alignment in total knee arthroplasty: a five-year prospective, multicentre, survivorship study. Bone Jt Open 2022; 3:656-665. [PMID: 36000465 PMCID: PMC9422905 DOI: 10.1302/2633-1462.38.bjo-2021-0214.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims The mid-term results of kinematic alignment (KA) for total knee arthroplasty (TKA) using image derived instrumentation (IDI) have not been reported in detail, and questions remain regarding ligamentous stability and revisions. This paper aims to address the following: 1) what is the distribution of alignment of KA TKAs using IDI; 2) is a TKA alignment category associated with increased risk of failure or poor patient outcomes; 3) does extending limb alignment lead to changes in soft-tissue laxity; and 4) what is the five-year survivorship and outcomes of KA TKA using IDI? Methods A prospective, multicentre, trial enrolled 100 patients undergoing KA TKA using IDI, with follow-up to five years. Alignment measures were conducted pre- and postoperatively to assess constitutional alignment and final implant position. Patient-reported outcome measures (PROMs) of pain and function were also included. The Australian Orthopaedic Association National Joint Arthroplasty Registry was used to assess survivorship. Results The postoperative HKA distribution varied from 9° varus to 11° valgus. All PROMs showed statistical improvements at one year (p < 0.001), with further improvements at five years for Knee Osteoarthritis Outcome Score symptoms (p = 0.041) and Forgotten Joint Score (p = 0.011). Correlation analysis showed no difference (p = 0.610) between the hip-knee-ankle and joint line congruence angle at one and five years. Sub-group analysis showed no difference in PROMs for patients placed within 3° of neutral compared to those placed > 3°. There were no revisions for tibial loosening; however, there were reports of a higher incidence of poor patella tracking and patellofemoral stiffness. Conclusion PROMs were not impacted by postoperative alignment category. Ligamentous stability was maintained at five years with joint line obliquity. There were no revisions for tibial loosening despite a significant portion of tibiae placed in varus; however, KA executed with IDI resulted in a higher than anticipated rate of patella complications. Cite this article: Bone Jt Open 2022;3(8):656–665.
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Affiliation(s)
- Ton Tran
- Monash Health, Melbourne, Victoria, Australia
| | - Peter McEwen
- Mater Hospital Pimlico, Townsville, Queensland, Australia
| | - Yi Peng
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | | | - William Donnelly
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Gavin Clark
- Royal Perth Hospital, Perth, Western Australia, Australia
- St John of God Subiaco, Perth, Western Australia, Australia
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Zeng X, Yang Y, Jia Z, Chen J, Shen H, Jin Y, Lu Y, Li P. The position of entry point in total knee arthroplasty is associate with femoral bowing both in coronal and sagittal planes. Front Surg 2022; 9:935840. [PMID: 35923443 PMCID: PMC9339686 DOI: 10.3389/fsurg.2022.935840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the femoral entry point of the intramedullary (IM) guiding rod applied to total knee arthroplasty (TKA) in Chinese subjects and the relationship with femoral bowing in the coronal and sagittal planes through three-dimensional (3D) validation methods. Methods Computed tomography (CT) images of 80 femurs in Chinese subjects were imported into Mimics 19.0 to construct 3D models. All operations were conducted by Rhinoceros software 5.0. The position of the IM rod entry point was assessed by calculating the distance between the entry point and the apex of the intercondylar notch (AIN) in the coronal and sagittal planes. The coronal femoral bowing angle (cFBA) and sagittal femoral bowing angle (sFBA) were also measured. Results The average optimal entry point was 0.17 mm medial and 12.37 mm anterior to the AIN in males, while it was 0.02 mm lateral and 16.13 mm anterior to the AIN in females. There was a significant difference between males and females in the sagittal plane (t = -6.570, p = 0.000). The mean cFBA was 1.68 ± 2.29°, and the mean sFBA was 12.66 ± 1.98°. The sFBA was strongly correlated with the anterior distance of the proper entry point, and the cFBA was moderately correlated with the lateral distance of the proper entry point. Conclusions There was a strong correlation between the position of the entry point and the femoral bowing angle in both the coronal and sagittal planes. Thus, to achieve better alignment, the position of the entry point should be measured individually based on femoral bowing.
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Affiliation(s)
- Xianli Zeng
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yiming Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Zhenyu Jia
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Jiarong Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hongyuan Shen
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yan Jin
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yao Lu
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- Department of Joint and Orthopedics, Orthopedic Center, Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Correspondence: Yao Lu Pingyue Li
| | - Pingyue Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- Correspondence: Yao Lu Pingyue Li
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Plancher KD, Brite JE, Briggs KK, Petterson SC. Pre-Arthritic/Kinematic Alignment in Fixed-Bearing Medial Unicompartmental Knee Arthroplasty Results in Return to Activity at Mean 10-Year Follow-up. J Bone Joint Surg Am 2022; 104:1081-1089. [PMID: 36149243 DOI: 10.2106/jbjs.21.00801] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal alignment strategy in unicompartmental knee arthroplasty (UKA) is debated. Recent studies have suggested that kinematic alignment may lead to improved biomechanics and outcomes. The aim of the present study was to determine if pre-arthritic/kinematic alignment of knees would result in sustained long-term restoration of function, without conversion to total knee arthroplasty (TKA), following non-robotically assisted, fixed-bearing medial UKA. METHODS A total of 236 UKAs were performed from 2000 to 2015. Of these, a total of 150 medial UKAs met the inclusion criteria and were included in the study. There were 76 UKAs performed in female patients. The mean age was 65 ± 10 years and the mean body mass index was 28.6 ± 5 kg/m2. Patients with ≥15° of varus alignment preoperatively were excluded. Varus deformity was evaluated with use of the hip-knee-ankle angle (HKAA). Pre-arthritic/kinematic alignment was estimated with use of an arithmetic HKAA (aHKA, calculated as the medial proximal tibial angle minus the lateral distal femoral angle). We defined pre-arthritic/kinematic alignment as a postoperative HKAA within 3° of the aHKA. The primary outcome measures were the Knee Injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living and Sport subscales, including the percentage of patients who met the patient acceptable symptom state (PASS) for these measures. Failure was defined as conversion to TKA. RESULTS The mean follow-up was 10 years (range, 4 to 20 years), with a mean survival time estimate of 18.3 years (95% confidence interval [CI], 17.8 to 18.8). The rate of conversion to TKA was 3% (5 of 150 UKAs). Postoperatively, 127 (85%) of 150 knees were pre-arthritic/kinematically aligned, and 23 knees (15%) were not. Patients with compared to those without pre-arthritic/kinematically aligned knees had significantly longer mean survival (18.6 years; 95% CI, 18.2 to 19) compared with 15.4 years; 95% CI, 13.4 to 17.5, respectively; p = 0.008) and higher KOOS Activities of Daily Living (92 compared with 74; p < 0.001) and Sport subscale scores (74 compared with 36; p < 0.001). A greater proportion of knees in the pre-arthritic/kinematically aligned cohort met the PASS for the KOOS Activities of Daily Living (85%, 106 of 125 knees) and Sport subscales (109 of 125, 87%) compared with the non-pre-arthritic/kinematically aligned cohort (28% and 57%, respectively; p < 0.01). CONCLUSIONS Pre-arthritic/kinematically aligned knees in this non-robotically assisted fixed-bearing medial UKA cohort had superior outcomes, including the KOOS Activities of Daily Living and Sport subscales and achievement of the PASS for these measures, compared with non-pre-arthritic/kinematically aligned at an average of 10 years after UKA. Knees that fell within 3° of a simple aHKA measurement on a 3-foot (1-m)-long standing radiograph had greater longevity and return to activities. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY.,Plancher Orthopaedics & Sports Medicine, New York, NY.,Orthopaedic Foundation, Stamford, Connecticut
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Ishida K, Shibanuma N, Hayashi S, Kurosaka M, Kuroda R, Matsumoto T. Robotic arm‐assisted posterior‐stabilised total knee arthroplasty reduces the amount of tibial bone resection thickness without increasing the rate of postoperative flexion contracture in varus knees in the short term: Comparison with image‐free navigated total knee arthroplasty. Int J Med Robot 2022; 18:e2370. [DOI: 10.1002/rcs.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Kazunari Ishida
- Department of Orthopaedic Surgery Kobe Kaisei Hospital Kobe Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery Kobe Kaisei Hospital Kobe Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan
| | | | - Ryosuke Kuroda
- Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan
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Hiranaka T, Suda Y, Saitoh A, Tanaka A, Arimoto A, Koide M, Fujishiro T, Okamoto K. Current concept of kinematic alignment total knee arthroplasty and its derivatives. Bone Jt Open 2022; 3:390-397. [PMID: 35532356 PMCID: PMC9134837 DOI: 10.1302/2633-1462.35.bjo-2022-0021.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The kinematic alignment (KA) approach to total knee arthroplasty (TKA) has recently increased in popularity. Accordingly, a number of derivatives have arisen and have caused confusion. Clarification is therefore needed for a better understanding of KA-TKA. Calipered (or true, pure) KA is performed by cutting the bone parallel to the articular surface, compensating for cartilage wear. In soft-tissue respecting KA, the tibial cutting surface is decided parallel to the femoral cutting surface (or trial component) with in-line traction. These approaches are categorized as unrestricted KA because there is no consideration of leg alignment or component orientation. Restricted KA is an approach where the periarthritic joint surface is replicated within a safe range, due to concerns about extreme alignments that have been considered ‘alignment outliers’ in the neutral mechanical alignment approach. More recently, functional alignment and inverse kinematic alignment have been advocated, where bone cuts are made following intraoperative planning, using intraoperative measurements acquired with computer assistance to fulfill good coordination of soft-tissue balance and alignment. The KA-TKA approach aims to restore the patients’ own harmony of three knee elements (morphology, soft-tissue balance, and alignment) and eventually the patients’ own kinematics. The respective approaches start from different points corresponding to one of the elements, yet each aim for the same goal, although the existing implants and techniques have not yet perfectly fulfilled that goal.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Yoshihito Suda
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Akira Saitoh
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Atsuki Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Akihiko Arimoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
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Giuntoli M, Scaglione M, Bonicoli E, Piolanti N, Puccioni G, Zepeda K, Giannini E, Marchetti S, Indelli PF. Intraoperative Load Sensing in Total Knee Arthroplasty Leads to a Functional but Not Clinical Difference: A Comparative, Gait Analysis Evaluation. J Funct Morphol Kinesiol 2022; 7:jfmk7010023. [PMID: 35225909 PMCID: PMC8883885 DOI: 10.3390/jfmk7010023] [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: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Although Total Knee Arthroplasty (TKA) is a successful procedure, a significant number of patients are still unsatisfied, reporting instability at the mid-flexion range (Mid-Flexion Instability-MFI). To avoid this complication, many innovations, including load sensors (LS), have been introduced. The intraoperative use of LS may facilitate the balance of the knee during the entire range of motion to avoid MFI postoperatively. The objective of this study was to perform a Gait Analysis (GA) evaluation of a series of patients who underwent primary TKA using a single LS technology. METHODS The authors matched and compared two groups of patients treated with the same posterior stabilized TKA design. In Group A, 10 knees were intraoperatively balanced with LS technology, while 10 knees (Group B) underwent standard TKA. The correct TKA alignment was preoperatively determined aiming for a mechanical alignment. Clinical evaluation was performed according to the WOMAC, Knee Society Score (KSS) and Forgotten Joint Score, while functional evaluation was performed using a state-of-the-art GA platform. RESULTS We reported excellent clinical results in both groups without any statistical difference in patient reported outcome measurements (PROMs); from a functional standpoint, several GA space-time parameters were closer to normal in the sensor group when compared to the standard group, but a statistically significant difference was not reached. CONCLUSIONS Gait Analysis represents a valid method to evaluate TKA kinematics. This study, with its limitations, showed that pressure sensitive technology represents a valid aid for surgeons aiming to improve the postoperative stability of TKA; however, other factors (i.e., level of intra-articular constraint and alignment) may play a major role in reproducing the normal knee biomechanics.
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Affiliation(s)
- Michele Giuntoli
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
- Correspondence:
| | - Michelangelo Scaglione
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Enrico Bonicoli
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Nicola Piolanti
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Gianmarco Puccioni
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Karlos Zepeda
- Harlem Campus, Touro College of Osteopathic Medicine, Harlem, New York, NY 10027, USA;
| | | | - Stefano Marchetti
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
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Sadekar VN, Datir S, Allgar V, Sharma H. A randomized controlled trial comparing functional outcomes for navigated kinematically aligned total knee arthroplasty versus navigated mechanically aligned total knee arthroplasty : the MaKKRO trial. Bone Jt Open 2021; 2:945-950. [PMID: 34783254 PMCID: PMC8636290 DOI: 10.1302/2633-1462.211.bjo-2021-0094.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims Nearly 99,000 total knee arthroplasties (TKAs) are performed in UK annually. Despite plenty of research, the satisfaction rate of this surgery is around 80%. One of the important intraoperative factors affecting the outcome is alignment. The relationship between joint obliquity and functional outcomes is not well understood. Therefore, a study is required to investigate and compare the effects of two types of alignment (mechanical and kinematic) on functional outcomes and range of motion. Methods The aim of the study is to compare navigated kinematically aligned TKAs (KA TKAs) with navigated mechanically aligned TKA (MA TKA) in terms of function and ROM. We aim to recruit a total of 96 patients in the trial. The patients will be recruited from clinics of various consultants working in the trust after screening them for eligibility criteria and obtaining their informed consent to participate in this study. Randomization will be done prior to surgery by a software. The primary outcome measure will be the Knee injury and Osteoarthritis Outcome Score The secondary outcome measures include Oxford Knee Score, ROM, EuroQol five-dimension questionnaire, EuroQol visual analogue scale, 12-Item Short-Form Health Survey (SF-12), and Forgotten Joint Score. The scores will be calculated preoperatively and then at six weeks, six months, and one year after surgery. The scores will undergo a statistical analysis. Discussion There is no clear evidence on the best alignment for a knee arthroplasty. This randomized controlled trial will test the null hypothesis that navigated KA TKAs do not perform better than navigated MA TKAs. Cite this article: Bone Jt Open 2021;2(11):945–950.
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Affiliation(s)
- Vilas Narayan Sadekar
- Trauma and Orthopaedics, Hull University Teaching Hospitals NHS Trust, Kingston Upon Hull, UK
| | - Sandeep Datir
- Trauma and Orthopaedics, Hull University Teaching Hospitals NHS Trust, Kingston Upon Hull, UK
| | | | - Hemant Sharma
- Trauma and Orthopaedics, Hull University Teaching Hospitals NHS Trust, Kingston Upon Hull, UK
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