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Liu G, Liu Q, Tian R, Wang K, Yang P. Associations of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial. Int J Surg 2024; 110:2115-2121. [PMID: 38241323 PMCID: PMC11019982 DOI: 10.1097/js9.0000000000001048] [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: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The association between postoperative outcomes of robotic-assisted total knee arthroplasty (RA-TKA) and nutrition status among elderly adults remained unclear. The authors aimed to evaluate these associations and provide a nutrition status reference for the surgical technique selection of TKA. METHODS In the present study, the authors used data from a multicenter, prospective, randomized controlled project, which recruited patients underwent TKA therapy. A total of 88 elderly adults (age ≥65 years old) were included in this study. Their preoperative and postoperative demographic data and radiographic parameters were collected. Clinical outcomes, including postoperative hip-knee-ankle (HKA) angle deviation, knee society score (KSS), 10 cm visual analog scale, and so on, were observed and compared between the RA-TKA group and the conventional TKA group. Logistic regression was performed to adjust several covariates. In addition, according to the results of restricted cubic splines analyses, all participants were categorized into two groups with GNRI≤100 and GNRI >100 for further subgroup analyses. RESULTS Our results showed despite having a lower postoperative HKA angle deviation, the RA-TKA group had a similar postoperative KSS score compared with the conventional TKA group in elderly adults. Among elderly patients with GNRI>100, RA-TKA group achieved significantly more accurate alignment (HKA deviation, P =0.039), but did not obtain more advanced postoperative KSS scores because of the compensatory effect of good nutrition status. However, among elderly patients with GNRI≤100, RA-TKA group had significantly higher postoperative KSS scores compared to the conventional TKA group ( P =0.025) and this association were not altered after adjustment for other covariates. CONCLUSION Considering the clinical outcomes of conventional TKA may be more susceptible to the impact of nutrition status, elderly patients with GNRI≤100 seem to be an applicable population for RA-TKA, which is more stable and would gain significantly more clinical benefits compared with conventional TKA.
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Affiliation(s)
- Guanzhi Liu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Qimeng Liu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Sheridan GA, Abdelmalek M, Howard LC, Neufeld ME, Masri BA, Garbuz DS. Navigated Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Prospective Randomized Controlled Trials. J Orthop 2024; 50:99-110. [PMID: 38187368 PMCID: PMC10770435 DOI: 10.1016/j.jor.2023.11.070] [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: 09/18/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background Recent evidence on the cost-effectiveness of technology in total knee arthroplasty (TKA) demonstrated that navigated computer-assisted methods (N-TKA) is likely to be most cost-effective in the clinical setting. The aim of the current meta-analysis is to compare radiographic, clinical and functional outcomes between conventional TKA (C-TKA) and N-TKA methods. Methods All prospective randomized controlled trials (pRCTs) comparing primary TKA performed using C-TKA and N-TKA techniques were eligible for inclusion. Radiographic outcomes included postoperative coronal, sagittal and axial component alignment. Clinical outcomes included all-cause revision and aseptic revision. Functional outcomes were analyzed when reported. A random-effects meta-analysis of all available cases was performed. This allowed for all missing data. Results Normal coronal mechanical alignment of the tibial (p < 0.001) and femoral (p = 0.001) components was achieved more frequently with N-TKA. Normal sagittal mechanical alignment of the tibial component was achieved significantly more with N-TKA (p < 0.010). There was no difference in short-term clinical survivorship (all-cause, p = 0.649; aseptic, p = 0.79) or in functional outcomes reported between groups. There was a clinically significant reduction in the mean C-TKA operative time (87 min, σ = 16.6, 95% CI 76.4-98.8) compared N-TKA (97.6 min, σ = 16.9, 95% CI 86.2-109.1) (p = 0.17). Conclusion Navigated TKA achieves superior radiographic alignment for femoral and tibial components in both the coronal and sagittal plane. Operative times are 10 min longer in the N-TKA group. Functional outcomes are similar between navigated and conventional groups. Clinical outcomes reported in Level I studies are limited to short-term follow-up so future prospective studies are required.
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Barahona M, Guzmán MA, Cartes S, Arancibia AE, Mora JE, Barahona MA, Palma D, Hinzpeter JR, Infante CA, Barrientos CN. Development of a Machine-Learning Model for Anterior Knee Pain After Total Knee Arthroplasty With Patellar Preservation Using Radiological Variables. J Arthroplasty 2024:S0883-5403(24)00105-0. [PMID: 38364878 DOI: 10.1016/j.arth.2024.02.006] [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: 09/27/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Anterior knee pain (AKP) following total knee arthroplasty (TKA) with patellar preservation is a common complication that significantly affects patients' quality of life. This study aimed to develop a machine-learning model to predict the likelihood of developing AKP after TKA using radiological variables. METHODS A cohort of 131 anterior stabilized TKA cases (105 patients) without patellar resurfacing was included. Patients underwent a follow-up evaluation with a minimum 1-year follow-up. The primary outcome was AKP, and radiological measurements were used as predictor variables. There were 2 observers who made the radiological measurement, which included lower limb dysmetria, joint space, and coronal, sagittal, and axial alignment. Machine-learning models were applied to predict AKP. The best-performing model was selected based on accuracy, precision, sensitivity, specificity, and Kappa statistics. Python 3.11 with Pandas and PyCaret libraries were used for analysis. RESULTS A total of 35 TKA had AKP (26.7%). Patient-reported outcomes were significantly better in the patients who did not have AKP. The Gradient Boosting Classifier performed best for both observers, achieving an area under the curve of 0.9261 and 0.9164, respectively. The mechanical tibial slope was the most important variable for predicting AKP. The Shapley test indicated that high/low mechanical tibial slope, a shorter operated leg, a valgus coronal alignment, and excessive patellar tilt increased AKP risk. CONCLUSIONS The results suggest that global alignment, including sagittal, coronal, and axial alignment, is relevant in predicting AKP after TKA. These findings provide valuable insights for optimizing TKA outcomes and reducing the incidence of AKP.
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Affiliation(s)
- Maximiliano Barahona
- Orthopedics Department of Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Mauricio A Guzmán
- Radiological Department of Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Sebastian Cartes
- Clinical Innovation Department at Clinica Las Condes, Santiago, Chile
| | | | - Javier E Mora
- Clinical Innovation Department at Clinica Las Condes, Santiago, Chile
| | - Macarena A Barahona
- Advanced Clinical Research Department at Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Daniel Palma
- Orthopedics Department of Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Jaime R Hinzpeter
- Orthopedics Department of Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Carlos A Infante
- Orthopedics Department of Hospital Clinico Universidad de Chile, Santiago, Chile
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Tarassoli P, Warnock JM, Lim YP, Jagota I, Parker D. Large multiplanar changes to native alignment have no apparent impact on clinical outcomes following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:432-444. [PMID: 38294963 DOI: 10.1002/ksa.12044] [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: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE This study sought to examine if achieved postoperative alignment when compared to the native anatomy would lead to a difference in Patient Reported Outcome Measures (PROMs), and whether the achieved alignment could be broadly categorised by an accepted alignment strategy. METHODS A retrospective cohort study of prospectively collected data on patients undergoing single primary or bilateral simultaneous total knee arthroplasty (TKA) was carried out. CT scans were used to determine the mean change ("delta values") between the pre and postoperative; hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle and femoral implant rotation. Femoral implant flexion and tibial implant slope were measured postoperatively. The primary outcome was the relationship of the variables to the change in KOOS pain subscale after one year. The secondary outcome was the number of knees which could be categorised postoperatively to an alignment strategy, and the mean PROMs in each cohort. RESULTS A total of 296 knees in 261 patients were available for analysis. With regards to the primary outcome, the delta values for each variable did not demonstrate any association with the change in knee injury and osteoarthritis outcome score (KOOS) pain score. Approximately 46% of knees could not be categorised to an alignment strategy based on postoperatively measured alignment, with no significant difference between each cohort with regards to the change in KOOS Pain score. CONCLUSION Achieved alignment does not consistently match accepted alignment strategies, and appears to confer no benefit to clinical outcomes when the native anatomy is most closely approximated, nor results in poorer outcomes in outliers. This study highlights the importance of routine three dimensional pre and postoperative imaging in clinical practice and for the valid analysis of outcomes in studies on alignment. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Payam Tarassoli
- Sydney Orthopaedic Research Institute, St Leonards, Australia
| | | | - Yoong Ping Lim
- Sydney Orthopaedic Research Institute, St Leonards, Australia
- The University of Sydney, Camperdown, Australia
- Charles Darwin University, Casuarina, Australia
| | - Ishaan Jagota
- 360 Med Care Pty Ltd, Pymble, Australia
- Flinders University, Adelaide, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, St Leonards, Australia
- The University of Sydney, Camperdown, Australia
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Aliyev O, Sarıkaş M, Uçan V, Uzer G, Tuncay İ, Yıldız F. Sagittal Patellar Offset Ratio Can Be a Predictor of Anterior Knee Pain after Primary Total Knee Arthroplasty without Patella Resurfacing. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:27-33. [PMID: 35654392 DOI: 10.1055/a-1823-1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Anterior knee pain (AKP) is an issue that persists even after successful total knee arthroplasty (TKA). In some patients, reasons for AKP occurrence are known, but it is unexplained in some others despite the patellofemoral joint being thought to be the main focus of pain. We investigated the relationship between unexplained AKP and the patellofemoral joint in the sagittal plane after primary TKA. METHODS We evaluated 372 knees of 317 patients retrospectively, who had completed a minimum 24-month follow-up. We divided them into two groups according to the presence of AKP. Sagittal patellar offset ratio (SPOR), anterior femoral offset ratio (AFOR), and Insall-Salvati ratio (ISR) were measured on lateral X-rays. Clinical outcomes were evaluated using the Oxford knee score (OKS) and WOMAC pre-and postoperatively, and AKP was evaluated using a visual analog scale (VAS) postoperatively. RESULTS Between non-AKP and AKP groups, SPOR (p < 0.001) and AFOR (p = 0.03) were significantly different but not ISR (p = 0.89). SPOR and AFOR were found to be two independent risk factors that may predict the likelihood of AKP. Receiver operating characteristic (ROC) analysis revealed that AFOR is a poor value, whereas SPOR is a reasonable predictive value. No correlation between SPOR and postoperative OKS (p = 0.92) and WOMAC (p = 0.25) and no correlation between AFOR and postoperative OKS (p = 0.44) and WOMAC (p = 0.58) were found. CONCLUSION We found that SPOR is a good predictive tool with a cutoff value of 46.4% and 91.5% sensitivity for AKP and its increased ratio increases the probability of AKP following TKA. Considering that the patellar offset will not change, especially in patients without patella resurfacing, care should be taken not to increase the anterior femoral offset.
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Affiliation(s)
- Orkhan Aliyev
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Murat Sarıkaş
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Vahdet Uçan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - İbrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
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Scott CEH, Snowden GT, Cawley W, Bell KR, MacDonald DJ, Macpherson GJ, Yapp LZ, Clement ND. Fifteen-year prospective longitudinal cohort study of outcomes following single radius total knee arthroplasty. Bone Jt Open 2023; 4:808-816. [PMID: 37873746 PMCID: PMC10594575 DOI: 10.1302/2633-1462.410.bjo-2023-0086.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: 10/25/2023] Open
Abstract
Aims This prospective study reports longitudinal, within-patient, patient-reported outcome measures (PROMs) over a 15-year period following cemented single radius total knee arthroplasty (TKA). Secondary aims included reporting PROMs trajectory, 15-year implant survival, and patient attrition from follow-up. Methods From 2006 to 2007, 462 consecutive cemented cruciate-retaining Triathlon TKAs were implanted in 426 patients (mean age 69 years (21 to 89); 290 (62.7%) female). PROMs (12-item Short Form Survey (SF-12), Oxford Knee Score (OKS), and satisfaction) were assessed preoperatively and at one, five, ten, and 15 years. Kaplan-Meier survival and univariate analysis were performed. Results At 15 years, 28 patients were lost to follow-up (6.1%) and 221 patients (51.9%) had died, with the mean age of the remaining cohort reducing by four years. PROMs response rates among surviving patients were: one-year 63%; five-year 72%; ten-year 94%; and 15-year 59%. OKS and SF-12 scores changed significantly over 15 years (p < 0.001). The mean improvement in OKS was 18.8 (95% confidence (CI) 16.7 to 19.0) at one year. OKS peaked at five years (median 43 years) declining thereafter (p < 0.001), though at 15 years it remained 17.5 better than preoperatively. Age and sex did not alter this trajectory. A quarter of patients experienced a clinically significant decline (≥ 7) in OKS from five to ten years and from ten to 15 years. The SF-12 physical component score displayed a similar trajectory, peaking at one year (p < 0.001). Patient satisfaction was 88% at one, five, and ten years, and 94% at 15 years. In all, 15-year Kaplan-Meier survival was 97.6% (95% CI 96.0% to 99.2%) for any revision, and 98.9% (95% CI 97.9% to 99.9%) for aseptic revision. Conclusion Improvements in PROMs were significant and maintained following single radius TKA, with OKS peaking at five years, and generic physical health peaking at one year. Patient satisfaction remained high at 15 years, at which point 2.4% had been revised.
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Affiliation(s)
- Chloe E. H. Scott
- Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Will Cawley
- Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
| | - Katrina R. Bell
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Liam Z. Yapp
- Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D. Clement
- Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Guruprasad H, Singh M, Naik AK, Jain VK. Association of sagittal alignment of tibial and femoral components with clinical outcome in total knee arthroplasty: A prospective cohort study. J Orthop 2023; 44:72-76. [PMID: 37720915 PMCID: PMC10504456 DOI: 10.1016/j.jor.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
Background In total knee replacement component alignment is a very crucial parameter to achieve better clinical outcomes. Only a few studies exist in the literature on the association between sagittal alignment of components and clinical outcomes. The study aimed to measure the functional outcome and association between the sagittal alignment of total knee replacement components and their clinical outcome. Material & methods Prospectively we collected data of 81 knees (cases) following total knee replacement. The sagittal femoral angle, anterior and posterior tibial slopes were assessed on 2nd postoperative week using a lateral radiograph. Based on these measures 2 groups were made. Group A comprises of the femoral component which was further divided into A1 (41 cases) and A2 (40 cases) based on the component's sagittal femoral angle in flexion or extension.Group B comprises of Tibial component subgrouped based on the degree of Tibal angle as the posterior tibial slope or anterior tibial slopes. The B1 subgroup has posterior tibial slope of more than 5° (23 cases), B2 posterior tibial slope within 5° (53 cases), and B3 anterior tibial slope (5 cases). Preoperative and follow-ups at one month, 6 months, and 3 year; the functional assessment was performed using the American Knee Society score and Oxford knee scores. The duration to raise the leg straight (in days) was also measured. Results 52 patients (81 total knee replacement cases) with a mean age of 62.88 ± 8.21 were enrolled. Results showed significant improvement in mean American Knee Society score (preoperative 32.91 ± 2.61 to 86.68 ± 2.52 postoperatively at 3 years; P < 0.001) and mean Oxford knee score (preoperative 34.69 ± 1.06 to 19.20 ± 1.91 postoperatively at 3-years; P < 0.001). The correlation of American Knee Society score between the femoral component angle and tibial component angle suggested that the maximum correlation was between Group A2 (Femoral angle = 91 to 95) and Group B2 (Tibal angle = 86 to 90), with p-value <0.0001. Conclusions There is a positive association between the proper sagittal alignment of femoral component and tibial component in total knee replacement with clinical outcome. The functional outcome (in terms of mean American Knee Society score) is better when the femoral component is positioned in extension and the posterior tibial slope of less than 5° is achieved.
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Affiliation(s)
- H.B. Guruprasad
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Mohit Singh
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Anant kumar Naik
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Vijay Kumar Jain
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
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Chalmers BP, Borsinger TM, Quevedo Gonzalez FJ, Vigdorchik JM, Haas SB, Ast MP. Referencing the center of the femoral head during robotic or computer-navigated primary total knee arthroplasty results in less femoral component flexion than the traditional intramedullary axis. Knee 2023; 44:172-179. [PMID: 37672908 DOI: 10.1016/j.knee.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/14/2023] [Accepted: 08/06/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND During robotic and computer-navigated primary total knee arthroplasty (TKA), the center of the femoral head is utilized as the proximal reference point for femoral component position rather than the intramedullary axis. We sought to analyze the effect on femoral component flexion-extension position between these two reference points. METHODS We obtained CT 3D-reconstructions of 50 cadaveric intact femurs. We defined the navigation axis as the line from center of the femoral head to center of the knee (lowest point of the trochlear groove) and the intramedullary axis as the line from center of the knee to center of the canal at the isthmus. Differences between these axes in the sagittal plane were measured. Degree of femoral bow and femoral neck anteversion were correlated with the differences between the two femoral axes. RESULTS On average, the navigated axis was 1.4° (range, -1.4° to 4.1°) posterior to the intramedullary axis. As such, the femoral component would have on average 1.4° less flexion compared with techniques referencing the intramedullary canal. A more anterior intramedullary compared with navigated axis (i.e., less femoral flexion) was associated with more femoral bow (R2 = 0.7, P < 0.001) and less femoral neck anteversion (R2 = 0.5, P < 0.05). CONCLUSION Computer-navigated or robotic TKA in which the center of the femoral head is utilized as a reference point, results in 1.4° less femoral component flexion than would be achieved by referencing the intramedullary canal. Surgeons should be aware of these differences as they may ultimately influence knee kinematics.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA.
| | - Tracy M Borsinger
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | | | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Steven B Haas
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Michael P Ast
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Zhou H, Wu ZR, Chen XY, Zhang LS, Zhang JC, Hidig SM, Feng S, Yang Z. Does mild flexion of the femoral prosthesis in total knee arthroplasty result in better early postoperative outcomes? BMC Musculoskelet Disord 2023; 24:711. [PMID: 37674188 PMCID: PMC10483864 DOI: 10.1186/s12891-023-06840-w] [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: 03/21/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The purpose of this study was to measure the femoral prosthesis flexion angle (FPFA) in total knee arthroplasty (TKA) using three-dimensional reconstruction, and to assess the differences in early clinical efficacy between patients with different degrees of flexion. METHODS We conducted a prospective cohort study. From June 2019 to May 2021, 113 patients admitted for TKA due to osteoarthritis of the knee were selected. The patients' postoperative knee joints were reconstructed in three dimensions according to postoperative three-dimensional computed tomography (CT) scans. The FPFA was measured, and the patients were divided into 4 groups: anterior extension group (FPFA < 0°), mildly flexed group (0° ≤ FPFA < 3°), moderately flexed group (3° ≤ FPFA < 6°) and excessively flexed group (6° ≤ FPFA). The differences in the Knee Society Score (KSS), knee Range of Motion (ROM), and visual analogue scale (VAS) scores were measured and compared between the four groups at each postoperative time point. RESULTS Postoperative KSS, ROM, and VAS were significantly improved in all groups compared to the preoperative period. At 1 year postoperatively, the ROM was significantly greater in the mildly flexed group (123.46 ± 6.51°) than in the anterior extension group (116.93 ± 8.05°) and the excessively flexed group (118.76 ± 8.20°) (P < 0.05). The KSS was significantly higher in the mildly flexed group (162.68 ± 12.79) than in the other groups at 6 months postoperatively (P < 0.05). The higher KSS (174.17 ± 11.84) in the mildly flexed group was maintained until 1 year postoperatively, with a statistically significant difference (P < 0.05). No significant difference in VAS scores was observed between groups at each time point. CONCLUSIONS A femoral prosthesis flexion angle of 0-3° significantly improved postoperative knee mobility, and patients could obtain better Knee Society Scores after surgery, which facilitated the postoperative recovery of knee function. TRIAL REGISTRATION ChiCTR2100051502, 2021/09/24.
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Affiliation(s)
- Hang Zhou
- Department of Orthopedics, The People’s Hospital of Rugao, Rugao, 226500 Jiangsu China
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Ze-Rui Wu
- Department of Orthopedics, Central Laboratory, Changshu Hospital Affiliated to Soochow University, First People’s Hospital of Changshu City, Changshu, 215500 Jiangsu China
| | - Xiang-Yang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Le-Shu Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Jin-Cheng Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Sakarie Mustafe Hidig
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Shuo Feng
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Zhi Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
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Scott CEH, Yapp LZ, Howard T, Patton JT, Moran M. Surgical approaches to periprosthetic femoral fractures for plate fixation or revision arthroplasty. Bone Joint J 2023; 105-B:593-601. [PMID: 37259633 DOI: 10.1302/0301-620x.105b6.bjj-2022-1202.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: 06/02/2023]
Abstract
Periprosthetic femoral fractures are increasing in incidence, and typically occur in frail elderly patients. They are similar to pathological fractures in many ways. The aims of treatment are the same, including 'getting it right first time' with a single operation, which allows immediate unrestricted weightbearing, with a low risk of complications, and one that avoids the creation of stress risers locally that may predispose to further peri-implant fracture. The surgical approach to these fractures, the associated soft-tissue handling, and exposure of the fracture are key elements in minimizing the high rate of complications. This annotation describes the approaches to the femur that can be used to facilitate the surgical management of peri- and interprosthetic fractures of the femur at all levels using either modern methods of fixation or revision arthroplasty.
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Affiliation(s)
- Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
| | - Liam Z Yapp
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tom Howard
- Royal Victoria Hospital, Kirkcaldy, Fife, UK
| | - James T Patton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew Moran
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Barahona M, Guzman MA, Bustos F, Rojas G, Ramirez M, Palma D, Guzman M, Barahona MA, Zelaya A. Concordance in Radiological Parameters of Different Knee Views After Total Knee Arthroplasty. Cureus 2023; 15:e38129. [PMID: 37113460 PMCID: PMC10129438 DOI: 10.7759/cureus.38129] [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: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is a cost-effective treatment for the end-stage of knee osteoarthritis. Despite the improvements in this surgery, a significant percentage of patients still report dissatisfaction after knee arthroplasty. Radiological results have been used to predict clinical outcomes and satisfaction after knee replacement. This study aims to evaluate the concordance of a set of radiographic views to assess alignment on total knee arthroplasty. Methods A concordance study was designed with 105 patients (130 TKA) that underwent conventional total knee arthroplasty cruciate-retaining design recruited for the study and scheduled for their annual radiograph control. Measurements were performed on the following radiograph after total knee replacement: full-length standing anteroposterior and lateral radiograph, anteroposterior standing, lateral and axial knee view, and the knee "seated view". A musculoskeletal radiologist and a knee surgeon were recruited to perform the radiological measurement and then estimate the interobserver agreement. Results There was an excellent correlation between Limb Length (LL), Hip-knee-ankle angle (HKA), Sagittal mechanical tibial component alignment (smTA), extension lateral and medial joint space (eLJS and eMJS), 90º flexion lateral and medial joint space (fLJS and fMJS) and Sagittal anatomic lateral view tibial component alignment (saLTA); the good correlation between Mechanical lateral femoral component alignment (mLFA), Sagittal anatomic tibial component alignment (saTA), Sagittal anatomic lateral view femoral component alignment 2 (saLFA2), Patella Height (PH); and moderate to poor correlation for the rest of measurements. Conclusion Excellent and good concordance can be achieved for radiographic measurements in different knee views to assess results after TKA. These findings must encourage future studies to address functional and survival outcomes using all knee views and not just one plane.
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Affiliation(s)
- Maximiliano Barahona
- Orthopaedics, Hospital Clinico Universidad de Chile, Santiago, CHL
- Orthopaedics, Clinica Las Condes, Santiago, CHL
| | | | - Felipe Bustos
- Orthopaedics, Hospital Clinico Universidad de Chile, Santiago, CHL
| | - Gaspar Rojas
- Orthopaedics, Hospital Clinico Universidad de Chile, Santiago, CHL
| | - Marcela Ramirez
- Orthopaedics, Hospital Clinico Universidad de Chile, Santiago, CHL
| | - Daniel Palma
- Orthopaedics, Hospital Clinico Universidad de Chile, Santiago, CHL
| | - Martin Guzman
- Orthopaedics, Hospital Clinico Universidad de Chile, Santiago, CHL
| | | | - Alex Zelaya
- Radiology, Hospital Clinico Universidad de Chile, Santiago, CHL
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Patellar resurfacing was not associated with a clinically significant advantage when a modern patellar friendly total knee arthroplasty is employed: A systematic review and meta-analysis. Knee 2023; 41:329-341. [PMID: 36827957 DOI: 10.1016/j.knee.2023.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Modern total knee arthroplasty (TKA) femoral components are designed to provide a more optimal articular surface for the patella whether or not it has been resurfaced. Previous systematic reviews comparing outcomes of patellar resurfacing and no resurfacing combine both historic and modern designs. AIMS The aim of this study was to investigate the effect of patellar resurfacing in modern "patellar friendly" implants on (1) incidence of anterior knee pain, (2) patient reported outcomes (3) complication rates, and (4) reoperation rates compared with unresurfaced patellae in primary TKA. METHODS MEDline, PubMed and google scholar studies were evaluated using SIGN assessment tool and data analysis was conducted using Review Manager 5.2 on only randomised controlled trials. The search terms were: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, patellar retaining. RESULTS Thirty-two randomised controlled studies were identified that reported the type of TKA implant used: 11 used modern "patellar friendly" implants; and 21 older "patellar non-friendly" implants. Among "patellar friendly" TKAs there were no significant differences in anterior knee pain rates between resurfaced and unresurfaced groups. Patellar resurfacing with "patellar friendly" implants had significantly higher clinical (mean difference (MD) -0.77, p = 0.007) and functional (MD -1.87, p < 0.0001) knee society scores (KSS) than unresurfaced counterparts but these did not exceed the minimal clinically important difference (MCID). Resurfacing with "patellar friendly" implants was not associated with a significant (p = 0.59) difference in the Oxford knee score (OKS), in contrast when a "patellar non-friendly" implant was used there was a significant difference (MD 3.3, p = 0.005) in favour of resurfacing. There was an increased risk of reoperation for unresurfaced TKAs with "non-patellar friendly" implants (Odds ratio (OR) 1.68, 95% CI 1.03-2.74, p = 0.04), but not for unresurfaced patellae with "patellar friendly" implants (OR 1.17, CI 0.59-2.30). CONCLUSIONS Patellar resurfacing in combination with a modern patellar friendly implant was not associated with a lower rate of anterior knee pain, complications, or reoperations compared to not resurfacing, nor did it give a clinically significant improvement in knee specific function. In contrast patellar resurfacing in combination with a "non-friendly" TKA implant was associated with a significantly better OKS and lower reoperation rate. Implant design should be acknowledged when patellar resurfacing is being considered.
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Laubach LK, Sharma V, Krumme JW, Larkin K, Satpathy J. Novel classification system for periprosthetic distal femoral fractures: a consideration for comminution. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-022-03468-9. [PMID: 36635567 DOI: 10.1007/s00590-022-03468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Comminution is an aspect of periprosthetic distal femoral fractures (PDFFs) that can influence postoperative outcomes and treatment selection, but is not included in current classification systems. We propose a new classification system for PDFFs based on comminution and cortical reads. This study aims to prove its reliability and efficacy to predict fracture severity and guide treatment. METHODS A retrospective chart review of patients treated with single or dual locking plates for PDFFs was performed. Two fellowship-trained orthopedic joint reconstruction specialists used available imaging to classify each PDFF as either type 1 (minimal or no comminution allowing for reconstruction of medial and lateral cortices), type 2 (comminution reasonably allowing for reconstruction of either medial or lateral cortex), and type 3 (extensive comminution not allowing reasonable reconstruction of medial or lateral cortex). Each PDFF was then analyzed for radiographic outcomes including lateral distal femoral angle (LDFA) and the posterior distal femoral angle (PDFA). RESULTS Interobserver reliability assessed by Cohen's Kappa statistic was 0.707, and average intraobserver reliability was 0.843, showing substantial reliability. Type 3 PDFFs had greater varus deformity than type 1 (p = 0.0457) or 2 (0.0198). CONCLUSION The proposed classification system accounts for comminution, demonstrates strong interobserver and intraobserver reliability, and can be used to guide treatment in regard to single versus dual plating. LEVEL OF EVIDENCE Retrospective comparative study, Level IV.
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Affiliation(s)
- Logan K Laubach
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, PO Box 980153, Richmond, VA, 23298, USA
| | - Viraj Sharma
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, PO Box 980153, Richmond, VA, 23298, USA
| | - John W Krumme
- KC Orthopedic Alliance, UMKC, 3651 College Blvd, Leawood, KS, 66211, USA
| | - Kevin Larkin
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, PO Box 980153, Richmond, VA, 23298, USA
| | - Jibanananda Satpathy
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, PO Box 980153, Richmond, VA, 23298, USA.
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Luan Y, Zhang M, Ran T, Wang H, Fang C, Nie M, Wang M, Cheng CK. Correlation between component alignment and short-term clinical outcomes after total knee arthroplasty. Front Surg 2022; 9:991476. [PMID: 36311927 PMCID: PMC9606652 DOI: 10.3389/fsurg.2022.991476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between component alignment and short-term clinical outcomes after total knee arthroplasty (TKA). METHODS 50 TKA patients from a regional hospital were enrolled in the study. The following component alignments were measured from radiological data acquired within 1 week after surgery: hip-knee-ankle angle (HKA), medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), femoral flexion-extension angle (FEA), tibial slope angle (TSA), femoral rotational angle (FRA) and tibial rotational angle (TRA). The Hospital for Special Surgery (HSS) knee scoring system was used to assess clinical outcomes after 1 year, with patients being divided into three groups (excellent, good and not good) according to the HSS scores. Difference analysis and linear correlation analysis were used for the statistical analysis. RESULTS The results showed significant differences in MDFA (p = 0.050) and FEA (p = 0.001) among the three patient groups. It was also found that the total HSS had only a moderate correlation with FEA (r = 0.572, p < 0.001), but FEA had a positive linear correlation with pain scores (r = 0.347, p = 0.013), function scores (r = 0.535, p = 0.000), ROM scores (r = 0.368, p = 0.009), muscle scores (r = 0.354, p = 0.012) and stability scores (r = 0.312, p = 0.028). A larger MDFA was associated with lower FE deformity scores (r = -0.289, p = 0.042) and the TSA had a positive influence on the ROM (r = 0.436, p = 0.002). Also, changes in FRA produced a consequent change in the FE deformity score (r = 0.312, p = 0.027), and the muscle strength scores increased as TRA increased (r = 0.402, p = 0.004). CONCLUSION The results show that the FEA plays a significant role in clinical outcomes after TKA. Surgical techniques and tools may need to be improved to accurately adjust the FEA to improve joint functionality and patient satisfaction.
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Affiliation(s)
- Yichao Luan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Min Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Tianfei Ran
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Huizhi Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chaohua Fang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Department of Joint Surgery, Ningbo No.6 Hospital, Ningbo, China
| | - Maodan Nie
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Min Wang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China,Correspondence: Min Wang Cheng-Kung Cheng
| | - Cheng-Kung Cheng
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Correspondence: Min Wang Cheng-Kung Cheng
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Sharma V, Laubach LK, Krumme JW, Satpathy J. Comminuted periprosthetic distal femoral fractures have greater postoperative extension malalignment. Knee 2022; 36:65-71. [PMID: 35526350 DOI: 10.1016/j.knee.2022.04.004] [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: 12/27/2021] [Revised: 02/19/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Comminution is a significant aspect of periprosthetic distal femoral fracture characterization and may influence post-surgical outcomes. Existing classification systems that guide treatment decisions do not take into account comminution and current literature is unclear on which surgical approach is optimal. We hypothesize that fractures with comminution will have poorer quality post-reduction alignment, especially with a lateral approach. MATERIALS AND METHODS 37 study patients were identified with billing codes designating a distal femoral periprosthetic fracture. A retrospective chart review was performed to categorize fractures by absence or presence of comminution and medial parapatellar versus lateral surgical approach. These patients underwent an imaging evaluation for the primary outcome of reduction quality including the anatomic lateral distal femoral angle (LDFA) and the posterior distal femoral angle (PDFA). Differences in radiographic outcomes were analyzed with Wilcoxon/Kruskal-Wallis tests, and analysis by approach was through Fisher's exact test. RESULTS Patients with comminuted fractures had significantly greater extension of the fragment (PDFA = 95.4° vs 90.0°, p = 0.018) and similar coronal alignment (LDFA = 85.3° vs 86.3°, p = 0.83) of the knee compared to non-comminuted fractures after surgical reduction. This difference was more prominent amongst those treated with a lateral approach (PDFA = 96.1° vs 89.4°, p = 0.032) than with a medial approach (PDFA = 93.7° vs 91.5°, p = 0.41) (Table 1). DISCUSSION Current classification systems and treatment guidelines for periprosthetic distal femoral fractures do not adequately address several issues that may influence treatment outcomes, especially comminution. Comminuted fractures had greater post-reduction extension malalignment, falling outside the recommended PDFA range of 87-90°, especially with a lateral approach. Consideration should be given to surgical approach and techniques to reduce excessive extension when treating comminuted periprosthetic distal femoral fractures.
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Affiliation(s)
- Viraj Sharma
- VCU Health Department of Orthopaedic Surgery, PO Box 980153, Richmond, VA 23298, United States.
| | - Logan K Laubach
- VCU Health Department of Orthopaedic Surgery, PO Box 980153, Richmond, VA 23298, United States.
| | - John W Krumme
- KC Orthopedic Alliance, UMKC, 3651 College Blvd, Leawood, KS 66211, United States.
| | - Jibanananda Satpathy
- VCU Health Department of Orthopaedic Surgery, PO Box 980153, Richmond, VA 23298, United States.
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Vajapey SP, Fitz W, Iorio R. The Role of Stability and Alignment in Improving Patient Outcomes After Total Knee Arthroplasty. JBJS Rev 2022; 10:01874474-202205000-00001. [PMID: 35749640 DOI: 10.2106/jbjs.rvw.22.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Total knee arthroplasty (TKA) is an effective treatment option for many patients, but a small group of patients are dissatisfied following TKA. » Alignment, in combination with balance, stability, and knee kinematics, is an important modifiable surgical factor that can affect patient outcomes. » Driven by the subset of dissatisfied patients after TKA, new techniques have evolved in the search for a more anatomic reconstruction of individual knee morphology and a more accurate approximation of the individual lower-extremity alignment. » There is a need to optimize 3 aspects of TKA to improve patient outcomes-mechanical tooling processes, implants that resurface the epiphysis, and techniques that respect the variable anatomy of patients.
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Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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17
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Kanna R, Ravichandran C, Shetty GM. Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA. Knee Surg Relat Res 2021; 33:46. [PMID: 34952652 PMCID: PMC8709981 DOI: 10.1186/s43019-021-00129-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/08/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning is planned perpendicular to the sagittal mechanical axis of femur (SMX). We intended to determine if, by opting to place the femoral component perpendicular to distal femur anterior cortex axis (DCX), notching can be reduced in navigated TKA. Methods We studied 171 patients who underwent simultaneous bilateral computer-assisted TKA. Femoral component sagittal positioning was planned perpendicular to SMX in one knee (Femur Anterior Bowing Registration Disabled, i.e. FBRD group) and perpendicular to DCX in the opposite knee (Femur Anterior Bowing Registration Enabled, i.e. FBRE group). Incidence and depth of notching were recorded in both groups. For FBRE knees, distal anterior cortex angle (DCA), which is the angle between SMX and DCX, was calculated by the computer. Results Incidence and mean depth of notching was less (p = 0.0007 and 0.009) in FBRE versus FBRD group, i.e. 7% versus 19.9% and 0.98 mm versus 1.53 mm, respectively. Notching was very high (61.8%) in FBRD limbs when the anterior bowing was severe (DCA > 3°) in the contralateral (FBRE) limbs. Conclusion Notching was less when femoral component sagittal positioning was planned perpendicular to DCX, in navigated TKA. Level of evidence Therapeutic level II.
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Affiliation(s)
- Raj Kanna
- Department of Orthopaedic Surgery, Prashanth Super Speciality Hospital, Velachery Main Road, Chennai, 600042, India.
| | - Chandramohan Ravichandran
- Department of Orthopaedic Surgery, Prashanth Super Speciality Hospital, Velachery Main Road, Chennai, 600042, India
| | - Gautam M Shetty
- Knee & Orthopaedic Clinic, Mumbai, India.,AIMD Research, Mumbai, India
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Raaij TMV, Meij EVD, Vries AJD, Raay JJAMV. Patellar Resurfacing Does Not Improve Clinical Outcome in Patients with Symptomatic Tricompartmental Knee Osteoarthritis. An RCT Study of 40 Patients Receiving Primary Cruciate Retaining Total Knee Arthroplasty. J Knee Surg 2021; 34:1503-1509. [PMID: 32434236 DOI: 10.1055/s-0040-1710369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is some evidence that patellofemoral (PF) joint osteoarthritis (OA) causes anterior knee pain (AKP) after total knee arthroplasty (TKA). We hypothesized that patellar resurfacing in primary TKA for patients with symptomatic tricompartmental knee OA yields better clinical results after 2 years than non-resurfacing. A single center randomized controlled clinical trial comparing 40 patients receiving 42 cruciate retaining TKAs with (n = 21) or without patellar resurfacing (n = 21) was conducted. Primary outcome was the specific PF joint score HSS Baldini and secondary outcomes were the Knee Society Score (KSS) and the Knee Osteoarthritis Outcome Scale (KOOS). After 2 years no significant differences between both groups and between the groups in time for HSS Baldini, KSS, and KOOS were found. HSS Baldini score improved significantly after 6 weeks in both groups (p < 0.001) and did not improve in time afterward. At final follow-up the HSS Baldini mean score improved from a preoperative mean of 39 to 88 (difference of 49 points; p < 0.001)) for without patellar resurfacing group, and from a preoperative mean of 37 to 81 for patellar resurfacing group (difference of 47 points; p < 0.001). One patient in the patellar resurfacing group underwent a soft tissue re-alignment procedure because of patellar subluxation. Two patients in without patellar resurfacing group received secondary patellar button placement. Patellar resurfacing in primary TKA for patients with symptomatic tricompartmental OA has no beneficial effect over non-resurfacing and seems unnecessary. A special PF joint outcome measurement tool (HSS Baldini) and common knee scores showed no better knee function or AKP outcomes for with patellar resurfacing over without patellar resurfacing group in time and after 2 years of follow-up.
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Affiliation(s)
- Tom M van Raaij
- Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - Evelien van der Meij
- Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - Astrid J de Vries
- Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - Jos J A M van Raay
- Department of Orthopedic Surgery, Martini Hospital Groningen, Groningen, The Netherlands
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Yıldız F, Aliyev O, Aghazada A, Elmalı N, Uzer G, Tuncay İ. Two-surgeon simultaneous bilateral total knee arthroplasty does not provide poor prosthetic alignment : A prospective randomized controlled study. DER ORTHOPADE 2021; 51:239-245. [PMID: 34735596 DOI: 10.1007/s00132-021-04183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Two-surgeon, simultaneous bilateral total knee arthroplasty (TKA) is considered as an unpredictable, complex procedure in terms of its radiographic and functional outcomes because of different surgeons and teams, and too many instruments and hands in a narrow space. We compared radiological and functional results of simultaneous bilateral TKA and single-surgeon sequential bilateral TKA. METHODS The 136 participants with a minimum of 24 months follow-up were prospectively randomized into 2 groups: two-surgeon bilateral TKA and single-surgeon bilateral TKA. We prespecified primary outcome of the study as between-group differences in terms of component alignment in the coronal and sagittal planes. Short-term functional outcomes were evaluated prospectively using the Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS Each group consisted of 136 knees of 68 patients. The mean tibial medial angles (TMA) were 89° ± 3 ° and 88° ± 5° in two-surgeons and single surgeon groups, respectively (p = 0.24). Radiological outcomes showed that the mean femoral lateral angles (FLA) were 87.9 ± 3.5° and 85.84 ± 3.7° (p = 0.12), posterior tibial slope angles (PTSA) were 8.2 ± 16.9° and 7.6 ± 17.8° (p = 0.84), and femoral flexion angles (FFA)were 86.8 ± 3.8° and 86.3 ± 3.5° (p = 0.41), anterior femoral offset ratios (AFOR) (%) were 29.5 ± 11.1 and 27.7 ± 7.9 (p = 0.31), and posterior femoral offset ratio (PFOR) (%) were 108.41 ± 31.3 and 108.45 ± 25.7 (p = 0.98), respectively. CONCLUSION Two-team simultaneous bilateral TKA is as safe as single stage one-surgeon sequential bilateral TKA in terms of short-term component radiological and the functional outcomes.
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Affiliation(s)
- Fatih Yıldız
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/Istanbul, Turkey.
| | - Orkhan Aliyev
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/Istanbul, Turkey
| | - Aghamazahir Aghazada
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/Istanbul, Turkey
| | - Nurzat Elmalı
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/Istanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/Istanbul, Turkey
| | - İbrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/Istanbul, Turkey
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Hernández-Vaquero D. The alignment of the knee replacement. Old myths and new controversies. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Hernández-Vaquero D. La alineación de la artroplastia de rodilla. Antiguos mitos y nuevas controversias. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recot.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Comparison of the clinical and radiological outcomes between an isolated tibial component revision and total revision knee arthroplasty in aseptic loosening of an isolated tibial component. J Orthop Sci 2021; 26:435-440. [PMID: 32620342 DOI: 10.1016/j.jos.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/24/2020] [Accepted: 05/06/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND An isolated tibial component revision could be a treatment option for isolated tibial side loosening; however, few studies have proved its efficacy. This study aimed to compare the clinical and radiological outcomes between isolated (tibial component) and total (femoral and tibial component) revision total knee arthroplasty (TKA). METHODS Between January 2008 and February 2017, 31 patients underwent revision TKA for isolated tibial side loosening; 14 underwent an isolated tibial component revision (isolated group) and 17 underwent total (both femoral and tibial components) revision surgery (total group). The postoperative range of motion (ROM), Western Ontario and McMaster Universities osteoarthritis (WOMAC) index, Knee Society knee score (KSKS), Knee Society function score (KSFS), and mechanical axis (MA) were compared between the two groups. The intraoperative tourniquet time and amount of blood drainage were also compared. RESULTS The mean follow-up durations in the isolated and total groups were 40.7 and 56.1 months, respectively. Both groups had similar postoperative ROM, WOMAC index, KSKS, KSFS, and MA; however, significantly shorter tourniquet time (105.2 vs. 154.6 min, P < 0.001) and less blood drainage (417.2 vs. 968.1 ml, P < 0.001) were noted in the isolated group than in the total group. CONCLUSION Isolated tibial component revision TKA for tibial component loosening showed comparable clinical and radiological outcomes to those of total revision TKA. The advantages of the isolated tibial component revision surgery were short operation time and small blood loss. STUDY DESIGN Level III, Retrospective comparative study.
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Gao J, Hou Y, Li R, Ke Y, Li Z, Lin J. The accelerometer-based navigation system demonstrated superior radiological outcomes in restoring mechanical alignment and component sagittal positioning in total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:351. [PMID: 33849489 PMCID: PMC8045229 DOI: 10.1186/s12891-021-04213-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to determine whether the accelerometer-based navigation (ABN) could improve the accuracy of restoring mechanical axis (MA), component positioning, and clinical outcomes compared to conventional (CON) total knee arthroplasty (TKA). Methods A total of 301 consecutive patients (ABN: 27, CON: 274) were included. A 1:4 propensity score matching (PSM) was performed between the two groups according to preoperative demographic and clinical parameters. The postoperative MA, femoral coronal angle (FCA), femoral sagittal angle (FSA), tibial coronal angle (TCA) and tibial sagittal angle (TSA) were compared. Absolute deviations of aforementioned angles were calculated as the absolute value of difference between the exact and ideal value and defined as norms if within 3°, otherwise regarded as outliers. Additional clinical parameters, including the Knee Society knee and function scores (KSKS and KSFS) and range of motion (ROM), were assessed at final follow-up (FU) (mean FU was 21.88 and 21.56 months respectively for ABN and CON group). A secondary subgroup analysis and comparison on clinical outcomes were conducted between norms and outliers in different radiological parameters. Results A total of 98 patients/102 knees were analyzed after the PSM (ABN: 21 patients/24 knees, CON: 77 patients/78 knees). In the ABN group, the mean MA, FCA and TSA were significantly improved (p = 0.019, 0.006, < 0.001, respectively). Proportions of TKAs within a ± 3°deviation were significantly improved in all the postoperative radiological variables except for TCA (p = 0.003, 0.021, 0.042, 0.013, respectively for MA, FCA, FSA, and TSA). The absolute deviations of FSA and TSA were also significantly lower in the ABN group (p = 0.020, 0.048, respectively). No significant differences were found in either mean value, absolute deviation or outlier ratio of TCA between two groups. On clinical outcomes, there were no significant differences between two groups, although KSKS, KSFS and ROM (p < 0.01, respectively) dramatically improved compared to baseline. The subgroup analysis also demonstrated no statistical difference on clinical outcomes between the outliers and norms in varied radiological parameters. Conclusions The ABN could improve the accuracy and precision of mechanical alignment and component positioning without significant improvement of clinical outcomes. Further high quality studies with long term FU are warranted to comprehensively evaluate the value of the ABN.
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Affiliation(s)
- Jiaxiang Gao
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yunfei Hou
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Rujun Li
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yan Ke
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.,Arthritis Institute, Peking University, Beijing, China
| | - Zhichang Li
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China. .,Arthritis Institute, Peking University, Beijing, China.
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China. .,Arthritis Institute, Peking University, Beijing, China.
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24
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Zaffagnini S, Di Paolo S, Meena A, Alesi D, Zinno R, Barone G, Pizza N, Bragonzoni L. Causes of stiffness after total knee arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:1983-1999. [PMID: 33821306 DOI: 10.1007/s00264-021-05023-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Knee stiffness after total knee arthroplasty (TKA) often leads to pain and discomfort, failing to meet patients' expectations on the surgical procedure. Despite the growing debate on the topic, a comprehensive literature analysis of stiffness causes has never been conducted. Thus, the purpose of the present study was to systematically review the literature regarding the main causes of stiffness after TKA. METHODS Pubmed Central, Scopus, and EMBASE databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for studies on stiffness and pain or discomfort after TKA through November 2020. Overall, 25 articles matched the selection criteria and were included in the study. Clinical relevance and strength of evidence of the included studies were graded using the risk of bias and the methodological index for non-randomized studies quality assessment tools. RESULTS The main causes of pain and discomfort due to stiffness were surgery-related issues, i.e., component malpositioning and over-voluming, implant loosening, psychological distress, and obesity, which could be considered "modifiable" factors, and expression of profibrotic markers, high material hypersensitivity-related cytokines level, male gender, previous contralateral TKA, and high pre-operative pain, which could be considered "non-modifiable" factors. CONCLUSION The use of alternative technologies such as surgical robots, anatomy-based devices, and more inert and less stiff component materials could help in reducing stiffness caused by both modifiable and even some non-modifiable factors. Furthermore, early diagnostic detection of stiffness onset could consistently support surgeons in patient-specific decision-making.
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Affiliation(s)
- Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | | | - Amit Meena
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
| | - Raffaele Zinno
- University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Giuseppe Barone
- University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
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25
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Noh JH, Kim NY, Song KI. Intraoperative patellar maltracking and postoperative radiographic patellar malalignment were more frequent in cases of complete medial collateral ligament release in cruciate-retaining total knee arthroplasty. Knee Surg Relat Res 2021; 33:9. [PMID: 33743836 PMCID: PMC7981897 DOI: 10.1186/s43019-021-00091-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patellar maltracking after total knee arthroplasty (TKA) can lead to significant patellofemoral complications such as anterior knee pain, increased component wear, and a higher risk of component loosening, patellar fracture, and instability. This study was to investigate the preoperative and operative variables that significantly affect patellar tracking after cruciate-retaining TKA. METHODS We studied 142 knee joints in patients who had undergone TKA: the knees were dichotomized based on postoperative patellar tracking, which was evaluated on patellar skyline, axial-projection radiographs: group 1, normal patellar tracking (lateral tilt ≤ 10° and displacement ≤ 3 mm) and group 2, patellar maltracking (lateral tilt > 10° or displacement > 3 mm). The patients' demographic data and clinical and radiographic measurements obtained before and after surgery were compared between the two groups. RESULTS Preoperative lateral patellar displacement was greater (4.1 ± 2.6 mm vs. 6.0 ± 3.5 mm), as was the frequency of medial collateral ligament (MCL) release (3/67 vs. 24/75) in group 2 than in group 1 (p < 0.001 and p < 0.001, respectively). The distal femur was cut in a greater degree of valgus in group 1 than in group 2. (6.3 ± 0.8° vs. 6.0 ± 0.8°) (p = 0.034). CONCLUSIONS Complete release of the MCL during surgery was associated with patellar maltracking (logistic regression: p = 0.005, odds ratio = 20.592). Surgeons should attend to patellar tracking during surgery in medially tight knees. LEVEL OF EVIDENCE Retrospective comparative study, level III.
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Affiliation(s)
- Jung Ho Noh
- Department of Orthopaedic Surgery, Kangwon National University School of Medicine, 1 Gangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, South Korea.
| | - Nam Yeop Kim
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, South Korea
| | - Ki Ill Song
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, South Korea
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26
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Parsons T, Al-Jabri T, Clement ND, Maffulli N, Kader DF. Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing. J Orthop Surg Res 2021; 16:185. [PMID: 33706779 PMCID: PMC7948323 DOI: 10.1186/s13018-021-02295-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively. AIMS To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty. METHOD A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae. RESULTS Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors. CONCLUSION Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.
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Affiliation(s)
- Thomas Parsons
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- Royal United Hospital Bath, Combe Park, Bath, Avon BA1 3NG UK
| | - Talal Al-Jabri
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ England
| | - Nick D. Clement
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG England
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, ST5 5BG UK
| | - Deiary F. Kader
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- University of Kurdistan Hewler, Erbil, Iraq
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27
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Carlson SW, Gausden EB, Trousdale RT. A Surgical Technique to Avoid Mediolateral Overhang during Total Knee Arthroplasty. Arthroplast Today 2021; 7:235-237. [PMID: 33614875 PMCID: PMC7881086 DOI: 10.1016/j.artd.2020.12.019] [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: 09/11/2020] [Revised: 12/05/2020] [Accepted: 12/18/2020] [Indexed: 11/27/2022] Open
Abstract
Femoral component sizing and positioning is an essential component of performing a successful total knee arthroplasty. Failure to size or position the femoral component correctly can result in reduced range of motion, instability, soft-tissue impingement, and irritation. The following is a description of a novel technique that allows the surgeon to use an intercondylar autograft to translate the femoral component in the mediolateral direction and avoid the consequences of mediolateral femoral component overhang.
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Affiliation(s)
- Samuel W Carlson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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28
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Holland G, Keenan OJ, Gillespie M, Gherman A, MacDonald DJ, Clement ND, Scott CEH. Patellar cartilage loss does not affect early outcomes of total knee arthroplasty performed without patella resurfacing. Knee 2021; 28:194-201. [PMID: 33418395 DOI: 10.1016/j.knee.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to compare the outcomes and cost economics of TKA without patella resurfacing in patients with and without patellar cartilage loss. METHODS Prospective case control study of 209 consecutive patients undergoing TKA without patella resurfacing. Patella cartilage status was documented intra-operatively: 108 patients had patella cartilage loss (mean age 70 ± 9.7, mean BMI 31 ± 6.2, 72 (67%) female) and 101 control patients did not (age 68 ± 9.2, BMI 31 ± 5.6, 52 (51%) female). The primary outcome measure was Oxford Knee Score (OKS) improvement at one year. Secondary outcomes included OKS, EQ-5D, anterior knee pain (AKP), Kujala scores and reoperation at 2-4 years. The cost to prevent secondary patella resurfacing was calculated. RESULTS There were more women in the patella cartilage loss group (67% Vs 51%, p = 0.037), but no other preoperative characteristics differed. There was no difference in OKS improvement between those with and without patella cartilage loss at 1 year (mean difference -1.03, -3.68 to 1.62 95%CI, p = 0.446) or 2-4 years (mean difference 1.52, -1.43 to 4.45 95%CI, p = 0.310). At 2-4 years there was no difference in AKP (14/87 with vs 17/80 without, p = 0.430) nor Kujala score (mean difference 2.66, -3.82 to 9.13 95%CI, p = 0.418). Routine patella resurfacing would have cost £58,311 to prevent one secondary resurfacing. CONCLUSION There was no difference in OKS, anterior knee pain, reoperation or Kujala scores up to 2-4 years between patients with and without patellar cartilage loss following TKA without patella resurfacing. Resurfacing for this indication would not have been a cost effective intervention.
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Affiliation(s)
- George Holland
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom
| | - Oisin J Keenan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom
| | - Matthew Gillespie
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom
| | - Anda Gherman
- Department of Orthopaedics, The University of Edinburgh, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom
| | - Deborah J MacDonald
- Department of Orthopaedics, The University of Edinburgh, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom
| | - Nicholas D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom; Department of Orthopaedics, The University of Edinburgh, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom.
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29
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Goh JKM, Chen JY, Yeo NEM, Liow MHL, Chia SL, Yeo SJ. Ten year outcomes for the prospective randomised trial comparing unlinked, modular bicompartmental knee arthroplasty and total knee arthroplasty. Knee 2020; 27:1914-1922. [PMID: 33221689 DOI: 10.1016/j.knee.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A sizeable proportion of knee osteoarthritis is limited to the medial and patellofemoral compartments. Whilst short- and medium-term studies comparing bicompartmental knee arthroplasty (BCA) and total knee arthroplasty (TKA) have shown similar outcome scores, there are no studies comparing long-term outcomes. This study aims to determine which procedure resulted in superior long-term outcome scores. METHODS Forty-eight patients with medial and patellofemoral compartment knee osteoarthritis were randomised to receive treatment in two groups: unlinked, modular BCA and TKA. The main outcome measures compared were the range of motion, Knee Society Function Score, Knee Society Knee Score, Oxford Knee Score, Physical Component Score and Mental Component Score of SF-36 pre-operatively and post-operatively up to 10 years. Radiographs of the operated knees were taken pre-operatively, post-operatively and at 10-year follow-up. RESULTS Twenty-six underwent BCA and 22 underwent TKA. Overall improvement was seen in both groups compared to pre-operatively, however there were no significant differences detected between the groups at 10 years. The median Hip-Knee-Ankle (HKA) angle was 183.38 (175.17-187.94) in the BCA group and 180.73 (174.96-185.65) in the TKA group. One patient from the BCA group had a peri-prosthetic fracture necessitating revision surgery to a TKA. CONCLUSIONS Outcome scores for BCA results were comparable to TKA at long-term follow-up. BCA is an alternative arthroplasty option in selected patients.
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Affiliation(s)
- Jeremy Keng Meng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Nicholas Eng Meng Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
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30
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Wang Y, Feng W, Zang J, Gao H. Effect of Patellar Denervation on Anterior Knee Pain and Knee Function in Total Knee Arthroplasty without Patellar Resurfacing: A Meta-Analysis of Randomized Controlled Trials. Orthop Surg 2020; 12:1859-1869. [PMID: 33112040 PMCID: PMC7767783 DOI: 10.1111/os.12815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/05/2020] [Accepted: 08/25/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the effect of patellar denervation (PD) in preventing anterior knee pain (AKP) and improving knee function after total knee arthroplasty (TKA) without patellar resurfacing, and to help surgeons decide whether or not to use PD in TKA. METHODS The electronic databases of Pubmed, Embase, Cochrane, Web of Science, and Scopus were searched for all randomized controlled trials (RCT) comparing the outcomes of PD and no patellar denervation (NPD) in TKA without patellar resurfacing. Primary outcomes were incidence of AKP, visual analogue scale for pain (VAS), and patellar score (PS). Secondary outcomes were Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Knee Score (OKS), knee range of motion (ROM), and complications. RESULTS A total of nine RCT met the inclusion criteria. On meta-analysis, PD significantly reduced the incidence of AKP (odds ratio 0.49; 95% confidence interval [CI] 0.26 to 0.92), reduced the VAS (weighted mean difference [WMD] -0.57; 95% CI -1.02 to -0.11), and improved the WOMAC (WMD -4.63; 95% CI -6.49 to -2.77) and the ROM (WMD 9.60; 95% CI 0.39 to 18.81) during the follow-up within 12 months. In addition, PD improved the PS (WMD 1.01; 95% CI 0.65 to 1.38), KSS (WMD 1.12; 95% CI 0.10 to 2.14), and the WOMAC (WMD -1.41; 95% CI -2.74 to -0.08) during the follow-up after 12 months. CONCLUSION Patellar denervation could significantly reduce the VAS and the incidence of AKP in the early stages after TKA as well as improve the clinical outcomes in terms of the PS, the WOMAC, the KSS, and the ROM. This study demonstrates that PD is a safe and recommendable technique that could be routinely performed in TKA.
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Affiliation(s)
- Yuhang Wang
- Day Care Unit, The First Hospital of Jilin University, Changchun, China
| | - Wei Feng
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
| | - Junting Zang
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
| | - Hang Gao
- Department of Orthopaedics, The First Hospital of Jilin University, Changchun, China
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Ou YL, Li PY, Xia H. Optimal Sagittal Insertion Depth and Direction of Femoral Intramedullary Rod in Total Knee Arthroplasty in Chinese Osteoarthritis Patients. Orthop Surg 2020; 12:1238-1244. [PMID: 32677327 PMCID: PMC7454151 DOI: 10.1111/os.12753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/22/2020] [Accepted: 06/18/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To identify the optimal femoral intramedullary rod insertion depth and direction on the sagittal plane in total knee arthroplasty (TKA) of Chinese osteoarthritis (OA) patients. Methods From January to December 2019, CT data were collected for 85 consecutive entire lower extremity Chinese OA patients. A three‐dimensional method was used to simulate intramedullary rod penetration. The intramedullary rods were inserted toward the anterior (TA), center (TC), and posterior (TP) of the femoral canal, respectively. Four penetration depths of 150, 200, 250, and 300 mm from the joint line were set. The intersection angle was measured between the simulated intramedullary rod and the mechanical axis of the femur (FMA) on the sagittal plane. Results Our study included 85 Chinese OA patients: 46 women, with a mean age of 65.7 ± 8.4 years (range, 51–85 years) and 39 men, with a mean age of 65.6 ± 8.1 years (range, 46–86 years). The intersection angle between the FMA and the femoral anatomical axis was smaller in men, 2.4° ± 1.6° (range, 0°–4.8°), than in women, 3.5° ± 2.3° (range, 0.7º–8.2°), with a significant statistical difference (P < 0.01). In the comparison of the intersection angle between the simulated intramedullary rod and the FMA, there was no statistical difference between TA200 and TC200 in women (P > 0.05). The proportions were up to 91% and 96% of TA200 at 0°–3° and 0°–5° intervals, respectively, but just 63% and 78% in TC200. In TA150, 76% of intersection angles were greater than 5°. Only approximately 60% in TA250 and TA300 were within the 0°–5° interval and 40% were less than 0°. Only 57% of intersection angles in TC150 were in the 0°–3° interval. TC250, TC300, and TP150 were mostly below 0°. In men, there were statistical differences between all groups. All intersection angles were greater than 5° in TA150. TA200 and TA250 were mostly greater than 5° (87% and 59%, respectively) and 72% of intersection angles were within 0°–5° interval in TA300. TC150 had 92% of intersection angles within the 0°–5° interval but only 62% between the 0° and 3° interval. In the TC200, up to 90% and 97% were within 0°–3° and 0°–5° intervals, respectively. TC300, TP150, and TP200 were mostly below 0°. Conclusion We described an innovative method for rapidly, simply, and accurately identifying the sagittal insertion depth and direction of the femoral intramedullary rod in TKA, which can optimize the position of the femoral prosthetic component on the sagittal plane in TKA.
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Affiliation(s)
- Yong-Liang Ou
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou, China
| | - Ping-Yue Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Hong Xia
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou, China
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32
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Liu L, Zhao F, Zha G, Zheng X, Yang G, Xu S. [Effect of surgeon's handedness on distribution of prosthesis during primary total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:696-701. [PMID: 32538558 DOI: 10.7507/1002-1892.201911042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effect of the surgeon's handedness on the distribution of prosthesis during primary total knee arthroplasty (TKA). Methods A retrospective analysis was performed on 86 patients (100 knees) with primary TKA completed by the same right-handed surgeon between December 2016 and December 2018, including 72 cases of single knee and 14 of bilateral knees. The patients were divided into dominant group (right side) and non-dominant group (left side) according to the operating position of the surgeon and each group had 50 knees. There was no significant difference in gender, age, body mass index, disease duration, clinical diagnosis, preoperative Hospital for Special Surgery (HSS) score, and other general data between the two groups ( P>0.05). The operation time and complications were recorded in both groups. The function of knee was evaluated by HSS score. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured by using X-ray film of full-length lower extremity before TKA and at 2 weeks after TKA that were used to evaluate the coronal position of the prosthesis. Posterior distal femoral angle (PDFA) and posterior proximal tibial angle (PPTA) were measured by using lateral X-ray films at 3 months after operation that were used to evaluate the sagittal position of the prosthesis. Results There was no significant difference in operation time between the two groups ( t=-1.128, P=0.262). One case of posterior tibial artery thrombosis occurred in the dominant group, and 1 case of poor healing of the incision occurred in each of the dominant group and the non-dominant group. Patients in both groups were followed up 12-34 months with an average of 22.0 months. The HSS scores at last follow-up were 87.2±4.3 in the dominant group and 86.8±5.0 in the non-dominant group. There was no significant difference between the two groups ( t=0.471, P=0.639). No complications such as periprosthetic infection, prosthetic loosening, or periprosthetic fracture occurred during follow-up. There was no significant difference in the HKA, mLDFA, and mMPTA between the two groups before and after operation ( P>0.05). The differences in the incidence of sagittal femoral prosthesis malposition and PDFA between the two groups were significant ( P<0.05); however, there was no significant difference in the PPTA, the rate of femoral prosthesis distributed in the neutral position, the incidence of over-flexed femoral prosthesis, and the incidence of anterior femoral notch ( P>0.05). Conclusion The surgeon's handedness is one of the factors affecting the placement of the sagittal femoral prosthesis in primary TKA. The incidence of sagittal femoral prosthesis malposition could increase when the surgeon performs on the non-dominant side.
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Affiliation(s)
- Lei Liu
- Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, P.R.China
| | - Fengchao Zhao
- Xuzhou Medical University, Xuzhou Jiangsu, 221004, P.R.China
| | - Guochun Zha
- Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, P.R.China
| | - Xin Zheng
- Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, P.R.China
| | - Guanjie Yang
- Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, P.R.China
| | - Shizhuang Xu
- Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, P.R.China
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Nishitani K, Kuriyama S, Nakamura S, Umatani N, Ito H, Matsuda S. Excessive flexed position of the femoral component was associated with poor new Knee Society Score after total knee arthroplasty with the Bi-Surface knee prosthesis. Bone Joint J 2020; 102-B:36-42. [PMID: 32475263 DOI: 10.1302/0301-620x.102b6.bjj-2019-1531.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed to evaluate the association between the sagittal alignment of the femoral component in total knee arthroplasty (TKA) and new Knee Society Score (2011KSS), under the hypothesis that outliers such as the excessive extended or flexed femoral component were related to worse clinical outcomes. METHODS A group of 156 knees (134 F:22 M) in 133 patients with a mean age 75.8 years (SD 6.4) who underwent TKA with the cruciate-substituting Bi-Surface Knee prosthesis were retrospectively enrolled. On lateral radiographs, γ angle (the angle between the distal femoral axis and the line perpendicular to the distal rear surface of the femoral component) was measured, and the patients were divided into four groups according to the γ angle. The 2011KSSs among groups were compared using the Kruskal-Wallis test. A secondary regression analysis was used to investigate the association between the 2011KSS and γ angle. RESULTS According to the mean and SD of γ angle (γ, 4.0 SD 3.0°), four groups (Extended or minor flexed group, -0.5° ≤ γ < 2.5° (n = 54)), Mild flexed group (2.5° ≤ γ < 5.5° (n = 63)), Moderate flexed group (5.5° ≤ γ < 8.5° (n = 26)), and Excessive flexed group (8.5° ≤ γ (n = 13)) were defined. The Excessive flexed group showed worse 2011KSSs in all subdomains (Symptoms, Satisfaction, Expectations, and Functional activities) than the Mild flexed group. Secondary regression showed a convex upward function, and the scores were highest at γ = 3.0°, 4.0°, and 3.0° in Satisfaction, Expectations, and Functional activities, respectively. CONCLUSION The groups with a sagittal alignment of the femoral component > 8.5° showed inferior clinical outcomes in 2011KSSs. Secondary regression analyses showed that mild flexion of the femoral component was associated with the highest score. When implanting the Bi-Surface Knee prosthesis surgeons should pay careful attention to avoiding flexing the femoral component extensively during TKA. Our findings may be applicable to other implant designs. Cite this article: Bone Joint J 2020;102-B(6 Supple A):36-42.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Umatani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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