1
|
Obana KK, Wong K, Shimoda BT, Rimm J, Stickley CD, Nakasone CK. Favorable outcomes of posterior cruciate-stabilized inserts over ultracongruent inserts in total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:5857-5865. [PMID: 36928502 DOI: 10.1007/s00402-023-04837-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Posterior cruciate-stabilized (PS) and ultracongruent (UC) inserts are used during total knee arthroplasty (TKA), but superiority in gaining postoperative knee flexion and functionality remains contested. Therefore, this study compared postoperative outcomes between PS and UC inserts. METHODS A retrospective review evaluated unilateral or bilateral TKAs with PS or UC inserts from August 2011 to March 2020. Nonparametric statistics were performed to evaluate differences in patient demographics, pre- and postknee flexion and Knee Society Knee (KSS-K) and Function Score (KSS-F). Univariate and multivariable regressions were performed to evaluate the influence on postoperative knee flexion ≥ 120°, presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS Patient demographics were not significantly different between the 577 PS and 399 UC knees evaluated. Postoperatively, a larger proportion of UC knees demonstrated knee flexion < 120° (36.0% vs. 18.6%, p < 0.001) and lower KSS-K (91.0 ± 8.7 vs. 91.6 ± 10.3, p < 0.001) and KSS-F (76.8 ± 21.6 vs. 79.9 ± 21.6, p = 0.007) than the PS group. The PS group had greater improvement in flexion angle (4.9° ± 14.9° vs. 1.0° ± 15.6°, p < 0.001) and KSS-F (27.3 ± 23.3 vs. 23.1 ± 25.3, p = 0.007) as compared to that of UC patients. Patients with preoperative flexion < 120° (OR 2.787, CI 2.066-3.761; p < 0.001), higher body mass index (OR 1.033, CI 1.006-1.061; p = 0.017) and UC insert (OR 2.461, CI 1.832-3.307; p < 0.001) were less likely to achieve flexion ≥ 120°. CONCLUSION Favorable clinical and functional outcomes were noted in the PS group as compared to UC inserts in TKA. The greater improvement in overall knee flexion may suggest the PS insert may be especially appropriate for patients with lower preoperative range of motion. LEVEL OF EVIDENCE III, retrospective comparative study.
Collapse
Affiliation(s)
- Kyle K Obana
- John A. Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Krystin Wong
- John A. Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Brent T Shimoda
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Julian Rimm
- John A. Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Christopher D Stickley
- Department of Anatomy, Biochemistry, and Physiology, University of Hawai'i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96818, USA.
- Department of Surgery, University of Hawai'i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
| |
Collapse
|
2
|
Movassaghi K, Patel A, Ghulam-Jelani Z, Levine BR. Modern Total Knee Arthroplasty Bearing Designs and the Role of the Posterior Cruciate Ligament. Arthroplast Today 2023; 21:101130. [PMID: 37151403 PMCID: PMC10160699 DOI: 10.1016/j.artd.2023.101130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/04/2023] [Accepted: 03/08/2023] [Indexed: 05/09/2023] Open
Abstract
The role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) surgery continues to be a source of debate among the adult reconstruction community. In native knee flexion, the PCL is comprised of an anterolateral and posteromedial bundle that work together to limit posterior tibial translation and allow adequate femoral rollback for deep flexion. In the arthritic knee, the PCL can often become dysfunctional and attenuated, which led to the development of posterior stabilized (PS) TKA bearing options. PS TKAs implement a cam-post construct to functionally replace a resected PCL. While PS designs may facilitate balancing knees with significant deformity, they are associated with complications such as postfracture, increased wear, and patellar clunk/crepitus. In recent years, newer designs have been popularized with greater degrees of congruency and incorporation of medial and lateral pivoting to better recreate native knee kinematics. The American Joint Registry has confirmed the recent predilection for ultra-congruent and cruciate-retaining TKA inserts over PS TKAs during the last decade. Studies have failed to identify an overall clinical superiority between the cruciate substituting and sacrificing designs. The literature has also failed to identify clinical consequences from PCL resection with modern, more conforming TKA designs. In this article, we review modern PCL sacrificing designs and discuss the impact of each on the kinematics after TKA. We also will delineate the role of the PCL in modern TKA in the hopes to better understand the recent surge in sacrificing but not substituting knee implants.
Collapse
Affiliation(s)
- Kamran Movassaghi
- Department of Orthopaedic Surgery, University of California, San Francisco Fresno, Fresno, CA, USA
- Corresponding author. University of California, San Francisco Fresno, 2823 Fresno Street, Fresno, CA 93721, USA. Tel.: +1 818 640 5244.
| | - Arpan Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Zohal Ghulam-Jelani
- Department of Orthopaedic Surgery, University of California, San Francisco Fresno, Fresno, CA, USA
| | - Brett R. Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
3
|
Castellarin G, Bori E, Rapallo L, Pianigiani S, Innocenti B. Biomechanical analysis of different levels of constraint in TKA during daily activities. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:3. [PMID: 36597168 PMCID: PMC9811790 DOI: 10.1186/s42836-022-00157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Numerous total knee prosthetic implants are currently available on the orthopedic market, and this variety covers a set of different levels of constraint: among the various models available, a significant role is covered by mobile bearing cruciate-retaining design with an ultra-congruent insert, mobile bearing cruciate-retaining design, fixed-bearing posterior stabilized prosthesis and fixed-bearing constrained condylar knee. A biomechanical comparative study among them could therefore be helpful for the clinical decision-making process. This study aimed to compare the effect of these different levels of constraint in the knee biomechanics of a patient, in three different configurations representing the typical boundary conditions experienced by the knee joint during daily activities. METHOD The investigation was performed via finite element analysis with a knee model based on an already published and validated one. Four different types of prosthesis designs were analyzed: two mobile-bearing models and two fixed-bearing models, each one having a different level of constraint. The different designs were incorporated in to the 3D finite element model of the lower leg and analyzed in three different configurations reproducing the landing and the taking-off phases occurring during the gait cycle and chair-rising. Implant kinetics (in terms of polyethylene contact areas and contact pressure), polyethylene and tibial bone stresses were calculated under three different loading conditions for each design. RESULTS The tibial stress distribution in the different regions of interest of the tibia remains relatively homogeneous regardless of the type of design used. The main relevant difference was observed between the mobile and fixed-bearing models, as the contact areas were significantly different between these models in the different loading conditions. As a consequence, significant changes in the stress distribution were observed at the interface between the prosthetic components, but no significant changes were noted on the tibial bone. Moreover, the different models exhibited a symmetrical medial and lateral distribution of the contact areas, which was not always common among all the currently available prostheses (i.e. medial pivot designs). CONCLUSION The changes of the prosthetic implant did not induce a big variation of the stress distribution in the different regions of the tibial bone, while they significantly changed the distribution of stress at the interface between the prosthetic components.
Collapse
Affiliation(s)
| | - Edoardo Bori
- grid.4989.c0000 0001 2348 0746BEAMS Department, Université Libre de Bruxelles, 1050 Bruxelles, Belgium
| | - Laurence Rapallo
- grid.4989.c0000 0001 2348 0746BEAMS Department, Université Libre de Bruxelles, 1050 Bruxelles, Belgium
| | - Silvia Pianigiani
- grid.4989.c0000 0001 2348 0746BEAMS Department, Université Libre de Bruxelles, 1050 Bruxelles, Belgium ,Adler Ortho, Cormano, 20032 Milan, Italy
| | - Bernardo Innocenti
- grid.4989.c0000 0001 2348 0746BEAMS Department, Université Libre de Bruxelles, 1050 Bruxelles, Belgium
| |
Collapse
|
4
|
A prospective comparison of total knee arthroplasty using ultra-congruent, condylar-stabilizing, and posterior-stabilized devices implanted with kinematic alignment: better 2-year outcomes with ultra-congruent. Knee Surg Sports Traumatol Arthrosc 2023; 31:1026-1033. [PMID: 36318322 PMCID: PMC9957877 DOI: 10.1007/s00167-022-07206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/19/2022] [Indexed: 02/14/2023]
Abstract
PURPOSE This study compared the 5-year results of posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA) with either a post and cam posterior-stabilized (PS) device, a dished, congruent condylar-stabilizing (CS) device, or a deep-dished ultra-congruent (UC) device. The hypothesis was that the clinical and radiographic outcomes would be equivalent. CS and PS participants were part of a prospective, randomized trial, and UC participants were part of a separate prospective, non-randomized protocol that was otherwise identical. A kinematic alignment surgical technique was utilized. METHODS Participants were assessed preoperatively, and postoperatively at 6 weeks, 6 months, and annually for 5 years by Knee Society Score (KSS), SF-36 v2, Lower Extremity Activity Scale (LEAS), and physical and radiographic evaluation. There were 116 CS/PS participants and 69 UC participants who participated in the study. RESULTS Tourniquet (P = .02) and operative (P = .01) times for the CS and UC groups were significantly shorter than the PS group. KSS Function scores were better for the UC group than the CS and PS groups at 6 months (P = .04) and 1 year (P = .03), and better in the UC group vs. CS at 2 years (P = .04). The KSS Pain-only score was also better in the UC compared to PS at 6 months (P = .04). There were no significant differences for the KSS Pain/Motion scores, flexion, SF-36, and LEAS scores at any time. CONCLUSION These data confirm the hypothesis that there are no clinically meaningful significant differences in outcomes between the three groups at a 5-year minimum follow-up, though there is a trend toward less pain and better function at earlier visits in the UC group. LEVEL OF EVIDENCE II.
Collapse
|
5
|
Hinarejos P, Leal-Blanquet J, Fraile-Suari A, Sánchez-Soler J, Torres-Claramunt R, Monllau JC. Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 2022; 30:3041-3048. [PMID: 34436635 DOI: 10.1007/s00167-021-06710-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/14/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to compare the posterior tibial translation after ultracongruent (UC) and posterior-stabilized (PS) total knee arthroplasty (TKA) with two different UC with different heights in the anterior lip, and two different PS designs. This study also aimed to compare the range of motion (ROM) and outcomes scores after the use of these TKA models. It was hypothesised less posterior tibial translation after PS than after UC TKA, and less posterior tibial translation with a higher anterior lip in the UC insert than with a lower one. METHODS It was designed as a prospective randomized study of a group of 120 patients operated with a cemented TKA. To clarify the main purpose of the study, four groups were analysed using different polyethylene designs: Triathlon PS insert in group one, Triathlon UC insert in group two, U2 PS insert in group three and U2 UC insert in group four. One year after surgery, a forced posterior drawer with a Telos Stress applying 15 kg of force posteriorly on the proximal tibia at 90° of knee flexion was analysed in the lateral radiograph. Limb alignment, tibial posterior slope and posterior condylar offset were also studied. RESULTS 30 patients were included in each group. The average age was 73 years. There were 72.2% female and 27.8% male patients. There were no significant differences in any demographic or radiographic studied variables, preoperative range of motion (ROM) or preoperative Knee Society Scores (KSS) among the different groups. One year after surgery, the average postoperative ROM and the postoperative KSS Knee and KSS Function scores improved in respect of the preoperative values in all the groups. There were no significant differences in the postoperative outcome scores among the different groups (p = n.s.). Postoperative alignment of the limb, tibial posterior slope and posterior condylar offset were similar in the 4 study groups (p = n.s.). The postoperative posterior tibial translation was different between groups: the PS groups (groups 1 and 3) showed significant inferior values (p < 0.001) in respect of the UC groups (groups 2 and 4). There were no differences between both groups of PS models, but there was a significant increase in the posterior tibial translation of the Triathlon UC insert (11.2 mm SD 3.2) in respect of the U2 UC insert (6.1 mm SD 4.5) (p = 0.004). CONCLUSIONS UC inserts restrict the posterior tibial translation after TKA less than PS inserts, but a design with a high anterior lip in the polyethylene UC insert can better control the posterior tibial translation than an insert with a small anterior lip. LEVEL OF EVIDENCE Level I. Randomised controlled trial.
Collapse
Affiliation(s)
- Pedro Hinarejos
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain. .,Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Joan Leal-Blanquet
- Department of Orthopedic Surgery, Hospital d'Igualada, Consorci Sanitari de L'Anoia, Av. Catalunya, 11, 08700, Igualada Barcelona, Spain
| | - Anna Fraile-Suari
- Department of Orthopedic Surgery, Hospital Sant Camil, Ronda Sant Camil S/N, 08810, Sant Pere de Ribes, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Juan Carlos Monllau
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
Krumme J, Kankaria R, Vallem M, Cyrus J, Sculco P, Golladay G, Kalore N. Comparative Analysis of Contemporary Fixed Tibial Inserts: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Orthop Rev (Pavia) 2022; 14:35502. [PMID: 35769654 PMCID: PMC9235430 DOI: 10.52965/001c.35502] [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: 12/16/2021] [Accepted: 05/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background Multiple options are available for the tibial insert in total knee arthroplasty (TKA). A systematic review (SR) and network meta-analysis (NMA) to compare available randomized controlled trials (RCTs) could assist with decision making. We aim to show that designs with increased conformity may improve function and satisfaction without an increase in complications though posterior stabilized (PS) inserts will likely have more flexion. Methods A search of MEDLINE, EMBASE, and the Cochrane Library was performed. Studies were limited to RCTs evaluating cruciate retaining (CR), PS, anterior stabilized (AS), medial pivot (MP), bicruciate retaining (BR), and bicruciate stabilizing (BCS) inserts. Mean differences (MD) were used for patient reported outcome measures (PROMs) and odds ratios (OR) for reoperation rates and MUA. A systematic review was performed for satisfaction. Results 27 trials were identified. The NMA showed no difference from a statistical or clinical standpoint for PROMs evaluated. There was a statistical difference for increased flexion for PS knees (3 degrees p 0.04). There were no differences in the MUA or reoperation rates. There was insufficient information to determine if a specific insert improved satisfaction. Discussion The results of this NMA show no statistical or clinical difference in PROMs. There was higher flexion for PS knees though the amount was not clinically significant. There was insufficient data for conclusions on patient satisfaction. Therefore, the surgeon should evaluate the clinical situation to determine the best insert rather than choose and insert based on functional scores, patient satisfaction, or complication rates.
Collapse
Affiliation(s)
- John Krumme
- Orthopaedic Surgery, University of Missouri Kansas City
| | | | - Madana Vallem
- Orthopaedic Surgery, Virginia Commonwealth university
| | - John Cyrus
- Orthopaedic Surgery, Virginia Commonwealth University
| | - Peter Sculco
- Orthopaedic Surgery, Hospital for Special Surgery
| | | | - Niraj Kalore
- Orthopaedic Surgery, Virginia Commonwealth University
| |
Collapse
|
7
|
Shatrov J, Sappey-Marinier E, Kafelov M, Gunst S, Batailler C, Servien E, Lustig S. Similar outcomes including maximum knee flexion between mobile bearing condylar-stabilised and fixed bearing posterior-stabilised prosthesis: a case control study. J Exp Orthop 2022; 9:17. [PMID: 35169966 PMCID: PMC8847635 DOI: 10.1186/s40634-022-00456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/11/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Prosthesis design influences stability in total knee arthroplasty and may affect maximum knee flexion. Posterior-stabilised (PS) and condylar-stabilised (CS) designed prosthesis do not require a posterior-cruciate ligament to provide stability. The aim of the current study was to compare the range of motion (ROM) and clinical outcomes of patients undergoing cemented total knee arthroplasty (TKA) using either a PS or CS design prosthesis. Methods A total of 167 consecutive primary TKAs with a CS bearing (mobile deep-dish polyethylene) were retrospectively identified and compared to 332 primary TKA with a PS constraint, with similar design components from the same manufacturer. Passive ROM was assessed at last follow-up with use of a handheld goniometer. Clinical scores were assessed using Patient-Reported Outcome Measures (PROMs); International Knee Society (IKS) knee and function scores and satisfaction score. Radiographic assessment was performed pre and post operatively consisting of mechanical femorotibial angle (mFTA), femoral and tibial mechanical angles measured medially (FMA and TMA, respectively) on long leg radiographs, tibial slope and patella height as measured by the Blackburne-Peel index (BPI). Results Both groups had a mean follow-up of 3 years (range 2–3.7 years). Mean post-operative maximum knee flexion was 117° ± 4.9° in the PS group and 119° ± 5.2° in the CS group (p = 0.29). Postoperative IKS scores were significantly improved in both groups compared to preoperative scores (p < 0.01). The mean IKS score in the PS group was 170.9 ± 24.1 compared to 170.3 ± 22.5 in the CS group (p = 0.3). Both groups had similar radiographic outcomes as determined by coronal and sagittal alignment, tibial slope and posterior condylar offset ratio measurements. When considering the size of tibial slope change and posterior-condylar offset ratio, there was no differences between groups (p = 0.4 and 0.59 respectively). The PS group had more interventions for post-operative stiffness (arthrolysis or manipulation under anaesthesia) 8 (2.7%) compared to 1 (0.6%) in the CS group (p = 0.17). Conclusion Condylar-stabilised TKA have similar patient outcomes and ROM at a mean follow-up of 3 years compared to PS TKA. Highly congruent inserts could be used without compromising results in TKA at short term. Level of evidence Level IV, retrospective case control study.
Collapse
Affiliation(s)
- Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Elliot Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France. .,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France.
| | - Moussa Kafelov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Stanislas Gunst
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| |
Collapse
|
8
|
Madden JA, Arnold PK, Buller LT, Deckard ER, Meneghini RM. Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty. Arthroplast Today 2021; 11:178-186. [PMID: 34646924 PMCID: PMC8498091 DOI: 10.1016/j.artd.2021.08.014] [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: 04/23/2021] [Revised: 08/09/2021] [Accepted: 08/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background In an effort to optimize clinical outcomes and enhance stability, ultracongruent bearings have been increasingly used in primary total knee arthroplasty (TKA). The importance of the posterior cruciate ligament (PCL) and optimal sagittal tibial baseplate position in ultracongruent bearing TKA remains unknown. This study sought to determine whether these modifiable, surgical-technique-dependent variables meaningfully impact patient-reported outcome measures. Methods A total of 759 primary TKAs of the same dual-pivot design performed using a consistent surgical technique between January 2016 and April 2019 were retrospectively reviewed. PCL status was recorded, and anteroposterior (AP) tibial baseplate position and posterior tibial slope were measured by two independent blinded raters. Patient-reported outcomes related to pain, function, satisfaction, and activity level were analyzed in relationship to PCL status, posterior tibial slope, and AP tibial baseplate position, in addition to other pertinent covariates. Results Median age and body mass index of the cohort were 68.3 years and 33.4 kg/m2, respectively, with 73% being female. In multivariate analysis, partial or full release of the PCL was predictive of a knee “always” feeling normal (odds ratio 1.42, P = .041). Furthermore, tibial baseplate position closer to the middle of the tibia was associated with greater improvements in pain with level walking, pain while climbing stairs, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement total scores (P ≤ .079). Conclusion In congruent dual-pivot bearing TKA, partially or fully releasing the PCL and AP tibial baseplate position closer to the middle of the tibia may provide greater improvement in pain and function scores at minimum 1-year follow-up.
Collapse
Affiliation(s)
- Joseph A Madden
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Payton K Arnold
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN, USA
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN, USA
| |
Collapse
|
9
|
Innocenti B, Bori E. Change in knee biomechanics during squat and walking induced by a modification in TKA size. J Orthop 2020; 22:463-472. [PMID: 33093756 DOI: 10.1016/j.jor.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/04/2020] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study is to analyze the effects of TKA under-dimensioning during daily activities. A regular ("control") size and an undersized design of the same fixed bearing asymmetric PS prosthesis were analyzed during walking and squat using finite element analysis. The two models showed similar internal-external rotations and antero-posterior displacements during both activities. Slightly higher displacements, wider contact areas and lower contact pressure were found in the control size. Post-cam engagement angles were similar on both sizes. Changes in TKA size slightly affected knee kinematics and kinetics, with post-cam related differences leading to minor changes in kinetic patterns.
Collapse
Affiliation(s)
- Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| |
Collapse
|
10
|
Rouquette L, Erivan R, Pereira B, Boisgard S, Descamps S, Villatte G. Tibiofemoral dislocation after primary total knee arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2019; 43:1599-1609. [DOI: 10.1007/s00264-019-04287-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/02/2019] [Indexed: 01/08/2023]
|
11
|
WANG W, LIU Z, LIU J, ZHEN P, LI X, SONG M. [Choice of total knee arthroplasty: posterior cruciate ligament preserved or not]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2018; 47:313-319. [PMID: 30226335 PMCID: PMC10393722 DOI: 10.3785/j.issn.1008-9292.2018.06.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/12/2018] [Indexed: 06/08/2023]
Abstract
Total knee arthroplasty is an effective method for the treatment of end-stage knee osteoarthrosis, which can effectively relieve joint pain and reconstruct the integrity of the joint. Whether the posterior cruciate ligament should be preserved during surgery or not, which is still in dispute. In recent years, posterior cruciate-retaining and substituting total knee prostheses are both applied in clinical practice. Both domestic and international studies have shown that there are no significant difference in patient satisfaction, knee flexion, survival rate of the prosthesis and the main clinical manifestations between two prostheses. However, posterior cruciate-retaining total knee prosthesis is more consistent with the normal physiology and biomechanics of the human body. The gait is more balanced and proprioceptive when walking up and down the stairs, but when the joints are buckling, the femur is abnormal to move back to the tibia, resulting in abnormal motion. While posterior cruciate-substituting total knee prosthesis can correct severe deformity of the knee, and keep better balance between flexion and extension of the knee joint, but there is a potential complication of patellar clunk syndrome. Therefore, under the same conditions, the younger patients may prefer to chose posterior cruciate-retaining total knee prosthesis, while elder patients may prefer to chose posterior cruciate-substituting total knee prosthesis. This paper reviews the function of posterior cruciate ligament, as well as the advantages and disadvantages of two prostheses, so as to provide some references for clinic.
Collapse
Affiliation(s)
| | | | - Jun LIU
- 刘军(1982-), 男, 博士, 主治医师, 主要从事骨关节功能重建及老年骨病防治研究; E-mail:
;
https://orcid.org/0000-0001-9332-6189
| | - Ping ZHEN
- 甄平(1963-), 男, 博士, 主任医师, 教授, 博士生导师, 主要从事人工关节置换和翻修临床及基础研究; E-mail:
;
https://orcid.org/0000-0003-3122-4042
| | | | | |
Collapse
|
12
|
Total knee arthroplasties from the origin to navigation: history, rationale, indications. INTERNATIONAL ORTHOPAEDICS 2018; 43:597-604. [PMID: 29589088 DOI: 10.1007/s00264-018-3913-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/16/2018] [Indexed: 12/31/2022]
Abstract
Since the early 1970s, total knee arthroplasties have undergone many changes in both their design and their surgical instrumentation. It soon became apparent that to improve prosthesis durability, it was essential to have instruments which allowed them to be fitted reliably and consistently. Despite increasingly sophisticated surgical techniques, preoperative objectives were only met in 75% of cases, which led to the development, in the early 1990s, in Grenoble (France), of computer-assisted orthopaedic surgery for knee prosthesis implantation. In the early 2000s, many navigation systems emerged, some including pre-operative imagery ("CT-based"), others using intra-operative imagery ("fluoroscopy-based"), and yet others with no imagery at all ("imageless"), which soon became the navigation "gold standard". They use an optoelectronic tracker, markers which are fixed solidly to the bones and instruments, and a navigation workstation (computer), with a control system (e.g. pedal). Despite numerous studies demonstrating the benefit of computer navigation in meeting preoperative objectives, such systems have not yet achieved the success they warrant, for various reasons we will be covering in this article. If the latest navigation systems prove to be as effective as the older systems, they should give this type of technology a well-deserved boost.
Collapse
|