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Kafelov M, Batailler C, Servien E, Lustig S. Restoration of the anterior compartment after robotic total knee arthroplasty significantly improves functional outcome and range of motion at 1 year. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38932605 DOI: 10.1002/ksa.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE This study aims to assess the functional outcomes based on restoring the anterior compartment after total knee arthroplasty (TKA). METHODS This retrospective study included 96 primary TKAs performed between 2021 and 2022. Functional positioning principles were applied using an image-based robotic-assisted system. The mean age was 69.2 ± 7.9 years. Knee Society Score (KSS), Kujala score, Forgotten Joint Score (FJS) and knee flexion were collected preoperatively and at 1 year. The depth difference between native and prosthetic trochlea was measured to assess anterior compartment restoration at full extension, 30°, 70° and 90° flexion. The global anterior compartment restoration combined the anterior compartment restoration and the patellar thickness restoration. RESULTS The trochlear offset was mostly understuffed after TKA compared to the native anatomy, mainly for medial and lateral condyles at 30° and 70° of flexion. The global anterior compartment restoration was understuffed in full extension (-0.7 mm ± 2), at 30° (-4.4 mm ± 2) and 70° of flexion (-3.6 mm ± 2.5). At 90°, the global anterior compartment restoration was overstuffed (2.2 mm ± 1.8). Functional scores were not significantly influenced by the anterior compartment stuffing at 0° and 30° (n.s.). The anterior compartment overstuffing at 70° and 90° was associated with decreased KSS function score (p = 0.009) and flexion (p = 0.04). CONCLUSION Moderate anterior understuffing was frequently observed after TKA performed with functional positioning and an image-based robotic-assisted system. This understuffing did not influence the functional outcomes. The overstuffing of the anterior compartment led to a reduction in KSS function score and flexion measurements at 1 year. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Moussa Kafelov
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- IFSTTAR, LBMC UMR_T9406, Univ Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Bulgaria
| | - Cécile Batailler
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- IFSTTAR, LBMC UMR_T9406, Univ Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Elvire Servien
- Orthopaedics surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Interuniversity Laboratory of Biology of Mobility, LIBM-EA 7424, 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
- IFSTTAR, LBMC UMR_T9406, Univ Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
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Genestoux V, Vermorel PH, Neri T, Farizon F, Philippot R. Does inverse kinematic alignment coupled with robot-assisted TKA optimize patellofemoral clinical and radiological results? Orthop Traumatol Surg Res 2024:103880. [PMID: 38582224 DOI: 10.1016/j.otsr.2024.103880] [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: 04/18/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION With a satisfaction rate of 80%, total knee arthroplasty (TKA) surgery has seen significant improvements in recent decades. The 20% of poor results may be explained by the alignment technique used for implant placement, which can influence patellofemoral kinematics. The objective of this study was to demonstrate that the use of inverse kinematic alignment makes it possible to obtain satisfactory clinical and radiological patellar scores in robotic TKA. HYPOTHESIS The inverse kinematic alignment technique coupled with robotic surgery makes it possible to restore the native kinematics of the patella. MATERIALS AND METHODS This prospective study including 100 TKAs with a primary TKA performed using the Stryker Mako™ robotic surgery system, and the inverse kinematic alignment technique. Patients who underwent patella resurfacing were excluded. Clinical and radiological scores were recorded preoperatively and 1 year postoperatively. RESULTS At one year, the specific patellar clinical scores were excellent with an average Kujala score of 85.69 and an average HSS Patellar score 88.15. The average patellar lateralization index was 0.15 and the average patellar tilt was 5.1°, showing no significant difference compared to preoperation (p=0.45 and p=0.18). The average external rotation of the femoral implant was 0.47±0.6° [-1.9; 2.1]. DISCUSSION The patellofemoral clinical results were excellent. The use of the robotic arm coupled with this alignment technique makes it possible to obtain a controlled external rotation of the femoral implant as well as an optimized orientation of the tibial component, favoring good restitution of the alignment of the extensor apparatus. This study did not demonstrate any radiological correction of patellar tilt and lateralization. CONCLUSION The combined use of robotic surgery with the inverse kinematic alignment technique seems effective on specific clinical results of the patellofemoral joint. LEVEL OF EVIDENCE II; prospective cohort.
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Affiliation(s)
| | | | - Thomas Neri
- CHU Nord Saint-Étienne, Saint-Priest-en-Jarez, France
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Palanisamy Y, Naidu SP, Prasad AR, Natarajan S, Rajan DV. When to Do Selective Patellar Resurfacing in Total Knee Arthroplasty: A Decision-Making Algorithm Based on Pre-operative and Intra-operative Findings. Indian J Orthop 2024; 58:30-39. [PMID: 38161405 PMCID: PMC10754792 DOI: 10.1007/s43465-023-01039-6] [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: 09/04/2023] [Accepted: 10/28/2023] [Indexed: 01/03/2024]
Abstract
Background Persistent anterior knee pain post total knee arthroplasty (TKA) is a significant cause of patient dissatisfaction. Selective patellar resurfacing is commonly practiced for primary total knee replacement (TKR) but there is a paucity in literature regarding its decision making. Study Objective This study aims to develop a decision-making algorithm for selective patellar resurfacing using Hospital for Special Surgery Patello-femoral Assessment score (HSS PFA score), weight-bearing patellofemoral X-ray, and intraoperative cartilage wear assessment based on the Outerbridge classification. Materials and Methods This prospective study enrolled 65 patients, assessing preoperative factors including HSS PFA score and Baldini view radiography. Intraoperative cartilage wear was categorized using the Outerbridge classification. Preoperative findings were correlated with intraoperative outcomes through statistical analysis, leading to the development of a predictive algorithm. The efficiency of algorithm was assessed at 3-year follow-up using HSS PFA score. Results A significant negative correlation (r = - 0.272, p = 0.029) was observed between HSS PFA score and cartilage wear. However, no significant relationships were established between HSS PFA score and Baldini view observations, including radiological tilt (p = 0.517) and displacement (p = 0.277). Intraoperative cartilage wear versus patellar tilt (p = 0.65) and displacement (p = 0.837) also yielded non-significant results. Three-year follow-up examinations revealed no complications and significant HSS PFA score improvements in all patients. Conclusion The requirement for patellar resurfacing can be predicted using a combination of preoperative parameter such as HSS PFA score and the intra-operative cartilage wear. We put forward an algorithm based on above findings to aid in the decision making.
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Affiliation(s)
| | - Surya Prakash Naidu
- Ortho-One Orthopaedic Speciality Centre, Tamil Nadu, Coimbatore, 641005 India
| | - Arjun R. Prasad
- Ortho-One Orthopaedic Speciality Centre, Tamil Nadu, Coimbatore, 641005 India
| | - Sugumar Natarajan
- Ortho-One Orthopaedic Speciality Centre, Tamil Nadu, Coimbatore, 641005 India
| | - David V. Rajan
- Ortho-One Orthopaedic Speciality Centre, Tamil Nadu, Coimbatore, 641005 India
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Jung Jung H, Kang MW, Lee JH, Lee JK, Kim JI. Preoperative patellar bone marrow lesions with full thickness cartilage defects correlate with residual anterior knee pain in total knee arthroplasty without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2023; 31:5048-5056. [PMID: 37695390 DOI: 10.1007/s00167-023-07551-4] [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: 05/17/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Residual anterior knee pain is one of the most common problems after total knee arthroplasty (TKA). However, the contributing factors affecting postoperative anterior knee pain (AKP) remain poorly understood. This study aimed to evaluate the effect of preoperative patellar bone marrow lesions (BMLs) and patellar cartilage defects on postoperative AKP after patellar non-resurfacing TKA. METHODS This retrospective study included 336 patients who underwent unilateral TKA without patella resurfacing. All patients underwent preoperative magnetic resonance imaging (MRI) to assess the presence of BMLs and the degree of cartilage defects in the patella. Patients were categorized into four groups according to the presence of BMLs (with or without BMLs) and the degree of cartilage defects (with or without full thickness cartilage defects). The Kujala Anterior Knee Pain Scale (AKPS) and the Hospital for Special Surgery Knee Rating Scale (HSS) scores at 2 years after TKA were compared among the groups. RESULTS Preoperative BMLs in the patella were found in 132 (39.3%) of 336 cases. Among the four groups, the group with both BMLs and full-thickness cartilage defects demonstrated significantly lower AKPS compared to the other groups at 2 years after TKA (p < 0.01), but no significant difference was shown in the HSS scores, between these groups. There were no significant differences in either AKPS or HSS scores among the other three patient groups. CONCLUSIONS The presence of preoperative BMLs with full-thickness cartilage defects in the patella was associated with worse postoperative AKP after TKA without patella resurfacing. Patella resurfacing should be considered in this patient group to minimize the risk of developing residual AKP after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ho Jung Jung
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Min Wook Kang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Hwa Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
- Department of Orthopedic Surgery, Hallym University Hospital, 1 Singilo, Yeongdeungpo-gu, Seoul, 07441, Korea.
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Choudhury AK, Bansal S, Jain A, Raja BS, Niraula BB, Kalia RB. Conventional rehabilitation post-TKA achieves better knee flexion with higher resource utilization compared to application-based rehabilitation - a systematic review and meta-analysis. J Orthop 2023; 44:77-85. [PMID: 37720916 PMCID: PMC10500420 DOI: 10.1016/j.jor.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023] Open
Abstract
Background Post-operative physiotherapy is a major component of the effectiveness of knee replacement. Adequate rehabilitation protocols are required for better functional outcomes. With the advent of smartphones and smartwatches, the use of telerehabilitation has increased recently. This study aims to compare tele rehabilitation using various mobile-based applications to conventional rehabilitation protocols. Methods From Jan 2000 to Jun 2022, all the RCTs from SCOPUS, EMBASE and PUBMED comparing patient-related outcome measures between the smartphone-based app and conventional rehabilitation protocols were scanned and seven studies meeting the eligibility criteria were included in this systematic review and meta-analysis. The quantitative analysis compared outcomes using the knee injury and osteoarthritis outcome score (KOOS), the knee society function score (KSFS), the active range of motion (AROM), Euro-Qol-5D-5L, and MUA. The qualitative analysis compared VAS, NRS, and Time up and go (TUG). Results The study shows statistically significant improvement in traditional rehabilitation over app based on KSFS score (M.D.: 6.05, p = 0.05) and AROM on long-term follow-up (12 months) (M.D.: 2.46, p = 0.02). AROM was insignificant on 3 months or less follow-up. NRS and VAS were found to be statistically better in app-based groups. No statistically significant results were seen on KOOS, Euro-Qol-5D-5L, MUA and TUG. 90 days of readmission and a number of physiotherapy visits were more in conventional groups. No difference was seen in single-leg stance and satisfaction rates. Conclusions The present review highlights improved early pain scores and comparable patient-reported outcome analysis at a short-term follow-up period among patients receiving mobile app-based rehabilitation. However, knee range of motion and KSFS score achieved after surgery is analysed to be better with traditional rehabilitation at the one-year end follow-up period.
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Affiliation(s)
| | - Shivam Bansal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Akash Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Balgovind S. Raja
- Department of Orthopedics, All India Institute of Medical Sciences, Patna, India
| | - Bishwa Bandhu Niraula
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Mekkawy KL, Zhang B, Wenzel A, Harris AB, Khanuja HS, Sterling RS, Hegde V, Oni JK. Mapping the course to recovery: a prospective study on the anatomic distribution of early postoperative pain after total knee arthroplasty. ARTHROPLASTY 2023; 5:37. [PMID: 37533087 PMCID: PMC10399043 DOI: 10.1186/s42836-023-00194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/08/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Early postoperative pain following total knee arthroplasty significantly impacts outcomes and patient satisfaction. However, the characteristics and sources of early pain after total knee arthroplasty remain unclear. Therefore, the purpose of this study was to determine the anatomic distribution and course of postoperative pain in the acute and subacute period following total knee arthroplasty. METHODS A prospective observational study of primary, elective unilateral total knee arthroplasty cases was conducted at our academic tertiary care medical center from January 2021 to September 2021. Preoperative variables were extracted from institutional electronic medical records. Postoperatively, patients utilized a knee pain map to identify the two locations with the most significant pain and rated it using the visual analog scale (VAS). The data were collected on day 0, at 2 weeks, 2 months, and 6 months after operation. RESULTS This study included 112 patients, with 6% of patients having no pain at postoperative day 0, 22% at 2 weeks, 46% at 2 months, and 86% at 6 months after operation. In those who reported pain, the VAS score (mean ± standard deviation) was 5.8 ± 2.4 on postoperative day 0 and decreased at each follow-up time point (5.4 ± 2.3 at 2 weeks, 3.9 ± 2.2 at 2 months, and 3.8 ± 2.7 at 6 months). The majority of patients were able to identify distinct loci of pain. The most common early pain loci were patellae, thigh, and medial joint line, and this distribution dissipated by 6 months. CONCLUSION At 2 postoperative weeks, pain was primarily at the medial joint, and at 6 months postoperatively, pain was more likely to be at the lateral joint. No relationship was found between pain at six months and pain scores or location at postoperative day 0 or 2 weeks. Understanding the distribution and progression of knee pain following total knee arthroplasty may benefit patient education and targeted interventions. LEVEL OF EVIDENCE Level II, prospective observational study.
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Affiliation(s)
- Kevin L Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
| | - Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Alyssa Wenzel
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Vishal Hegde
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
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Barahona M, Barrientos C, Alegría A, Barahona MA, Navarro T, Hinzpeter J, Palet M, Zamorano Á, Catalán J, Infante C. Anterior knee pain and sit-up tests predicts patients' satisfaction and improvement in quality of life after anterior stabilized total knee replacement without patellar resurfacing. J Exp Orthop 2023; 10:73. [PMID: 37493976 PMCID: PMC10371966 DOI: 10.1186/s40634-023-00641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE The purpose of this study was to assess patient satisfaction and identify risk factors for dissatisfaction after anterior stabilised conventional total knee arthroplasty (TKA) without patellar resurfacing, using the Goodman score. METHODS We conducted a cross-sectional study using data from our institutional database from 1 January 2018 to 1 March 2021. Patients who underwent TKA with the Vanguard® Cruciate Retaining Anterior Stabilized Knee System (Zimmer Biomet, Warsaw, Indiana, USA) without patellar replacement were included. Patients with other bearing surfaces (posterior stabilised or medial congruent) or diagnosed with infection or instability were excluded. Patients' reported outcomes, body mass index (BMI), passive range of motion, the timed up-and-go test, sit-up test, and algometry were assessed. Patients were also asked if they had anterior knee pain. Satisfaction was assessed using the Goodman scale, and logistic multivariate regression was used to identify variables associated with dissatisfaction and perceived improvement in quality of life. RESULTS A total of 131 TKA patients were included in the study. The median satisfaction score was 100 (interquartile range [IQR], 87.5 to 100), with the 75-point threshold at the 90th percentile according to Section A of Goodman. Section B of Goodman showed that 113 TKA patients (86.26%) reported "great improvement" or "more than I ever dreamed." Multivariate logistic regression revealed that anterior knee pain (OR 5.16, 95% CI 1.24 to 21.39), the sit-up test (OR 0.63, 95% CI 0.49 to 0.81), and BMI (OR 0.84, 95% CI 0.70 to 0.99) were significantly associated with patient dissatisfaction and a worse perceived improvement in quality of life. The receiver operating characteristics curve for the models had areas under the curve of 0.83 (95% CI 0.69 to 0.97) and 0.82 (95% CI 0.70 to 0.94), respectively. CONCLUSION Anterior stabilised TKA without patellar resurfacing can achieve 90% satisfaction and 86% improvement in quality of life. To improve these results, it is essential to prevent and treat anterior knee pain and enhance quadriceps strength. LEVEL OF EVIDENCE Level III (retrospective cohort study).
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Affiliation(s)
- Maximiliano Barahona
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile.
| | - Cristian Barrientos
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Anselmo Alegría
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Macarena A Barahona
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Tomas Navarro
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Jaime Hinzpeter
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Miguel Palet
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Álvaro Zamorano
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Jaime Catalán
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
| | - Carlos Infante
- Orthopaedic Department at Hospital Clinico Universidad de Chile, 999 Carlos Lorca Tobar Street, 3Rd Floor, Office 351. Independencia, Santiago, Chile
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van de Ven WAF, Bosga J, Hullegie W, Verra WC, Meulenbroek RGJ. Inertial-Sensor-Based Monitoring of Sample Entropy and Peak Frequency Changes in Treadmill Walking during Recovery after Total Knee Arthroplasty. SENSORS (BASEL, SWITZERLAND) 2023; 23:4968. [PMID: 37430890 DOI: 10.3390/s23104968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/06/2023] [Accepted: 05/21/2023] [Indexed: 07/12/2023]
Abstract
This study aimed to investigate whether sample entropy (SEn) and peak frequency values observed in treadmill walking could provide physical therapists valuable insights into gait rehabilitation following total knee arthroplasty (TKA). It was recognized that identifying movement strategies that during rehabilitation are initially adaptive but later start to hamper full recovery is critical to meet the clinical goals and minimize the risk of contralateral TKA. Eleven TKA patients were asked to perform clinical walking tests and a treadmill walking task at four different points in time (pre-TKA, 3, 6, and 12 months post-TKA). Eleven healthy peers served as the reference group. The movements of the legs were digitized with inertial sensors and SEn and peak frequency of the recorded rotational velocity-time functions were analyzed in the sagittal plane. SEn displayed a systematic increase during recovery in TKA patients (p < 0.001). Furthermore, lower peak frequency (p = 0.01) and sample entropy (p = 0.028) were found during recovery for the TKA leg. Movement strategies that initially are adaptive, and later hamper recovery, tend to diminish after 12 months post-TKA. It is concluded that inertial-sensor-based SEn and peak frequency analyses of treadmill walking enrich the assessment of movement rehabilitation after TKA.
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Affiliation(s)
- Werner A F van de Ven
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6525 GD Nijmegen, The Netherlands
- FysioHolland Twente, 7512 AC Enschede, The Netherlands
| | - Jurjen Bosga
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6525 GD Nijmegen, The Netherlands
| | - Wim Hullegie
- Physiotherapy Practice Hullegie and Richter MSC, 7512 AC Enschede, The Netherlands
| | - Wiebe C Verra
- Medisch Spectrum Twente, Department of Orthopedic Surgery, 7512 KZ Enschede, The Netherlands
| | - Ruud G J Meulenbroek
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6525 GD Nijmegen, The Netherlands
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De Oliveira Silva D, Webster KE, Feller JA, McClelland JA. Anterior Knee Pain Following Primary Unilateral Total Knee Arthroplasty With Posterior-Stabilized Prosthesis and Patellar Resurfacing: Prevalence and Clinical Implications. J Arthroplasty 2023; 38:281-285. [PMID: 36067885 DOI: 10.1016/j.arth.2022.08.042] [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: 05/31/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Anterior knee pain following total knee arthroplasty (TKA) is associated with patient dissatisfaction. Factors related to postoperative anterior knee pain and its impact on patient outcomes are poorly understood. The following are the aims of this study: (1) to report the prevalence of anterior knee pain before and after TKA using a posterior-stabilized prosthesis with routine patellar resurfacing; (2) to investigate the association of preoperative clinical factors with the presence of anterior knee pain after TKA; and (3) to explore the association of postoperative anterior knee pain with postoperative self-reported function and quality of life. METHODS This retrospective study included 506 patients who had undergone elective primary unilateral TKA with a posterior-stabilized prosthesis and patellar resurfacing. Outcome measures prior to and 12 months after TKA included self-reported anterior knee pain, knee function, and quality of life. RESULTS Prevalence of anterior knee pain was 72% prior to and 15% following TKA. Patients who had preoperative anterior knee pain had twice the risk of experiencing anterior knee pain after TKA than patients who did not have preoperative anterior knee pain (risk ratio: 2.37, 95% CI 1.73-2.96). Greater severity of preoperative anterior knee pain and worse self-reported function were associated with the presence of postoperative anterior knee pain (rho = 0.15, P < .01; rho = 0.13, P < .01, respectively). Preoperative age, gender, and quality of life were not associated with postoperative anterior knee pain. Greater severity of postoperative anterior knee pain was associated with worse knee function at 12 months postoperative (rho = 0.49, P < .01). CONCLUSION One in 7 patients reported anterior knee pain 12 months following posterior-stabilized and patella-resurfaced TKA. The presence of preoperative anterior knee pain and worse self-reported function are associated with postoperative anterior knee pain.
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Affiliation(s)
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Julian A Feller
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; OrthoSport Victoria Research Unit, Epworth HealthCare, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Oikonomidis L, Santini AJA, Davidson JS, Banks JV, Phillipson A, Pope J. The Journey Bicruciate Knee Replacement: Design Modifications Yield Better Early Functional Results and Reduce Complications. J Knee Surg 2022; 35:767-775. [PMID: 33111275 DOI: 10.1055/s-0040-1718599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Journey-I total knee replacement was designed to improve knee kinematics but had several complications including early dislocation. The Journey-II modification was introduced to reduce these while maintaining high function. To assess whether the modified Journey-II prosthesis has succeeded in its designers aims, we undertook an observational study of prospectively recorded data to analyze and compare the two knees. A total of 217 Journey-I and 129 Journey-II knees were identified from the department's prospectively collated registry and were assessed at 1 year by a comparative statistical analysis using numerous factors including pain, functional activity, physical assessment, Short Form-12 (SF-12), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Oxford scores. The statistical tests included Chi-square, Wilcoxon's rank and Mann-Whitney U-tests with the level of significance set at p < 0.05. There was a variation in primary patella resurfacing between the two groups with 14.3% in the Journey-I cohort and 66.7% in the Journey-II cohort. Both replacements demonstrated excellent postoperative function, but the Journey II performed significantly better than Journey I with fewer complications (37 vs. 10) and better improvement in almost all clinical scores including pain (p < 0.01), mobility outcomes (p = 0.018), Oxford (p = 0.004), and WOMAC (p = 0.039) scores but not with flexion improvement and SF-12 score. There was significant improvement in patellofemoral pain postoperatively in both the Journey I (p = 0.011) and Journey II (p = 0.042) arthroplasty; however the primarily resurfaced patella in a Journey-II implant had better postoperative scores. The main complication of dislocation in the Journey I was not seen in the modified Journey-II implant with stiffness requiring intervention reduced in Journey II. These results suggest that the Journey II has improved short-term clinical outcomes compared with Journey I with reduction of dislocation and other complications.
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Affiliation(s)
- Lazaros Oikonomidis
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Alasdair J A Santini
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - John S Davidson
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Joanne V Banks
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew Phillipson
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Jill Pope
- Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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11
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Rao L, Taylor WR, Horn N, List R, Preiss S, Schütz P. Can tibio-femoral kinematic and kinetic parameters reveal poor functionality and underlying deficits after total knee replacement? A systematic review. Knee 2022; 34:62-75. [PMID: 34883331 DOI: 10.1016/j.knee.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/13/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extensive efforts have been made to understand joint kinematics and kinetics in total knee arthroplasty (TKA) in subjects with satisfactory outcomes during daily functional activities and clinical tests, but it remains unclear whether such movement characteristics hold the potential to indicate the underlying aetiology of unsatisfactory or bad TKA outcomes. PURPOSE To investigate which kinematic and kinetic parameters assessed during passive clinical tests and functional activities of daily living are associated with poor functionality and underlying deficits after total knee replacement. METHODS We focused on studies characterizing the kinematic or kinetic parameters of the knee joint that are associated with poor clinical outcome after TKA. Seventeen articles were included for the review, and kinematic and kinetic data from 719 patients with minimal follow up of 6 months were extracted and analyzed. RESULTS Passive posterior translation at 90°flexionexhibited good potential for differentiating stable and unstable TKAs. Anterior-posterior (A-P) translation of the medial condyle at 0-30° and 30-60° flexion, A-P translation of the lateral condyle at 60-90°during closed chain exercises, as well asknee extension moment during stair ascent and descent, knee abduction moment during stair descent, knee internal rotation moment and plantar flexion moment during walking, 2ndpeak ground reaction force during stair ascent and walkingshowed the greatest promise as functional biomarkers for a dissatisfied/poor outcome knee after TKA. CONCLUSION In this study, we systematically reviewed the state-of-the-art knowledge of kinematics and kinetics associated with functional deficits, and found 11 biomechanical parameters that showed promise for supportingdecision making in TKA.
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Affiliation(s)
- L Rao
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - W R Taylor
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland.
| | - N Horn
- Schulthess Clinic, Zürich, Switzerland
| | - R List
- Schulthess Clinic, Zürich, Switzerland
| | - S Preiss
- Schulthess Clinic, Zürich, Switzerland
| | - P Schütz
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
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12
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Cooper AM, Connolly K, Penna S, Parvizi J. Evaluation and Management of a Painful Knee After Total Knee Arthroplasty. Orthopedics 2021; 44:341-352. [PMID: 34618636 DOI: 10.3928/01477447-20211001-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pain after total knee arthroplasty (TKA) is not infrequent and may be indicative of a broad spectrum of prosthesis-related, intra-articular, or extra-articular pathologies. To diagnose and treat the underlying cause of a painful TKA, systematic evaluation of the patient is critical to ensure that they are managed appropriately and expeditiously. This evidence-based review presents current concepts regarding the pathophysiology, etiology, and diagnosis of painful TKA and our recommended approach for management. [Orthopedics. 2021;44(6):341-352.].
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13
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Goicoechea N, Hinarejos P, Torres-Claramunt R, Leal-Blanquet J, Sánchez-Soler J, Monllau JC. Patellar denervation does not reduce post-operative anterior knee pain after primary total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2021; 29:3346-3351. [PMID: 32761276 DOI: 10.1007/s00167-020-06164-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Anterior knee pain (AKP) is a frequent symptom after a total knee arthroplasty (TKA). Patellar denervation (PD) has been put forth as a technique to reduce this pain; however, its effects have not been assessed in combination with patellar resurfacing. The aim of this study is to evaluate the effect of PD on AKP and functional outcomes after TKA with patellar resurfacing. METHODS A prospective study was designed that included patients scheduled for TKA with patellar resurfacing. The 202 recruited patients were randomized into either the PD group or the non-denervation group [mean age 72.7 years (SD 8.2); 119 (70.4%) women and 50 (29.6%) men; average body mass index 31.4 kg/m2 (SD 4.9)]. Pressure pain threshold (PPT) assessed by pressure algometry (PA), visual analogue scale(VAS), patellofemoral Feller score and the Knee Society Scores (KSS) were recorded preoperatively and at the 1-year follow-up. RESULTS 169 patients were included in data analysis. At the 1-year follow-up, there were mild differences between denervation and non-denervation group in PPT value (494.4 kPa vs. 552.3 kPa, p = 0.047) and in VAS at stairs (2.9 vs. 1.5, p = 0.003) in favour of the non-denervation group. There was no difference in the improvement between groups in patellofemoral Feller score and KSS, but slightly higher improvement in non-denervation group in PPT (94.1 kPa vs. 160 kPa, p = 0.047), VAS walking (5.3 vs. 6.2, p = 0.041) and VAS at stairs (4.6 vs. 5.7, p = 0.022). CONCLUSION Patellar denervation does not improve AKP and clinical outcomes in primary TKA with patellar resurfacing compared to patellar replacement without denervation. PD cannot be recommended when patellar replacement is performed in TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Nerea Goicoechea
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain.
| | - Pedro Hinarejos
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Joan Leal-Blanquet
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital de la Esperanza, Universitat Autònoma de Barcelona, Sant Josep de la Muntanya 12, 08024, Barcelona, Spain
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14
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Rehabilitation Process Issues and Functional Performance after Total Hip and Knee Replacement. Healthcare (Basel) 2021; 9:healthcare9091126. [PMID: 34574900 PMCID: PMC8472343 DOI: 10.3390/healthcare9091126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 12/04/2022] Open
Abstract
(1) Background: to ensure satisfactory outcomes in patients who have undergone total hip or knee replacement, it is crucial to prioritize postoperative rehabilitation process and its management rather than the successful surgery alone. The goal of our study was to investigate the outcomes of rehabilitation process after the total hip or knee replacement, including local orthopedic follow-up, communication with local health authorities, patients’ satisfaction regarding rehabilitation, and their functional performance after the surgery. (2) Methods: the study included 523 patients who underwent total hip replacement, and 650 patients who underwent total knee replacement. All patients were surveyed via formalized phone interviews containing questions related to postoperative rehabilitation parameters and outcomes. (3) Results: in postsurgical period, nearly 70% of patients had regular local orthopedic follow-up. Lack of the latter at the local level was indicated by approximately 10% of patients, and the rest of the respondents note the practice of sporadic follow-up. Half of patients reported pains of various severity. Good physical activity (e.g., ability to walk unassisted within their residential district) was acknowledged by about a quarter of patients. Ability to walk unassisted was reported by just 54.5% of patients. (4) Conclusions: the disproportion between generally high patient satisfaction of rehabilitation management (>80%) and low feedback level on the part of local health authorities (9.4%) demonstrated lack of communication between the key parties involved in the rehabilitation process.
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15
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Li D, Bi AS, Samra SS, Samra NS, Wu D, Ma Y. Functional Outcomes Following Total Knee Arthroplasty Without Patellar Resurfacing: A Minimum Two-Year Follow-Up Retrospective Cohort Study. Cureus 2021; 13:e16036. [PMID: 34345536 PMCID: PMC8321597 DOI: 10.7759/cureus.16036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/29/2021] [Indexed: 11/06/2022] Open
Abstract
This paper seeks to address the effectiveness of total knee arthroplasty (TKA) when performed without patellar resurfacing. The objective of this article is to investigate the effect of total knee arthroplasty without patellofemoral resurfacing on postoperative outcome. All patients with degenerative knee osteoarthritis (OA) that underwent TKA without patellar resurfacing were included in the study. The clinical data of 163 patients, including 98 females and 65 males with a mean age of 63 years (range 54-78 years) were retrospectively analyzed from April 2008 to April 2011. Intraoperative cartilage degeneration according to Outerbridge classification criteria was as follows: 22 cases of grade I, 38 cases of grade II, 64 cases of grade III, 39 cases of grade IV. There were no significant differences in gender, age, and side differences between the patients at all levels (P > 0.05). The duration of tourniquet use and related complications were recorded. Knee function was assessed using the American Knee Society Scoring System (KSS) and the patellar score (PS). Patient satisfaction and knee pain were assessed by the pain visual analog scale (VAS). The evaluation was conducted using routine X-ray film to observe the position of the prosthesis and the patella. Statistical analysis used included a comparison between groups by analysis of variance (ANOVA) using the Student-Newman-Keuls (SNK) test and comparison of grade data using the rank-sum test. The average tourniquet time was 125 minutes, with a range of 90-150 minutes. All the incisions healed with primary intention without early complications. All patients were followed for two to five years with an average of 3.6 years. At six months and at the last follow-up, the KSS and PS scores were significantly higher than those before surgery (P < 0.05). There was no significant difference between the sixth month and the last follow-up (P > 0.05). There were significant differences in preoperative KSS and PS scores between patients with different grades of cartilage degeneration (P < 0.05), but there was no significant difference at the last follow-up (P > 0.05). At the last follow-up, seven patients had persistent anterior knee pain, five patients had mild pain, and two patients had moderate pain according to the VAS assessment criteria. Patient satisfaction evaluation was as follows: 90 patients were very satisfied, 66 patients were satisfied, five patients were uncertain, and two patients were unsatisfied. There were no significant differences in satisfaction and knee pain between patients with different grades of patellofemoral degeneration (P > 0.05). In conclusion, at six months and at the last follow-up, outcome measures for patients were significantly higher than before surgery for TKA without the use of patellar resurfacing and the majority of patients were satisfied with the outcome of the procedure. TKA continues to be a successful procedure without the use of patellar resurfacing.
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Affiliation(s)
- Daniel Li
- Orthopedics, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Andrew S Bi
- Orthopaedic Surgery, New York University Langone Health, New York, USA
| | - Sahej S Samra
- Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Nehal S Samra
- Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Decheng Wu
- Medicine, Chinese Academy of Sciences, 301 PLA Military Hospital, Beijing, CHN
| | - Yuangzheng Ma
- Orthopaedic Surgery, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, CHN
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16
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Laubach M, Hellmann JT, Dirrichs T, Gatz M, Quack V, Tingart M, Betsch M. Anterior knee pain after total knee arthroplasty: A multifactorial analysis. J Orthop Surg (Hong Kong) 2021; 28:2309499020918947. [PMID: 32338135 DOI: 10.1177/2309499020918947] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Dissatisfaction and an impaired quality of life after total knee arthroplasty (TKA) is often associated with postsurgical anterior knee pain (AKP). The underlying pathological mechanisms are not yet fully understood. Therefore, a multifactorial approach encompassing clinical and radiological parameters seemed reasonable and promising to investigate postsurgical AKP. METHODS In this cross-sectional study, 25 patients without and 25 patients with postsurgical AKP after unilateral TKA were randomly recruited from a larger cohort of patients. Multiple clinical and radiological parameters-including real-time shear wave elastography (SWE) to measure the patellar and quadriceps tendon elasticity-were acquired and subsequently associated with AKP. For statistical analysis, SPSS (IBM, version 25) was used. RESULTS In total 50 participants (58.0% men, mean age 63.42 years, mean body mass index 29.75 kg/m2), having different prosthetic designs implanted, were included. Independently of key covariates, the strength of the quadriceps muscle (p = 0.021), a thinner inlay (p = 0.041), and a lower position of the patella (p = 0.041) were associated with AKP. Although no correlation with AKP was found (p = 0.346, resp. p = 0.154), we observed significantly decreased Young's modulus of the patellar and quadriceps tendons for the involved knee compared to the uninvolved knee (p < 0.001). CONCLUSION In conclusion, quadriceps muscle strength, inlay thickness, and the patella position might be of particular relevance in avoiding postsurgical AKP. Future studies with larger sample sizes are needed to clarify the impact of quadriceps muscle strength and the postoperative patella position as well as the role of SWE as a personalized modifiable prediction marker.
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Affiliation(s)
- Markus Laubach
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Julian Tr Hellmann
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Gatz
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
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17
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Lyu SR, Hsu CC, Hung JP. Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty. J Orthop Surg Res 2021; 16:61. [PMID: 33468201 PMCID: PMC7814453 DOI: 10.1186/s13018-020-02191-7] [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: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Persistent post-operative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty. The surgical techniques and outcomes of incorporating this concept into the management of both primary arthroplasty cases and patients suffering from unknown causes of PPOP after arthroplasties were presented. Materials and methods In a 1-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated medial abrasion phenomenon (MAP) on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasties were referred to the author for the arthroscopic medial release procedure (the AMR group) after being diagnosed as MAS. Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study. Results All 166 patients were followed for more than 3 years (mean 3.7 years, 3.1–4.2) for the outcome study. All knees receiving arthroplasty showed medial plicae with MAP at the time of surgery. Only 2 of them suffered from PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA, and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society Scores and all subscales of KOOS were statistically improved in all groups. Conclusions MAS is a cause of pain in patients who have received knee arthroplasties, and MAP should be eliminated to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-020-02191-7.
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Affiliation(s)
- Shaw-Ruey Lyu
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan. .,Tzu Chi University, Hualien City, Taiwan.
| | - Chia-Chen Hsu
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Jung-Pin Hung
- Joint Center, Dalin Tzu Chi General Hospital, Chiayi, Taiwan
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18
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Wang Z, Zhang YQ, Ding CR, Wang YZ, Xu H. Early Patellofemoral Function of Medial Pivot Prostheses Compared with Posterior-Stabilized Prostheses for Unilateral Total Knee Arthroplasty. Orthop Surg 2021; 13:417-425. [PMID: 33403815 PMCID: PMC7957395 DOI: 10.1111/os.12895] [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: 02/25/2020] [Revised: 10/03/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To systematically evaluate the patellofemoral joint design of medial pivot prosthesis, which incorporates a variety of “patella‐friendly” design features, by comparing clinical and radiographic results with another prosthesis. Methods All consecutive patients who underwent unilateral total knee arthroplasty (TKA) with medial pivot prosthesis (Group MP, 126 cases) between September 2016 and April 2018 were enrolled in this retrospective study. For each patient reviewed, a control patient was matched, according to age, gender, side, body mass index (BMI), preoperative range of motion (ROM), and operating period, who had received primary unilateral TKA with a conventional posterior‐stabilized prosthesis at the same period as the study group (Group PS, 126 cases). All patients underwent at least 1‐year follow‐up. At the preoperative and final follow‐up periods, data on the Knee Society Score (KSS) score, WOMAC score, Kujala score, and ROM were collected. Merchant views were taken with the knee flexion at 30°, 60°, and 90° to measure patella shift and tilt. Preoperative posterior condylar angle (PCA) was also measured. Postoperative complications, including anterior knee pain, maltracking, patellar clunk or crepitus (PCC), were evaluated. Results There were no significant differences in the demographics or clinical characteristics between the two groups. No statistically significant difference was identified in the KSS total score, including knee score and function score, or in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between the two groups after the operation. We found statistically significant differences in the postoperative Kujala scores and the ROMs between the two groups. The mean Kujala score in group MP was better than in group PS (MP 77.16 ± 3.80 vs PS 75.97 ± 4.06, P < 0.05), while the ROM in group PS was significantly higher than in group MP (MP 122.24° ± 4.45° vs PS 123.78° ± 6.05°, P < 0.05). Simultaneously, the preoperative/postoperative Kujala score improvement in group MP was observed to be significantly larger than in group PS (MP 27.82 ± 5.31 vs PS 26.17 ± 4.89, P < 0.05), but the average ROM improvement in group PS was significantly greater than in group MP (MP 19.00° ±9.90° vs PS 21.57° ± 9.62°). In the 90° Merchant view, the mean patella tilt of group MP was statistically smaller than that of group PS (MP 4.21° ± 1.62° vs PS 4.74° ± 1.95°, P < 0.05), and the average patella tilt change in group MP was significantly greater than in group PS (MP –3.8° ± 1.43° vs PS –3.23° ± 1.33°, P < 0.05). Preoperative PCA did not show significant differences between the two groups. Two cases of PCC and three cases of anterior knee pain were noted in group MP, and nine cases and six cases, respectively, were observed in group PS. The incidence of PCC was significantly lower in group MP (1.6% vs 7.1%, P < 0.05). There was no significant difference in follow‐up time between the two groups. Conclusion The medial pivot prosthesis could achieve satisfactory outcomes with better patellofemoral performance attributed to its “patella‐friendly” design characteristics compared to the conventional posterior‐stabilized prosthesis.
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Affiliation(s)
- Zhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Yu-Qing Zhang
- Ophthalmology Department, Affiliated Qingdao Central Hospital, Qingdao University, Qingdao, China
| | - Chang-Rong Ding
- Department of Electrocardiogram, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying-Zhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hao Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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19
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Seki Y, Katagiri H, Otabe K, Nakagawa Y, Miyatake K, Sekiya I, Koga H. Investigation of association between the preoperative intra-articular anesthetic test and persistent pain after total knee arthroplasty. J Orthop Sci 2020; 25:1055-1060. [PMID: 32107135 DOI: 10.1016/j.jos.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/12/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A better understanding of the etiology of persistent pain after total knee arthroplasty (TKA) is required to prevent unfavorable outcomes. The purpose of this study was to investigate the association of persistent pain after TKA, patient characteristics, and the remaining pain ratio per the preoperative intra-articular anesthetic test. METHODS This study included 89 patients who underwent TKA and underwent an intra-articular anesthetic test preoperatively. The remaining pain ratio out of 100 percent 30 min after intra-articular anesthetic injection and demographic data were also evaluated preoperatively. Numerical rating scale (NRS) scores for pain during movement (Q1), at rest (Q2), at first movement in the morning (Q3), and during climbing up and down stairs (Q4) were evaluated 1 year after TKA. Multiple linear regression analysis was performed to assess the impact of independent variables on the NRS score for questionnaire No.4. and the remaining pain ratio per the intra-articular anesthetic. RESULTS The mean remaining pain ratio per the preoperative intra-articular anesthetic test was 29.3%. The NRS score for Q4 was significantly higher than those for any of the other NRS questionnaires administered 1 year after TKA (Q1-Q4, Q2-Q4, P < 0.001; Q3-Q4, P < 0.05). The analysis found the weak correlation between the pain ratio of anesthetic test and the NRS score for Q4 after TKA (R = 0.28, P = 0.018). BMI and preoperative FTA were the major predictors of remaining pain ratio per the intra-articular anesthetic test (R = 0.40, P = 0.002). CONCLUSION This study revealed that the remaining pain ratio per the preoperative intra-articular anesthetic test was weakly correlated with persistent pain during climbing up and down stairs 1 year after TKA. In addition, BMI and preoperative FTA were associated with the remaining pain ratio per the preoperative intra-articular anesthetic test.
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Affiliation(s)
- Yoshie Seki
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koji Otabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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20
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Herregodts S, Verhaeghe M, Paridaens R, Herregodts J, Vermue H, Arnout N, De Baets P, Victor J. Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty. Bone Joint J 2020; 102-B:1324-1330. [PMID: 32993324 DOI: 10.1302/0301-620x.102b10.bjj-2019-1602.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level. METHODS A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). RESULTS The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. CONCLUSION This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324-1330.
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Affiliation(s)
- Stijn Herregodts
- Department of Physical Medicine and Orthopaedic Surgery, Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
| | - Mathijs Verhaeghe
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Rico Paridaens
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Jan Herregodts
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Hannes Vermue
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Nele Arnout
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Patrick De Baets
- Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
| | - Jan Victor
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
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21
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Modern total knee arthroplasty designs do not reliably replicate anterior femoral morphology. Knee Surg Sports Traumatol Arthrosc 2020; 28:2808-2815. [PMID: 31352496 DOI: 10.1007/s00167-019-05610-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Biomechanical studies suggest that PF tracking is not reliably restored to physiological values in TKA despite surgical technique optimization. A clinical observation is that current TKA designs may not replicate anterior femoral offset. The aim was to examine the intraoperative resection thicknesses of the anterior femoral condyles during TKA and correlate these findings relative to modern prostheses. METHODS This was a retrospective analysis of 199 patients who underwent 233 TKAs using a single implant design with measured anterior femoral condylar resection thicknesses. The aim was to restore posterior condylar offset whilst minimizing overstuffing of the anterior compartment of the knee by choosing the smallest prosthesis to allow for the maximal anterior resection as close to the cortex without inducing notching. Prosthetic measurements from 7 commonly used TKAs were collected by analysis of 3D models of median sized explants. RESULTS An average of 7.9 mm (SD 2.5 mm, range 2-16.5 mm) and 11.5 mm (SD 2.5 mm, range 2-21 mm) was resected from the medial and lateral aspects of the anterior femur, respectively. The average anterior flange thickness for the prosthesis data set was 6.6 mm (SD 0.6 mm, range 6.1-7.9 mm) medially and 7.6 mm (SD 0.7 mm, range 6.8-9.0 mm) laterally. Comparison across patients who received the median prosthesis size of 5 (SD 1.3, range 2-8) was inadequately restored by 1.4 mm (p < 0.00001) medially and 3.4 mm (p < 0.00001) laterally. CONCLUSION Host anatomy is not routinely restored during TKA. The surgical teaching to aim for an anterior femoral osteotomy close to the anterior cortex will result in understuffing of the PFJ and based on current prosthesis designs, the risk of overstuffing is not as significant as once believed. Future prostheses and surgical techniques should aim to restore not only posterior femoral but also anterior femoral offset. LEVEL OF EVIDENCE IV, Case series.
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Rajgopal A, Aggarwal K, Kumar S. A Five-Year Comparative Functional and Clinical Evaluation of Two Contemporary Cruciate-Retaining Knee Implants. Arthroplast Today 2020; 6:369-377. [PMID: 32577480 PMCID: PMC7303521 DOI: 10.1016/j.artd.2020.05.009] [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: 01/14/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/08/2022] Open
Abstract
Background The purpose of our study was to compare 2 commonly used highly successful cruciate-retaining knee designs on the basis of patient-reported outcome measures (PROMs), range of motion (ROM), and anterior knee pain (AKP) at a minimum follow-up of 5 years. Methods A cohort of 65 patients underwent unilateral total knee arthroplasty, from January 2013 to December 2013, using NexGen Cruciate Retaining (Zimmer Biomet, Warsaw, IN), a nonmorphogenic knee (NMK) system. They were subsequently operated upon for the contralateral knee using Persona Cruciate Retaining (Zimmer Biomet, Warsaw, IN), a morphogenic knee (MK) system between January 2014 and June 2014. Of the 65 patients, 63 participated in this study. All the patients were compared preoperatively and postoperatively on the basis of PROMs, ROM, and AKP. Results On the basis of PROMs, ROM, and AKP, there was a statistically significant difference between the 2 groups favoring the MK group, with an ROM of 126.14° in the MK group as compared with 120.76° in the NMK group and P value of <.01. Conclusions PROMs, ROM, and AKP improved significantly over time after total knee arthroplasty using both MK and NMK implants; however, the outcomes of the former were better than those of the latter, although this difference was not clinically significant.
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Affiliation(s)
- Ashok Rajgopal
- Institute of Musculoskeletal disorders and Orthopaedics, Medanta- The Medicity Hospital, Gurugram, Haryana 122001, India
| | - Kalpana Aggarwal
- Institute of Musculoskeletal disorders and Orthopaedics, Medanta- The Medicity Hospital, Gurugram, Haryana 122001, India
| | - Sumit Kumar
- Institute of Musculoskeletal disorders and Orthopaedics, Medanta- The Medicity Hospital, Gurugram, Haryana 122001, India
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Kim CW, Lee CR, Huh TY. The effect of patellar facet angle on patellofemoral alignment and arthritis progression in posterior-stabilized total knee arthroplasty without patellar resurfacing. Knee Surg Relat Res 2020; 32:29. [PMID: 32660603 PMCID: PMC7285713 DOI: 10.1186/s43019-020-00045-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/11/2020] [Indexed: 12/17/2022] Open
Abstract
Background The purpose of this study was to evaluate the effect of patellar facet angle on pre- and postoperative patellofemoral alignment and the progress of arthritis of the patellofemoral joint in posterior-stabilized total knee arthroplasty (PS TKA) without patellar resurfacing. Methods Patients who had a PS TKA for a varus osteoarthritic knee who were followed up for more than 2 years were included in this study. The radiologic and clinical outcomes were compared between 72 knees (group A) whose patellar facet angle was greater than 126° (> 126°) and 32 knees (group B) whose patellar facet angle was smaller than or equal to 126° (≤ 126°). For the radiologic assessment, the Kellgren-Lawrence grade, mechanical femorotibial angle, Insall-Salvati ratio, patellar tilt angle, patellar displacement and the osteosclerosis of the patellar ridge were evaluated. The range of motion (ROM) and patient-reported outcomes (the Knee Society knee score, the Knee Society function score, the Feller patellar score, and the Kujala patellofemoral score) were used for the clinical assessment. Results The preoperative patellar tilt angle was 9.8° (standard deviation [SD] 5.5) and 14.6° (SD 4.1) in group A and group B, respectively, a significant difference (p < 0.001). Other preoperative radiologic parameters and preoperative patient-reported outcomes and ROM showed no significant difference between the two groups (all parameters (p > 0.05). At the last-follow-up, 22 knees (30.6%) showed progression of osteosclerosis of the patellar ridge in group A and 13 knees (40.6%) showed progression of osteosclerosis in group B (p = 0.371). The postoperative radiologic and clinical outcomes showed no significant difference between the two groups (all parameters, p > 0.05). Conclusions Although a narrow patellar facet angle was related to an increase of lateral tilting of the patella, it showed no impact on the preoperative clinical assessment. The radiologic and clinical outcomes evaluated after the PS TKA showed no statistical difference according to the patellar shape. Although the patellar shape evaluated by the patellar facet angle can partially affect the preoperative patellofemoral alignment, this study result indicated insignificant clinical relevance of the patellar shape in the PS TKA.
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Affiliation(s)
- Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea.
| | - Tae-Yung Huh
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea
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Does total contact of the patella with the femoral trochlea during no thumb test significantly reduce anterior knee pain? Knee 2019; 26:1338-1347. [PMID: 31405630 DOI: 10.1016/j.knee.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/11/2018] [Accepted: 09/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Complications such as anterior knee pain (AKP) and crepitus continue to be causes of dissatisfaction after total knee arthroplasty (TKA). This prospective study aimed to study the significance of total patellar contact with the femoral trochlea of the implant, with the no thumb test during trial reduction, and its effect on reducing AKP. METHODS Between 2014 and 2016, 445 patellofemoral joints (M:F 126:319, age 45-80 years) and their contact with the trochlea of the femoral component were graded at trial reduction without lateral retinaculum release (Grades I, Ia, II, III based on existing publications). The aim was to restore all patellae to pre-operative thickness. Posterior stabilized implants with a domed patella were used in all cases. The Knee Society Score (KSS) and Visual Analogue Scale (VAS) score were noted at follow up between 12 and 24 months after surgery. RESULTS AKP was significantly lower with 100% patellofemoral contact. The KSS and VAS had statistically significant P-values of 0.021 and 0.025 in Grade I and Ia contact, respectively. Better results were achieved where patellar thickness was restored in Grades I and Ia with P-values of 0.041 and 0.046 for VAS change and 0.038 and 0.044 for KSS change, respectively. CONCLUSION At follow up, superior results were obtained where there was a complete patellofemoral contact at trial reduction in Grade I and Grade Ia, and when other confounding factors such as patellar thickness and normal rotation of the femoral and tibial components were standardized. To minimize AKP it is imperative to have total patellar contact with the femoral trochlea.
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25
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Slane LC, Dandois F, Bogaerts S, Scheys L, Vandenneucker H. Patellar tendon buckling in post-operative total knee arthroplasty patients is more prominent than in healthy controls. Med Eng Phys 2019; 69:28-32. [PMID: 31221515 DOI: 10.1016/j.medengphy.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 03/30/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
Recent evidence suggests the patellar tendon undergoes buckling during normal knee flexion, which likely contributes to the functioning of the extensor mechanism. Thus, evaluating buckling in patients following total knee arthroplasty (TKA), where extensor mechanism dysfunction remains a common complication, may be relevant. The study goals were to identify whether post-TKA patients exhibit differences in patellar tendon buckling from healthy, similarly-aged adults and whether such buckling correlates with knee and patellar tendon health. Patellar tendon buckling was assessed during passive knee flexion using ultrasound in post-TKA patients (n = 20; 12M, 68 ± 8 years) and compared with previously reported data from healthy adults (n = 12; 12M; 70 ± 8 years). Patients exhibited significantly larger (p < 0.01) buckling magnitude and angles than healthy adults, and reduced distal buckling was linked with better Knee Society Scores (p = 0.04, R2 = 0.24). The greater patellar tendon buckling observed in post-TKA patients could arise due to factors related to the surgery itself (e.g. infrapatellar fat pad resection) or it may be that post-TKA patients had greater patellar tendon buckling before their procedure. Alterations in patellar tendon buckling may predispose individuals to post-surgical complications including instability, anterior knee pain, and extensor mechanism dysfunction, with further work necessary to elucidate potential links.
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Affiliation(s)
- Laura Chernak Slane
- KU Leuven, Institute for Orthopaedic Research and Training, UZ Pellenberg, Weligerveld 1/Blok 1, Pellenberg, Leuven 3212, Belgium.
| | - Félix Dandois
- KU Leuven, Institute for Orthopaedic Research and Training, UZ Pellenberg, Weligerveld 1/Blok 1, Pellenberg, Leuven 3212, Belgium
| | - Stijn Bogaerts
- KU Leuven, Institute for Orthopaedic Research and Training, UZ Pellenberg, Weligerveld 1/Blok 1, Pellenberg, Leuven 3212, Belgium; University Hospitals Leuven, Campus Pellenberg, Pellenberg, Belgium
| | - Lennart Scheys
- KU Leuven, Institute for Orthopaedic Research and Training, UZ Pellenberg, Weligerveld 1/Blok 1, Pellenberg, Leuven 3212, Belgium; University Hospitals Leuven, Campus Pellenberg, Pellenberg, Belgium
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Chua JL, Goh GSH, Liow MHL, Tay DKJ, Lo NN, Yeo SJ. Modern TKA implants are equivalent to traditional TKA implants in functional and patellofemoral joint-related outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:1116-1123. [PMID: 30269170 DOI: 10.1007/s00167-018-5161-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/24/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare patient-reported outcomes measures, health-related quality of life and satisfaction rates between a new Modern TKA system (M-TKA) and an existing Traditional TKA system (T-TKA). METHODS Prospectively collected registry data of 65 patients who underwent T-TKA and 65 patients who underwent M-TKA at a single institution from 2014 to 2015 was reviewed. The range of motion, Knee Society Knee Score (KSKS), Function Score (KSFS), Oxford Knee Score (OKS), SF-36, satisfaction and expectation fulfilment were compared at Pre-op, 6 months and 2 years. Patellofemoral joint-related OKS subscores (3, 5, 7, 12) were also compared between the groups. Minimal clinically important difference (MCID) in OKS/SF-36 were analysed for both groups. Propensity scores generated using logistic regression were used to adjust for confounding variables, thus allowing matching of T-TKA to M-TKA in a 1:1 ratio. RESULTS Both groups showed a significant improvement in all measured variables at 6 month and 2 years (p < 0.001) when compared to baseline. There was no significant difference in KSKS, KSFS, OKS, SF-36 and Patellofemoral joint-related OKS subscores (3, 5, 7, 12) between the two groups (n.s.). At 2 years, there were high satisfaction rates of 89.2% and 92.2% in the T-TKA and M-TKA groups, respectively (n.s.). Similarly, both groups demonstrated high expectation fulfilment rates of 84.6% and 90.6% for the T-TKA and M-TKA groups, respectively (n.s.). CONCLUSION Using an extensive battery of standardized patient-reported, health-related quality of life and MCID assessments, our study demonstrated no difference in clinical outcomes between M-TKA and T-TKA that would justify the use of the newer and costlier M-TKA. Longer follow-up is necessary to evaluate the possible advantages of this new implant design. LEVEL OF EVIDENCE Level III, Retrospective Study.
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Affiliation(s)
- Jia Long Chua
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Graham Seow-Hng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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27
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Bigoni M, Zanchi N, Turati M, Pirovano G, Zatti G, Munegato D. Short-term differences in anterior knee pain and clinical outcomes between rotating and fixed platform posterior stabilized total knee arthroplasty with a new femoral component design. World J Orthop 2019; 10:128-136. [PMID: 30918796 PMCID: PMC6428999 DOI: 10.5312/wjo.v10.i3.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/16/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare rotating versus fixed-bearing Press-Fit Condylar (PFC) Sigma posterior stabilized (PS) total knee arthroplasty (TKA) with the new “J curve” femoral design in terms of clinical outcomes and anterior knee pain.
METHODS We retrospectively analyzed 39 patients who underwent primary total knee replacement surgery for knee osteoarthritis using the PFC Sigma PS TKA with either fixed (FP group, 20 cases) or rotating platform (RP group, 19 cases) treated between 2009 and 2013 by the same surgeon. The two groups were homogeneous for age, gender, weight, American Society of Anesthesiologists status, pre-operative clinical and functional scores, and prosthetic alignment at two years after surgery. We analyzed clinical outcomes score at two years follow-up using Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Performance Score, Short Form (SF) 36, and anterior knee pain assessed by the Hospital for Special Surgery (HSS) patellar score.
RESULTS No differences were found in KSS, Knee Performance Score, and SF-36 outcome scores. A statistically significant difference was found in the HSS Patella score objective (FP: 22.36; RP: 28.75; P < 0.05), HSS Patella score total (FP: 73.68; RP: 86.50; P < 0.05), and KOOS symptoms (FP: 73.49; RP: 86.44; P < 0.05).
CONCLUSION Rotating platform in PFC Sigma PS TKA appears to reduce the short-term incidence of anterior knee pain compared to the fixed platform.
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Affiliation(s)
- Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Nicolò Zanchi
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, Grenoble-Alpes University, Grenoble 38043, France
| | - Gabriele Pirovano
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
| | - Daniele Munegato
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza 20900, Italy
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Pressure algometry is a suitable tool to assess anterior knee pain in osteoarthritic patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1089-1093. [DOI: 10.1007/s00590-019-02391-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
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Glogaza A, Schröder C, Woiczinski M, Müller P, Jansson V, Steinbrück A. Medial stabilized and posterior stabilized TKA affect patellofemoral kinematics and retropatellar pressure distribution differently. Knee Surg Sports Traumatol Arthrosc 2018; 26:1743-1750. [PMID: 29124287 DOI: 10.1007/s00167-017-4772-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/30/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Patellofemoral kinematics and retropatellar pressure distribution change after total knee arthroplasty (TKA). It was hypothesized that different TKA designs will show altered retropatellar pressure distribution patterns and different patellofemoral kinematics according to their design characteristics. METHODS Twelve fresh-frozen knee specimens were tested dynamically in a knee rig. Each specimen was measured native, after TKA with a posterior stabilized design (PS) and after TKA with a medial stabilized design (MS). Retropatellar pressure distribution was measured using a pressure sensitive foil which was subdivided into three areas (lateral and medial facet and patellar ridge). Patellofemoral kinematics were measured by an ultrasonic-based three-dimensional motion system (Zebris CMS20, Isny Germany). RESULTS Significant changes in patellofemoral kinematics and retropatellar pressure distribution were found in both TKA types when compared to the native situation. Mean retropatellar contact areas were significantly smaller after TKA (native: 241.1 ± 75.6 mm2, MS: 197.7 ± 74.5 mm2, PS: 181.2 ± 56.7 mm2, native vs. MS p < 0.001; native vs. PS p < 0.001). The mean peak pressures were significantly higher after TKA. The increased peak pressures were however seen in different areas: medial and lateral facet in the PS-design (p < 0.001), ridge in the MS design (p < 0.001). Different patellofemoral kinematics were found in both TKA designs when compared to the native knee during flexion and extension with a more medial patella tracking. CONCLUSION Patellofemoral kinematics and retropatellar pressure change after TKA in different manner depending on the type of TKA used. Surgeons should be aware of influencing the risks of patellofermoral complications by the choice of the prosthesis design.
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Affiliation(s)
- Alexander Glogaza
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Peter Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
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Bugelli G, Ascione F, Cazzella N, Franceschetti E, Franceschi F, Dell'Osso G, Svantesson E, Samuelsson K, Giannotti S. Pseudo-patella baja: a minor yet frequent complication of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1831-1837. [PMID: 29273898 DOI: 10.1007/s00167-017-4828-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE One of the complications in total knee arthroplasty (TKA) is pseudo-patella baja (PPB). PPB is present when there is no shortening of the patellar tendon, but the joint line is elevated. The purpose of this study is to investigate the incidence of PPB after TKA and its clinical effects. METHODS A case series of 158 patients undergoing TKA surgery between 1999 and 2012 at the 2nd Department of Orthopaedics and Traumatology, Pisa were retrospectively reviewed. Surgeries were performed by three senior surgeons, using the same surgical procedure for the implantation of a cemented posterior stabilized prosthesis. Lateral radiographs at 30° knee flexion were evaluated and the presence of PPB defined as modified Blackburne-Peel Index (mBPI) of < 0.54. All the patients were clinically evaluated using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). Anterior knee pain was evaluated by visual analogue scale (VAS) and range of motion (ROM) was assessed through clinical examination. RESULTS The cohort group consisted of 158 patients, 109 (69.0%) female and 49 (31.0%) male. Median age at time of surgery was 74 years (range 36-87) and median follow-up was 66 months (range 12-163 months). Bilateral TKA surgery was performed in 50 patients, resulting in a total of 208 implants for investigation. On radiological evaluation, 139 (66.8%) showed no abnormalities (no joint line elevation and no patellar tendon shortening) and 55 (26.4%) presented joint line elevation with absence of patellar tendon shortening (PPB). No significant differences were found between the groups in terms of the KSS, WOMAC score, VAS or ROM. CONCLUSION Post TKA PPB is a relatively common complication. Careful preoperative planning, adequate soft tissue release, optimal cutting of bone components, on the femoral side in particular, and the use of thin polyethylene inserts can help to avoid this complication. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Giulia Bugelli
- Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | | | - Niki Cazzella
- Orthopedics and Traumatology Department, Ospedale Vito Fazzi, Lecce, Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Giacomo Dell'Osso
- Orthopedics and Traumatology Department, Ospedale San Luca, Lucca, Italy
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Stefano Giannotti
- Orthopedics and Traumatology Department, University of Siena, Siena, Italy
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Smallman TV, Portner OT, Race A, Shekitka K, Mann K. Arthroscopic Untethering of the Fat Pad of the Knee: Release or Resection of the Infrapatellar Plica (Ligamentum Mucosum) and Related Structures for Anterior Knee Pain. Arthrosc Tech 2018; 7:e575-e588. [PMID: 29942735 PMCID: PMC6011586 DOI: 10.1016/j.eats.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/04/2018] [Indexed: 02/03/2023] Open
Abstract
Anterior knee pain (AKP), a multifactorial symptom complex, can be successfully treated surgically. A specific diagnosis often cannot be made, but the pain is linked to an unrecognized common factor in most patients: the mechanical behavior of the non-isometric contents of the anterior compartment of the knee-the fat pad (FP) and infrapatellar plica (IPP). The objective of this presentation is to describe an effective arthroscopic technique that treats AKP by addressing this common factor. The operation consists of release or resection of the IPP, or ligamentum mucosum, which tethers the FP. These highly innervated tissues act together as a hydraulic shock absorber, filling the anterior compartment. They stretch and deform at the extremes of knee motion because of constraint centrally by the non-isometric IPP. These dynamic changes in shape are eliminated when the plica is released or resected. Pain perception is from perturbed nociceptive nerves: pain relief results from de-tensioning these contained nerves by untethering the fat pad. Ascribing pain causation is problematic because morphologic change, such as inflammation, fibrosis, or contracture of these structures, is only present in a minority of cases. Nonetheless, AKP is both physically linked to these central, pain-sensitive structures and relieved by this operation.
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Affiliation(s)
- Thomas Victor Smallman
- Department of Orthopaedic Surgery, Upstate Medical University, Syracuse, New York, U.S.A
- Auburn Community Hospital, Auburn, New York, U.S.A
| | - Oliver Torben Portner
- University of Ottawa, Ottawa, Ontario, Canada
- Division of Orthopaedics, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amos Race
- Department of Orthopaedic Surgery, Upstate Medical University, Syracuse, New York, U.S.A
- Institute for Human Performance, Syracuse, New York, U.S.A
| | - Kris Shekitka
- Department of Pathology, MedStar Montgomery Medical Center, Olney, Maryland, U.S.A
| | - Ken Mann
- Department of Orthopaedic Surgery, Upstate Medical University, Syracuse, New York, U.S.A
- Institute for Human Performance, Syracuse, New York, U.S.A
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Planckaert C, Larose G, Ranger P, Lacelle M, Fuentes A, Hagemeister N. Total knee arthroplasty with unexplained pain: new insights from kinematics. Arch Orthop Trauma Surg 2018; 138:553-561. [PMID: 29322318 DOI: 10.1007/s00402-018-2873-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Up to 20% of total knee arthroplasty patients remain unsatisfied post-surgery, and a large proportion of them report anterior knee pain. This study aims to verify whether patients who experience anterior knee pain after total knee arthroplasty (TKA) will exhibit kinematic characteristics similar to those associated with patellofemoral syndrome, including in the frontal and transverse planes. MATERIALS AND METHODS Using four different assessment methods [radiological, patient-reported outcome, musculoskeletal assessment with functional performance testing, and a 3D kinematic assessment during gait], the clinical and 3D knee kinematic profiles of three groups were compared: a painful and an asymptomatic TKA group and a healthy control group. All three groups underwent a three-dimensional kinematic knee assessment while walking on a treadmill. Prosthetic component rotation was assessed through a CT scan measurement performed by one experienced radiologist. Flexion/extension, ab/adduction, and tibial internal rotation curves were compared, and significant differences were highlighted through ANCOVA analysis performed on SPSS. RESULTS A total of 62 knees were evaluated, 24 asymptomatic, 21 painful, and 17 control. A dynamic flexion contracture during gait was observed in the painful group, which was associated with a lack of flexibility of the thigh muscles. Moreover, painful TKA cases exhibited a valgus alignment (- 1.5°) during stance, which increases the Q angle and lateralizes the patella. Finally, CT scan evaluation of painful total knee arthroplasty patients revealed that their combined components rotation was in slight internal rotation (- 1.4°, SD 7.0°). CONCLUSIONS Painful TKA patients presented three well-known characteristics that tend to increase patellofemoral forces and that could be the cause of the unexplained pain: a stiff knee gait, a valgus alignment when walking, and combined TKA components slightly internally rotated.
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Affiliation(s)
- Célia Planckaert
- École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada.,Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Gabriel Larose
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada.,Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Pierre Ranger
- Hôpital Jean-Talon, 1385 Rue Jean-Talon E, Montreal, QC, H2E 1S6, Canada.,Hôpital Sacré-Coeur, Canada, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Marc Lacelle
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Alexandre Fuentes
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Nicola Hagemeister
- École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada. .,Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada.
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Breugem SJM, Linnartz J, Sierevelt I, Bruijn JD, Driessen MJM. Evaluation of 1031 primary titanium nitride coated mobile bearing total knee arthroplasties in an orthopedic clinic. World J Orthop 2017; 8:922-928. [PMID: 29312851 PMCID: PMC5745435 DOI: 10.5312/wjo.v8.i12.922] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/06/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the influence of the titanium nitride (TiN) coating on the results of a total knee arthroplasty (TKA).
METHODS A total of 910 patients (338 men; 572 woman), with a mean age of 65 (range 36-94) undergoing 1031 primary TKAs were assessed. Clinical evaluation and patient-reported outcomes were gathered one year after surgery. The questionnaires included the Knee injury and Osteoarthritis Outcome Score (KOOS)-Dutch version, Visual Analogue Scale (VAS) pain scores in rest and during active knee movement, VAS-satisfaction scores, and EQ-5D-3L health scores. This was aimed to assess the overall knee function and patient satisfaction, and to enable us to make a gross comparison to other TKAs.
RESULTS At a mean follow-up of 46 mo (range 1-92) the overall implant survival was 97.7% and 95.1% for any operative reason related to the implant. Twenty-three knees (2.2%) required revision surgery. Arthrofibrosis was the most common indication for a re-operation. The clinical evaluation and patient-reported outcomes revealed good to excellent patient satisfaction and function of the arthroplasty. The median postoperative VAS-pain scores on a scale of 0-100, at one year after surgery were 1 in rest and 2 during movement.
CONCLUSION The TiN coated, mobile bearing TKA results are excellent and similar to those of other widely used TKA designs. Residual pain of the knee remains a concern and the TiN coating in combination with the mobile bearing does not seem to be the simple solution to this problem. Future research will have to show that the coating gives a better survival than the cobalt chrome version.
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Affiliation(s)
| | - Jeroen Linnartz
- Orthopedium, Orthopedic Clinic, Delft 2616 LS, The Netherlands
| | | | - Jon D Bruijn
- Orthopedium, Orthopedic Clinic, Delft 2616 LS, The Netherlands
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[Anterior knee pain after total knee arthroplasty : Causes, diagnosis and treatment]. DER ORTHOPADE 2017; 45:386-98. [PMID: 27125231 DOI: 10.1007/s00132-016-3256-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anterior knee pain is one of the most common complications after total knee arthroplasty. An incidence of up to 30 % has been reported in peer-reviewed studies. TARGET The purpose of this study was to systematically review the literature and to identify determinants that have been analyzed with regard to anterior knee pain. CAUSES Patient- and knee-specific characteristics, prosthetic designs and operative techniques are addressed as well as functional and neurologic determinants. Instability, increased contact pressure in the patellofemoral joint and patella maltracking due to malrotation of components, offset errors, ligament insufficiencies or patella baja are mechanical reasons for anterior knee pain. Functional causes include pathologic gait patterns, quadriceps imbalance and dynamic valgus. They have to be differentiated from infectious and inflammatory causes as well as soft tissue impingement, arthrofibrosis and neurologic diseases. TREATMENT A differentiated treatment algorithm is recommended. Often conservative treatment options exist, however, particularly with most mechanical causes revision surgery is necessary.
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Momoli A, Giarretta S, Modena M, Micheloni GM. The painful knee after total knee arthroplasty: evaluation and management. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 28657566 PMCID: PMC6179006 DOI: 10.23750/abm.v88i2-s.6515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis of the knee. The aging of population and the need to maintain high quality of life have increased the demand for TKA. Although considered a successful procedure, 15-30% of patients presenting persistent pain. The management of these patients requires a clinical, laboratory and radiological assessment in order to address the underlying aetiology. There are several causes of pain, divided in joint and non-joint related, which should be diagnosed and treated promptly. Patients with unexplained pain should be treated conservatively since a plausible reason has been identified. (www.actabiomedica.it)
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Momoli A, Giarretta S, Modena M, Micheloni GM. The painful knee after total knee arthroplasty: evaluation and management. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:60-67. [PMID: 28657566 DOI: 10.23750/abm.v88i2 -s.6515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 12/27/2022]
Abstract
Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis of the knee. The aging of population and the need to maintain high quality of life have increased the demand for TKA. Although considered a successful procedure, 15-30% of patients presenting persistent pain. The management of these patients requires a clinical, laboratory and radiological assessment in order to address the underlying aetiology. There are several causes of pain, divided in joint and non-joint related, which should be diagnosed and treated promptly. Patients with unexplained pain should be treated conservatively since a plausible reason has been identified.
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Hamilton WG, Ammeen DJ, Parks NL, Goyal N, Engh GA, Engh CA. Patellar Cut and Composite Thickness: The Influence on Postoperative Motion and Complications in Total Knee Arthroplasty. J Arthroplasty 2017; 32:1803-1807. [PMID: 28108171 DOI: 10.1016/j.arth.2016.12.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Little data exist on the influence of patellar thickness on postoperative motion or complications after total knee arthroplasty (TKA). This study addresses the following questions: Is postoperative motion influenced by change in composite patellar thickness? Is change in patellar thickness associated with more complications? And do more complications occur in the knees with a patellar bone remnant (<12 mm) and a native patellar thickness <18 mm? METHODS In total, 3655 TKAs were performed by 3 surgeons over a 28-year interval. All knees had caliper measurement of patellar thickness before the patellar cut, after implantation of the component and postoperative motion recorded in the database 1 or 2 years after TKA. RESULTS Patellar composite thickness was the same (1034 knees), thicker (1617 knees), and thinner (1004 knees). A significant but weak relationship was identified between the change in patellar thickness and motion (P < .01, ρ = -0.046); an increase in "composite patellar thickness" of 10 mm would result in a 3° loss of knee motion. Significant differences were identified between change in thickness and manipulations (P < .05), ruptures (P = .01), and patellar clunk/crepitus (P < .01). Examining knees with bone remnant thicknesses (<12 mm/≥12 mm), there was no difference in fractures (P = .26). No extensor ruptures occurred in knees with remnant thickness <12 mm. Comparing knees with native bone thickness (≤18 mm/>18 mm), significant differences were found in fractures (P < .01) and patellar radiolucencies (P = .01). CONCLUSION As this data does not demonstrate a strong tendency toward losing motion when the patellar thickness is increased, the authors recommend avoiding compromise of the patellar bone stock and tendon insertion. When native patellar bone is thin (<18 mm), we recommend maintaining 12 mm of patellar bone stock and accept the increase in composite thickness.
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Affiliation(s)
| | | | - Nancy L Parks
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Nitin Goyal
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Gerard A Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - C Anderson Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
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Ranawat CS, White PB, West S, Ranawat AS. Clinical and Radiographic Results of Attune and PFC Sigma Knee Designs at 2-Year Follow-Up: A Prospective Matched-Pair Analysis. J Arthroplasty 2017; 32:431-436. [PMID: 27600300 DOI: 10.1016/j.arth.2016.07.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/27/2016] [Accepted: 07/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anterior knee pain (AKP) and/or crepitation are important causes of dissatisfaction after total knee arthroplasty (TKA). Aim of this prospective, matched-pair study was to compare 2 different designs of patellofemoral (ie, trochlear groove) TKA. The Attune knee has an anatomic trochlear groove with a medialized dome patellar component vs the PFC Sigma with a single radius trochlear groove with a domed shaped patella. METHODS Between January 2010 and December 2014, 100 consecutive Attune TKAs were matched to 100 PFC Sigma TKAs based on age, gender, side, and body mass index. All surgeries were performed via medial parapatellar approach and used cemented, posterior-stabilized implants with patellar resurfacing. Clinical evaluations were assessed using Knee Society Scores (KSS) and a patient-administered questionnaire at 2-year follow-up (range, 1.5-3 years). RESULTS Based on the KSS clinical rating system, excellent clinical results were achieved in 89.4% and 90.7% of Attune and PFC Sigma TKAs, respectively. There were no significant differences in the KS pain or function scores. The overall incidence of AKP was significantly lower with the Attune knee compared to that of the PFC Sigma (12.5% vs 25.8%; P = .02). The incidence of hearing or feeling noise was also less with the Attune knee (17.7% vs 30.9%; P = .02). The incidence of painful crepitation was low in both groups (1.0% vs 4.1%) with no significant difference between groups (P = .37). Both groups had similar high satisfaction scores of 8.6 and 8.4 for the Attune and PFC groups, respectively (P = .09). CONCLUSION At 2-year follow-up, there were no differences between the PFC Sigma and Attune knees in KSS or satisfaction. However, the Attune group had a lesser incidence of AKP and crepitation. Further studies should focus on AKP and noise in cruciate-retaining knees.
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Affiliation(s)
| | | | - Sarah West
- Hospital for Special Surgery, New York, New York
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Yuenyongviwat V, Iamthanaporn K, Hongnaparak T. Lateral facetectomy decreased patellofemoral contact pressure in total knee replacement: A cadaveric study. J Clin Orthop Trauma 2017; 8:82-84. [PMID: 28360504 PMCID: PMC5359518 DOI: 10.1016/j.jcot.2016.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/28/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To study the patellofemoral contact pressure in patellar non-resurfacing total knee replacement after lateral facetectomy in different amounts of bone removal. METHODS Eight knees from four fresh-frozen whole body cadavers were used for this study. Total knee replacement of all knees was performed by the same surgical technique. The contact pressure was measured and recorded when the knee performed passive motion from full extension to full flexion in native patella, lateral retinacular junction release, 10% lateral facetectomy, and 20% lateral facetectomy. RESULTS Peak patellofemoral contact pressure decreased progressively from native patellar, junctional release of the patella, 10% facetectomy, and 20% facetectomy. The peak patellofemoral contact pressures were statistically significantly different in each patellar condition (p = 0.025). CONCLUSION In the experimental study, lateral facetectomy can reduce the peak patellofemoral contact pressure in patellar non-resurfacing total knee arthroplasty.
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Park CN, White PB, Meftah M, Ranawat AS, Ranawat CS. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty. Orthopedics 2016; 39:e246-52. [PMID: 26811953 DOI: 10.3928/01477447-20160119-06] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/22/2015] [Indexed: 02/03/2023]
Abstract
Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly. Because residual pain has been associated with an un-resurfaced patella, this review includes only registry data and total knee arthroplasty with patella replacement. Some suggest that the pathogenesis of residual knee pain may be related to mechanical stimuli that activate free nerve endings around the patellofemoral joint. Various etiologies have been implicated in residual pain, including (1) low-grade infection, (2) midflexion instability, and (3) component malalignment with patellar maltracking. Less common causes include (4) crepitation and patellar clunk syndrome; (5) patellofemoral symptoms, including overstuffing and avascular necrosis of the patella; (6) early aseptic loosening; (7) hypersensitivity to metal or cement; (8) complex regional pain syndrome; and (9) pseudoaneurysm. Because all of these conditions can lead to residual pain, identifying the etiology can be a difficult diagnostic challenge. Often, patients with persistent pain and normal findings on radiographs and laboratory workup may benefit from a diagnostic injection or further imaging. However, up to 10% to 15% of patients with residual pain may have unexplained pain. This literature review summarizes the findings on the causes of residual pain and presents a diagnostic algorithm to facilitate an accurate diagnosis for residual pain after total knee arthroplasty.
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Peersman G, Taeymans K, Jans C, Vuylsteke P, Fennema P, Heyse T. Malrotation deformities of the lower extremity and implications on total knee arthroplasty: a narrative review. Arch Orthop Trauma Surg 2016; 136:1491-1498. [PMID: 27531495 DOI: 10.1007/s00402-016-2554-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is a successful procedure for the management of osteoarthritis (OA) of the knee. Axial plane deformities are more common than suspected in patients presenting with osteoarthritis of the knee joint. Recent research has indicated that torsional deformities could play an important role in the development of anterior knee pain (AKP). METHODS In a narrative review of the literature, the aetiology of maltorsion deformity of the lower extremity in both, childhood and adulthood, as well as the development of postoperative femoral axial plane deformities are examined. This includes the numerous surgical interventions that have been described for the treatment of maltorsion syndrome, and the role of patient-specific instrumentation. Finally, correcting for maltorsion deformity during and its potential implications for the current clinical care pathway, in terms of both pre- and perioperative practices is discussed. DISCUSSION AND CONCLUSION Axial plane alignment is considered the 'third dimension' in TKA. Correct axial alignment the lower extremity and of prosthetic components is deemed an important prerequisite for a postoperatively stable and painless knee. Identification of and, where appropriate, adjustment for any pre-existing maltorsion deformities is thought to significantly reduce the proportion of patients with residual complaints following TKA. Well-designed and well-conducted clinical studies are required to support our hypotheses.
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Affiliation(s)
- Geert Peersman
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium.
| | - Kim Taeymans
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Christophe Jans
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Philippe Vuylsteke
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Peter Fennema
- AMR Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland
| | - Thomas Heyse
- Department of Orthopedics and Rheumatology, University Hospital Marburg, 35043, Marburg, Germany
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Preston S, Petrera M, Kim C, Zywiel MG, Gandhi R. Towards an understanding of the painful total knee: what is the role of patient biology? Curr Rev Musculoskelet Med 2016; 9:388-395. [PMID: 27613710 DOI: 10.1007/s12178-016-9363-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Total knee arthroplasty (TKA) remains the treatment of choice for end-stage osteoarthritis of the knee. With an aging population, the demand for TKA continues to increase, placing a significant burden on a health care system that must function with limited resources. Although generally accepted as a successful procedure, 15-30 % of patients report persistent pain following TKA. Classically, pain generators have been divided into intra-articular and extra-articular causes. However, there remains a significant subset of patients for whom pain remains unexplained. Recent studies have questioned the role of biology (inflammation) in the persistence of pain following TKA. This article aims to serve as a review of previously identified causes of knee pain following TKA, as well as to explore the potential role of biology as a predictor of pain following knee replacement surgery.
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Affiliation(s)
- Stephen Preston
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Massimo Petrera
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Christopher Kim
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Michael G Zywiel
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.,Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst St, Room 1E439, Toronto, Ontario M5T 2S8 Canada
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Abstract
There are many causes of residual pain after total knee arthroplasty (TKA). Evaluation and management begins with a comprehensive history and physical examination, followed by radiographic evaluation of the replaced and adjacent joints, as well as previous films of the replaced joint. Further workup includes laboratory analysis, along with a synovial fluid aspirate to evaluate the white blood cell count with differential as well as culture. Advanced imaging modalities may be beneficial when the diagnosis remains unclear. Revision surgery is not advisable without a clear diagnosis, as it may be associated with poor results.
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Affiliation(s)
- Mitchell McDowell
- Department of Orthopaedic Surgery, Kaiser Permanente Riverside Medical Center, 10800 Magnolia Avenue, Riverside, CA, USA
| | - Andrew Park
- Department of Orthopaedic Surgery, Midwest Orthopedics at Rush, 1611 West Harrison Street Suite 300, Chicago, IL, USA
| | - Tad L Gerlinger
- Department of Orthopaedic Surgery, Midwest Orthopedics at Rush, 1611 West Harrison Street Suite 300, Chicago, IL, USA; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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Kwon SK, Nguku L, Han CD, Koh YG, Kim DW, Park KK. Is Electrocautery of Patella Useful in Patella Non-Resurfacing Total Knee Arthroplasty?: A Prospective Randomized Controlled Study. J Arthroplasty 2015; 30:2125-7. [PMID: 26100474 DOI: 10.1016/j.arth.2015.05.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/14/2015] [Accepted: 05/29/2015] [Indexed: 02/01/2023] Open
Abstract
There is controversy over the need for electrocauterization of the patella in non-resurfacing total knee arthroplasty (TKA). We investigated whether this procedure is beneficial through a prospective randomized controlled trial. Fifty patients who underwent electrocautery were compared with 50 patients who did not undergo this procedure. We determined cartilage status, preoperative and postoperative American Knee Society (AKS) score, the Western Ontario and McMaster Universities score (WOMAC) and the Patellofemoral (PF) scores for a minimum of 5 years. The two groups did not differ significantly in demographics, intraoperative cartilage status, or preoperative or postoperative outcomes. No complications were detected in either group. We found no benefits of electrocautery of the patella in patellar non-resurfacing TKA up to 5 years.
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Affiliation(s)
- Sae Kwang Kwon
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Bucheon, Korea
| | - Levis Nguku
- AIC-CURE International Children's Hospital of Kenya, Kijabe, Kenya
| | - Chang Dong Han
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Gon Koh
- Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Bucheon, Korea
| | - Dong-Wook Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kwan Kyu Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Aasvang E, Luna I, Kehlet H. Challenges in postdischarge function and recovery: the case of fast-track hip and knee arthroplasty. Br J Anaesth 2015. [DOI: 10.1093/bja/aev257] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Welborn BT, Friedman RJ. Pain After Total Knee Arthroplasty Due to Unrecognized 180° Rotation of the Mobile-Bearing Tibial Insert: A Case Report. JBJS Case Connect 2015; 5:e109. [PMID: 29252815 DOI: 10.2106/jbjs.cc.o.00113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A woman presented with continuously worsening right knee pain and stiffness six years after a total knee arthroplasty. During revision total knee arthroplasty, we discovered that the rotating-platform tibial component was rotated 180°. This likely occurred during a minor bedside fall on postoperative day one after the index procedure. CONCLUSION This case demonstrates that a 180° rotation of the rotating tibial insert can occur with minimal trauma, resulting in persistent pain and stiffness. This cause of pain should be added to the differential diagnosis of patients with pain after total knee arthroplasty with a rotating-platform tibial insert.
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Affiliation(s)
- Benjamin T Welborn
- Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425
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