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Laoruengthana A, Reosanguanwong K, Rattanaprichavej P, Sahasoonthorn K, Santisathaporn N, Pongpirul K. Cruciate-Retaining Total Knee Arthroplasty versus Unicompartmental Knee Arthroplasty in Medial Compartmental Osteoarthritis: A Propensity Score-Matched Analysis of Early Postoperative Recovery. Orthop Res Rev 2024; 16:103-110. [PMID: 38616802 PMCID: PMC11016268 DOI: 10.2147/orr.s444547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background Cruciate-retaining (CR) total knee arthroplasty (TKA) may provide better physiological knee kinematics, proprioception, and quadricep recovery than posterior-stabilized (PS) TKA. Therefore, we hypothesized that CR TKA with multimodal pain control may provide comparable postoperative pain and recovery as unicompartmental knee arthroplasty (UKA). Methods This study included patients with isolated medial compartment knee osteoarthritis who underwent CR TKA and UKA. TKA and UKA patients were propensity score-matched with age and body mass index (BMI) and compared using visual analog scales (VAS) for pain scores, total amount of morphine use (TMU), knee flexion angle, straight leg raise (SLR), independent ambulation, length of hospital stay (LOS), and costs during hospitalization. Results After propensity score matching, 46 patients were included in the TKA and UKA groups, respectively, with no differences in demographic data. VAS at 6-72 h and TMU at 48 h after surgery were comparable between the groups. The knee flexion angle in the UKA group was significantly higher at 24 h (60.0° vs 46.6°; p<0.001) and 48 h (76.9° vs 69.1°; p = 0.021) than that in the TKA group. The SLR in the UKA group was significantly higher than that in the TKA group at 24-72 h. The UKA group ambulated significantly earlier (1.56 vs 2.13 days; p<0.001), had shorter LOS (3.68 vs 4.28 days; p<0.004) and incurred 12.43% lower costs when compared to the TKA group. Conclusion Patients who underwent CR TKA with multimodal pain management did not experience more postoperative pain or morphine use than those who underwent UKA. However, UKA patients seem to experienced faster recovery and shorter LOS than CR-TKA patients during the early postoperative course. Accordingly, UKA may be considered instead of TKA for patients who are good candidates for UKA and require expedited recovery.
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Affiliation(s)
- Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Kongpob Reosanguanwong
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Kamonnop Sahasoonthorn
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pourmodheji R, Chalmers BP, Debbi EM, Long WJ, Wright TM, Westrich GH, Mayman DJ, Imhauser CW, Sculco PK, Kahlenberg CA. Impact of Selective Posterior Cruciate Ligament Fiber Release on Femoral Rollback in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study. J Arthroplasty 2024:S0883-5403(24)00302-4. [PMID: 38599529 DOI: 10.1016/j.arth.2024.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Partial or total release of the posterior cruciate ligament (PCL) is often performed intraoperatively in cruciate-retaining total knee arthroplasty (CR-TKA) to alleviate excessive femoral rollback. However, the effect of the release of selected fibers of the PCL on femoral rollback in CR-TKA is not well understood. Therefore, we used a computational model to quantify the effect of selective PCL fiber releases on femoral rollback in CR-TKA. METHODS Computational models of 9 cadaveric knees (age: 63 years, range 47 to 79) were virtually implanted with a CR-TKA. Passive flexion was simulated with the PCL retained and after serially releasing each individual fiber of the PCL, starting with the one located most anteriorly and laterally on the femoral notch and finishing with the one located most posteriorly on the medial femoral condyle. The experiment was repeated after releasing only the central PCL fiber. The femoral rollback of each condyle was defined as the anterior-posterior distance between tibiofemoral contact points at 0° and 90° of flexion. RESULTS Release of the central PCL fiber in combination with the anterolateral (AL) fibers, reduced femoral rollback a median of 1.5 [0.8, 2.1] mm (P = .01) medially and by 2.0 [1.2, 2.5] mm (P = .04) laterally. Releasing the central fiber alone reduced the rollback by 0.7 [0.4, 1.1] mm (P < .01) medially and by 1.0 [0.5, 1.1] mm (P < .01) laterally, accounting for 47 and 50% of the reduction when released in combination with the AL fibers. CONCLUSIONS Releasing the central fibers of the PCL had the largest impact on reducing femoral rollback, either alone or in combination with the release of the entire AL bundle. Thus, our findings provide clinical guidance regarding the regions of the PCL that surgeons should target to reduce femoral rollback in CR-TKA.
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Affiliation(s)
- Reza Pourmodheji
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - William J Long
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Park KT, Nam TS, Son DW, Lee JK, Ahn JH. The Impact of Patellar Position on Mediolateral Joint Gap in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Prospective Study. J Arthroplasty 2024; 39:884-890. [PMID: 37858710 DOI: 10.1016/j.arth.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND This prospective study aimed to investigate the influence of patellar position (ie, eversion, lateralization, and reduction) on medial and lateral gap measurements during total knee arthroplasty (TKA) in both cruciate-retaining (CR) and posterior-stabilized (PS) TKA designs. METHODS The present work analyzed 50 knees with primary osteoarthritis that underwent TKA between July and November 2019. Medial and lateral gaps were measured at different knee flexion angles (0°, 45°, 90°, and 120°) in 3 patellar positions after sequentially inserting CR type and PS type trial component in the same knee. RESULTS In CR TKA, medial gaps in patellar reduction showed significantly smaller gaps at 90° and 120° of knee flexion compared to those in eversion and lateralization (P < .001). Lateral gaps in patellar reduction were also significantly larger than those in eversion and lateralization (P < .001). The mediolateral gap difference in patellar reduction was significantly greater at all flexion angles compared to those in eversion and lateralization (P < .001). In PS TKA, similar patterns were observed for medial gaps, lateral gaps, and mediolateral gap differences (P < .001). CONCLUSIONS The ligament balancing with the patella everted or subluxed may lead to an overly tight medial gap and/or loose lateral gap in the knee with a closed arthrotomy, which has potential consequences for knee function in both CR and PS TKA designs. The results of this study highlight the importance of considering patellar position to ensure optimal soft-tissue balance and joint stability in TKA.
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Affiliation(s)
- Ki Tae Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Seok Nam
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Dong Wook Son
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Kwang Lee
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Ahn
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Sakai S, Nakamura S, Kuriyama S, Nishitani K, Morita Y, Matsuda S. Anterior Position of the Femoral Condyle During Mid-Flexion Worsens Knee Activity After Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00112-8. [PMID: 38350519 DOI: 10.1016/j.arth.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The effects of kinematics on patient-reported outcome measures (PROMs) after cruciate-retaining (CR) total knee arthroplasty (TKA) remain unclear. This study investigated the effects of kinematic patterns after CR-TKA on PROMs. METHODS We examined 35 knees (27 patients) undergoing primary CR-TKA. Knee kinematics and 2011 Knee Society Score were evaluated at a mean follow-up of 72.4 (± 28.2) months. Knee kinematics was analyzed using fluoroscopy, and the femoral antero-posterior position relative to the tibial component was assessed separately for medial and lateral compartments during a squat. The correlations between kinematics and PROMs were evaluated. RESULTS The average amount of posterior femoral translation from full extension to maximum flexion was 0.2 (± 2.6) mm for the medial femoral condyle and 4.1 (± 2.9) mm for the lateral condyle. Medial pivot motion was observed in 24 knees (68.6%) with a low rate (14.3%) of paradoxical anterior translation. The anterior position of the medial femoral condyle at 60° had a negative impact on discretionary activities (ρ = -0.37; P = .039), and at maximum flexion, had a negative impact on total functional activities (ρ = -0.46; P = .005), advanced activities (ρ = -0.45; P = .006), and discretionary activities (ρ = -0.63; P < .001). Anterior position of the lateral femoral condyle at 30° had a negative impact on total functional activities (ρ = -0.48; P = .005), walking and standing (ρ = -0.56; P < .001), and advanced activities (ρ = -0.49; P = .004), and at 60° had a negative impact on walking and standing (ρ = -0.45; P = .010). CONCLUSIONS The anterior positions of the medial and lateral femoral condyles at mid-flexion and maximum flexion had negative impacts on PROMs. Soft tissue conditions should be carefully managed to achieve medial knee joint stability, which can improve PROMs.
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Affiliation(s)
- Sayako Sakai
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Yugo Morita
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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Tille E, Beyer F, Lützner C, Postler A, Lützner J. Better Flexion but Unaffected Satisfaction After Treatment With Posterior Stabilized Versus Cruciate Retaining Total Knee Arthroplasty - 2-year Results of a Prospective, Randomized Trial. J Arthroplasty 2024; 39:368-373. [PMID: 37598783 DOI: 10.1016/j.arth.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Both the cruciate-retaining (CR) and posterior-stabilized (PS) implant systems are commonplace in modern total knee arthroplasty (TKA) practice. However, there is controversy regarding functional outcomes and survivorship. The aim of the underlying study was to evaluate differences between CR and PS TKA regarding knee function, patient-reported outcome measures (PROMs) as well as complication rates. METHODS 140 patients with knee osteoarthritis scheduled for an unconstrained TKA were enrolled in a prospective, randomized study. Patients received either a CR or PS implant. Range of motion and PROMs (Oxford Knee Score, Knee Society Score, European Quality of Life 5 Dimensions 3 Level, University of California Los Angeles Activity scale and subjective satisfaction) were assessed prior to, 3 months, 1 and 2 years after surgery. RESULTS We found minor differences between treatment groups regarding demographic factors. Within the PS group duration of surgery was longer (mean PS 81.4 min vs CR 76.0 min, P = .006). We observed better flexion (median PS 120.0° vs CR 115°, P = .017) and an overall better range of motion (median PS 120.0° vs CR 115.0°, P = .008) for the PS group. PROMs did not differ between groups. At 2-year follow-up there were no revisions in either cohort. Five patients needed reoperations. Three patients needed manipulation under anesthesia, 2 in the CR and one in the PS group. CONCLUSION While PS TKA achieved a better flexion capability, PROMs were similar in CR and PS TKA. The CR implant design continues to be a reliable option for patients with an intact posterior cruciate ligament.
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Affiliation(s)
- Eric Tille
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany; Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Anne Postler
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
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Wenzel AN, Hasan SA, Chaudhry YP, Mekkawy KL, Oni JK, Khanuja HS. Ultracongruent Designs Compared to Posterior-Stabilized and Cruciate-Retaining Tibial Inserts - What Does the Evidence Tell Us? A Systematic Review and Meta-Analysis. J Arthroplasty 2023; 38:2739-2749.e7. [PMID: 37276953 DOI: 10.1016/j.arth.2023.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Posterior-stabilized (PS) and cruciate-retaining (CR) have been the most common tibial designs used in total knee arthroplasty. Ultra-congruent (UC) inserts are becoming popular because they preserve bone without relying on the posterior cruciate ligament balance and integrity. Despite increasing use, there is no consensus on how UC inserts perform versus PS and CR designs. METHODS A comprehensive literature search of 5 online databases was performed for articles from January 2000 to July 2022 comparing the kinematic and clinical outcomes of PS or CR tibial inserts to UC inserts. There were nineteen studies included. There were 5 studies comparing UC to CR and 14 comparing UC to PS. Only one randomized controlled trial (RCT) was rated "good quality". RESULTS For CR studies, pooled analyses showed no difference in knee flexion (n = 3, P = .33) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (n = 2, P = .58). For PS studies, meta-analyses showed better anteroposterior stability (n = 4, P < .001) and more femoral rollback (n = 2, P < .001) for PS but no difference in knee flexion (n = 9, P = .55) or medio-lateral stability (n = 2, P = .50). There was no difference with WOMAC (n = 5, P = .26), Knee Society Score (n = 3, P = .58), Knee Society Knee Score (n = 4, P = .76), or Knee Society Function Score (n = 5, P = .51). CONCLUSION Available data demonstrates there are no clinical differences between CR or PS and UC inserts in small short-term studies ending around 2 years after surgery. More importantly, high-quality research comparing all inserts is lacking, demonstrating a need for more uniform and longer-term studies beyond 5 years after surgery to justify increased UC usage.
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Affiliation(s)
- Alyssa N Wenzel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed A Hasan
- Department of Orthopaedic Surgery, University of Central Florida/HCA Healthcare GME, Ocala, Florida
| | - Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Kevin L Mekkawy
- Department of Orthopaedic Surgery, Holy Cross Orthopaedic Institute, Fort Lauderdale, Florida
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Yang K, Sohn G, Sambandam S. Cruciate-Retaining Total Knee Arthroplasty: Current Concepts Review. Cureus 2023; 15:e43813. [PMID: 37746387 PMCID: PMC10511824 DOI: 10.7759/cureus.43813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/26/2023] Open
Abstract
Posterior cruciate-retaining (CR) total knee arthroplasty for osteoarthritis of the knee is a popular implant choice. At present, there is no consensus on whether sacrifice or retention of the posterior cruciate ligament (PCL) offers superior outcomes. This review explores the current literature available on CR total knee arthroplasty (TKA). PubMed was searched by keyword to find relevant articles for inclusion. Additional sources came from article references and joint registry reports. CR design knees have distinct kinematic gait patterns from posterior-stabilizing (PS) knees and exhibit paradoxical anterior femoral movement with less femoral rollback. While CR implants offer less flexion than PS designs, the difference is not clinically detectable as clinical scores are similar in the short and long term. CR implants have better long-term survival compared to PS knees, likely due to lower risk of aseptic loosening. CR total knee arthroplasties also have shorter operating times and lower risk of peri-prosthetic fractures. Because the CR implant is unconstrained, there may be an increased risk of instability compared to PS designs, but the literature is mixed. Overall, the current literature supports the continued use of CR TKAs due to their lower risk of complications, durability, and demonstrated equivalence in function to posterior-substituting models.
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Affiliation(s)
- Kristine Yang
- Orthopedics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Garrett Sohn
- Orthopedics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Senthil Sambandam
- Orthopedics, University of Texas Southwestern Medical Center, Dallas, USA
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Hao K, Niu Y, Feng A, Wang F. Coronal Laxity at Flexion is Larger After Posterior-Stabilized Total Knee Arthroplasty Than With Cruciate-Retaining Procedures. J Arthroplasty 2022:S0883-5403(22)01116-0. [PMID: 36584764 DOI: 10.1016/j.arth.2022.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It is unclear whether coronal stability differs between cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA). The purpose of this study was to compare coronal laxity, radiological, and clinical outcomes between CR-TKA and PS-TKA. METHODS Seventy five CR-TKAs and 72 PS-TKAs with a minimum 2-year follow-up were retrospectively evaluated. Coronal laxity was assessed at knee extension and 80° of flexion on varus and valgus stress radiographs. Radiological evaluation included femoral-tibial angle, hip-knee-ankle angle, and positions of femoral and tibial components. Clinical evaluation included the modified Hospital for Special Surgery score, the Western Ontario and McMaster Universities Osteoarthritis index, and range of motion. RESULTS PS-TKA resulted in significantly larger varus, valgus, and total laxities at 80° flexion (P = .034, .031, and 0.001, respectively) compared with CR-TKA, while no significant difference was found at extension (P = .513, .964, and .658, respectively). No statistical difference was found in radiological and clinical outcomes between CR-TKA and PS-TKA, but the functional scores were slightly better in CR-TKA. There were adverse correlations between varus laxity at flexion and the Western Ontario and McMaster Universities Osteoarthritis index, the modified Hospital for Special Surgery score, and range of motion (r = 0.933, -0.229, -0.472, respectively). CONCLUSION Coronal laxity at 80° of flexion was larger after PS-TKA than CR-TKA. In addition, clinical outcomes were adversely affected by the larger varus laxity at flexion. Care should be taken to maintain the coronal stability, especially at flexion, during surgery to obtain better patient-reported outcomes. LEVEL OF EVIDENCE Level III.
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D’Ambrosi R, Menon PH, Salunke A, Mariani I, Palminteri G, Basile G, Ursino N, Mangiavini L, Hantes M. Octogenarians Are the New Sexagenarians: Cruciate-Retaining Total Knee Arthroplasty Is Not Inferior to Posterior-Stabilized Arthroplasty in Octogenarian Patients. J Clin Med 2022; 11:jcm11133795. [PMID: 35807083 PMCID: PMC9267517 DOI: 10.3390/jcm11133795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T0) and at two consecutive follow-ups at least 1 (T1) and 2 (T2) years after surgery. Implant survival was calculated using the Kaplan−Meier method. Results: Both groups showed statistically significant improvements at each follow-up compared with the preoperative values (p < 0.05). The CR group showed a higher flexion degree at T1 than the PS group (116.14 ± 5.57° versus 113.16 ± 7.66°; p = 0.048). No differences were found between the two groups regarding survival rate (chi-squared test p-value = 0.789). Three failures were noted in the CR group, while there were four in the PS group. Conclusions: This prospective clinical study demonstrates that CR and PS TKA had similar clinical outcomes in octogenarians with regard to knee function, postoperative knee pain, and other complications. Prosthesis survivorship for CR and PS TKA were both satisfactory, and in selected octogenarian patients, CR TKA should always be considered because of the reduced surgical time.
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Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-339-706-6151
| | - Prem Haridas Menon
- Division of Orthopedics and Traumatology, Government Medical College Trivandrum, Kerala University of Health Sciences, Thiruvananthapuram 695011, India;
| | | | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Giovanni Palminteri
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Giuseppe Basile
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.P.); (G.B.); (N.U.); (L.M.)
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Michael Hantes
- Department of Orthopaedic Surgery, Faculty of Medicine, University Hospital of Larissa, University of Thessalia, 41110 Larissa, Greece;
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Guven MF, Karaismailoglu B, Kara E, Ahmet SH, Guler C, Tok O, Ozsahin MK, Aydıngöz Ö. Does posterior cruciate ligament sacrifice influence dynamic balance after total knee arthroplasty? Comparison of cruciate-retaining and cruciate-substituting designs in bilaterally operated patients. J Orthop Surg (Hong Kong) 2022; 29:23094990211061610. [PMID: 34872402 DOI: 10.1177/23094990211061610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aimed to evaluate whether the posterior cruciate ligament sacrifice during total knee arthroplasty (TKA) has any effect on postoperative standing balance or not. METHODS The patients who underwent bilateral TKA with either CR or PS design were analyzed. 30 patients (10 PS, 20 CR) were included for the final analysis. TKA designs were compared in terms of Lysholm score, range of motion, and balance characteristics including somatosensorial, vestibular, and visual balance scales, adaptation, limits of stability, and weight-bearing/squat tests by computerized dynamic posturography. RESULTS The mean follow-up time was 59 months for CR, 49 months for PS group. The average Lysholm score values were 94 for CR and 95 for PS group, indicating functionally similar patient groups. The average knee flexion was found significantly higher in PS group (114°) compared to CR group (102°) (p = 0.009). In the CR group, motor adaptation tests (toes up/toes down) were found to be better (p = 0.034). In the on-axis velocity parameter (linear goal orientation) of limits of stability test, PS group patients were found to be more successful (p = 0.035). CONCLUSIONS The use of CR implants can be recommended in patients with a high risk of falling since they provide better motor adaptation providing rapid reactions to rapid surface changes. Better linear goal orientation in PS group, providing a faster movement in an intended direction, should be considered when planning the ideal implant for the patients with relevant activities.
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Affiliation(s)
- Mehmet Fatih Guven
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bedri Karaismailoglu
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eyyup Kara
- Department of Audiology, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Cevaydin Guler
- Department of Orthopaedics and Traumatology, 567570Sancaktepe Training and Research Hospital, Istanbul, Turkey
| | - Okan Tok
- 64296Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Mahmut Kursat Ozsahin
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Önder Aydıngöz
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
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Lin TL, Tsai CH, Fong YC, Shie MY, Chen HY, Chen YW. Cruciate-Retaining vs Posterior-Stabilized Antibiotic Cement Articulating Spacers for Two-Stage Revision of Prosthetic Knee Infection: A Retrospective Cohort Study. J Arthroplasty 2021; 36:3750-3759.e2. [PMID: 34284935 DOI: 10.1016/j.arth.2021.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/17/2021] [Accepted: 06/21/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Antibiotic cement articulating spacers are recommended during 2-stage revision for prosthetic knee infection because of increased range of motion (ROM) and improved function; however, spacer mechanical complications have been reported. We aimed to determine the association between different constraints of articulating spacers and the rate of complications and infection eradication, functional outcomes, and ROM. METHODS A retrospective study of prosthetic knee infection using cruciate-retaining (CR) or posterior-stabilized (PS) spacers was conducted between 2011 and 2018. The rate of spacer mechanical complications, infection eradication after reimplantation and reoperation, Hospital of Special Surgery (HSS) knee score, and ROM during the interim stage were analyzed. All patients were regularly followed up for 2 years. RESULTS One hundred forty-one patients were included, with 66 CR and 75 PS spacers. Overall mechanical complication rate was lower in PS (9.3%) than in CR spacers (45.5%) (P < .001), especially in joint dislocation (1.3% vs 30.3%, respectively, P < .001). Overall reoperation rate was lower in PS (16.0%) than in CR spacers (36.4%) (P < .001), especially for mechanical complications (1.3% vs 24.2%, respectively, P < .001). HSS knee score was higher in PS (72.3) than in CR spacers (63.8) (P < .001). ROM was greater in PS (90.3°) than in CR spacers (80.6°) (P = .005), especially at maximum flexion (102.4° vs 89.6°, respectively, P = .003). Infection eradication was comparable between the spacers. CONCLUSION Both spacers can control infection; however, PS spacers had a lower rate of mechanical complications and reoperation, better HSS knee scores, and greater ROM than CR spacers.
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Affiliation(s)
- Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan; Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan; Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan; Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan; Department of Orthopedics, China Medical University Beigang Hospital, Yunlin, Taiwan
| | - Ming-You Shie
- X-Dimension Center for Medical Research and Translation, China Medical University Hospital, Taichung, Taiwan; School of Dentistry, China Medical University, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Hui-Yi Chen
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Wen Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; X-Dimension Center for Medical Research and Translation, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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12
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Tramer JS, Maier LM, Klag EA, Ayoola AS, Charters MA, North WT. Return to Play and Performance in Golfers After Total Knee Arthroplasty: Does Component Type Matter? Sports Health 2021; 14:433-439. [PMID: 34085837 DOI: 10.1177/19417381211019348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Golf is a popular sport among patients undergoing total knee arthroplasty (TKA). The golf swing requires significant knee rotation, which may lead to changes in golfing ability postoperatively. The type of implant used may alter the swing mechanics or place different stresses on the knee. The purpose of this study was to evaluate golf performance and subjective stability after TKA and compare outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) implants. HYPOTHESIS Patients with CR implants will experience better stability during the golf swing compared to patients with PS implants. STUDY DESIGN Retrospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS Patients who underwent primary TKA were identified from the medical record and sent an electronic questionnaire focusing on return to play (RTP), performance, pain, and stability during the golf swing. Knee injury and Osteoarthritis Outcome Scores (KOOS) were collected before and at multiple time points after surgery. Patients were surveyed postoperatively and asked to evaluate overall performance, pain, and stability before and after surgery. Outcomes were compared based on implant type. RESULTS Most patients (81.5%) were able to return to golf at an average of 5.3 ± 3.1 months from surgery. The average postoperative KOOS was 74.6 ± 12.5 in patients able to RTP compared with 64.4 ± 9.5 in those who were not (P < 0.05). Knee pain during golf significantly improved from 6.4 ± 2.1 to 1.8 ± 2.2 (P < 0.01). There were no significant differences in pain, performance, or stability between the CR and PS patients. CONCLUSION Most patients can successfully return to golfing after TKA. Knee replacement offers patients reliable pain relief during the golf swing and fewer physical limitations during golf, with no detriment to performance. There is no difference in performance or subjective knee stability based on component type. CLINICAL RELEVANCE Understanding associated outcomes of different TKA knee systems allows for unbiased and confident recommendations of either component to golfers receiving total knee replacement.
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13
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Meding JB, Meding LK, Meneghini RM, Malinzak RA. Progressive Tibial Bearing Sagittal Plane Conformity in Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty 2021; 36:520-525. [PMID: 32873449 DOI: 10.1016/j.arth.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We hypothesized that when the posterior cruciate ligament (PCL) is found deficient at total knee arthroplasty (TKA), using an anterior-stabilized (AS) tibial insert would provide similar function and survivorship when compared to using a more traditional cruciate-retaining (CR) bearing when the (PCL) is balanced. METHODS A total of 1731 TKAs were performed using the same TKA design. Of them, 868 TKAs had a standard CR insert implanted (CR-S), 480 TKAs used a lipped CR insert (CR-L), and 383 TKAs used an AS insert. If the PCL was considered nonfunctional or absent, an AS bearing was placed. When the PCL was balanced, a CR-S or CR-L bearing was used. Follow-up was performed using the Knee Society scoring system. Kaplan-Meier survivorship was used with failure defined as aseptic loosening. RESULTS At final follow-up, there were no significant differences in knee flexion, pain, function, or stair scores. Walking scores were significantly lower in the AS group. Posterior instability was higher in the CR-S group, whereas the manipulation rate was highest in the CR-L group (1.7%, 1.3%, and 0% for CR-L, CR-S, and AS groups, respectively). Kaplan-Meier survivorship at 5 years demonstrated no significant difference between the 3 groups (99% 100%, and 99% for CR-S, CR-L, and AS groups, respectively). CONCLUSION Using an AS insert provided similar function and 5-year survivorship as compared to using a CR-S and CR-L tibial insert when the PCL was balanced. Using an ultracongruent AS dished tibial component appears to be a reasonable option when the PCL is completely released or found deficient at operation.
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Affiliation(s)
- John B Meding
- The Center for Hip and Knee Surgery, St. Francis Hospital Mooresville, Mooresville, IN
| | - Lindsey K Meding
- The Center for Hip and Knee Surgery, St. Francis Hospital Mooresville, Mooresville, IN
| | - R Michael Meneghini
- The Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; The IU Hip and Knee Center, Fishers, IN
| | - Robert A Malinzak
- The Center for Hip and Knee Surgery, St. Francis Hospital Mooresville, Mooresville, IN
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14
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Song SJ, Lee HW, Park CH. A Current Prosthesis With a 1-mm Thickness Increment for Polyethylene Insert Could Result in Fewer Adjustments of Posterior Tibial Slope in Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty 2020; 35:3172-3179. [PMID: 32665154 DOI: 10.1016/j.arth.2020.06.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To compare posterior tibial slope (PTS) and incidence of excessive PTS between cruciate-retaining (CR) total knee arthroplasties (TKAs) with the current prosthesis, providing a 1-mm increment of polyethylene insert thickness, and its predecessor, providing a 2-mm increment. METHODS Each of 154 CR TKAs with Persona (current group) and NexGen (predecessor group) prostheses with a minimum follow-up period of 2 years were retrospectively reviewed. Preoperative demographics, including age, sex, and body mass index, were similar. Factors affecting the flexion gap were matched in terms of preoperative range of motion, mechanical axis, PTS, preoperative and postoperative posterior femoral offset (PFO), and PFO ratio. The PTS was evaluated radiographically. The incidence of excessive PTS (PTS > 10°) and the frequency of intraoperative PTS-increasing procedures were investigated. RESULTS There were no significant differences in preoperative and postoperative range of motion, mechanical axis, PFO, and PFO ratios between the 2 groups. The preoperative PTS was not significantly different, but the postoperative PTS was significantly lower in the current group (4.6° vs 6.2°, P < .001). There was no case of excessive PTS in the current group, but there were 9 cases (5.8%) in the predecessor group (P = .030). The intraoperative PTS-increasing procedure was performed more frequently in the predecessor group (12.3% vs 21.4%, P = .047). CONCLUSION The current prosthesis providing a 1-mm increment of polyethylene insert thickness could decrease the PTS and the occurrence of excessive PTS in CR TKA. The target angle for PTS can be decreased in TKA using the current prosthesis in comparison with its predecessor. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
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15
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Lee WG, Song EK, Choi SW, Jin QH, Seon JK. Comparison of Posterior Cruciate-Retaining and High-Flexion Cruciate-Retaining Total Knee Arthroplasty Design. J Arthroplasty 2020; 35:752-755. [PMID: 31676176 DOI: 10.1016/j.arth.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/02/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High-flexion prostheses have been developed to achieve deep flexion after total knee arthroplasty. The purpose of this study is to compare standard NexGen (CR, cruciate-retaining) and high-flexion NexGen (CR-flex) total knee prostheses in terms of range of motion, clinical and radiologic outcomes, rates of complications, and survivorship in long-term follow-up. METHODS From January 2000 to December 2008, 423 consecutive knees underwent total knee arthroplasty using standard CR or CR-flex prostheses. Fifty-three patients were lost to follow-up or declined to participate and 54 died, leaving 290 knees. The minimum duration of follow-up was 8 years (mean 10.1 years). Physical examination and knee scoring of patients were assessed preoperatively, at 6 months and 1 year after surgery, and annually thereafter. Supine anteroposterior and lateral radiographs and standing anteroposterior hip-to-ankle radiographs were obtained preoperatively and at each follow-up. RESULTS Mean postoperative range of motions in the standard CR group and the CR-flex group were similar, showing no significant difference between the 2 groups (P = .853). At the time of the final follow-up, mean total Hospital for Special Surgery scores were similar between the 2 groups (P = .118). Mean Knee Society pain (P = .325) and function scores (P = .659) were also comparable between the 2 groups. Western Ontario and McMaster Universities Osteoarthritis Index score showed no intergroup difference either (P = .586). The mean hip-knee-ankle angle at the final follow-up was approximately the same (P = .940). Mean coronal angles of femoral and tibial component at final follow-up were also similar (P = .211 and P = .764, respectively). The prevalence of the radiolucent line was 0.6% in the standard CR group and 0.9% in the CR-flex group. Estimated survival rate according to Kaplan-Meier survival analysis was 97.2% in the standard CR group and 95.6% in the CR-flex group at mean follow-up of 10.1 years. CONCLUSION This study suggests that excellent clinical and radiographic outcomes could be achieved with both standard and high-flexion CR total knee designs. High-flexion CR prosthesis did not show any advantages over the standard design.
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Affiliation(s)
- Won-Gyun Lee
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Eun-Kyoo Song
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Seung-Won Choi
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Quan He Jin
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Jong-Keun Seon
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
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16
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Broberg JS, Ndoja S, MacDonald SJ, Lanting BA, Teeter MG. Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up. J Arthroplasty 2020; 35:272-7. [PMID: 31473060 DOI: 10.1016/j.arth.2019.07.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/18/2019] [Accepted: 07/31/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is controversy regarding the superiority of posterior-stabilizing (PS) total knee arthroplasty (TKA) and cruciate-retaining (CR) TKA. Substantial work has made comparisons between PS and CR TKA at follow-ups of less than 5 years. It was the goal of the present study to compare the kinematics at greater than 5 years postoperatively between CR and PS TKA, with a secondary goal of comparing patient function. METHODS A total of 42 knees were investigated, with equal representation in the PS and CR TKA groups. Patients underwent radiostereometric analysis imaging at 0°, 20°, 40°, 60° 80°, and 100° of flexion. Contact position, magnitude of excursion, and condylar separation on each condyle were measured. A Timed-Up-and-Go functional test was also performed by patients, with the total test time being measured. Preoperative and postoperative clinical outcome scores were also collected. RESULTS There were differences in contact position on both the medial and lateral condyles at multiple angles of flexion (P < .05). There was no difference (P = .89) in medial excursion; however, PS TKA had greater lateral excursion than CR TKA (P < .01). No difference (P > .99) was found in frequency of condylar separation. PS TKA was associated with faster (P = .03) total Timed-Up-and-Go test times. There were no differences in clinical outcome scores between the groups preoperatively or postoperatively. CONCLUSION We found kinematic and functional differences that favor PS TKA. Our results suggest posterior cruciate ligament insufficiency in CR TKA, indicating that perhaps the cam/post systems in PS TKA better maintain knee kinematics and function long term.
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17
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Fujito T, Tomita T, Yamazaki T, Oda K, Yoshikawa H, Sugamoto K. Influence of Posterior Tibial Slope on Kinematics After Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty 2018; 33:3778-3782.e1. [PMID: 30195655 DOI: 10.1016/j.arth.2018.07.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the influence of posterior tibial slope (PTS) on knee kinematics after cruciate-retaining total knee arthroplasty (CR-TKA). These influences were evaluated using a prosthesis designed with high geometric conformity to the medial articular surface under the weight-bearing condition of deep knee bending. METHODS We evaluated 71 knees (52 patients) after CR-TKA using 2- to 3-dimensional registration techniques. All patients were categorized into 2 groups: group A (PTS ≤ 7°) and group B (PTS ≥ 8°). We compared in vivo knee kinematics during deep knee bending under weight-bearing conditions between the 2 groups. The anteroposterior position of the nearest points, flexion angles, and external rotation angles of the femoral components relative to the tibial components were evaluated. Additionally, the knee flexion angles of the femur relative to the tibia obtained from the installation angles of the components were evaluated. RESULTS PTS did not affect the external rotation angles and anteroposterior position. The postoperative maximum flexion angle and range of motion between the femur and tibia in group B were significantly greater than those in group A. CONCLUSION PTS of 8° or more in CR-TKA using prosthetics designed with high geometric conformity to the medial articular surface did not affect the anteroposterior position and external rotation, but increased the postoperative maximum flexion angle and range of motion.
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Affiliation(s)
- Toshitaka Fujito
- Department of Orthopaedic Biomaterial Science, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Saitama Institute of Technology, Fukaya, Saitama, Japan
| | - Kosaku Oda
- Department of Orthopaedic Surgery, Takatsuki Red Cross Hospital, Takatsuki, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
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18
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Serna-Berna R, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles Muñoz FA, Gonzalez-Navarro B, Lopez-Prats FA. Cruciate-Retaining vs Posterior-Stabilized Primary Total Arthroplasty. Clinical Outcome Comparison With a Minimum Follow-Up of 10 Years. J Arthroplasty 2018; 33:2491-2495. [PMID: 29691173 DOI: 10.1016/j.arth.2018.02.094] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Controversy continues regarding whether the posterior cruciate ligament should be retained or removed during total knee arthroplasty (TKA) procedure. The objective was to compare the clinical outcomes with a minimum follow-up of 10 years between patients who received contemporary cruciate-retaining or posterior-stabilized primary TKA. METHODS Case-control study of 268 patients who underwent cruciate-retaining TKA vs 211 to posterior-stabilized design, with the same arthroplasty system, and a minimum follow-up of 10 years. Clinical assessment was performed by Knee Society scores, Western Ontario and MacMasters Universities and Short-Form 12 questionnaires, range of motion, and patient satisfaction. RESULTS Successful outcomes were found for both designs. No significant differences in functional scores, range of motion, patient-related scores, or patient satisfaction. Between the 5-year and last postoperative follow-up, there were a significant decrease of all clinical scores in both groups. In addition, complication rate and implant survival were similar between groups. CONCLUSION The superiority of one design over the other was not found. Both designs can be used expecting long-term successful outcomes and high survival. The choice of the design depended on the status of the posterior cruciate ligament and surgeon preference.
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Affiliation(s)
- Ricardo Serna-Berna
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain; Traumatology and Orthopaedia, Miguel Hernandez University, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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19
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Nam D, Kopinski JE, Meyer Z, Rames RD, Nunley RM, Barrack RL. Perioperative and Early Postoperative Comparison of a Modern Cemented and Cementless Total Knee Arthroplasty of the Same Design. J Arthroplasty 2017; 32:2151-2155. [PMID: 28238584 DOI: 10.1016/j.arth.2017.01.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/09/2017] [Accepted: 01/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) designs that incorporate a highly porous, titanium surface have the potential to achieve biologic fixation and improve component survivorship. This study's purpose was to compare perioperative and early postoperative outcomes of a cemented vs cementless TKA of the same design. METHODS This was a retrospective review of a consecutive series of TKAs performed at a single institution using a cemented or cementless TKA of the same design (Triathlon, Stryker Inc, Mahwah, NJ). All patients with a minimum of 1-year clinical and radiographic follow-up were reviewed, with 1:1 matching performed for age, gender, body mass index, and preoperative Oxford Knee Score. Chi-square or independent student t tests were used for statistical analyses. RESULTS Overall, 62 cemented and 66 cementless TKAs were reviewed, with secondary analyses performed after 1:1 matching of 38 patients in each cohort. In both overall and secondary 1:1 matching analyses, there was no difference in baseline demographics (P = .6-.9). Total operative times were decreased in the cementless cohort (P = .03), but there was no difference in the estimated blood loss or change in hemoglobin levels (P = .2-.7). At a mean of 1.4 ± .5 years postoperatively, patients in both cohorts demonstrated similar improvements in Oxford Knee Scores and satisfaction scores (P = .2-.8), with no patients requiring a revision surgical procedure. CONCLUSION A recently introduced cementless TKA design demonstrates excellent perioperative and early postoperative results without failures. Continued surveillance is necessary to elucidate the survivorship and potential long-term benefits of this cementless design.
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Affiliation(s)
- Denis Nam
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Judith E Kopinski
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Zachary Meyer
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Richard D Rames
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
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Zeller IM, Sharma A, Kurtz WB, Anderle MR, Komistek RD. Customized versus Patient-Sized Cruciate-Retaining Total Knee Arthroplasty: An In Vivo Kinematics Study Using Mobile Fluoroscopy. J Arthroplasty 2017; 32:1344-1350. [PMID: 27814916 DOI: 10.1016/j.arth.2016.09.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Historically, knee arthroplasties have been designed using average patient anatomy. Recent advances in imaging and manufacturing have facilitated the development of customized prostheses designed to fit the unique shape of individual patients. The purpose of this study is to determine if improving implant design through customized total knee arthroplasty (TKA) improves kinematic function. METHODS Using state-of-the-art mobile fluoroscopy, tibiofemoral kinematics were analyzed for 24 subjects with a customized individually made (CIM), cruciate-retaining TKA, and 14 subjects having an asymmetric condylar cruciate-retaining TKA. Subjects performed a weight-bearing deep knee bend and a rise from a seated position. Each patient was evaluated for weight-bearing range of motion, femorotibial translation, femorotibial axial rotation, and condylar liftoff occurrence. RESULTS Subjects having a CIM TKA experienced greater weight-bearing knee flexion compared with the traditional posterior cruciate-retaining (PCR) TKA design. During flexion, the CIM TKA subjects consistently exhibited more posterior femoral rollback than the traditional PCR TKA subjects. The CIM TKA was found to have statistically greater axial rotation compared with the traditional PCR TKA (P = .05). Of note, only the CIM TKA patients experienced femoral internal rotation at full extension, as exhibited in a normal knee. Compared with the traditional PCR TKA, the CIM TKAs demonstrated minimal occurrences of paradoxical sliding and reverse rotation during flexion and extension. The CIM TKA subjects showed minimal liftoff and hence better stability in earlyflexion to midflexion compared with the traditional PCR subjects. CONCLUSION The CIM TKA demonstrated kinematics more similar to a normal knee. Therefore, using customized implant technology through CIM TKA designs affords benefits including more normal motion compared with a traditional PCR TKA.
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Affiliation(s)
- Ian M Zeller
- Center for Musculoskeletal Research, MABE Department, University of Tennessee, Knoxville, Tennessee
| | - Adrija Sharma
- Center for Musculoskeletal Research, MABE Department, University of Tennessee, Knoxville, Tennessee
| | - William B Kurtz
- Department of Orthopedic Surgery, St. Thomas-Midtown Hospital, Tennessee Orthopedic Alliance, Nashville, Tennessee
| | - Mathew R Anderle
- Center for Musculoskeletal Research, MABE Department, University of Tennessee, Knoxville, Tennessee
| | - Richard D Komistek
- Center for Musculoskeletal Research, MABE Department, University of Tennessee, Knoxville, Tennessee
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Nakano N, Matsumoto T, Muratsu H, Takayama K, Kuroda R, Kurosaka M. Postoperative Knee Flexion Angle Is Affected by Lateral Laxity in Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty 2016; 31:401-5. [PMID: 26518359 DOI: 10.1016/j.arth.2015.09.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although many studies have reported that postoperative knee flexion is influenced by preoperative conditions, the factors which affect postoperative knee flexion have not been fully elucidated. We tried to investigate the influence of intraoperative soft tissue balance on postoperative knee flexion angle after cruciate-retaining (CR) total knee arthroplasty (TKA) using a navigation and an offset-type tensor. METHODS We retrospectively analyzed 55 patients with osteoarthritis who underwent TKA using e.motion-CR (B. Braun Aesculap, Germany) whose knee flexion angle could be measured at 2 years after operation. The exclusion criteria included valgus deformity, severe bony defect, infection, and bilateral TKA. Intraoperative varus ligament balance and joint component gap were measured with the navigation (Orthopilot 4.2; B. Braun Aesculap) while applying 40-lb joint distraction force at 0° to 120° of knee flexion using an offset-type tensor. Correlations between the soft tissue parameters and postoperative knee flexion angle were analyzed using simple linear regression models. RESULTS Varus ligament balance at 90° of flexion (R = 0.56; P < .001) and lateral compartment gap at 90° of flexion (R = 0.51; P < .001) were positively correlated with postoperative knee flexion angle. In addition, as with past studies, joint component gap at 90° of flexion (R = 0.30; P < .05) and preoperative knee flexion angle (R = 0.63; P < .001) were correlated with postoperative knee flexion angle. CONCLUSION Lateral laxity as well as joint component gap at 90° of flexion is one of the most important factors affecting postoperative knee flexion angle in CR-TKA.
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Affiliation(s)
- Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Han CW, Yang IH, Lee WS, Park KK, Han CD. Evaluation of postoperative range of motion and functional outcomes after cruciate-retaining and posterior-stabilized high-flexion total knee arthroplasty. Yonsei Med J 2012; 53:794-800. [PMID: 22665348 PMCID: PMC3381472 DOI: 10.3349/ymj.2012.53.4.794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. MATERIALS AND METHODS Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. RESULTS After the 2-year postoperative period, the mean range of motion was 131° in the CR-Flex group and 133° in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2±9.1 points) than in the PS-Flex group (11.9±9.6 points); however, this difference was not statistically significant (p=non-significant). CONCLUSION The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.
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Affiliation(s)
- Chang Wook Han
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ick Hwan Yang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Suk Lee
- 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
| | - Chang Dong Han
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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