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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] [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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Cretu B, Costache M, Cursaru A, Serban B, Spiridonica R, Popa M, Cirstoiu C, Iordache S. Restoring Anatomical Features in Primary Total Knee Arthroplasty. Cureus 2023; 15:e40616. [PMID: 37342300 PMCID: PMC10278159 DOI: 10.7759/cureus.40616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
Today, the number of people affected by gonarthrosis symptoms is increasing proportionally. Total knee arthroplasty (TKA) is a successful intervention that aims to reduce pain and restore knee function. However, studies have shown that active young patients still have limitations in performing activities such as skiing, golfing, surfing, and dancing. Over the last few years, total knee arthroplasty has undergone significant changes. Most of the modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological pattern with greater compliance in the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side. Unfortunately, functional outcomes are compromised in approximately half of TKA patients. This loss may be caused by the abnormal kinematics and inherent instability of many contemporary implants. The proper alignment of the femoral component during TKA is a crucial step that influences postoperative results. The position of the femoral component in the axial plane is responsible for flexion stability, knee joint kinematics, flexion alignment, and patellar tracking. The main goal when choosing a type of prosthesis is to achieve an adequate recovery that leads to an improvement in mobility and an increase in the efficiency of the quadriceps.
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Affiliation(s)
- Bogdan Cretu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
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3
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Hayashi S, Miyazaki S. Gross Appearances of the Posterior Cruciate Ligament Correlate With Its Histological Features but not With In Vivo Function in Cruciate-Retaining Total Knee Arthroplasty. Cureus 2023; 15:e38128. [PMID: 37252485 PMCID: PMC10212607 DOI: 10.7759/cureus.38128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background No study has evaluated whether the macroscopic appearance or histological features of the posterior cruciate ligament (PCL) affect the in vivo PCL function in cruciate-retaining (CR) total knee arthroplasty (TKA). The aim of this study is to elucidate the correlation between intraoperative gross appearances of the PCL and clinical parameters, their corresponding histological features, and the in vivo function. Methods The intraoperative gross appearances of the PCLs were evaluated; we also examined their correlations with clinical parameters, corresponding histological features, and the in vivo function in CR-TKA. Results There were significant correlations between intraoperative gross appearances of the PCL and that of the anterior cruciate ligament, the preoperative knee flexion angle, and the intercondylar notch stenosis. There was a significant correlation between the intraoperative gross appearance in the middle part and the corresponding histological features. However, there was no significant correlation between the intraoperative gross appearance or histological features and the PCL tension, amount of rollback, and maximum knee flexion angle. Conclusions The intraoperative gross appearance of the PCL correlated with clinical parameters. Also, there was a significant correlation between the intraoperative gross appearance in the middle part and the corresponding histological features; however, there was no correlation between the intraoperative gross appearance or histological features and the in vivo function.
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Affiliation(s)
- Seiju Hayashi
- Orthopedic Surgery, Yawatahama City General Hospital, Ehime, JPN
| | - Satoshi Miyazaki
- Orthopedic Surgery, Yawatahama City General Hospital, Ehime, JPN
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Yoshioka T, Okimoto N, Sawa M, Asano K, Obayashi K, Kawasaki M, Majima T. In Vivo Postoperative Motion of Fixed and Mobile Medial Pivot Knees Under Weight-Bearing Conditions after Cruciate-Sacrificing Total Knee Arthroplasty. J NIPPON MED SCH 2023; 90:103-110. [PMID: 36908123 DOI: 10.1272/jnms.jnms.2023_90-116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
BACKGROUND In vivo three-dimensional (3D) motion under weight-bearing conditions was analyzed postoperatively in medial pivot cruciate-substituting (CS) knee systems with fixed and mobile inserts. METHODS Tibiofemoral knee kinematics during squatting were captured with X-ray fluoroscopy for 4 patients in each cohort. The 3D motion of implants was analyzed with KneeMotion motion analysis software (LEXI Corporation; Tokyo, Japan). In addition, anterior-posterior (AP) movement of the distal-most points and the angle of axial rotation of the femoral component on the tibial component were assessed in both cohorts. RESULTS Mean AP movement of the femoral component on the tibial component was 3.8±0.5 mm on the medial side and 9.5±0.5 mm on the lateral side in the cohort with fixed prostheses and 5.9±2.1 mm on the medial side and 10.0±2.5 mm on the lateral side in the cohort with mobile prostheses. The mean angle of axial rotation of the femoral component on the tibial component was 14.4±1.1 degrees and 8.2±2.7 degrees of external rotation for fixed knees and mobile knees, respectively. CONCLUSIONS Postoperative motion analysis confirmed that fixed and mobile CS implants, which have a similar design, guided medial pivot motion under weight-bearing conditions. However, motion differed between these implant types after mid-flexion: bicondylar rollback after medial pivot motion was noted in the mobile cohort.
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Affiliation(s)
| | - Nobukazu Okimoto
- Department of Orthopaedic Surgery, Shimura Hospital.,Okimoto Clinic
| | - Mikiya Sawa
- Department of Orthopaedic Surgery, Shimura Hospital
| | - Kei Asano
- Department of Orthopaedic Surgery, Shimura Hospital
| | | | - Makoto Kawasaki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health
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5
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Kahlenberg CA, Chalmers B, Sun HJ, Mayman DJ, Westrich GH, Haas SB, Sculco PK. Polyethylene Components in Primary Total Knee Arthroplasty: A Comprehensive Overview of Fixed Bearing Design Options. J Knee Surg 2022; 35:1401-1408. [PMID: 33618396 DOI: 10.1055/s-0041-1723981] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The articular design of a polyethylene insert influences the kinematics and overall function of a total knee arthroplasty (TKA). Standard symmetric posterior-stabilized and cruciate-retaining polyethylene designs have a long track record of high patient satisfaction and longevity in TKA. However, the number and variety of polyethylene inserts and articulations have continued to evolve in an attempt to better replicate native knee kinematics or provide additional constraint. Ultracongruent polyethylene designs have been touted as increasing stability while maintaining the benefits of cruciate-retaining knees. Medial pivot and lateral/dual pivot polyethylene designs were introduced to mimic more normal knee kinematics with regard to femoral rollback. Further, with increasing recognition of knee instability as a cause for persistent symptoms and revision TKA, the utilization of midlevel constraint polyethylene inserts has been increasing, with multiple implant companies offering an insert design with increased constraint for use with a primary femoral component. In this rapidly evolving arena in with a myriad of options available, surgeons should be knowledgeable about the design concepts and their applicable uses for specific patient scenarios. Future research is needed to better understand whether a particular type or design of polyethylene insert and articulation leads to improved patient reported outcomes, improved replication of knee kinematics, and long-term durable implant survivorship.
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Affiliation(s)
- Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Brian Chalmers
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Hyung Jin Sun
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Steven B Haas
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York City, New York
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Vishwanathan K, Kambhampati SBS, Vaishya R. Equivalent outcomes of ultra-congruent and standard cruciate-retaining inserts in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:3076-3091. [PMID: 35013748 DOI: 10.1007/s00167-021-06833-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE No systematic review has compared the clinical outcome of anterior stabilized ultra-congruent and standard cruciate-retaining inserts in fixed-bearing primary total knee arthroplasty. This study aimed to compare the outcomes and establish the superiority or equivalence of these inserts. METHODS Pubmed, EMBASE, Medline, AMED, ERIC, and Proquest databases were searched electronically. PRISMA guidelines were followed in the conduct of the study. The clinical outcomes compared in the meta-analysis were overall knee score, WOMAC, score for knee function, score for knee pain, SF-12 PCS, knee flexion, manipulation under anaesthesia for postoperative knee stiffness, revision total knee arthroplasty or change of polyethylene insert for post-operative instability (relative risk [RR]) and survivorship. Study quality was evaluated using the Newcastle Ottawa Scale and the Modified Jadad scale. RESULTS Fourteen studies comprising 9989 knees (three RCTs and 11 comparative case-cohort studies) were included for qualitative and quantitative analysis. The pooled analysis of the ultracongruent insert and the standard cruciate retaining insert was based on a cohort of 2860 and 7129 TKA, respectively. Knee pain was significantly better in patients that had standard inserts (p = 0.02; 95% CI - 1.06 to - 0.10), and the physical component of health-related quality of life was also significantly better in patients that had standard inserts (p = 0.02; 95% CI - 6.43 to - 0.64). There was a 72% lesser chance of revision TKA or change of insert for postoperative instability in knees that had been implanted with ultracongruent inserts (RR = 0.28; p = 0.0002; 95% CI 0.15-0.55). There was no difference in the otheroutcome measures. There was no significant difference between the two inserts, considering the minimal clinically important difference or absolute ratio. CONCLUSION Differences observed between the two types of inserts were not clinically significant. Therefore, based on current evidence, arthroplasty surgeons can use either of these inserts with cruciate-retaining knee prosthesis. LEVEL OF EVIDENCE Therapeutic study, Level II.
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Affiliation(s)
- Karthik Vishwanathan
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Limda, Waghodia, Vadodara, Gujarat, 391760, India.
| | - Srinivas B S Kambhampati
- Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, 531127, India
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Puijk R, Rassir R, Sierevelt IN, Vergroesen DA, de Jong T, Nolte PA. Eighteen-Year Outcome of an Uncemented "Meniscal Bearing", Cruciate-Retaining Total Knee System. J Arthroplasty 2022; 37:1586-1593. [PMID: 35367336 DOI: 10.1016/j.arth.2022.03.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the survival, radiographic, and functional outcomes of the uncemented "meniscal bearing" cruciate-retaining Low Contact Stress (LCS) (DePuy Synthes, Warsaw, IN, USA) total knee system after a long-term follow-up period. METHODS A total of 56 patients (67 knees) who received an uncemented "meniscal bearing" cruciate-retaining LCS total knee system between 2000 and 2005 were retrospectively reviewed. Patients were 64 ± 7 years old with osteoarthritis as the indication for arthroplasty. The survivorship, radiographs, and patient-reported outcome measures (PROMs) were analyzed. RESULTS The all-cause survival after 5, 10, 15, and 18 years was 97.0%, 93.8%, 92.0%, and 92.0%, respectively. Survival with revision for aseptic loosening as an end point was 98.4% at 5 years and 96.7% at 10, 15, and 18 years. Reasons of revisions and their interventions consisted of anterior knee pain requiring secondary patellar resurfacing (n = 3, 60%), polyethylene wear requiring an insert exchange (n = 2, 40%), and bearing spin-out requiring an insert exchange (n = 1, 20%). Two of the 5 revision cases developed aseptic loosening of the tibial component later on during the study period. A radiographic analysis demonstrated radiolucent lines in 14/47 implants (30%) after 12.0 ± 3.8 years, but were not revised, respectively. After a mean follow-up of 18.5 years, PROMs (n = 20) were found comparable with the 1-year postoperative PROMs of all implants reported by the LROI (Dutch Arthroplasty Register). CONCLUSION This present study demonstrates good results of the uncemented "meniscal bearing" cruciate-retaining LCS total knee system toward survival and functional outcomes after a long-term median follow-up of 17.5 years. LEVEL OF EVIDENCE Therapeutic retrospective cohort study, LEVEL III.
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Affiliation(s)
- Raymond Puijk
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Rachid Rassir
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands; Specialized Center of Orthopedic Research and Education (SCORE), Xpert Orthopedie, Amsterdam, the Netherlands
| | | | - Tjitte de Jong
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
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8
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Meneghini RM, Deckard ER, Banks SA. The Effect of Posterior Cruciate Ligament Release on Kinematics and Outcomes in Primary Total Knee Arthroplasty With a Dual-Pivot Conforming Polyethylene. J Arthroplasty 2022; 37:S231-S237. [PMID: 35217184 DOI: 10.1016/j.arth.2022.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ultracongruent bearings are increasingly utilized in total knee arthroplasty (TKA); however, implications of surgical technique on knee kinematics and outcomes with these bearings are not well understood. This study's purpose was to evaluate the relationship of 3-dimensional knee kinematics and patient-reported outcome measures (PROMs) in a dual-pivot congruent bearing TKA with and without posterior cruciate ligament (PCL) release. METHODS Forty patients undergoing TKA with an asymmetric ultracongruent bearing were prospectively enrolled for gait analysis preoperatively and 4 months postoperatively. Three-dimensional gait analysis was performed utilizing infrared motion capture. Knee kinematic data and PCL disposition were analyzed for correlations with PROMs. RESULTS The PCL was fully released in 52.5% (21/40) of cases. Greater maximum anteroposterior femoral translation correlated with lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (rho = -0.596, P = .012), greater Knee Society Score pain with level walking (rho = 0.411, P = .101), and greater Knee Society Score pain while climbing stairs (rho = 0.469, P = .058) at 4-month follow-up. The PCL-release group was associated with greater maximum femoral anteroposterior translation (9.8 vs 5.5 mm, P = .053) and greater maximum internal tibial rotation (-6.2° vs -3.0°, P = .040), supporting a more anterior-based position of the medial condyle. The PCL released group had lower median Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores (70.7 vs 76.3, P = .031) and reported that their knees "sometimes or always" feel normal less frequently (81.8% vs 92.3%, P = .576). CONCLUSION With this asymmetric ultracongruent bearing TKA, preservation or partial titration release of the PCL, as opposed to full PCL release, appears to minimize deleterious anterior femoral translation and internal tibial rotation, which is correlated with optimized patient-reported outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery; Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, Indiana
| | - Evan R Deckard
- Department of Orthopaedic Surgery; Indiana University School of Medicine, Indianapolis, Indiana
| | - Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida
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Shah D, Bates T, Kampfer C, Hope D. Biomechanics and Outcomes of Modern Tibial Polyethylene Inserts. Curr Rev Musculoskelet Med 2022; 15:194-204. [PMID: 35381973 DOI: 10.1007/s12178-022-09755-6] [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] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW There have been many attempts to use variations in tibial polyethylene design to better recreate normal knee kinematics in the total knee arthroplasty. The goal of this review is to provide an overview of the various types of tibial inserts that exist and review the theoretical mechanics versus what was demonstrated in vivo. RECENT FINDINGS Many polyethylene inserts have been attempted to re-create normal knee kinematics, but none have been able to successfully do so. Previously the only two types of inserts were posterior stabilized (PS) and cruciate retaining (CR) polyethylene inserts. Both of these have shown excellent long-term survival but neither has demonstrated native kinematics. Initially, it was thought that retention of the posterior cruciate ligament (PCL) would allow for more native kinematics, but fluoroscopic evidence has shown that the PCL alone cannot accomplish this. Newer inserts try to restore femoral roll back and the screw home mechanism. The bicruciate retaining total knee inserts are having the most "normal" kinematics, suggesting the importance of both the ACL and PCL in knee biomechanics. Modern polyethylene inserts show favorable short-term data with bicruciate retaining inserts having the best kinematics; however, long-term studies are still needed to determine if survivorship and patient outcomes remain favorable.
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Affiliation(s)
- Darshan Shah
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA.
| | - Taylor Bates
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
| | - Craig Kampfer
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
| | - Donald Hope
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
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10
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Survivorship Comparisons of Ultracongruent, Cruciate-Retaining and Posterior-Stabilized Tibial Inserts Using a Single Knee System Design: Results From the Australian Orthopedic Association National Joint Replacement Registry. J Arthroplasty 2022; 37:468-475. [PMID: 34748914 DOI: 10.1016/j.arth.2021.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ultracongruent (UC) tibial inserts can increase knee replacement stability, but how survivorship compares to cruciate retaining (CR) or posterior stabilized (PS) inserts is unclear. METHODS Data from a large joint registry were used to calculate the cumulative percent revision of a single popular knee design used with different inserts. There were 67,523 procedures, of which 12,434 were UC, 21,635 CR, and 33,454 PS. Revision rates and reasons for revision were analyzed. RESULTS The cumulative percent revision at 18 years was 8.3% for UC, 9.2% for CR, and 8.9% for PS. There was no difference when UC was compared to CR, but PS had a higher risk of revision. Revision reasons were similar. CONCLUSION Compared to the CR, an UC insert did not increase revision rates and was actually lower than a PS insert. An UC insert does not compromise long-term total knee arthroplasty survivorship in the Genesis II prosthesis.
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11
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Chaiyakit P, Dokkhum P. Posterior Cruciate Ligament Resection and Varus Correction in Total Knee Arthroplasty: A Study Using Computer-Assisted Surgery. Arthroplast Today 2022; 13:176-180. [PMID: 35097174 PMCID: PMC8783108 DOI: 10.1016/j.artd.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/12/2021] [Accepted: 11/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Pruk Chaiyakit
- Corresponding author. Faculty of Medicine, Department of Orthopedics, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. Tel: +66 81 827 8238.
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12
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Cruciate Substituting Implants in Primary Total Knee Arthroplasty. Adv Orthop 2022; 2022:2676715. [PMID: 35111342 PMCID: PMC8803465 DOI: 10.1155/2022/2676715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 12/04/2022] Open
Abstract
The use of cruciate substituting (CS) total knee replacement has been increasing in popularity. There are numerous factors that have likely contributed to this expansion. The CS philosophy incorporates the ease of use commonly cited by advocates of the posterior stabilized (PS) total knee design with the bone preservation associated with a cruciate retaining (CR) design. The ultra-congruent highly cross-linked polyethylene liner increases stability without an appreciable change in wear. Furthermore, balancing the flexion and extension gaps does not require “titrating” the posterior cruciate ligament, improving the user-friendliness. This paper reviews the nuances of this implant design compared to PS and CR designs as well as provides surgical technique recommendations/considerations.
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13
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Conforming Polyethylene Inserts in Total Knee Arthroplasty: Beyond the Posterior-Stabilized and Cruciate-Retaining Debate. J Am Acad Orthop Surg 2021; 29:e1097-e1104. [PMID: 34478416 DOI: 10.5435/jaaos-d-20-01232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/24/2021] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty continues to be one of the most commonly performed surgical procedures worldwide. However, considerable controversy exists regarding the optimal implant design. Total knee implants with both posterior-stabilized and cruciate-retaining designs have excellent long-term outcomes with inadequate data demonstrating superiority of either design. Recently, the popularity of total knee designs with more conforming polyethylene liners has increased. These polyethylene inserts prevent paradoxical anterior translation of the femur, without relying on a cam and post mechanism, and promote more physiologic native knee kinematics. This review summarizes the design rationale of several commercially available implants, discusses the kinematic data of several designs, and reviews the available clinical data.
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14
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Madden JA, Arnold PK, Buller LT, Deckard ER, Meneghini RM. Tibial baseplate position and posterior cruciate ligament status impact patient-reported outcomes in conforming dual-pivot bearing total knee arthroplasty. Arthroplast Today 2021; 11:178-186. [PMID: 34646924 PMCID: PMC8498091 DOI: 10.1016/j.artd.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/09/2021] [Accepted: 08/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background In an effort to optimize clinical outcomes and enhance stability, ultracongruent bearings have been increasingly used in primary total knee arthroplasty (TKA). The importance of the posterior cruciate ligament (PCL) and optimal sagittal tibial baseplate position in ultracongruent bearing TKA remains unknown. This study sought to determine whether these modifiable, surgical-technique-dependent variables meaningfully impact patient-reported outcome measures. Methods A total of 759 primary TKAs of the same dual-pivot design performed using a consistent surgical technique between January 2016 and April 2019 were retrospectively reviewed. PCL status was recorded, and anteroposterior (AP) tibial baseplate position and posterior tibial slope were measured by two independent blinded raters. Patient-reported outcomes related to pain, function, satisfaction, and activity level were analyzed in relationship to PCL status, posterior tibial slope, and AP tibial baseplate position, in addition to other pertinent covariates. Results Median age and body mass index of the cohort were 68.3 years and 33.4 kg/m2, respectively, with 73% being female. In multivariate analysis, partial or full release of the PCL was predictive of a knee “always” feeling normal (odds ratio 1.42, P = .041). Furthermore, tibial baseplate position closer to the middle of the tibia was associated with greater improvements in pain with level walking, pain while climbing stairs, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement total scores (P ≤ .079). Conclusion In congruent dual-pivot bearing TKA, partially or fully releasing the PCL and AP tibial baseplate position closer to the middle of the tibia may provide greater improvement in pain and function scores at minimum 1-year follow-up.
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Affiliation(s)
- Joseph A Madden
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Payton K Arnold
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN, USA
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN, USA
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15
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Akti S, Karakus D, Sezgin EA, Cankaya D. No differences in clinical outcomes or isokinetic performance between cruciate-substituting ultra-congruent and posterior stabilized total knee arthroplasties: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2021; 29:3443-3449. [PMID: 32940732 DOI: 10.1007/s00167-020-06275-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCL-sacrificing TKA. METHODS Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no significant differences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. RESULTS There were no significant differences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no significant differences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and flexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). CONCLUSION The use of UC or PS inserts in TKA did not affect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential differences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacrificing the PCL in TKA. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Sefa Akti
- Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Tacin Street, 68120, Aksaray, Turkey.
| | - Dilek Karakus
- Department of Physical Medicine and Rehabilition, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Erdem Aras Sezgin
- Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Tacin Street, 68120, Aksaray, Turkey
| | - Deniz Cankaya
- Department of Orthopaedic and Traumatology, Aksaray University Education and Research Hospital, Tacin Street, 68120, Aksaray, Turkey
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16
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Midterm Outcomes and Survivorship of Anterior Stabilized Versus Cruciate Retaining Bearing in Primary Total Knee Arthroplasty. J Arthroplasty 2021; 36:998-1002. [PMID: 33268208 DOI: 10.1016/j.arth.2020.09.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/15/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There has been increasing utilization of ultracongruent bearings with a cruciate retaining (CR) femoral component in primary total knee arthroplasty. The purpose of this study is to compare outcomes and survivorship between an ultracongruent anterior stabilized (AS) and CR bearing. METHODS A retrospective review was performed from 2010 through 2014 of all primary total knee arthroplasties with a single knee systems identical CR femur and AS or CR bearing with minimum 2-year follow-up yielding a study cohort of 3323 patients (4164 knees). Knee range of motion, Knee Society pain scores, Knee Society clinical scores, Knee Society functional scores, and University of California Los Angeles activity scores were evaluated. The need for manipulation under anesthesia (MUA), nonrevision surgery and revisions were assessed. RESULTS AS bearing was used in 1471 knees (35%) and CR bearing used in 2693 knees (65%). Mean follow-up was 5.4 years. The AS group had significantly higher improvements in knee range of motion, Knee Society clinical, Knee Society functional, and Knee Society pain scores. MUAs were performed on 120 knees (8.2%) in the AS group compared with 158 knees (5.9%) in the CR group (P = .005). The AS group had significantly less all-cause failure, aseptic failures, revisions for instability, and revisions for isolated polyethylene wear. The 10-year aseptic survival for AS was 98.3% and for 92.3% for the CR group (P = .002). CONCLUSION These mid-term results demonstrate the AS bearing had significantly higher improvements in clinical and functional outcomes as well as greater survivorship. Knees in which an AS bearing was used did have a higher incidence of MUA.
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17
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Kim MS, Koh IJ, Kim CK, Choi KY, Jeon JH, In Y. Comparison of Joint Perception Between Posterior-Stabilized and Ultracongruent Total Knee Arthroplasty in the Same Patient. J Bone Joint Surg Am 2021; 103:44-52. [PMID: 33259430 DOI: 10.2106/jbjs.20.00279] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Posterior-stabilized and ultracongruent designs are 2 common examples of posterior cruciate ligament-substituting total knee arthroplasty (TKA) prostheses. There is a lack of evidence regarding joint perception differences between ultracongruent and posterior-stabilized TKA. The purpose of this study was to compare the postoperative knee stability, function, and joint perception between ultracongruent and posterior-stabilized TKA in the same patients in order to determine whether there was a difference based on design. METHODS This prospective, randomized controlled trial included 50 patients who underwent same-day bilateral TKA utilizing Persona (Zimmer Biomet) posterior-stabilized implants in 1 knee (posterior-stabilized group) and ultracongruent implants in the other knee (ultracongruent group). At 2 years postoperatively, patients were evaluated for knee stability, function, and joint perception. Postoperative static knee anteroposterior stability and femoral rollback were compared. Knee function was evaluated with use of the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Joint perception was compared by evaluating noise generation, side preference, satisfaction, and the Forgotten Joint Score. RESULTS The ultracongruent group had more knee anteroposterior laxity (4.5 mm compared with 1.8 mm in the posterior-stabilized group; p < 0.001) and less femoral rollback (4.2 mm compared with 9.0 mm in the posterior-stabilized group; p < 0.001). Knee Society Score and WOMAC scores were not significantly different between groups (all p > 0.05). Although the ultracongruent group showed less noise generation than the posterior-stabilized group (18% compared with 38%, respectively; p = 0.026), there were no differences in side preference, satisfaction, or Forgotten Joint Score (all p > 0.05). CONCLUSIONS Both groups had similar joint perception 2 years postoperatively, with obvious differences in noise generation and more sagittal laxity with less femoral rollback in the ultracongruent group. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Kyu Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Hwa Jeon
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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18
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Anterior-stabilized TKA is inferior to posterior-stabilized TKA in terms of postoperative posterior stability and knee flexion in osteoarthritic knees: a prospective randomized controlled trial with bilateral TKA. Knee Surg Sports Traumatol Arthrosc 2020; 28:3217-3225. [PMID: 31970430 DOI: 10.1007/s00167-019-05827-2] [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] [Received: 06/27/2019] [Accepted: 12/11/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine whether knee stability, range of motion (ROM) and clinical scores differ between anterior-stabilized (AS) and posterior-stabilized (PS) total knee arthroplasty (TKA). METHODS This prospective randomized controlled trial included 34 patients with severe bilateral knee osteoarthritis who underwent bilateral TKA between June 2010 and July 2011 using AS and PS designs of a single-implant system. AS TKA with ultracongruent inserts was performed in one knee and PS TKA with a cam-post mechanism was performed in the other knee in each patient. Clinical and radiological data from a mean follow-up period of 5 years, including ROM, clinical scores, peak knee torque determined by isokinetic test, knee joint laxity determined by Telos stress views, tourniquet time and subjects' preference were analyzed. RESULTS The mean postoperative knee flexion angle did not differ between groups until 1 year. Beginning 2 years postoperatively, the knee flexion angle decreased slightly in the AS group and was smaller than that in the PS group (p = 0.004). The mean Knee Society knee score was higher in the PS group than in the AS group after 2 years. The quadriceps strength did not differ between groups. The mean posterior laxity after TKA was 6-8 mm greater in the AS group than in the PS group. No radiological loosening was observed in either group. More subjects preferred PS knees to AS knees. However, this difference was not significant. CONCLUSION AS primary TKA was inferior to PS TKA in terms of posterior knee stability, postoperative knee flexion and clinical scores after 2 years. LEVEL OF EVIDENCE Therapeutic study, Level 1.
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19
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Inokuchi T, Ishida K, Takayama K, Shibanuma N, Hayashi S, Kurosaka M, Kuroda R, Matsumoto T. Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:2816-2822. [PMID: 31324963 DOI: 10.1007/s00167-019-05624-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the correlation between intraoperative tibiofemoral anteroposterior changes at 90° of flexion and postoperative maximum flexion angles in navigated cruciate-substituting TKA. The hypothesis of this study was that intraoperative tibiofemoral anteroposterior changes at 90° of flexion indirectly reflect posterior cruciate ligament (PCL) function and associate with postoperative maximum flexion angles. METHODS Fifty-five consecutive patients with varus osteoarthritis treated with primary TKA were retrospectively analysed. All patients received the same type of implant, placed with an image-free navigation system. The PCL was retained, and cruciate-substituting inserts were used in all cases. The mean follow-up was 44 ± 8 months. The preoperative and postoperative kinematics were measured intraoperatively with a navigation system, and the preoperative and postoperative tibiofemoral anteroposterior positions at 90° of flexion were determined. The correlation between intraoperative anteroposterior position changes and postoperative maximum flexion angles was investigated. The correlation between the change of anteroposterior position and tibiofemoral rotational angles was also assessed. RESULTS The intraoperative anteroposterior position change was -1.7 ± 3.4 mm (a positive value indicates tibial posterior shift). Flexion angle improvement was negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2 = 0.17, p < 0.005). Postoperative maximum flexion angles were also negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R2 = 0.09, p < 0.05). The postoperative amount of tibial internal rotation was positively correlated with the preoperative amount (R2 = 0.60, p < 0.0001); however, the intraoperative anteroposterior position change was not correlated with the postoperative amount of tibial internal rotation (n.s.). CONCLUSION A navigation system may be able to indirectly evaluate PCL function and predict the postoperative flexion angles in cruciate-substituting TKA. Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting TKA. LEVEL OF EVIDENCE Level 3, retrospective comparative study.
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Affiliation(s)
- Takao Inokuchi
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.,Department of Orthopedic Surgery, Kobe Rehabilitation Center Hospital, 1070 Akebono, Nishi, Kobe, 651-2181, Japan
| | - Kazunari Ishida
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.
| | - Koji Takayama
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Nao Shibanuma
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Masahiro Kurosaka
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
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20
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Hosseini Nasab SH, Smith C, Schütz P, Postolka B, Ferguson S, Taylor WR, List R. Elongation Patterns of the Posterior Cruciate Ligament after Total Knee Arthroplasty. J Clin Med 2020; 9:jcm9072078. [PMID: 32630654 PMCID: PMC7408829 DOI: 10.3390/jcm9072078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed to understand the ability of fixed-bearing posterior cruciate ligament (PCL)-retaining implants to maintain functionality of the PCL in vivo. To achieve this, elongation of the PCL was examined in six subjects with good clinical and functional outcomes using 3D kinematics reconstructed from video-fluoroscopy, together with multibody modelling of the knee. Here, length-change patterns of the ligament bundles were tracked throughout complete cycles of level walking and stair descent. Throughout both activities, elongation of the anterolateral bundle exhibited a flexion-dependent pattern with more stretching during swing than stance phase (e.g., at 40° flexion, anterolateral bundle experienced 3.9% strain during stance and 9.1% during swing phase of stair descent). The posteromedial bundle remained shorter than its reference length (defined at heel strike of the level gait cycle) during both activities. Compared with loading patterns of the healthy ligament, postoperative elongation patterns indicate a slackening of the ligament at early flexion followed by peak ligament lengths at considerably smaller flexion angles. The reported data provide a novel insight into in vivo PCL function during activities of daily living that has not been captured previously. The findings support previous investigations reporting difficulties in achieving a balanced tension in the retained PCL.
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Affiliation(s)
- Seyyed Hamed Hosseini Nasab
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Colin Smith
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Pascal Schütz
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Barbara Postolka
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Stephen Ferguson
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - William R. Taylor
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
- Correspondence:
| | - Renate List
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
- Human Performance Lab, Schulthess Clinic, 8008 Zurich, Switzerland
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21
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Willing R, Moslemian A, Yamomo G, Wood T, Howard J, Lanting B. Condylar-Stabilized TKR May Not Fully Compensate for PCL-Deficiency: An In Vitro Cadaver Study. J Orthop Res 2019; 37:2172-2181. [PMID: 31206794 DOI: 10.1002/jor.24392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/06/2019] [Indexed: 02/04/2023]
Abstract
Increased-congruency bearing options are widely available in numerous total knee replacement (TKR) systems, with the intended purpose of compensating for posterior-cruciate ligament (PCL) deficiency. However, their ability to provide adequate stability in this setting has been debated. This in vitro joint simulator study measured changes in knee joint kinematics and stability during passive flexion-extension motions and simulated activities of daily living resulting from TKR with condylar-stabilized (CS) TKR without a PCL versus cruciate-retaining (CR) TKR. During passive flexion, the CS TKR resulted in a more posterior tibial positioning than both the intact joint and CR TKR (by 3.4 ± 1.0 mm and 4.8 ± 0.7 mm, respectively). With a posterior tibial force applied, the CS TKR tibia was again significantly more posterior than that of the intact joint and CR TKR (by 4.7 ± 1.3 mm and 5.6 ± 0.8 mm, respectively). Furthermore, there were significant differences in the anterior/posterior kinematics of both TKR with respect to intact knees during gait, and differences between the CS and CR TKR during stair ascent and descent. Overall, there appears to be a reduction in anterior-posterior stability of the PCL-deficient CS TKR knee, suggesting that contemporary increased-congruency bearing surface designs may not adequately compensate for the loss of the PCL. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2172-2181, 2019.
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Affiliation(s)
- Ryan Willing
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Alireza Moslemian
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Geofrey Yamomo
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Thomas Wood
- Department of Orthopaedic Surgery, London Health Sciences Centre University Hospital, London, Ontario, Canada
| | - James Howard
- Department of Orthopaedic Surgery, London Health Sciences Centre University Hospital, London, Ontario, Canada
| | - Brent Lanting
- Department of Orthopaedic Surgery, London Health Sciences Centre University Hospital, London, Ontario, Canada
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22
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Ng JWG, Bloch BV, James PJ. Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty. EFORT Open Rev 2019; 4:519-524. [PMID: 31538002 PMCID: PMC6719604 DOI: 10.1302/2058-5241.4.180083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multi radius (MR) total knee arthroplasty (TKA) has been associated with mid-flexion instability. Single radius (SR) TKA may provide better anteroposterior stability through single flexion axis and biomechanical advantage for quadriceps function. Medial pivot (MP) TKA and gradually reducing (GR) radius TKA produce better knee kinematics. Clinical outcomes are equivalent for SR, MR and MP TKA. Short-term studies have shown better clinical outcomes and kinematics for GR TKA. Thinner and narrow anterior flange, deeper trochlea groove and more anatomical trochlea design reduces patellofemoral complications in TKA Ultracongruent inserts provide comparable clinical outcomes to posterior-stabilized TKA and cruciate retaining TKA.
Cite this article: EFORT Open Rev 2019;4:519-524. DOI: 10.1302/2058-5241.4.180083
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23
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Stirling P, Clement ND, MacDonald D, Patton JT, Burnett R, Macpherson GJ. Early functional outcomes after condylar-stabilizing (deep-dish) versus standard bearing surface for cruciate-retaining total knee arthroplasty. Knee Surg Relat Res 2019; 31:3. [PMID: 32660531 PMCID: PMC7219520 DOI: 10.1186/s43019-019-0001-7] [Citation(s) in RCA: 5] [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: 05/04/2019] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
AIMS The primary study aim was to compare early knee-specific function of patients undergoing cemented total knee arthroplasty (TKA) with either a cruciate-retaining (CR) polyethylene insert or a highly congruent condylar-stabilizing (CS) insert. Secondary aims were to compare general health and satisfaction between the groups. METHODS A total of 418 consecutive primary TKAs were identified retrospectively. Demographics and preoperative and 1-year postoperative patient-reported outcome measures (PROMs) were collected prospectively. PROMs consisted of Oxford Knee Scores, EuroQol-5 Dimensions scores, and Short Form-12 scores. RESULTS A total of 54 (12.9%) patients received a CS insert and 364 patients received a CR TKA. The CS group had a significantly (odds ratio (OR) 2.9; p = 0.002) greater proportion of females (77.8% versus 54.9%). The only significant difference in postoperative PROMs was a higher Short Form-12 physical component score in the CR group (difference 3.1; 95% confidence interval (CI) 0.1 to 6.1; p = 0.04). Linear regression analysis demonstrated no significant difference for all postoperative PROMs (p > 0.25). There was no significant difference in satisfaction rate (OR 0.94; 95% CI 0.42 to 2.12; p = 0.56) or pain visual analogue score (difference 6.1; 95% CI -1.9 to 14.0; p = 0.14) between the groups. CONCLUSION More congruent CS inserts have equivalent PROMs and patient satisfaction at 1 year compared with less congruent CR inserts. These represent an option for surgeons undertaking TKA where increased congruency is desired.
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Affiliation(s)
- P Stirling
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
| | - N D Clement
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - D MacDonald
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - J T Patton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - R Burnett
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - G J Macpherson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
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24
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Indelli PF, Risitano S, Hall KE, Leonardi E, Migliore E. Effect of polyethylene conformity on total knee arthroplasty early clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:1028-1034. [PMID: 30328496 DOI: 10.1007/s00167-018-5170-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Total knee arthroplasty is a successful procedure in treating subjects with end-stage knee osteoarthritis. The objective of this matched study was to evaluate subjective patient satisfaction and clinical and radiological outcomes in two groups of patients undergoing primary TKA using an identical third-generation design with different conformity in the polyethylene insert. METHODS One hundred consecutive patients undergoing TKA because of knee osteoarthritis were randomized in two matched groups. Group A included 50 Posterior-Stabilized (PS) implants, while group B included 50 Medially Congruent (MC) implants. The surgical technique was identical: gap balancing in extension and measured resection in flexion; cruciate ligaments were always removed; the coronal alignment followed the mechanical axis and the tibial slope was set at 3° in the PS group and 5° in the MC. Oxford Knee Score (OKS) and Knee Society Score (KSS) were assessed preoperatively and at 2 year minimum follow-up. Two-sample T test statistical analysis was performed. RESULTS All patients were available at final follow-up: there were no preoperative statistical differences between the two groups in the average preoperative ROM (PS 112°, MC 108°; n.s.), average preoperative KSS (PS 64.4, MC 63.7; n.s.), average preoperative OKS (PS 19.6; MC 19.0; n.s.), and average BMI (PS 34.40, MC 34.60; n.s.). At final follow-up, there were no statistical differences between the two groups in the average OKS (PS 40,5; MC 41.1; n.s.) and in the average KSS (PS 161,5, MC 165,7; n.s.). We found a statistically but not clinically significant difference at final ROM: the average maximum active flexion was 120° in the PS group and 123° in the MC group (s.s.). CONCLUSION This study evaluated two biomechanically different polyethylene inserts in the same TKA design, showing that reducing the level of intra-articular conformity had minimal effects on PROMs and objective short-term clinical results but a potentially beneficial effect on ROM. This study suggests that, once a satisfactory intra-operative stability is obtained, the minimal level of constraint should be used. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pier Francesco Indelli
- Department Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, USA.
- PAVAHCS, Surgical services, 1801 Miranda Ave, Palo Alto, CA, 94304, USA.
| | - Salvatore Risitano
- Department Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, USA
- PAVAHCS, Surgical services, 1801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Kimberly E Hall
- Department Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, USA
- PAVAHCS, Surgical services, 1801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Erika Leonardi
- Department Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, USA
- PAVAHCS, Surgical services, 1801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Eleonora Migliore
- Department Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, USA
- PAVAHCS, Surgical services, 1801 Miranda Ave, Palo Alto, CA, 94304, USA
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The original Akagi line is the most reliable: a systematic review of landmarks for rotational alignment of the tibial component in TKA. Knee Surg Sports Traumatol Arthrosc 2019; 27:1018-1027. [PMID: 30203197 DOI: 10.1007/s00167-018-5131-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is no present consensus on the most reliable anatomical landmarks or axes for tibial rotational alignment in total knee arthroplasty (TKA). The goal was therefore to review the literature and compare accuracy and repeatability of different axes for tibial baseplate rotation in TKA. METHODS Medline and Embase were searched for articles that reported accuracy in terms of error or discrepancy from the trans-epicondylar axes (TEA), and/or repeatability in terms of intraclass correlation coefficient, of one or more axes used for tibial baseplate rotation in TKA. Twenty-one articles met criteria, and their data were extracted and tabulated. RESULTS The selected articles evaluated 15 different axes, 13 for reliability, 12 for repeatability. The lowest errors or discrepancies from the projected TEA were reported for the original 'Akagi line' (posterior cruciate ligament posteriorly to medial border of tibial tuberosity), its variant using the sulcus of the tibial spines as anterior landmark, as well as the anterior tibial border and the curve-on-curve technique. The best inter-observer repeatabilities were reported for 'Akagi line' variants that use the geometric centre of the tibial plateau posteriorly and the medial border of the tibial tuberosity, or the medial sixth of the patellar tendon anteriorly. Considering accuracy and repeatability simultaneously, only two axes were found to satisfy both criteria consistently: the original 'Akagi line' and the anterior tibial border. CONCLUSIONS Because of the small number of studies found, the collected evidence remains insufficient to recommend reference axes for intra-operative rotational alignment of the tibial baseplate in TKA. A combination of two or more anatomical landmarks or projected axes could be used to ensure adequate tibial baseplate rotation, while considering individual patient morphology and implant design to optimize knee kinematics and prevent prosthetic overhang. LEVEL OF EVIDENCE Level IV, systematic review of level III and IV studies.
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Migliorini F, Eschweiler J, Tingart M, Rath B. Posterior-stabilized versus cruciate-retained implants for total knee arthroplasty: a meta-analysis of clinical trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:937-946. [PMID: 30649620 DOI: 10.1007/s00590-019-02370-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/04/2019] [Indexed: 01/28/2023]
Abstract
AIM A meta-analysis comparing the outcomes of patients undergoing cruciate retaining (CR) versus posterior stabilized (PS) in primary total knee arthroplasty was performed. The outcomes of interest were the Knee Society Rating System, clinical (KSCS) and functional (KSFS) subscales, joint range of motion (ROM), surgical duration and further complications (anterior knee pain, instability and revision rate). MATERIALS AND METHODS The search was conducted in July 2018, accessing the following databases: Cochrane Systematic Reviews, Scopus, PubMed, EMBASE, CINAHL, AMED and Google Scholar. We included only clinical trials level of evidence I and II. During the statistical analysis, we excluded all the studies that affect negatively the I2 test, in order to achieve more reliable results. For the methodological quality assessment we referred to the PEDro score. The risk of publication's bias was evaluated by the funnel plots across all the comparisons. RESULTS The PEDro score reported a good methodological quality assessment. The funnel plot detected a very low risk of publication's bias. We included in this study 36 articles, counting a total of 4052 patients and 4884 procedures. The mean follow-up term for both groups was 3.39 years. The ROM resulted in an overall estimate effect of 2.18° in favor of the PS group. The overall WOMAC showed a result in favor of the PS group. The overall estimate effect of the KSCS was 0.02% higher in the CR group. The KSFS showed an overall estimate effect of 2.09% in favor of the PS group. Concerning the surgical duration, the estimate effect resulted in 6.87 min shorter in the CR group. No differences were reported across the two groups regarding anterior knee pain, knee joint instability or revision rate. CONCLUSION Both the prosthetic implants provided to be a safety and feasible solution to treat end-stage knee joint degeneration. The PS implants reported improvements in the knee range of motion and a prolongation of the surgical time. No clinically relevant dissimilarities concerning the analyzed scores were evidenced. No statistically significant relevant differences in complications were detected.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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Bae JH, Yoon JR, Sung JH, Shin YS. Posterior-stabilized inserts are preferable to cruciate-substituting ultracongruent inserts due to more favourable kinematics and stability. Knee Surg Sports Traumatol Arthrosc 2018; 26:3300-3310. [PMID: 29459998 DOI: 10.1007/s00167-018-4872-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE It is unknown whether the conforming superiority of ultracongruent (UC) inserts over posterior stabilized (PS) inserts, due to an increased anterior lip for prevention of anterior displacement of the condyles during knee flexion, leads to better knee scores or greater knee stability in arthroplasty patients. This meta-analysis compared clinical outcomes, intraoperative kinematics, sagittal stability, and range of motion (ROM) between groups with either UC or PS inserts in primary total knee arthroplasty (TKA). METHODS Studies that recorded clinical outcomes, intraoperative kinematics, sagittal stability, and ROM in patients who underwent primary TKA with UC or PS inserts were included in the meta-analysis. Subgroup analyses based on differences in flexion angles were performed for intraoperative kinematics. RESULTS Thirteen studies met the criteria for inclusion in the meta-analysis. The UC and PS insert groups reported similar pain scores (95% CI - 0.15 to 0.16; n.s.) and function scores (95% CI - 0.30 to 0.14; n.s.). In contrast, femoral rotation during flexion (95% CI - 0.06 to 6.35; p = 0.05), posterior femoral translation during flexion (95% CI - 2.74 to - 0.15; p = 0.03), tibial sagittal laxity at 90° (95% CI 2.91 to 7.72; p < 0.0001), and ROM (95% CI - 4.84 to - 1.53; p = 0.0002) differed significantly between the groups. Subgroup analyses revealed that the pooled data for femoral rotation were significantly different between groups: 60°, 4.09 (p < 0.00001); 90°, 7.94 (p < 0.00001); and 120°, 8.16 (p < 0.00001). Furthermore, pooled data for posterior femoral translation were significantly different between groups: 90°, - 3.70 (p < 0.00001); and 120°, - 3.96 (p < 0.00001). CONCLUSIONS There were no significant differences in clinical outcomes between the groups with UC and PS inserts. However, the UC insert group showed significantly greater external femoral rotation, less posterior femoral translation, greater tibial laxity in the sagittal plane, and less ROM than the PS insert group. Based on the results of the current meta-analysis, in substituting the PCL, PS inserts are preferable to UC inserts due to more favourable kinematics and stability, even though both inserts have equivalent clinical outcomes. LEVEL OF EVIDENCE Therapeutic study, Level II.
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Affiliation(s)
- Ji-Hoon Bae
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea
| | - Ju-Hyoung Sung
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea.
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Okada Y, Teramoto A, Takagi T, Yamakawa S, Sakakibara Y, Shoji H, Watanabe K, Fujimiya M, Fujie H, Yamashita T. ACL Function in Bicruciate-Retaining Total Knee Arthroplasty. J Bone Joint Surg Am 2018; 100:e114. [PMID: 30180063 DOI: 10.2106/jbjs.18.00099] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bicruciate-retaining total knee arthroplasty (BCR-TKA) is attracting attention because of the functional and satisfaction outcomes associated with keeping the anterior cruciate ligament (ACL) intact. However, knowledge of the functional importance of the ACL after BCR-TKA is limited. We performed a biomechanical investigation of ACL function following BCR-TKA compared with that in the intact knee. METHODS We investigated 8 fresh-frozen human cadaveric knees using a 6-degrees-of-freedom robotic system that allowed natural joint motion. Three knee states-intact knee, BCR-TKA, and BCR-TKA with ACL transection (BCR-TKA + ACLT)-were evaluated. For each knee state, the kinematics during passive flexion-extension motion (from 0° to 120°) and anteroposterior laxity at 0°, 15°, 30°, 60°, and 90° of flexion in response to a 100-N load were investigated. The recorded knee motions of the intact and BCR-TKA knees during each test were repeated after ACLT to calculate the ACL in situ force. RESULTS The femur in the BCR-TKA group translated posteriorly and rotated externally during passive knee flexion and was in an anterior position compared with the femur in the intact-knee state. After ACLT, the femur translated posteriorly, compared with the BCR-TKA group, at 0° and 10° (p < 0.05). The anteroposterior laxities of the BCR-TKA and intact knees were comparable at all flexion angles and increased 2-fold or more after ACLT (p < 0.01). The ACL in situ force in the BCR-TKA knees was 2-fold to 6-fold higher than that in the intact knees at 0°, 15°, 90°, and 120° during a passive path (p < 0.05) and equivalent to that in the intact knees under anterior loading. CONCLUSIONS The preserved ACL in the BCR-TKA knees was functional, like the ACL in the intact knees, under anterior tibial loading and contributed to good anteroposterior stability. However, the kinematics and ACL in situ force differed between the intact and BCR-TKA knees during passive flexion-extension movements. CLINICAL RELEVANCE Surgeons may not be able to prevent overtensioning of the ACL during a standardized BCR-TKA procedure, which could potentially limit range of motion.
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Affiliation(s)
- Yohei Okada
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuzuru Sakakibara
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroaki Shoji
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan
| | - Mineko Fujimiya
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
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Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1465-1470. [PMID: 28093635 DOI: 10.1007/s00167-017-4427-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was the comparison of intraoperative kinematics, stability, and range of motion (ROM) between the native osteoarthritic knee and cruciate-substituting fixed-bearing total knee arthroplasty (TKA) using both an ultracongruent (UC) and a posterior-stabilized (PS) insert design in the same patient. We hypothesized less knee flexion and less antero-posterior stability in the UC TKA. METHODS Intraoperative measurements of kinematics, stability, and ROM were performed in 40 patients before soft-tissue release and bone cuts, and after implantation of the final femoral and tibial implants with both a UC insert and a PS insert. All measurements were performed using a navigation system. RESULTS Kinematics changed significantly from a constant posterior femoral rollback before surgery to a paradoxical anterior translation during initial knee flexion with both inserts, but less pronounced with the PS insert (p < 0.001). There was significantly more posterior femoral rollback with the PS insert compared to the UC insert (p < 0.01). Stability measurements demonstrated no differences at full extension and 30° of knee flexion but significantly increased antero-posterior translation in 60° and 90° of knee flexion with the UC insert compared to the PS insert (p < 0.001). ROM measurements demonstrated improvement of knee flexion from 118° at the beginning of the surgery to 123° with the UC insert and 128° with the PS insert (p < 0.001). CONCLUSION The use of a UC insert intraoperatively resulted in less antero-posterior stability and slightly less knee flexion compared to a PS insert. Surgeons should be aware of these differences when deciding for one of these options to substitute the posterior cruciate ligament (PCL). The impact of these findings on clinical outcome needs further investigation. LEVEL OF EVIDENCE II.
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No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:3515-3521. [PMID: 27659044 DOI: 10.1007/s00167-016-4331-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The use of an ultracongruent (UC) insert with a standard femoral component for substitution of the posterior cruciate ligament (PCL) is a bone-preserving and therefore interesting alternative to the established box and cam mechanism of posterior stabilized (PS) total knee arthroplasty (TKA). This study investigated range of motion (ROM), stability and patient-reported outcome (PRO) in UC and PS TKA. We hypothesized better knee flexion with the PS design but no difference in stability and PRO between UC and PS TKA. METHODS A randomized controlled study was performed. One hundred and twenty-seven patients were included, 63 with an UC and 64 with a PS TKA (Columbus, Aesculap, Tuttlingen, Germany). Intraoperative stability and range of motion was measured with the use of a navigation system. Patients were assessed before surgery, 3 months and 1 year postoperatively. RESULTS There was no difference in ROM between both groups, neither intraoperatively nor at follow-up. There was 5 mm less sagittal translation at 90° of knee flexion (p < 0.001) and more posterior femoral rollback during knee flexion in the PS TKA. Axial rotation between extension and knee flexion was reduced by both designs. UC TKA was 7 min faster (p = 0.001). At the one-year follow-up, the Knee Society Score was similar in both groups, the Oxford Knee Score demonstrated better results in the UC TKA group (p = 0.048). CONCLUSION Increased intraoperative sagittal translation and reduced posterior femoral rollback during knee flexion of UC TKA seem to have no negative influence on short-term clinical outcome. Therefore, UC TKA seems to be a practical alternative to the established PS TKA for substitution of the PCL. This might be especially interesting for surgeons who do not always substitute the PCL. LEVEL OF EVIDENCE I.
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Totlis T, Iosifidis M, Melas I, Apostolidis K, Agapidis A, Eftychiakos N, Alvanos D, Kyriakidis A. Cruciate-retaining total knee arthroplasty: How much of the PCL is really retained? Knee Surg Sports Traumatol Arthrosc 2017; 25:3556-3560. [PMID: 27141866 DOI: 10.1007/s00167-016-4144-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE It is questionable how much of the PCL is really preserved following a complete transverse tibial cut during a cruciate-retaining (CR) total knee arthroplasty (TKA). It is hypothesized that a complete transverse tibial cut jeopardizes the PCL tibial insertion during a common CR TKA. Thus, the aim of the present study was to assess intraoperatively the amount of PCL tibial attachment damage following a standard complete tibial cut technique. METHODS Thirty consecutive female patients suffering from degenerative knee osteoarthritis were included. Two measurements were performed on preoperative MRI images. On sagittal plane, the PCL facet of tibia and the PCL tibial attachment were measured. All 30 patients underwent a TKA using a common CR prosthesis. Postoperatively, the amount of PCL facet resection was measured on the resected tibial plateau using a digital sliding caliper. RESULTS In preoperative MRI images, the length of the PCL facet of tibia was found 25.5 ± 2.1 mm and the length of the PCL tibial attachment was 14.5 ± 1.3 mm. The amount of PCL facet resection following TKA was 20.6 ± 2.2 mm on average. This result corresponds to an average resection of 65.1 ± 15.9 % of the PCL tibial attachment following TKA. CONCLUSION The hypothesis that a complete transverse tibial cut during a conventional CR TKA jeopardizes the PCL tibial insertion was confirmed. According to measurements performed on preoperative knee MRI scans and surgical specimens of resected tibial plateaus, a significant amount of the PCL insertion on the tibia is actually removed in the majority of cases. Surgeons should be aware that when resecting the tibial plateau without using a technique that spares the PCL tibial attachment, there is a high risk of considerable damage to the PCL that may, in turn, increase the likelihood of potential complications due to PCL deficiency. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Trifon Totlis
- 2nd Orthopaedic Department of "Papageorgiou" General Hospital, Ring Road, 56403, Thessaloniki, Greece
| | - Michael Iosifidis
- 2nd Orthopaedic Department of "Papageorgiou" General Hospital, Ring Road, 56403, Thessaloniki, Greece.
| | - Ioannes Melas
- 2nd Orthopaedic Department of "Papageorgiou" General Hospital, Ring Road, 56403, Thessaloniki, Greece
| | - Konstantinos Apostolidis
- 2nd Orthopaedic Department of "Papageorgiou" General Hospital, Ring Road, 56403, Thessaloniki, Greece
| | - Alexios Agapidis
- 2nd Orthopaedic Department of "Papageorgiou" General Hospital, Ring Road, 56403, Thessaloniki, Greece
| | - Nikolaos Eftychiakos
- 2nd Orthopaedic Department of "Papageorgiou" General Hospital, Ring Road, 56403, Thessaloniki, Greece
| | - Dimitrios Alvanos
- 2nd Orthopaedic Department of "Papageorgiou" General Hospital, Ring Road, 56403, Thessaloniki, Greece
| | - Anastasios Kyriakidis
- 2nd Orthopaedic Department of "Papageorgiou" General Hospital, Ring Road, 56403, Thessaloniki, Greece
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Total knee arthroplasty using ultra-congruent inserts can provide similar stability and function compared with cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3530-3535. [PMID: 28439638 DOI: 10.1007/s00167-017-4553-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Recently, ultra-congruent (UC) inserts have shown successful outcomes following total knee arthroplasty (TKA). It was hypothesized that patients in the UC group would not show significantly different in vivo stability or functional outcomes from those in the cruciate-retaining (CR) group. METHODS The prospective study enrolled patients who had been treated with either CR or UC TKAs (38 cases in each group), after a minimum 3-year follow-up. The same surgical technique was used with the same femoral components in both groups except for the polyethylene inserts (CR or UC). The clinical outcome measures were knee range of motion (ROM), Hospital for Special Surgery (HSS) score, Knee Society (KS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale score. The mediolateral laxity at full extension and anteroposterior laxity at 90° flexion were measured in stress radiographs and compared between the two groups. RESULTS Both the CR and UC groups showed significant improvements in post-operative ROM, HSS, KS, and WOMAC scores without inter-group differences between two groups. Moreover, there were no differences in mediolateral or anteroposterior laxity between the two groups (p > 0.05). CONCLUSION TKA with posterior cruciate ligament (PCL) resection using the UC design showed comparable functional outcomes with those of CR TKA and provided similar in vivo stability. Therefore, UC inserts can be a good option in TKA without bony box cut when the PCL is damaged during an operation. LEVEL OF EVIDENCE II.
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Gait Parameters and Functional Outcomes After Total Knee Arthroplasty Using Persona Knee System With Cruciate Retaining and Ultracongruent Knee Inserts. J Arthroplasty 2017; 32:87-91. [PMID: 27436502 DOI: 10.1016/j.arth.2016.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/15/2016] [Accepted: 06/06/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is a well-established treatment for managing end-stage symptomatic knee osteoarthritis. Currently, different designs of prostheses are available with majority ensuring similar clinical outcomes. Altered surface geometry is introduced to strive toward gaining superior outcomes. We aimed to investigate any differences in functional outcomes between 2 different polyethylene designs namely the Persona CR (cruciate retaining) and Persona UC (ultracongruent) tibial inserts (Zimmer-Biomet, Warsaw, IN). METHODS This prospective single blind, single-surgeon randomized controlled trial reports on 105 patients, (66 female and 39 male), who underwent simultaneous bilateral total knee arthroplasty using the Persona knee system (Zimmer-Biomet) UC inserts in one side and CR inserts in the contralateral side. By a blind assessor, at regular time intervals patients were assessed in terms of function and gait. The functional knee scoring scales used were the Western Ontario and McMaster Universities Osteoarthritis Index and Modified Knee Society Score. The gait parameters evaluated were foot pressure and step length. RESULTS During the study period, no patient was lost to follow-up or underwent revision surgery for any cause. Western Ontario and McMaster Universities Osteoarthritis Index scores, Modified Knee Society Score, and knee range of motion of all 105 patients assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years showed statistically better results (P < .05) for UC inserts. Gait analysis measuring foot pressures and step length, however, did not show any statistically significant differences at 2-year follow-up. CONCLUSION Ultracongruent tibial inserts show significantly better functional outcomes as compared to CR inserts during a 2-year follow-up period. However, in this study these findings were not shown to be attributed to differences in gait parameters.
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Bae DK, Song SJ, Kim KI, Hur D, Lee HH. Intraoperative factors affecting conversion from cruciate retaining to cruciate substituting in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:3247-3253. [PMID: 26733275 DOI: 10.1007/s00167-015-3971-3] [Citation(s) in RCA: 12] [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: 07/26/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to analyse the factors affecting the conversion from posterior cruciate ligament (PCL)-retaining (CR) to PCL-substituting (PS) prostheses during total knee arthroplasty (TKA). METHODS A total of 920 TKAs, which had been preoperatively planned to undergo implantation of CR-type prostheses, were reviewed retrospectively. Of these, 83 knees (9.0 %) were converted intraoperatively to PS prostheses. The clinical and radiological factors of the non-converted (CR) and converted (PS) groups were compared. Clinically, age, gender, body mass index, angle of flexion contracture, size of the femoral component, and thickness of the polyethylene insert were compared between the CR and PS groups. Radiologically, the severity of the varus deformity and the posterior tibial slope angle (PSA) were compared between the CR and PS groups. RESULTS No significant differences in age, gender, body mass index, range of motion, thickness of the polyethylene insert, or severity of varus deformity were identified. The average preoperative angle of flexion contracture was 5.9° ± 7.4° in the CR group and 8.1° ± 9.1° in the PS group (p = 0.002). The average preoperative PSA was 9.6° ± 4.0° in the CR group and 11.0° ± 5.0° in the PS group (p = 0.018). The conversion rates to a PS-type femoral component of size C, D, and E were 13.1, 7.0, and 6.3 %, respectively (p = 0.004). CONCLUSION The conversion rate from CR- to PS-type prostheses was high in patients with severe flexion contracture, steep posterior slope, and a small femoral component size. These factors should be carefully considered for appropriate selection of prosthesis type. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dae Kyung Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Seoul, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 024447, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Seoul, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 024447, Korea.
| | - Kang Il Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Seoul, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 024447, Korea
| | - Dong Hur
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Seoul, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 024447, Korea
| | - Hyun Ho Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Seoul, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 024447, Korea
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Mazzucchelli L, Deledda D, Rosso F, Ratto N, Bruzzone M, Bonasia DE, Rossi R. Cruciate retaining and cruciate substituting ultra-congruent insert. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:2. [PMID: 26855938 DOI: 10.3978/j.issn.2305-5839.2015.12.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The posterior cruciate ligament (PCL) conservation and the polyethylene insert constraint in total knee arthroplasty (TKA) are still debated. The PCL is one of the primary stabilizers of the joint, but cruciate retaining (CR) implants have the disadvantage of a difficult balancing of the PCL. Postero-stabilized (PS) implants were introduced to reduce this problem. However, also the PS implants have some disadvantages, due to the cam-mechanism, such as high risk of cam-mechanism polyethylene wear. To minimize the polyethylene wear of the cam-mechanism and the bone sacrifice due to the intercondylar box, different types of inserts were developed, trying to increase the implant conformity and to reduce stresses on the bone-implant interface. In this scenario ultra-congruent (UC) inserts were developed. Those inserts are characterized by a high anterior wall and a deep-dished plate. This conformation should guarantee a good stability without the posterior cam. Few studies on both kinematic and clinical outcomes of UC inserts are available. Clinical and radiological outcomes, as well as kinematic data are similar between UC mobile bearing (MB) and standard PS MB inserts at short to mid-term follow-up. In this manuscript biomechanics and clinical outcomes of UC inserts will be described, and they will be compared to standard PS or CR inserts.
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Affiliation(s)
- Luca Mazzucchelli
- 1 University of Study of Torino, Via Po 8, 10123 Torino, Italy ; 2 AO Ordine Mauriziano, Largo Filippo Turati 62, 10128 Torino, Italy
| | - Davide Deledda
- 1 University of Study of Torino, Via Po 8, 10123 Torino, Italy ; 2 AO Ordine Mauriziano, Largo Filippo Turati 62, 10128 Torino, Italy
| | - Federica Rosso
- 1 University of Study of Torino, Via Po 8, 10123 Torino, Italy ; 2 AO Ordine Mauriziano, Largo Filippo Turati 62, 10128 Torino, Italy
| | - Nicola Ratto
- 1 University of Study of Torino, Via Po 8, 10123 Torino, Italy ; 2 AO Ordine Mauriziano, Largo Filippo Turati 62, 10128 Torino, Italy
| | - Matteo Bruzzone
- 1 University of Study of Torino, Via Po 8, 10123 Torino, Italy ; 2 AO Ordine Mauriziano, Largo Filippo Turati 62, 10128 Torino, Italy
| | - Davide Edoardo Bonasia
- 1 University of Study of Torino, Via Po 8, 10123 Torino, Italy ; 2 AO Ordine Mauriziano, Largo Filippo Turati 62, 10128 Torino, Italy
| | - Roberto Rossi
- 1 University of Study of Torino, Via Po 8, 10123 Torino, Italy ; 2 AO Ordine Mauriziano, Largo Filippo Turati 62, 10128 Torino, Italy
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Van Opstal N, Feyen H, Luyckx JP, Bellemans J. Mean tensile strength of the PCL in TKA depends on the preservation of the tibial insertion site. Knee Surg Sports Traumatol Arthrosc 2016; 24:273-8. [PMID: 25308158 DOI: 10.1007/s00167-014-3377-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 10/03/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE The tibial insertion of the posterior cruciate ligament (PCL) frequently becomes damaged when performing a tibial cut in a PCL-retaining total knee replacement (TKA). The aim of this study was to quantify the functional effect of this structural damage on the tensile strength and failure load. METHODS Six paired knees from fresh-frozen cadaver specimens were used. All soft tissues but the PCL were removed. In the left-sided specimens, a classic tibial cut at a depth of 9 mm with 3° of posterior slope was made, while in the right-sided specimens, a bone block was left in front of the tibial PCL insertion. After cementing a tibial tray, the specimens were mounted in a loading frame in 60° of flexion. The femur was translated anteriorly at a constant velocity rate of 0.5 mm/s. Tensions in the PCL were measured continuously until failure occurred. RESULTS In one specimen, the tibial PCL insertion was completely removed by the tibial cut. In the other five paired specimens, the mean tensile strength of the PCL was 380.6 ± 154.7 N in the left-sided knees. In the right-sided knees, the mean tensile strength was 738.4 ± 166.7. The average right-to-left ratio was 2.2 ± 0.7 (p = 0.006). CONCLUSION The results of this study indicate that the conventional technique for tibial preparation in cruciate-retaining total knee arthroplasty can result in a significant decrease in tensile strength of the PCL, rendering it susceptible to failure and subsequent midflexion instability. Therefore, we recommend leaving the posterior tibial cortex anterior to the PCL insertion intact when performing a cruciate-retaining TKA.
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Affiliation(s)
- N Van Opstal
- Heilig Hart Lier, Mechelsestraat 24, 2500, Lier, Belgium.
| | - H Feyen
- Heilig Hart Lier, Mechelsestraat 24, 2500, Lier, Belgium
| | - J P Luyckx
- Heilig Hart Lier, Mechelsestraat 24, 2500, Lier, Belgium
| | - J Bellemans
- Heilig Hart Lier, Mechelsestraat 24, 2500, Lier, Belgium
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Does cruciate retention primary total knee arthroplasty affect proprioception, strength and clinical outcome? Knee Surg Sports Traumatol Arthrosc 2015; 23:1644-52. [PMID: 25343873 DOI: 10.1007/s00167-014-3384-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 10/09/2014] [Indexed: 01/07/2023]
Abstract
PURPOSE It remains unclear what the contribution of the PCL is in total knee arthroplasty (TKA). The goal of this study was to investigate the influence of the PCL in TKA in relationship to clinical outcome, strength and proprioception. METHODS Two arthroplasty designs were compared: a posterior cruciate-substituting (PS) and a posterior cruciate-retaining (CR) TKA. A retrospective analysis was performed of 27 CR and 18 PS implants with a minimum of 1 year in vivo. Both groups were compared in terms of clinical outcome (range of motion, visual analogue scale for pain, Hospital for Special Surgery Knee Scoring system, Lysholm score and Knee Injury and Osteoarthritis Outcome Score), strength (Biodex System 3 Dynamometer(®)) and proprioception (balance and postural control using the Balance Master system(®)). Each design was also compared to the non-operated contralateral side in terms of strength and proprioception. RESULTS There were no significant differences between both designs in terms of clinical outcome and strength. In terms of proprioception, only the rhythmic weight test at slow and moderate speed shifting from left to right was significant in favour of the CR design. None of the unilateral stance tests showed any significant difference between both designs. There was no difference in terms of strength and proprioception between the operated side and the non-operated side. CONCLUSION Retaining the PCL in TKA does not result in an improved performance in terms of clinical outcome and proprioception and does not show any difference in muscle strength. LEVEL OF EVIDENCE III.
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