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Gattu N, Sutton M, Doherty DB, Lanfermeijer ND, Rodriguez-Quintana D, Ismaily SK, Pletka CA, Noble PC, Han S. Variations in Trochlear Morphology of Contemporary and Legacy Total Knee Arthroplasty Prostheses: A Review of 22 Designs. J Arthroplasty 2024; 39:1583-1588. [PMID: 38072096 DOI: 10.1016/j.arth.2023.12.010] [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: 10/07/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/01/2024] Open
Abstract
BACKGROUND The morphology of the trochlear compartment of total knee arthroplasty (TKA) prostheses is a major determinant of postoperative patello-femoral kinematics, particularly with unresurfaced patellae. The objective of this study was to quantify and compare the trochlear morphology of a large series of contemporary and legacy TKA designs. METHODS The 3-dimensional surface models of 22 femoral components (13 contemporary and 9 legacy) were created using high-resolution laser scanning. The trochlear profile of each component was analyzed from proximal to distal in 15° increments around the trochlear axis. In each profile, the following variables were measured: sulcus angle, medio-lateral deviation of the sulcus, the height and width of the facets, and the trochlear groove orientation. RESULTS In the contemporary group, the sulcus angle decreased progressively along the trochlear arc to varying degrees, except for 2 symmetrical designs, whereas the sulcus angle of the legacy designs showed considerable variability. The height of the medial facet was very strongly correlated with that of the lateral facet in the contemporary group (R2 = 0.89), whereas the correlation was weak for the legacy designs (R2 = 0.36). Moreover, the trochlear sulcus deviated laterally from distal to proximal in 10 contemporary designs and 7 legacy designs, resulting in a trochlear groove orientation of 4.2 to 11.1° and 4.3 to 10.5°, respectively. In the remaining 5 designs (3 contemporary and 2 legacy), the sulcus was vertical. CONCLUSIONS There is more consistency in trochlear morphology of contemporary TKA designs compared to that of legacy designs, yet there are still large variations between different designs.
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Affiliation(s)
- Nikhil Gattu
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Marriah Sutton
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David B Doherty
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nicholas D Lanfermeijer
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David Rodriguez-Quintana
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Camryn A Pletka
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Philip C Noble
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
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Orsi AD, Shatrov J, Plaskos C, Kreuzer S. Personalized alignment techniques better restore the native trochlear groove compared to systematic alignment techniques in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:915-928. [PMID: 38426570 DOI: 10.1002/ksa.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The relationship between constitutional coronal alignment and implant positioning on trochlear groove restoration in total knee arthroplasty (TKA) is poorly understood. This study aimed to determine whether the choice of alignment philosophy significantly affects the restoration of the trochlea groove. METHODS Sixty-one imageless robotic TKAs performed by a single orthopaedic surgeon were retrospectively reviewed. In each case, the entire native trochlea was digitized to generate the native femoral anatomy, and implants were planned according to a functional alignment (FA) technique. Final implant position was recorded using the validated bone resection planes from the navigation system. Simulated femoral component positions were generated according to previously described alignment techniques: mechanical alignment (MA), gap balancing (GB), kinematic alignment (KA), restricted kinematic alignment (rKA) and restricted inverse kinematic alignment (riKA). Trochlear angle (TA), trochlear under/overstuffing and mediolateral sulcus offset were compared between the six simulated alignment techniques, as well as the final implanted technique. Further analyses investigated the effect of preoperative coronal alignment on trochlear position. Comparisons were assessed with an analysis of variance and Welch's t-tests or Wilcoxon's rank-sum tests with Bonferroni corrections. RESULTS The implanted and simulated techniques all resulted in greater TA valgus compared to the native groove (p < 0.001). The implanted technique, KA and rKA were closer to the native TA than GB, MA and riKA (p > 0.001). All alignment philosophies understuffed the native trochlea groove. KA and rKA understuffed less than all other techniques (p < 0.001), and GB understuffed more than all other techniques (p < 0.001). In extension, all techniques shifted the trochlear sulcus laterally, while in flexion, they medialized it. These effects were most prominent in GB and MA. CONCLUSION Personalized alignment techniques such as KA and rKA, which consider variations in individual anatomy, best restore the native patellar groove compared to systematic alignment techniques when using a standardized femoral component. LEVEL OF EVIDENCE Level III, retrospective review.
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Affiliation(s)
| | - Jobe Shatrov
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
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Dossett HG, Deckey DG, Clarke HD, Spangehl MJ. Individualizing a Total Knee Arthroplasty with Three-Dimensional Planning. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00010. [PMID: 38478756 PMCID: PMC10923344 DOI: 10.5435/jaaosglobal-d-24-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 03/17/2024]
Abstract
Total knee arthroplasty (TKA) is evolving from mechanical alignment to more individualized alignment options in an attempt to improve patient satisfaction. Thirteen-year survival of kinematically aligned prostheses has recently been shown to be similar to mechanically aligned TKA, allaying concerns of long-term failure of this newer individualized technique. There is a complex inter-relationship of three-dimensional knee and limb alignment for a TKA. This article will review planning parameters necessary to individualize each knee, along with a discussion of how these parameters are related in three dimensions. Future use of computer software and machine learning has the potential to identify the ideal surgical plan for each patient. In the meantime, the material presented here can assist surgeons as newer individual alignment planning becomes a reality.
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Affiliation(s)
- Harold Gene Dossett
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - David G. Deckey
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - Henry D. Clarke
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - Mark J. Spangehl
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
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Saeed AZ, Khaleeq T, Ahmed U, Ajula R, Boutefnouchet T, D'Alessandro P, Malik SS. No clinical advantage with customized individually made implants over conventional off-the-shelf implants in total knee arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:1311-1330. [PMID: 37979098 DOI: 10.1007/s00402-023-05090-8] [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: 02/15/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) can be performed with either conventional off-the-shelf (OTS) or customized individually-made (CIM) implants. The evidence for CIM implants is limited and variable, and the aim of this review was to compare clinical and radiological outcomes between CIM and OTS implants. METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Studies reporting on clinical, radiological, or alignment outcomes for CIM and OTS implants were selected. The studies were appraised using the Methodical index for non-randomized studies tool. RESULTS Twenty-three studies fulfilled the inclusion criteria. The studies comprised 2856 CIM and 1877 OTS TKAs. Revision rate was higher with CIM (5.9%) compared to OTS (3.7%) implants [OR 1.23(95% CI 0.69-2.18)]. Manipulation under anesthesia (MUA) was higher in CIM (2.2%) compared to OTS (1.1%) group [OR 2.95(95% CI 0.95-9.13)] and complications rate was higher in CIM (5%) vs. OTS (4.5%) [OR 1.45(95% CI 0.53-3.96)] but neither reached statistical significance. Length of stay was significantly shorter in CIM group 2.9 days vs. 3.5 days [MD - 0.51(95% CI - 0.82 to - 0.20)]. Knee Society Score showed no difference between CIM and OTS groups for Knee 90.5 vs. 90.6 [MD - 0.27(95% CI - 4.27 to 3.73)] and Function 86.1 vs. 83.1 [MD 1.51(95% CI - 3.69 to 6.70)]. CONCLUSION CIM implants in TKA have theoretical benefits over OTS prostheses. However, in this present review, CIM implants were associated with higher revisions, MUA, and overall complication rates. There was no difference in outcome score and CIM implants did not improve overall target alignment; however, more CIM TKAs were found to be in the HKA target zone compared to OTS TKAs. The findings of this review do not support the general utilization of CIM over OTS implants in TKA.
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Affiliation(s)
- Abu Z Saeed
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK.
| | - Tahir Khaleeq
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK
| | - Usman Ahmed
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Randeep Ajula
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Peter D'Alessandro
- Orthopaedic Research Foundation of Western Australia, Medical School, Discipline of Surgery, University of Western Australia, Perth, Australia
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Karasavvidis T, Pagan Moldenhauer CA, Lustig S, Vigdorchik JM, Hirschmann MT. Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) - there is no winner yet. J Exp Orthop 2023; 10:120. [PMID: 37991599 PMCID: PMC10665290 DOI: 10.1186/s40634-023-00697-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Dissatisfaction following total knee arthroplasty (TKA) has been extensively documented and it was attributed to numerous factors. In recent years, significant focus has been directed towards implant alignment and stability as potential causes and solutions to this issue. Surgeons are now exploring a more personalized approach to TKA, recognizing the importance of thoroughly understanding each individual patient's anatomy and functional morphology. A more comprehensive preoperative analysis of alignment and knee morphology is essential to address the unresolved questions in knee arthroplasty effectively. The crucial task of determining the most appropriate alignment strategy for each patient arises, given the substantial variability in bone resection resulting from the interplay of phenotype and the alignment strategy chosen. This review aims to comprehensively present the definitions of different alignment techniques in all planes and discuss the consequences dependent on knee phenotypes.Level of evidence V.
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Affiliation(s)
- Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Cale A Pagan Moldenhauer
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Sébastien Lustig
- Department of Orthopaedic Surgery and Sports Medicine, Croix-Rousse Hospital, Lyon, 69004, France
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, CH-4101, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, CH-4001, Switzerland
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Shatrov J, Coulin B, Batailler C, Servien E, Walter B, Lustig S. Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology. INTERNATIONAL ORTHOPAEDICS 2023; 47:329-341. [PMID: 36112197 PMCID: PMC9877070 DOI: 10.1007/s00264-022-05570-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE The ability of kinematic alignment (KA) to consistently restore trochlea anatomy in total knee arthroplasty (TKA) is unknown despite recreation of constitutional anatomy being its rationale for use. The purpose of this study was to assess if alignment choice in TKA effects the ability to restore the native trochlea groove. METHODS One hundred and twenty-two consecutive patients undergoing robotic-assisted TKA using the MAKO image-based robotic platform had simulated femoral components placed according to kinematic, mechanical and functional alignment principals. Implant position and trochlea restoration between groups were compared. Restoration was assessed by shift (medial-lateral) and depth relative to the native groove from three consistent points; full extension (0°), mid-flexion (30°-40°) and deep flexion (70°-80°). RESULTS Three hundred and sixty-six alignment options were analysed. Femoral alignment was significantly different between groups. Of KA, 13.1% compared to 3.3% of FA plans were outside safe coronal boundaries. The trochlear groove was translated the most by MA compared to KA and FA (full extension, MA 7.84 ± 1.99 mm lateral to the native groove, KA 6.40 ± 2.43 mm and FA 6.88 ± 1.74 mm, p ≤ 0.001). In full extension, FA most closely restored the trochlear groove depth in all three positions of flexion. CONCLUSION Alignment philosophy led to significant differences in trochlea groove recreation. A kinematically placed femoral component led to positioning considered unsafe in over 13% of cases. A functionally placed femoral component most closely restored trochlea depth in all three positions of flexion.
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Affiliation(s)
- Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Sydney Orthopaedic Research Institute at Landmark Orthopaedics, St. Leonards, Sydney, Australia
| | - Benoit Coulin
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Bill Walter
- University of Sydney, St Leonards, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Sebastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
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