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D'Ambrosi R, Rubino F, Ursino C, Mariani I, Ursino N, Formica M, Prinz J, Migliorini F. Change in patellar height in medial and lateral unicompartmental knee arthroplasty: a clinical trial. Arch Orthop Trauma Surg 2024; 144:1345-1352. [PMID: 38108862 PMCID: PMC10896931 DOI: 10.1007/s00402-023-05139-8] [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: 07/24/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Evidence on patellar height changes following unicompartmental knee arthroplasty (UKA) is lacking. Therefore, this study compared the patella height in patients who underwent medial versus lateral UKA. Moreover, a subgroup analysis was conducted to investigate whether sex, age, and BMI of the patients exert an influence on the postoperative patellar height. METHODS Radiographs and hospital records of patients undergoing UKA were prospectively collected. Surgeries were performed by one author with long experience in UKA in a highly standardised fashion. The implants were fixed-bearing medial PPK (Zimmer Biomet, Warsaw, Indiana, USA) and fixed-bearing lateral ZUK (Lima Corporate, Udine, Italy). The patellar height was measured using the Insall-Salvati and Caton-Deschamps indices. RESULTS A total of 203 patients were included: 119 patients were included in the medial and 84 in the lateral UKA. The mean age of the patients was 68.9 ± 6.7 years, and the mean BMI was 28.1 ± 4.1 kg/m2. 54% (110 of 203 patients) were women. On admission, between-group comparability was found in age, BMI, sex, and length of the follow-up. No between-group and within-group difference was detected pre- and post-operatively in the Insall-Salvati and Caton-Deschamps indices in patients who have undergone medial versus lateral UKA. Concerning the subgroup analyses, no between-group and within-group difference was detected pre- and post-operatively in all comparisons according to sex, age, and BMI. CONCLUSION No difference was found in patella height in patients who have undergone medial compared to lateral UKA. Furthermore, there was no evidence of an association between patient characteristics (sex, age, BMI) and patella height between medial and lateral UKA.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Francesco Rubino
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Chiara Ursino
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Matteo Formica
- Orthopaedic Clinic, IRCCS Hospital Policlinico San Martino, Genoa, Italy
- DISC - Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Julia Prinz
- Department of Ophthalmology, RWTH University Hospital, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
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Brutico J, Paul RW, Wright M, Destine H, Johnson EE, Bishop ME, Erickson BJ, Freedman KB, Tjoumakaris FP. Preoperative Patella Alta on Caton-Deschamps Index Is a Predictor of Outcome Following Isolated Medial Patellofemoral Ligament Reconstruction. Arthrosc Sports Med Rehabil 2023; 5:e523-e528. [PMID: 37101886 PMCID: PMC10123505 DOI: 10.1016/j.asmr.2023.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 02/14/2023] [Indexed: 03/13/2023] Open
Abstract
Purpose The purpose of this study was to determine whether a preoperative Caton-Deschamps index (CDI) ≥ 1.30, as measured by magnetic resonance imaging, is associated with rates of postoperative instability, revision knee surgery, and patient-reported outcomes in patients undergoing isolated medial patellofemoral ligament (MPFL) reconstruction. Methods Patients who underwent primary medial patellofemoral ligament reconstruction (MPFLR) between 2015 and 2019 at a single institution were assessed. Only those with at least 2 year follow up were included. Patients who had undergone a previous ipsilateral knee surgery, concomitant tibial tubercle osteotomy and/or ligamentous repair/reconstruction at the time of MPFL reconstruction were excluded from the study. CDIs were evaluated by three investigators based on magnetic resonance imaging measurement. Patients with a CDI ≥ 1.30 were included in the patella alta group, while those with a CDI between 0.70 and 1.29 served as controls. A retrospective review of clinical notes was used to evaluate the number of postoperative instability episodes and revisions. Functional outcomes were measured by the International Knee Documentation Committee (IKDC) and 12-Item Short Form Health Survey (SF-12) physical and mental scores. Results Overall, 49 patients (50 knees, 29 males, 59.2%) underwent isolated MPFLR. Nineteen (38.8%) patients had a CDI ≥ 1.30 (mean: 1.41, range: 1.30-1.66). The patella alta group was significantly more likely to experience a postoperative instability episode (36.8% vs 10.0%; P = .023) and was more likely to return to the operating room for any reason (26.3% vs 3.0%; P = .022) compared to those with normal patellar height. Despite this, the patella alta group had significantly greater postoperative IKDC (86.5 vs 72.4; P = .035) and SF-12 physical (54.2 vs 46.5; P = .006) scores. Pearson's correlation showed a significant association between CDI and postoperative IKDC (R 2 = 0.157; P = .022) and SF-12P (R 2 = .246; P = .002) scores. There was no difference in postoperative Lysholm (87.9 vs 85.1; P = .531). and SF-12M (48.9 vs 52.5; P = .425) scores between the groups. Conclusion Patients with preoperative patella alta, as measured by CDI had higher rates of postoperative instability and return to the OR with isolated MPFL reconstruction for patellar instability. Despite this, higher preoperative CDI was associated with greater postoperative IKDC scores and SF-12 physical scores in these patients. Level of Evidence Retrospective cohort study, Level IV.
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Affiliation(s)
- Joseph Brutico
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Maggie Wright
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Henson Destine
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Emma E. Johnson
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | | | | | - Fotios P. Tjoumakaris
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
- Address correspondence to Fotios Tjoumakaris, M.D., Rothman Orthopaedics at Thomas Jefferson University, 125 South 9th St., Philadelphia, PA, 19130, U.S.A.
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Schreiner AJ, Spiegel L, Yan SG, Konrads C, Erne F, Hemmann P, Schmidutz F. Evaluation of modified and newly applied patella height indices in primary total knee arthroplasty. Skeletal Radiol 2023; 52:73-82. [PMID: 35943544 PMCID: PMC9666313 DOI: 10.1007/s00256-022-04142-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this radiological study was to compare several relevant modified and newly applied patella height indices (PHI) in navigated primary total knee arthroplasty (TKA) to determine intra- and interobserver reliability in order to give a recommendation for clinical application in measuring patella height (PH) in primary TKA. MATERIALS AND METHODS A retrospective data analysis assessing different PHI (modified Insall-Salvati index (mISI), Caton-Deschamps index (mCDI), Blackburne-Peel index (mBPI), Plateau-Patella Angle (mPPA); Miura-Kawaramura index (MKI), Knee-Triangular index (KTI)) on lateral knee radiographs was performed by two blinded observers using the same software three months pre- and postoperatively. Concordance correlation coefficient and Pearson's correlation respectively were determined for intra- and interobserver rating as well as a categorization according to Landis and Koch and Cohen. RESULTS A total of 337/291 patients of a 5-year period could be analyzed pre-/postoperatively. Excellent postoperative interrater results according to the categorization of Landis and Koch were achieved for the mBPI (Pearson 0.98) > mPPA (0.90) > KTI (0.86), good results for the MKI (0.79) and the mCDI (0.69), and moderate results for the mISI (0.52) with a predominantly strong Cohen correlation in almost all cases. Preoperatively, the mBPI and the KTI were the best interrated PHI. No PH changes could be found postoperatively for the mISI, KTI, MKI, and mPPA. CONCLUSION The mBPI, the mPPA, and the KTI can be recommended for PH assessment in TKA. The mPPA might be the easiest one to use in a daily clinical set-up.
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Affiliation(s)
- Anna Janine Schreiner
- Orthopaedic Clinic Markgroeningen, Markgroeningen, Germany ,grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Lena Spiegel
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Shuang Gen Yan
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.412679.f0000 0004 1771 3402Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No. 1 Baicao Road, Hefei, 230088 China
| | - Christian Konrads
- grid.10392.390000 0001 2190 1447Department of Orthopaedic Surgery, University of Tuebingen, Tuebingen, Germany
| | - Felix Erne
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Philipp Hemmann
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Florian Schmidutz
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.5252.00000 0004 1936 973XDepartment of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany ,Orthopedic Surgery, Orthopedic Center Rosenheim, Rosenheim, Germany
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Lee OS, Lee J, Lee MC, Han HS. Effect of Posterior Tibial Slope Change on Postoperative Range of Motion and Clinical Outcomes after Posterior Cruciate-Substituting Total Knee Arthroplasty. J Knee Surg 2023; 36:87-94. [PMID: 33992035 DOI: 10.1055/s-0041-1729967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the preoperative and postoperative PTS, ROM, visual analog scale pain scale, Western Ontario and McMaster University Index (WOMAC), Hospital for Special Surgery Knee Score, Knee Society Score, and Forgotten Joint Score (FJS). The association of the absolute change in PTS with ROM and clinical scores was analyzed using correlation analysis and multiple regression analysis. As a result, the mean PTS and mean ROM changed from 9.6 ± 3.4 and 120.1 ± 15.4 degrees preoperatively to 2.0 ± 1.3 and 128.4 ± 9.3 degrees postoperatively, and the mean PTS change was 7.6 ± 3.5 degrees. The PTS change had no statistically significant association with the postoperative ROM and clinical scoring systems, although it did have a weak positive correlation with WOMAC function, No 10 (difficulty in rising from sitting) (correlation coefficient = 0.342, p = 0.041), and moderate positive correlation with the FJS, No. 6 (awareness when climbing stairs) (correlation coefficient = 0.470, p = 0.001). The authors concluded that the amount of change in PTS did not affect the postoperative ROM and clinical scores, although proximal tibial resection with a constant target of PTS resulted in individually different changes in the PTS after PS TKA.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si, Korea (the Republic of)
| | - Jangyun Lee
- Department of Orthopedic Surgery, National Medical Center, Seoul, Korea (the Republic of)
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
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Konrads C, Schreiner AJ, Cober S, Schüll D, Ahmad SS, Alshrouf MA. Evaluation of patella height in native knees and arthroplasty: an instructional review. SICOT J 2022; 8:36. [PMID: 35997518 PMCID: PMC9397114 DOI: 10.1051/sicotj/2022037] [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: 06/22/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Total knee arthroplasty (TKA) is the gold standard for treating advanced knee osteoarthritis. Among the postoperative complications of TKA are true patella infera (TPI) and pseudo patella infera (PPI), which should be differentiated since TPI exhibits significantly worse clinical outcomes. Multiple radiological patella height indices (PHI) exist; some were modified or originally designed for knees with implanted endoprostheses. However, there is no consensus on measuring and comparing patella height. Due to the lack of established, simple, reliable, and reproducible concepts for assessing patella height for arthroplasty, measuring patella height and the change of patella height by or after TKA have been challenging tasks for clinicians and researchers. This is a review of the current literature on methods for measuring patella height, with special attention to the ability to differentiate between the TPI and PPI after TKA. All literature on the topic was retrieved, and references from relevant articles were investigated until the end of April 2022.
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Affiliation(s)
- Christian Konrads
- Department of Orthopaedic Surgery, University of Tübingen, 72076 Tübingen, Germany
| | | | - Simone Cober
- Department of Orthopaedic Surgery, University of Tübingen, 72076 Tübingen, Germany
| | - Daniel Schüll
- Department of Orthopaedic Surgery, University of Tübingen, 72076 Tübingen, Germany
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany
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OTAĞ İLHAN, ÇIMEN KAAN, TORUN YUNIS, PAZARCI ÖZHAN, AKKOYUN SERKAN, OTAĞ AYNUR, ÇIMEN MEHMET. MODELING OF PATELLA HEIGHT WITH DISTAL FEMUR AND PROXIMAL TIBIA REFERENCE POINTS WITH ARTIFICIAL NEURAL NETWORK. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The patellofemoral joint is one of the parts of the knee extension mechanism that plays a role in the stability of the knee by enlarging the force arm of the quadriceps muscle and changing the direction of the muscle strength. For the entire knee joint to perform its task painlessly and functionally, the positions and strength of the muscles, the strength of the ligaments, and their reaction to movement must be compatible. The Insall–Salvati (Ins-Sal) index is useful for showing changes in patellar height produced by repositioning the tibial plateau, in other words, showing changes in patellar tendon length. Patella height is an important value to be taken into account in knee prosthesis surgery, tibial osteotomy, and anterior cruciate ligament reconstruction. The morphometric relationship between the reference measurements of the distal femur and proximal tibia and the position of the patella will be useful in determining the natural anatomy. In this study, we aimed to determine the relationship between patella height and distal femur and proximal tibia reference areas by using the artificial neural network method as an alternative approach method. In order to assess the performance of the estimation of the Ins-Sal index, the four ANN model with six input combinations which included age, gender and the reference measurements for the right and left sides have been constructed and tested. The MSE and [Formula: see text] values are calculated for every four models for the training and test phase. The results show that the proposed approach for modeling of relation between reference measurements and the Ins-Sal index is a powerful approach.
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Affiliation(s)
- İLHAN OTAĞ
- Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - KAAN ÇIMEN
- Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - YUNIS TORUN
- Department of Electric-Electronics Engineering, Sivas Cumhuriyet University, Sivas, Turkey
- Artificial Intelligence Systems and Data Science Application and Research Center, Sivas Cumhuriyet University, Sivas, Turkey
| | - ÖZHAN PAZARCI
- Department of Orthopedics and Traumatology, Sivas Cumhuriyet University, Sivas, Turkey
| | - SERKAN AKKOYUN
- Artificial Intelligence Systems and Data Science Application and Research Center, Sivas Cumhuriyet University, Sivas, Turkey
- Department of Physics, Faculty of Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - AYNUR OTAĞ
- Department of Physiotherapy, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - MEHMET ÇIMEN
- Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
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Cenni MHF, Pinheiro Junior LFB, Oliveira MAD, Lago AG, Rodrigues RC. Variação da altura patelar nas artroplastias totais do joelho e sua relação com a substituição ou não da patela. Rev Bras Ortop 2021; 58:67-71. [PMID: 36969769 PMCID: PMC10038717 DOI: 10.1055/s-0041-1736468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/25/2021] [Indexed: 10/19/2022] Open
Abstract
Resumo
Objetivo Comparar a medida da altura patelar no pré- e pós-operatório das artroplastias totais do joelho (ATJs) e sua variação nos pacientes com e sem substituição patelar.
Métodos Avaliação retrospectiva de radiografias de pacientes submetidos a ATJ entre 2014 e 2020. Foi feita a avaliação de radiografias em perfil, usando o índice de altura patelar de Caton-Deschamps modificado, comparando as medidas do pré- e pós-operatório de 90 pacientes, totalizando 100 joelhos. A seguir, foi feita a comparação de dois grupos, com técnica cirúrgica distinta, considerando a substituição ou não da patela. Todos os pacientes que tiveram radiografias avaliadas tiveram indicação de ATJ por osteoartrose sem procedimentos prévios que pudessem interferir na altura patelar.
Resultados A análise estatística demonstrou uma diferença estatisticamente significativa, sendo o índice pré-operatório superior ao pós-operatório; evidenciando um abaixamento global da altura patelar. O índice Caton-Deschamps modificado para ATJ pré-operatório médio foi de 1,41 (±0,25), e o pós foi de 1,31 (±0,25), p < 0,001.Não foi encontrada diferença significativa na variação deste índice quando comparados os grupos com e sem substituição patelar. A diferença média do índice no grupo sem patela foi de 0,11 e no grupo com patela foi de 0,08, sendo esta diferença considerada não significativa, p = 0,510.
Conclusão Podemos concluir que a altura patelar teve variação significativa no grupo total, com redução da altura patelar no pós-operatório. Entretanto, a altura não variou de forma significativa entre os grupos pós-operatórios com e sem substituição patelar, independentemente da opção do cirurgião.
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Cao L, Sun K, Yang H, Wang H, Zeng R, Fan H. Influence of Patellar Morphology Classified by Wiberg Classification on Knee Joint Function and Patellofemoral Tracking After Total Knee Arthroplasty Without Patellar Resurfacing. J Arthroplasty 2021; 36:3148-3153. [PMID: 33962823 DOI: 10.1016/j.arth.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/06/2021] [Accepted: 04/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To evaluate the influence of patellar morphology on knee joint function and patellofemoral tracking in patients with primary osteoarthritis after total knee arthroplasty (TKA) without patellar resurfacing. METHODS We performed a retrospective study of 156 patients with primary osteoarthritis who underwent TKA without patellar resurfacing from April 2018 to July 2019. As per Wiberg classification, patients were divided into Wiberg type I (group A, n = 38), II (group B, n = 88), and III (group C, n = 30) groups. The clinical data, postoperative follow-up data, and radiological data between three groups were compared. RESULTS There was no statistically significant difference in the HSS score and Feller score between the three groups before surgery and at each follow-up point after surgery (P > .05). At the last follow-up, there were no significant differences in the height and relative thickness of the patella between the three groups (P > .05). However, the incidence of anterior knee pain was significantly higher in group C than in the group B (P < .05). The patellar tilt angle was significantly larger in group C than in the groups A and B (both P < .05). The patellar facet angle was significantly larger in group A than in group B and C, which was also significantly larger in group B than in group C (both P < .05). CONCLUSION Patients with three different morphologic types of the patella both exhibited improved knee joint function after TKA, however, patients with Wiberg type Ⅲ patella were more prone to have poor patellofemoral tracking and anterior knee pain after surgery.
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Affiliation(s)
- Le Cao
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Kai Sun
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Haitao Yang
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Hanbang Wang
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Ran Zeng
- Department of Intensive Care Unit, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Haitao Fan
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
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Laubach M, Hellmann JT, Dirrichs T, Gatz M, Quack V, Tingart M, Betsch M. Anterior knee pain after total knee arthroplasty: A multifactorial analysis. J Orthop Surg (Hong Kong) 2021; 28:2309499020918947. [PMID: 32338135 DOI: 10.1177/2309499020918947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Dissatisfaction and an impaired quality of life after total knee arthroplasty (TKA) is often associated with postsurgical anterior knee pain (AKP). The underlying pathological mechanisms are not yet fully understood. Therefore, a multifactorial approach encompassing clinical and radiological parameters seemed reasonable and promising to investigate postsurgical AKP. METHODS In this cross-sectional study, 25 patients without and 25 patients with postsurgical AKP after unilateral TKA were randomly recruited from a larger cohort of patients. Multiple clinical and radiological parameters-including real-time shear wave elastography (SWE) to measure the patellar and quadriceps tendon elasticity-were acquired and subsequently associated with AKP. For statistical analysis, SPSS (IBM, version 25) was used. RESULTS In total 50 participants (58.0% men, mean age 63.42 years, mean body mass index 29.75 kg/m2), having different prosthetic designs implanted, were included. Independently of key covariates, the strength of the quadriceps muscle (p = 0.021), a thinner inlay (p = 0.041), and a lower position of the patella (p = 0.041) were associated with AKP. Although no correlation with AKP was found (p = 0.346, resp. p = 0.154), we observed significantly decreased Young's modulus of the patellar and quadriceps tendons for the involved knee compared to the uninvolved knee (p < 0.001). CONCLUSION In conclusion, quadriceps muscle strength, inlay thickness, and the patella position might be of particular relevance in avoiding postsurgical AKP. Future studies with larger sample sizes are needed to clarify the impact of quadriceps muscle strength and the postoperative patella position as well as the role of SWE as a personalized modifiable prediction marker.
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Affiliation(s)
- Markus Laubach
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Julian Tr Hellmann
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Gatz
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
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Creteur V, De Angelis R, Absil J, Kyriakidis T, Madani A. Sonographic and radiographic evaluation of the extensor tendons in early postoperative period after total knee arthroplasty. Skeletal Radiol 2021; 50:485-494. [PMID: 32803377 DOI: 10.1007/s00256-020-03574-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/02/2020] [Accepted: 08/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To prospectively assess the early changes in the quadriceps and patellar tendons before and after total knee arthroplasty using ultrasound, shear wave elastography, and X-rays. MATERIALS AND METHODS Radiographs, ultrasound, and shear wave elastography were performed on 23 patients (16 women; aged 51-85, mean 66 ± 9 years) before and after surgery at 6 weeks and on 11 patients at 3 months. Patellar position and patellar tendon lengths were evaluated by radiography; joint effusion or synovitis, quadriceps and patellar tendon lengths, and thicknesses, echogenicity, vascularity, and stiffness were assessed with ultrasound and shear wave elastography. RESULTS In the early postoperative period, 87% of the patients had joint effusion, and 43% had signs of synovitis. There was a significant thickening of the quadriceps tendon in 51.5% (p < .0001) and of the patellar tendon in 93.8% (p < .0001) of patients with a significant shortening of the patellar tendon in 7.8% (p < .0001). A hypoechoic defect on the medial aspect of the quadriceps tendon was found in 87% of the patients. There was a significant increase in Young's modulus in the quadriceps tendon (p = .0006) but not in the patellar tendon. CONCLUSION The following should not be considered to be pathological findings at early postoperative imaging: joint effusion, synovitis, increasing of stiffness and thickening of quadriceps tendons by more than 50%, thickening of patellar tendon by more than 90%, focal defect through the medial aspect of the quadriceps tendon, and shortening of the patellar tendon by 8%.
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Affiliation(s)
- Viviane Creteur
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Riccardo De Angelis
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Theofylaktos Kyriakidis
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Afarine Madani
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium.
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Improving radiographic patello-femoral tracking in total knee arthroplasty with the use of a flexion spacer: a case-control study. Knee Surg Sports Traumatol Arthrosc 2021; 29:586-593. [PMID: 32279109 DOI: 10.1007/s00167-020-05991-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to compare the effectiveness of a flexion spacer in the clinical and radiological outcomes of patients who underwent total knee arthroplasty (TKA) and to compare these patients to a group of patients subjected to the same type of surgery but without the use of a flexion spacer. It was hypothesized that patients who underwent TKA using a flexion spacer would have better clinical and radiological outcomes than those without a flexion spacer in both short- and medium-term follow-ups. METHODS A consecutive series of patients undergoing TKA were included, yielding 20 patients in the study group. The control group was identified from the consultant database of the senior author, yielding 21 patients who underwent the same operation. All 41 patients received a Vanguard Knee System (Zimmer-Biomet, Warsaw, Indiana, USA). Cases were defined as those patients who had undergone TKA using a flexion spacer device for gap balancing; controls were defined as patients who had undergone TKA without the support of a flexion spacer device. Patients were clinically and radiographically evaluated at two consecutive follow-ups: T1-13.1 ± 1.3 months and T2-108 ± 6 months. Clinical evaluation was performed using the Knee Society Scoring System and the Western Ontario, McMaster Universities Osteoarthritis Index score. Radiographic evaluation included the femoral angle (α), the tibial angle (β), the sagittal femoral (γ) angle and the tibial slope (δ). Furthermore, the lateral patellofemoral angle (LPFA) and the Caton-Deschamps index were evaluated. RESULTS No statistically significant clinical differences were found between the two groups at T1 and T2; moreover, the clinical outcomes of the two groups were stable between the two follow-ups, with no significant improvement or worsening. Radiographic evaluation showed no difference in the two groups between T1 and T2; the only significant radiographic difference between the two groups concerned the LPFA (both at 30° and 60°) at each follow-up, which was significantly greater in cases than in controls (p = 0.001). CONCLUSIONS The current study demonstrates that the use of a flexion spacer significantly improves radiographic patello-femoral tracking, although no significant clinical differences were found between the two groups. LEVEL OF EVIDENCE Case-control study, level III.
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Reliability of a Caton-Deschamps-derived patella height index for knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:2001-2005. [PMID: 33471223 PMCID: PMC8338832 DOI: 10.1007/s00264-020-04931-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/29/2020] [Indexed: 12/01/2022]
Abstract
Purpose The original Caton-Deschamps index (oCDI) detects functional patella height. It cannot be used in knees with an implanted endoprosthesis. The “modified Caton-Deschamps index” (mCDI) for knee arthroplasty can miss pseudo-patella-infera (PPI), which is common after TKA. A derivate of the oCDI could be a simple analogue to the index published in 1982 using a modified tibial reference point at the anterior proximal point of the inlay, which can indirectly be located on the lateral knee radiograph. It was the aim of this study to determine the intra- and inter-rater agreement of a derived Caton-Deschamps index (dCDI) for knee arthroplasty. We hypothesized that the derived Caton-Deschamps index (dCDI) is a reliable radiological measure for patella height in knee arthroplasty. Methods Several patella height indices were measured by three independent raters in two passes. The second pass was performed after 6 weeks in random order. Intra- and inter-observer agreements were determined and analyzed using the intraclass correlation coefficient (ICC). For radiographic evaluation, digital lateral radiographs of 150 knees before and after primary TKA were used. Results We found high interrater reliability for all analyzed indices. We found the highest agreements for the ISI preop (ICC = 0.914) and postop (ICC = 0.920), respectively. We also found very good intra-rater reliability for the CDI (ICCpreop = 0.954), dCDI (ICCpostop = 0.945), ISI (ICCpreop = 0.960; ICCpostop=0.940) and BPI (ICCpreop = 0.969; ICCpostop = 0.955). Fourteen cases (9.3%) with insignificant PPI were found. Conclusion The derived Caton-Deschamps index (dCDI) can easily be used in knee arthroplasty and demonstrated high intra- and interrater agreement, which was similar to other commonly used and established patella height indices.
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Bayomy AF, Forrester LA, Crowley SG, Popkin CA. Eponyms in Pediatric Sports Medicine: A Historical Review. Open Access J Sports Med 2021; 12:11-22. [PMID: 33488127 PMCID: PMC7814277 DOI: 10.2147/oajsm.s287663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023] Open
Abstract
The use of eponyms in the orthopedics literature has come under scrutiny, and there is a growing body of literature evaluating the utility of these terms in modern healthcare delivery. Although the field of pediatric orthopedic sports medicine is a relatively modern subspecialty, it is built on a foundation of over 100 years of pediatric musculoskeletal medicine. As a result, eponyms account for a significant portion of the vernacular used in the field. The purpose of this review is to summarize and describe the history of common eponyms relevant to pediatric sports pathology, examination maneuvers, classification systems, and surgical procedures. Use of eponyms in medicine is flawed. However, an improved understanding of these terms allows for informed use in future scientific discourse, patient care and medical education and may encourage future innovation and research into understanding pediatric orthopedic pathologies.
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Affiliation(s)
- Ahmad F Bayomy
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Lynn Ann Forrester
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Stephen G Crowley
- Department of Orthopedic Surgery, Albany Medical College, Albany, NY, USA
| | - Charles A Popkin
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:768. [PMID: 33220714 PMCID: PMC7680598 DOI: 10.1186/s12891-020-03794-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background The measurement of patellar height and restoration of the natural position of the joint line are crucial to total knee arthroplasty (TKA). However, there remains a lack of consensus on an optimal measurement method to associate the patellar height with the joint line position. The objective of this study was to introduce a new method and validate the application in TKA both preoperatively and postoperatively. Methods Instead of taking marginal landmarks as the tibial references, the tibial shaft axis was used to construct the new measurement method, which comprises the axis-patella (AP), joint axis-patella (jAP) indices and joint line height (JLH). Patellar heights were measured using the Insall-Salvati (IS), modified Insall-Salvati (mIS), Blackburne-Peel (BP), Caton-Deschamps (CD) indices, and the new method in 175 knees both preoperatively and postoperatively. Intraclass correlation coefficients and Pearson’s correlation analyses were respectively used to evaluate the reliabilities and correlations. Results There were good correlations between the proposed method and the mIS, CD, and BP indices. High inter-observer reproducibility was found for AP (preoperative and postoperative 0.83), jAP (preoperative 0.82; postoperative 0.86) indices and JLH (preoperative 0.88; postoperative 0.95). High intra-observer repeatability was also found for AP (preoperative 0.85; postoperative 0.87), jAP (preoperative 0.83; postoperative 0.87) indices and JLH (preoperative 0.80; postoperative 0.92). Conclusions The new method is reliable for measuring patellar height before and after TKA, providing an alternative to distinguish between true and pseudo patella baja. Furthermore, JLH can be applied to assess and restore the joint line position in TKA.
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Comparison of the Therapeutic Effects of Tension Band with Cannulated Screw and Tension Band with Kirschner Wire on Patella Fracture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:4065978. [PMID: 32908578 PMCID: PMC7468626 DOI: 10.1155/2020/4065978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 11/17/2022]
Abstract
Background Patella fracture accounts for 1% of bone injury, of which anatomical reduction is of great significance to the recovery. Tension band with cannulated screw and Kirschner wire is commonly used methods for the treatment of displaced patella fracture. However, there is still some controversy on the clinical efficacy of the two treatment methods. Objective This study aimed at comparing the therapeutic effects of the cannulated screw and Kirschner wire tension bands on patella fracture and at providing more data basis for clinical selection of treatment methods for patella fracture. Methods Altogether, 146 patients with displaced patella fracture admitted to our hospital from March 2016 to February 2018 were selected and divided into two groups according to the different treatment methods. Among them, 71 patients received tension band with a cannulated screw (TBWCS group) and 75 patients received tension band with Kirschner wire (TBWKW group). Two groups of patients were compared in terms of surgical treatment effect after one year of treatment, complications within six months after the operation and operation-related indexes. The pain visual analogue scale (VAS) score, knee flexion degree, Lysholm score, and Bostman score were recorded at 1, 3, 6, and 12 months after operation, and the activity of daily living scale (ADL) score was evaluated at the last follow-up. Results During the operation of patella fracture patients, the intraoperative blood loss, hospitalization time, and knee flexion loss of patients in TBWCS group were less than those in the TBWKW group (P < 0.05), the starting time of postoperative functional exercise was earlier than that of patients in TBWKW group (P < 0.05), and the incidence rate of secondary operation was lower than that of patients in the TBWKW group (P < 0.05), but there was no statistical difference in the operation time, incision length, and postoperative fracture gap between the two groups. The results of curative effect analysis showed that the knee flexion, Lysholm score, and Bostman score of patients treated with tension band with cannulated screw were higher than those treated with Kirschner wire (P < 0.05), and VAS score was lower. Tension band with cannulated screw had a better curative effect on patella fracture (P < 0.05), lower complication rate (P < 0.05), and higher quality of life of patients (P < 0.05). Conclusion Tension band with cannulated screw has a good curative effect on patella fracture, low incidence of complications, early start of postoperative functional exercise, and high quality of life.
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Schröder FF, Post CE, van Raak SM, Simonis FFJ, Wagenaar FCBM, Huis In't Veld RMHA, Verdonschot N. The diagnostic potential of low-field MRI in problematic total knee arthroplasties - a feasibility study. J Exp Orthop 2020; 7:59. [PMID: 32737621 PMCID: PMC7394973 DOI: 10.1186/s40634-020-00274-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/15/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Low-field MRI, allowing imaging in supine and weight-bearing position, may be utilized as a non-invasive and affordable tool to differentiate between causes of dissatisfaction after TKA (‘problematic TKA’). However, it remains unclear whether low-field MRI results in sufficient image quality with limited metal artefacts. Therefore, this feasibility study explored the diagnostic value of low-field MRI concerning pathologies associated with problematic TKA’s’ by comparing low-field MRI findings with CT and surgical findings. Secondly, differences in patellofemoral parameters between supine and weight-bearing low-field MRI were evaluated. Methods Eight patients with a problematic TKA were scanned using low-field MRI in weight-bearing and supine conditions. Six of these patients underwent revision surgery. Scans were analysed by a radiologist for pathologies associated with a problematic TKA. Additional patellofemoral and alignment parameters were measured by an imaging expert. MRI observations were compared to those obtained with CT, the diagnosis based on the clinical work-up, and findings during revision surgery. Results MRI observations of rotational malalignment, component loosening and patellofemoral arthrosis were comparable with the clinical diagnosis (six out of eight) and were confirmed during surgery (four out of six). All MRI observations were in line with CT findings (seven out of seven). Clinical diagnosis and surgical findings of collateral excessive laxity could not be confirmed with MRI (two out of eight). Conclusion Low-field MRI shows comparable diagnostic value as CT and might be a future low cost and ionizing radiation free alternative. Differences between supine and weight-bearing MRI did not yield clinically relevant information. The study was approved by the Medical Research Ethics Committees of Twente (Netherlands Trial Register: Trial NL7009 (NTR7207). Registered 5 March 2018, https://www.trialregister.nl/trial/7009).
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Affiliation(s)
- Femke F Schröder
- OCON, centre for orthopaedic surgery, Geerdinksweg 141 postbus 546, 7550, AM, Hengelo, The Netherlands. .,University of Twente, Faculty of Engineering Technology, Biomechanical Engineering, postbus 217 7500 AE, Enschede, The Netherlands.
| | - Corine E Post
- OCON, centre for orthopaedic surgery, Geerdinksweg 141 postbus 546, 7550, AM, Hengelo, The Netherlands.,University of Twente, Faculty of Engineering Technology, Biomechanical Engineering, postbus 217 7500 AE, Enschede, The Netherlands.,Orthopaedic Research Laboratory, Radboud University Medical Center, postbus, 9101 6500, HB, Nijmegen, The Netherlands
| | - Sjoerd M van Raak
- Department of Radiology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609PP, Almelo, The Netherlands
| | - Frank F J Simonis
- University of Twente, Faculty of science and technology, Magnetic Detection and Imaging, postbus 217 7500 AE, Enschede, The Netherlands
| | | | | | - Nico Verdonschot
- University of Twente, Faculty of Engineering Technology, Biomechanical Engineering, postbus 217 7500 AE, Enschede, The Netherlands.,Orthopaedic Research Laboratory, Radboud University Medical Center, postbus, 9101 6500, HB, Nijmegen, The Netherlands
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Is Pseudo-Patella Baja Really a Serious Complication of Total Knee Arthroplasty? J Arthroplasty 2020; 35:557-562. [PMID: 31615703 DOI: 10.1016/j.arth.2019.09.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/10/2019] [Accepted: 09/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The available evidence on pseudo-patella baja (PPB) is limited. The purpose of this study is to investigate prospectively the occurrence of PPB after primary total knee arthroplasty and its clinical consequences in a large series of patients with a minimum follow-up of 2 years. PPB was defined as a patella distally displaced in relationship to the femoral trochlea with absence of patellar tendon shortening (Grelsamer RP. J Arthroplasty 2002;17:66-69) due to elevation of the joint line. METHODS This study is a prospective case series of 354 patients with a mean age of 71.7 (range 52-87) years. Clinical evaluation was performed by the Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form 12-item (SF12), and range of motion. Patellar height was assessed by the Insall-Salvati and Blackburne-Peel ratios. RESULTS The mean follow-up was 3.6 (range 2.0-6.6) years. Postoperatively, 286 (80.7%) patients had a normal patellar height, 17 (4.8%) had true patella baja (TPB), and 51 (14.4%) had PPB. There were no significant differences between the 3 groups in mean KSS-function (P = .107), range of motion (P = .408), WOMAC-pain (P = .095), WOMAC-stiffness (P = .279), or SF12-mental (P = .363). Between normal and PPB groups, there were no significant differences in mean KSS-knee (P = .903), WOMAC-function (P = .294), or SF12-physical (P = .940). However, the TPB group had significantly lower mean KSS-knee (P = .031), WOMAC-function (P = .018), and SF12-physical (P = .005) as compared with either 2 other groups. CONCLUSION PPB was a relatively common finding, but no significant differences in terms of clinical outcomes were found as compared to patients with postoperative normal patellar height. TPB was infrequent, but these patients had significantly worse clinical outcomes than those with PPB or normal patellar height.
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Ha C, Wang B, Li W, Sun K, Wang D, Li Q. Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial. INTERNATIONAL ORTHOPAEDICS 2019; 43:2519-2527. [PMID: 31227852 PMCID: PMC6848038 DOI: 10.1007/s00264-019-04361-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 06/12/2019] [Indexed: 12/20/2022]
Abstract
Purpose Resurfacing the patella in one-stage bilateral total knee arthroplasty (TKA) remains debatable. This study aimed to assess the mid-term outcomes of patients after one-stage bilateral TKA performed with and without patellar resurfacing, respectively, with at least five years of follow-up. Methods Sixty-six patients (132 knees) scheduled for first-ever one-stage bilateral TKA due to osteoarthritis received patellar resurfacing and retention, respectively, on one knee and the other, randomly selected. All patients received Scorpio NRG knee prostheses and were evaluated by radiology (anteroposterior, lateral, and axial views) pre-operatively and yearly post-operatively, for at least five years. Knee Society Score and Feller Score values were measured. Anterior knee pain, patellar clunk, and patient satisfaction were assessed. Results One patient died within five years of operation and four were lost to follow-up. One patient developed severe dementia and could not be constructively questioned. Therefore, 60 patients (120 knees) were finally analyzed. There were significantly improved Knee Society and Feller scores (P < 0.001) in the resurfacing group compared with the non-resurfacing group post-operatively. Anterior knee pain and patellar clunk rates were lower on the resurfaced side compared with the non-resurfaced side (P < 0.001). Meanwhile, 47% and only 7% patients preferred the resurfaced and non-resurfaced sides, respectively, at final follow-up. No revision was performed for patellofemoral complications, and no significant differences were found between the two groups in radiographic outcomes. Conclusions Using the Scorpio NRG knee prosthesis, patellar resurfacing is superior to non-resurfacing in patients with osteoarthritis observed for ≥ five years. Registration trials number NCT03600922 Key Points • Findings Patellar resurfacing is superior to non-resurfacing in osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) with the Scorpio NRG knee prosthesis. • Implications Patellar resurfacing should be performed in OA patients during TKA. • Caution Several prosthesis types should be assessed in the same study setting, and multicenter studies are required before generalizability of the present findings. Electronic supplementary material The online version of this article (10.1007/s00264-019-04361-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chengzhi Ha
- Department of Joint Surgery, Liaocheng People's Hospital, Liaocheng, 252000, ShanDong, China
| | - Baoxin Wang
- Department of Joint Surgery, Liaocheng People's Hospital, Liaocheng, 252000, ShanDong, China
| | - Wei Li
- Department of Joint Surgery, Liaocheng People's Hospital, Liaocheng, 252000, ShanDong, China
| | - Kang Sun
- Department of Joint Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutai mountain Road, Economic Development Zone, Qingdao, 266071, Shandong, China
| | - Dawei Wang
- Department of Joint Surgery, Liaocheng People's Hospital, Liaocheng, 252000, ShanDong, China.
| | - Qicai Li
- Department of Joint Surgery, Affiliated Hospital of Qingdao University, No. 1677 Wutai mountain Road, Economic Development Zone, Qingdao, 266071, Shandong, China.
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Park CH, Bae JK, Song SJ. Factors affecting the choice of constrained prostheses when performing revision total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 43:1831-1840. [PMID: 30327936 DOI: 10.1007/s00264-018-4200-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purposes of the present study were to assess the levels of prosthetic constraint chosen during revision total knee arthroplasty (TKA) and to identify factors influencing the choice of a constrained prosthesis. METHODS We retrospectively reviewed data on 274 revision TKAs. The mean follow-up period after revision TKA was 7.2 years. The femorotibial angle (FTA), joint line height (JLH), and Insall-Salvati ratio (ISR) were radiographically evaluated. Factors affecting the extent of constraint chosen were evaluated in terms of age, gender, body mass index, primary diagnosis, the cause of revision TKA, the Anderson Orthopedic Research Institute (AORI) classification, and changes in the JLH and ISR. RESULTS Totals of 247 (90.1%), 11 (4.0%), and 9 (3.4%) knees received posteriorly stabilized prostheses, constrained condylar knees, and rotating hinge prostheses, respectively. On multivariate analysis, the cause of revision TKA including loosening and instability and the changes in the JLH and ISR affected independently the choice of a constrained prosthesis. CONCLUSIONS The frequency of implantation of constrained prostheses was 7.4% in the present study. Consideration of various factors including the cause of revision TKA and changes in the JLH and ISR will aid the TKA surgeon in selecting prostheses with appropriate constraints when performing revision TKAs.
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Affiliation(s)
- Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Jung Kwon Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, South Korea.
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Patellar tendon shortening following patellofemoral joint replacement. INTERNATIONAL ORTHOPAEDICS 2018; 43:2077-2081. [PMID: 30315337 DOI: 10.1007/s00264-018-4194-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Patellar tendon shortening may occur following patellofemoral joint replacement (PFJR). We hypothesized that patellar tendon shortening results in unfavourable patient-reported outcomes (PROs). The aim of this study was to determine the effect of patellar tendon shortening following PFJR on PROs. METHODS In this substudy of a prospective cohort study, a total of 108 patients with isolated patellofemoral osteoarthritis underwent 124 patellofemoral joint replacements. We measured both patellar tendon length and length of the patella on pre-operative radiographs, and on radiographs acquired at eight weeks and at one year post-operative. More than 10% decrease in patellar tendon length relative to the pre-operative patellar tendon length was defined as patellar tendon shortening. Clinical outcomes were assessed using the knee-specific KOOS questionnaire (Knee Injury and Osteoarthritis Outcome Score). Repeated measures ANOVA was used to analyze for differences in change from baseline KOOS subscales between patients with and patients without patellar tendon shortening. RESULTS A complete series of standardized pre-operative, eight weeks and one year post-operative radiographs was available for 87 knees in 82 patients. At eight weeks, 16 of 87 knees (18%) showed patellar tendon length shortening, and 27 of 87 knees (31%) at one year. We found no statistically significant relation between patellar tendon length shortening and change from baseline KOOS subscales at one year follow-up (pain p = 0.29, symptoms p = 0.56, ADL p = 0.23, sport or recreation p = 0.22, knee-related quality of life (QOL) p = 0.15). CONCLUSIONS Patellar tendon length shortening following PFJR occurs in 31% of knees at one year, and does not result in inferior PROs.
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Primary cementless total knee arthroplasty with or without stem extension: a matched comparative study of ninety eight standard stems versus ninety eight long stems after more than ten years of follow-up. INTERNATIONAL ORTHOPAEDICS 2018; 43:1849-1857. [PMID: 30284003 DOI: 10.1007/s00264-018-4191-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Using a cementless fixation for total knee arthroplasty (TKA) is controversial. We hypothesized that cementless tibial base plate with a monoblock long stem (MLS) would provide secure tibial alignment and stable fixation when bone conditions were considered as poor for a cementless fixation. The purpose of this study was to compare the mean eight year survivorship of cementless standard keels (SK) vs cementless MLS. MATERIAL METHODS We report a matched series of 98 cases of SK and 98 cases of MLS in patients with poor bone conditions. The two cohorts were statistically compared. Revision for tibial loosening was used as the endpoint in the survivorship analysis. RESULTS We recorded two cases of tibial loosening and three cases of bipolar loosening in the SK group (0% MLS vs 5% SK). No tibial loosening occurred in the MLS group (statistically significant). No tibial periprosthetic or intra-operative fractures occurred in either group. The survivorship at eight years of follow-up was 95.6% in the SS cohort vs 100% in the MLS cohort using revision for tibial loosening as the endpoint. DISCUSSION This study was not randomized. Its strength was that it took into account the comparative midterm outcomes of a matched cohort of patients implanted with two types of cementless components in the same bone conditions. We did not record any tibial loosening in the MLS group. Using long stems has been criticized but we did not observe any adverse reactions and no intra-operative tibial fracture occurred. CONCLUSION MLS improves the alignment and fixation of cementless TKA. This is a safe solution when bone conditions are poor or modified by previous surgery.
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Roessler PP, Wimmer MD, Jacobs C, Bornemann R, Stein T, Lahner M. Medial patellofemoral ligament reconstruction fails to correct mild patella alta in cases of patellofemoral instability-a case-control study. INTERNATIONAL ORTHOPAEDICS 2018; 43:2071-2075. [PMID: 30225588 DOI: 10.1007/s00264-018-4162-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/12/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE Medial patellofemoral ligament reconstruction (MPFL-R) is the gold standard in patella soft tissue surgery for patellofemoral instability. Although claimed, recent reports indicate that MPFL-R may fail to distalize the patella in mild cases of patella alta. The present study is a retrospective case-control study to compare radiographic patella height between MPFL-R and historical Insall's proximal realignment (IPR) pre- and post-operatively with respect to distalization and assess redislocation rates at a mid-term follow-up. METHODS Sixty-four patients were age/sex matched (1:1), yielding 32 patients for group 1 MPFL-R (cases) and 32 patients for group 2 IPR (controls). Insall-Salvati, Blackburne-Peel and Caton-Deschamps indices were analyzed for differences pre- and post-operatively. An additional inter-rater reliability analysis was performed by means of intra-class correlation (ICC). Redislocation rates were considered as treatment failures in this study. RESULTS ICC was excellent for all three patella indices. MPFL-R failed to show significant differences if compared to IPR with respect to distalization in mild stages of patella alta. Moreover, redislocation rates significantly favored MPFL-R (3.1%) over IPR (12.5%; p < 0.0001). CONCLUSIONS MPFL-R has become a popular option to restore native patellofemoral biomechanics after ligament rupture. However, the procedure's potential to correct concomitant patella alta should not be overestimated and indications considered carefully.
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Affiliation(s)
- Philip P Roessler
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Matthias D Wimmer
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Cornelius Jacobs
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Rahel Bornemann
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Thomas Stein
- Department of Sporttraumatology, Knee and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Matthias Lahner
- Joint Center Hilden, Ruhr-University Bochum, Bochum, Germany
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Roessler PP, Moussa R, Jacobs C, Schüttler KF, Stein T, Schildberg FA, Wirtz DC. Predictors for secondary patellar resurfacing after primary total knee arthroplasty using a “patella-friendly” total knee arthroplasty system. INTERNATIONAL ORTHOPAEDICS 2018; 43:611-617. [DOI: 10.1007/s00264-018-4075-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/24/2018] [Indexed: 12/14/2022]
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Prudhon JL, Verdier R. Cemented or cementless total knee arthroplasty? - Comparative results of 200 cases at a minimum follow-up of 11 years. SICOT J 2017; 3:70. [PMID: 29232186 PMCID: PMC5726856 DOI: 10.1051/sicotj/2017046] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Since 1996 we have been using cementless fixation with hydroxyapatite (HA) coating. The purpose of this paper is to compare survivorship of a series of 100 cemented Total Knee Arthroplasty (TKA) to a similar series of 100 cementless with a follow up of 11-16 years. Material methods: Both TKA are mobile bearing total knee postero-stabilized. They can be used with cement or without cement. Among 1030 New Wave TKATM implanted from 2002 to 2015 we have identified 100 cemented TKAs and 100 cementless TKAs. All these cases were primary replacement. Differences in survival probability were determined using log-rank test. RESULTS Survival probabilities at 11 years of follow-up were: Cemented group: 90.2% CI95% [81.9-94.8]; Cementless group: 95.4% CI95% [88.1-98.2]. Comparison between both group showed significant difference, p = 0.32. DISCUSSION The advantages of cementless TKA are bone stock preservation, cement debris protection and the potential to achieve biologic fixation. Cementless implants rely on a porous or roughened surface to facilitate bone formation. HA has been shown to accelerate bone integration and to decrease micro motion of the components and to increase fixation. With a survival probability of 90.2% (cemented version) and 95.4% (cementless version), this total knee prosthesis performs as intended in primary total knee arthroplasty. No statistical differences could be found between cemented and cementless implants.
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Affiliation(s)
| | - Régis Verdier
- Groupe Lépine, 175 rue Jacquard, CS 50307, 69727 Genay Cedex, France
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Xu B, Xu WX, Lu D, Sheng HF, Xu XW, Ding WG. Application of different patella height indices in patients undergoing total knee arthroplasty. J Orthop Surg Res 2017; 12:191. [PMID: 29233153 PMCID: PMC5727872 DOI: 10.1186/s13018-017-0694-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/28/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND One complication of total knee arthroplasty (TKA) is patella baja (PB). Patellar tendon shortening and joint line elevation are two main causes of PB. The purpose of this study was to determine the incidence of PB before and after TKA by measuring the patellar height and provide evidence for choosing a suitable index. METHODS In total, 256 consecutive patients who underwent primary TKA were included in this study. Radiographic measurements were performed; the Insall-Salvati (IS) index, modified IS (MIS) index, Blackburne-Peel (BP) index, and Caton-Deschamps (CD) index were computed; and the incidence of PB was calculated before and after the operation. The consistency between the IS and MIS indices and between the BP and CD indices was analyzed. RESULTS The preoperative incidence of true PB (TPB) and pseudo-PB (PPB) was 9.4 and 0.8%, respectively. The postoperative incidence of TPB and PPB was 10.2 and 9.0%, respectively. The consistency between the IS and MIS indices was moderate preoperatively (pre-kappa = 0.602) and postoperatively (post-kappa = 0.742). The consistency between the BP and CD indices was moderate preoperatively (pre-kappa = 0.742) and good postoperatively (post-kappa = 0.797). CONCLUSION The incidence of PB, especially PPB, increased after TKA. The CD and BP indices are of greater importance for the diagnosis of PB after TKA. The MIS index is a better choice than the IS index to measure the length of the patellar tendon. To measure the height of the joint line, the BP index is better postoperatively and the CD index is better preoperatively.
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Affiliation(s)
- Bin Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Wei-Xing Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Di Lu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Hong-Feng Sheng
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Xin-Wei Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Wei-Guo Ding
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China.
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Franck F, Ouanezar H, Jacquel A, Pibarot V, Wegrzyn J. The predictive factors of secondary patellar resurfacing in computer-assisted total knee arthroplasty. A prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2017; 42:1051-1060. [PMID: 28889222 DOI: 10.1007/s00264-017-3630-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/28/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The decision to resurface the patella during total knee arthroplasty (TKA) remains controversial. This prospective cohort study aimed to evaluate the outcome and survivorship of the native patella in computer-assisted TKA (CAS TKA) implanted for primary knee osteoarthritis, and to determine the predictive factors of secondary patellar resurfacing (SPR). METHODS A prospective cohort of 273 cementless ultra-congruent mobile-bearing CAS TKA implanted without patellar resurfacing was included in our total joint registry. Patients were evaluated with the International Knee Society (IKS) and Hospital for Special Surgery Patellar (HSSP) scores. Radiographic evaluation was focused on the patellofemoral (PF) compartment to assess: the patellar dysplasia (Wiberg classification), PF osteoarthritis (Iwano classification), femoral trochlear dysplasia (femoral sulcus angle), patellar maltracking (patellar tilt and lateralization), and patella height (Blackburne-Peel ratio). RESULTS At a six-year median follow-up, the CAS TKA survivorship using SPR as end-point was 95% (range, 91-99%). The IKS and HSSP improved significantly after SPR (p = 0.001 and 0.004, respectively). No significant difference in the IKS and HSSP was detected between TKA with native patella and SPR-TKA at latest follow-up. Importantly, four pre-operative radiographic PF parameters were significantly associated with SPR: higher stages of patellar dysplasia and PF osteoarthritis, and higher sulcus angle and patellar lateralization (hazard ratios = 5.1 to 11.6, p = 0.009 to 0.04). CONCLUSION When preserving the native patella, surgeons should be aware of pre-operative PF radiographic parameters that could influence the outcome and survivorship of CAS TKA leading to SPR. Particularly, evidence of PF dysplasia, osteoarthritis and maltracking should be determined pre-operatively to resurface the patella at the time of TKA. LEVEL OF EVIDENCE Therapeutic Level II (prospective cohort study).
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Affiliation(s)
- Florent Franck
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Hervé Ouanezar
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Alexandre Jacquel
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Vincent Pibarot
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Julien Wegrzyn
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France. .,INSERM UMR 1033, Université de Lyon, Lyon, France.
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