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Bakırhan S, Şahinoğlu E, Uysal E, Ünver B, Karatosun V. The effectiveness of cruciate-retaining versus posterior-stabilized designs on extensor mechanism function and knee function in patients after simultaneous bilateral total knee arthroplasty: A two-year retrospective follow-up study. Orthop Traumatol Surg Res 2023; 109:103701. [PMID: 37813332 DOI: 10.1016/j.otsr.2023.103701] [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: 03/20/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION The importance of the posterior-cruciate ligament in knee functionality is known; however, the effect of preserving the posterior-cruciate ligament in total knee arthroplasty (TKA) on extensor mechanism function and knee function is not clear. We aimed to compare extensor mechanism function and knee function between patients operated with the cruciate-retaining and posterior-stabilized designs for simultaneous bilateral TKA. HYPOTHESIS Patients operated with the cruciate-retaining design would produce better outcomes than those operated with the posterior-stabilized design. MATERIALS AND METHODS A total of 104 patients were divided into two groups as the cruciate-retaining (n=52) and posterior-stabilized (n=52) groups. The groups were compared for extensor mechanism function (chair-rise test) and knee function (Hospital for Special Surgery [HSS] knee score). The follow-up points were six weeks, three months, six months, one year and two years. RESULTS No statistically significant effect on chair-rise performance of the group-by-time interaction (χ2 [5, n=104]=5.32, p=.37) or of group (χ2 [1, n=104]=1.69, p=.19). In the HSS knee score, the group-by-time interaction was statistically significant (F [5.510]=6.24, p<.001). A statistically significant difference of 7.4 points in favor of the posterior-stabilized group was found at six weeks (p=.002). No statistically significant differences were found between the groups at the other follow-up points. DISCUSSION The cruciate-retaining and posterior-stabilized designs have similar outcomes with regard to extensor mechanism function and knee function in the long-term period in patients who underwent simultaneous bilateral TKA. In the short-term period, the posterior-stabilized design shows better knee function than the cruciate-retaining design. LEVEL OF EVIDENCE III; a retrospective study.
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Affiliation(s)
- Serkan Bakırhan
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Ege University, İzmir, Turkey
| | | | - Emre Uysal
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Ege University, İzmir, Turkey
| | - Bayram Ünver
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopedics and Traumatology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Sun K, Wu Y, Wu L, Shen B. Comparison of clinical outcomes among total knee arthroplasties using posterior-stabilized, cruciate-retaining, bi-cruciate substituting, bi-cruciate retaining designs: a systematic review and network meta-analysis. Chin Med J (Engl) 2023; 136:1817-1831. [PMID: 37365688 PMCID: PMC10406014 DOI: 10.1097/cm9.0000000000002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Despite the advent of innovative knee prosthesis design, a consistent first-option knee implant design in total knee arthroplasty (TKA) remained unsettled. This study aimed to compare the clinical effects among posterior-stabilized (PS), cruciate-retaining (CR), bi-cruciate substituting (BCS), and bi-cruciate retaining designs for primary TKA. METHODS Electronic databases were systematically searched to identify eligible randomized controlled trials (RCTs) and cohort studies from inception up to July 30, 2021. The primary outcomes were the range of knee motion (ROM), and the secondary outcomes were the patient-reported outcome measures (PROMs) and complication and revision rates. Confidence in evidence was assessed using Confidence in Network Meta-Analysis. The Bayesian network meta-analysis was performed for synthesis. RESULTS A total of 15 RCTs and 18 cohort studies involving 3520 knees were included. The heterogeneity and inconsistency were acceptable. There was a significant difference in ROM at the early follow-up when PS was compared with CR (mean difference [MD] = 3.17, 95% confidence interval [CI] 0.07, 7.18) and BCS was compared with CR (MD = 9.69, 95% CI 2.18, 17.51). But at the long-term follow-up, there was no significant difference in ROM in any one knee implant compared with the others. No significant increase was found in the PROMs and complication and revision rates at the final follow-up time. CONCLUSIONS At early follow-up after TKA, PS and BCS knee implants significantly outperform the CR knee implant in ROM. But in the long run, the available evidence suggests different knee prostheses could make no difference in clinical outcomes after TKA with extended follow-up.
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Affiliation(s)
- Kaibo Sun
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Mei F, Li J, Zhang L, Gao J, Li H, Zhou D, Xing D, Lin J. Posterior-Stabilized Versus Cruciate-Retaining Prostheses for Total Knee Arthroplasty: An Overview of Systematic Reviews and Risk of Bias Considerations. Indian J Orthop 2022; 56:1858-1870. [PMID: 36310555 PMCID: PMC9561447 DOI: 10.1007/s43465-022-00693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
Background Numerous systematic reviews have been published comparing the outcomes of patients undergoing posterior stabilized (PS) versus cruciate-retaining (CR) procedures in total knee arthroplasty (TKA), but with some overlaps and contradictions. The objectives of this study were (1) to perform an overview of current systematic reviews comparing PS versus CR in TKA, by evaluating their methodological quality and risk of bias, and (2) to provide recommendations through the best evidence. Methods A systematic search of systematic reviews comparing PS and CR in TKA, published until June 2021 was conducted using the MEDLINE, EMBASE, and Cochrane Library databases. Included systematic reviews were assessed for methodological quality and risk of bias by the AMSTAR2 instrument and ROBIS tool, respectively. The choice of best evidence was conducted according to the Jadad decision algorithm. Results A total of eight systematic reviews were eligible for inclusion in this study. The Jadad decision algorithm suggested that reviews with the highest AMSTAR2 scores should be selected. According to the ROBIS tool, there were three reviews with a low risk of bias and five with a high risk of bias. Consequently, one systematic review conducted by Verra et al. with the highest AMSTAR2 score and low risk of bias was selected as the best evidence. Conclusions Although current systematic reviews demonstrated some statistical differences in clinical presentation and functional outcomes between PS and CR, the current outcome indicators cannot be taken to provide recommendations for undergoing PS or CR. The decision for prosthesis selection could be made mostly based on the surgeon's preference, indications and other indicators.
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Affiliation(s)
- Fengyao Mei
- Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, 100044 China
- Arthritis Institute, Peking University, Beijing, China
| | - Jiaojiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - Liyi Zhang
- Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, 100044 China
- Arthritis Institute, Peking University, Beijing, China
| | - Jiaxiang Gao
- Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, 100044 China
- Arthritis Institute, Peking University, Beijing, China
| | - Hu Li
- Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, 100044 China
- Arthritis Institute, Peking University, Beijing, China
| | - Diange Zhou
- Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, 100044 China
- Arthritis Institute, Peking University, Beijing, China
| | - Dan Xing
- Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, 100044 China
- Arthritis Institute, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, 100044 China
- Arthritis Institute, Peking University, Beijing, China
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Shah D, Bates T, Kampfer C, Hope D. Biomechanics and Outcomes of Modern Tibial Polyethylene Inserts. Curr Rev Musculoskelet Med 2022; 15:194-204. [PMID: 35381973 DOI: 10.1007/s12178-022-09755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW There have been many attempts to use variations in tibial polyethylene design to better recreate normal knee kinematics in the total knee arthroplasty. The goal of this review is to provide an overview of the various types of tibial inserts that exist and review the theoretical mechanics versus what was demonstrated in vivo. RECENT FINDINGS Many polyethylene inserts have been attempted to re-create normal knee kinematics, but none have been able to successfully do so. Previously the only two types of inserts were posterior stabilized (PS) and cruciate retaining (CR) polyethylene inserts. Both of these have shown excellent long-term survival but neither has demonstrated native kinematics. Initially, it was thought that retention of the posterior cruciate ligament (PCL) would allow for more native kinematics, but fluoroscopic evidence has shown that the PCL alone cannot accomplish this. Newer inserts try to restore femoral roll back and the screw home mechanism. The bicruciate retaining total knee inserts are having the most "normal" kinematics, suggesting the importance of both the ACL and PCL in knee biomechanics. Modern polyethylene inserts show favorable short-term data with bicruciate retaining inserts having the best kinematics; however, long-term studies are still needed to determine if survivorship and patient outcomes remain favorable.
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Affiliation(s)
- Darshan Shah
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA.
| | - Taylor Bates
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
| | - Craig Kampfer
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
| | - Donald Hope
- Department of Orthopaedics, Brooke Army Medical Center, 3551 Roger Brooke Dr., San Antonio, TX, 78234, USA
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Guven MF, Karaismailoglu B, Kara E, Ahmet SH, Guler C, Tok O, Ozsahin MK, Aydıngöz Ö. Does posterior cruciate ligament sacrifice influence dynamic balance after total knee arthroplasty? Comparison of cruciate-retaining and cruciate-substituting designs in bilaterally operated patients. J Orthop Surg (Hong Kong) 2022; 29:23094990211061610. [PMID: 34872402 DOI: 10.1177/23094990211061610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aimed to evaluate whether the posterior cruciate ligament sacrifice during total knee arthroplasty (TKA) has any effect on postoperative standing balance or not. METHODS The patients who underwent bilateral TKA with either CR or PS design were analyzed. 30 patients (10 PS, 20 CR) were included for the final analysis. TKA designs were compared in terms of Lysholm score, range of motion, and balance characteristics including somatosensorial, vestibular, and visual balance scales, adaptation, limits of stability, and weight-bearing/squat tests by computerized dynamic posturography. RESULTS The mean follow-up time was 59 months for CR, 49 months for PS group. The average Lysholm score values were 94 for CR and 95 for PS group, indicating functionally similar patient groups. The average knee flexion was found significantly higher in PS group (114°) compared to CR group (102°) (p = 0.009). In the CR group, motor adaptation tests (toes up/toes down) were found to be better (p = 0.034). In the on-axis velocity parameter (linear goal orientation) of limits of stability test, PS group patients were found to be more successful (p = 0.035). CONCLUSIONS The use of CR implants can be recommended in patients with a high risk of falling since they provide better motor adaptation providing rapid reactions to rapid surface changes. Better linear goal orientation in PS group, providing a faster movement in an intended direction, should be considered when planning the ideal implant for the patients with relevant activities.
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Affiliation(s)
- Mehmet Fatih Guven
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bedri Karaismailoglu
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eyyup Kara
- Department of Audiology, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Cevaydin Guler
- Department of Orthopaedics and Traumatology, 567570Sancaktepe Training and Research Hospital, Istanbul, Turkey
| | - Okan Tok
- 64296Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Mahmut Kursat Ozsahin
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Önder Aydıngöz
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
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Oh SM, Bin SI, Kim JY, Lee BS, Kim JM. Impact of preoperative varus deformity on postoperative mechanical alignment and long-term results of "mechanical" aligned total knee arthroplasty. Orthop Traumatol Surg Res 2019; 105:1061-1066. [PMID: 31279768 DOI: 10.1016/j.otsr.2019.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Preoperative varus deformity may affect postoperative mechanical alignment and outcomes of total knee arthroplasty (TKA). In this study, we aimed to determine whether (1) greater degrees of preoperative varus deformity increase the incidence of varus-aligned TKAs and (2) residual varus alignment improves the long-term survival rate in TKAs with preoperative varus deformity. METHODS We retrospectively reviewed 905 primary TKAs for varus-type osteoarthritis from November 1998 to June 2009. The mean follow-up was 8.23 years (±3.47 years). We measured pre- and postoperative mechanical hip-knee-ankle axis angle (HKA) on full-length standing radiographs to assess the severity of preoperative varus deformities, defined as mild (0°<HKA≤5°), moderate (5°<HKA≤10°), severe (10°<HKA≤15°), and very severe (HKA>15°). Postoperative alignment was divided to four groups: valgus (HKA<-3°), neutral (-3°≤HKA≤3°), mild varus (3°<HKA≤6°), and severe varus (HKA>6°). We performed survival analysis in all cases for mechanical failure. RESULTS Varus-aligned TKAs increased proportionally to increasing preoperative varus deformity (p<0.001). The survival rate showed no significant difference according to the preoperative varus deformity (p=0.147). However, the survival time for postoperative neutral alignment (16.13±0.10 years, 95% CI 15.94-16.33 years) was longer than the survival time for mild varus (15.32±0.35 years, 95% CI 14.64-16.00 years) and severe varus (13.38±0.53 years, 95% CI 12.35-14.42 years) alignment (p<0.001). CONCLUSION Postoperative varus malalignment appears to increase proportionally to the severity of preoperative varus deformity. Also, postoperative neutral alignment results in longer TKA survival time than residual varus alignment. LEVEL OF EVIDENCE III, Retrospective comparative cohort study.
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Affiliation(s)
- Sung-Mok Oh
- Department of Orthopedic Surgery, Nanoori Incheon Hospital, 156, Jange-ro, Bupyung-gu, 21353 Incheon, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea.
| | - Jae-Young Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
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Serna-Berna R, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles Muñoz FA, Gonzalez-Navarro B, Lopez-Prats FA. Cruciate-Retaining vs Posterior-Stabilized Primary Total Arthroplasty. Clinical Outcome Comparison With a Minimum Follow-Up of 10 Years. J Arthroplasty 2018; 33:2491-2495. [PMID: 29691173 DOI: 10.1016/j.arth.2018.02.094] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Controversy continues regarding whether the posterior cruciate ligament should be retained or removed during total knee arthroplasty (TKA) procedure. The objective was to compare the clinical outcomes with a minimum follow-up of 10 years between patients who received contemporary cruciate-retaining or posterior-stabilized primary TKA. METHODS Case-control study of 268 patients who underwent cruciate-retaining TKA vs 211 to posterior-stabilized design, with the same arthroplasty system, and a minimum follow-up of 10 years. Clinical assessment was performed by Knee Society scores, Western Ontario and MacMasters Universities and Short-Form 12 questionnaires, range of motion, and patient satisfaction. RESULTS Successful outcomes were found for both designs. No significant differences in functional scores, range of motion, patient-related scores, or patient satisfaction. Between the 5-year and last postoperative follow-up, there were a significant decrease of all clinical scores in both groups. In addition, complication rate and implant survival were similar between groups. CONCLUSION The superiority of one design over the other was not found. Both designs can be used expecting long-term successful outcomes and high survival. The choice of the design depended on the status of the posterior cruciate ligament and surgeon preference.
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Affiliation(s)
- Ricardo Serna-Berna
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain; Traumatology and Orthopaedia, Miguel Hernandez University, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Kirschberg J, Goralski S, Layher F, Sander K, Matziolis G. Normalized gait analysis parameters are closely related to patient-reported outcome measures after total knee arthroplasty. Arch Orthop Trauma Surg 2018; 138:711-717. [PMID: 29392391 DOI: 10.1007/s00402-018-2891-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 11/25/2022]
Abstract
Up till now, only a weak connection could be shown between patient-related outcome measures (PROMs) and measurements obtained by gait analysis (e.g. speed, step length, cadence, ground reaction force, joint moments and ranges of motion) after total knee arthroplasty (TKA). This may result from the methodical problem that regression analyses are performed using data that are not normalized against a healthy population. It does appear reasonable to assume that patients presenting a physiological gait pattern are content with their joint. The more the gait parameters differ from a normal gait pattern the worse the clinical outcome measured by PROMs should be expected to be. In this retrospective study, 40 patients were enrolled who had received a gait analysis after TKA, and whose PROMs had been evaluated. A gender- and age-matched control group was formed out of a group of test persons who had already undergone gait analysis. Gait analysis was undertaken using the motion analysis system 3D Vicon with ten infrared cameras and three strength measuring force plates. The physiological gait analysis parameters were deduced from arithmetic mean values taken from all control patients. The deviances of the operated patients' gait analysis parameters from the arithmetic mean values were squared. From these values, the Pearson correlation coefficients for different PROMs were then calculated, and regression analyses were performed to elucidate the correlation between the different PROMs and gait parameters. In the regression analysis, the normalized cadence, relative gait speed of the non-operated side, and range of the relative knee moment of the operated side could be identified as factors which influence the Forgotten Joint Score (FJS-12). The explanation model showed an increase of the FJS-12 with minimisation of these normalized values corresponding to an approximation of the gait pattern seen in the healthy control group. The connection was strong, having a correlation coefficient of 0.708. A physiological gait pattern after TKA results in better PROMs, especially the FJS-12, than a non-physiological gait pattern does.
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Affiliation(s)
- Julia Kirschberg
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Szymon Goralski
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Frank Layher
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Klaus Sander
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
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Minoda Y, Sugama R, Ohta Y, Nakamura H. Impingement of the patellar component against the tibial post after posterior stabilized and constrained TKA: a pilot study. Arch Orthop Trauma Surg 2017; 137:861-865. [PMID: 28349206 DOI: 10.1007/s00402-017-2682-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patella-post impingement (PPI), contact of the patellar component with the tibial post, occurs during deep knee flexion after posterior stabilized total knee arthroplasty (TKA). PPI can cause anterior knee pain, increased patellar pressure, wear of the polyethylene patellar component and tibial post, and poor range of motion. There have been no reports on the relationship between PPI and tibial post design. The aim of this study was to compare different tibial post designs with regard to PPI incidence. MATERIALS AND METHODS Five posterior stabilized total knee prostheses were implanted in full-length models of the femur and tibia (Sawbones) using a navigation system. The thickness of the tibial component was 10 mm in all prostheses. The patella was set on a transparent polypropylene sheet, which was fixed to the tibial tubercle. The distance between the lower edge of the patellar component and the cut surface of the tibia was defined as the tibial-patellar clearance (TPC), which represents the length of the patellar tendon. The TPC was varied from 18 to 40 mm and the knee was moved from full extension to deep flexion while the knee angle at which PPI occurred (PPI angle) was recorded. RESULTS The PPI angle differed between tibial post designs (p < 0.05). Shorter TPCs resulted in smaller PPI angles and longer TPCs resulted in larger PPI angles (p < 0.05). CONCLUSIONS This is the first study to analyze the relationship between PPI and the design of tibial post. Our results clearly show that tibial post design and TPC affect PPI. To avoid patellar component and tibial post impingement in deep flexion, appropriate TPC must be achieved during surgery. Improvements in tibial post design, especially in constrained prostheses, are also desirable. This study highlights the potential risk of PPI during deep flexion after TKA.
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Affiliation(s)
- Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan.
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
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Murakami K, Hamai S, Okazaki K, Ikebe S, Nakahara H, Higaki H, Shimoto T, Mizu-Uchi H, Kuwashima U, Iwamoto Y. Kinematic analysis of stair climbing in rotating platform cruciate-retaining and posterior-stabilized mobile-bearing total knee arthroplasties. Arch Orthop Trauma Surg 2017; 137:701-711. [PMID: 28289890 DOI: 10.1007/s00402-017-2662-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of our study was to compare and contrast the effects of two types of mobile-bearing total knee arthroplasties (TKA), namely, the cruciate-retaining (CR) and posterior-stabilized (PS) TKAs, on clinical outcomes and in vivo kinematics during stair climbing. MATERIALS AND METHODS The Press-Fit Condylar Sigma rotating platform was used for both CR and PS TKAs. Patient-reported outcomes were assessed using the 2011 Knee Society Score. Quadriceps muscle strength was evaluated by isokinetic dynamometry. In vivo kinematics were evaluated using periodic sagittal plane radiographic images obtained during stair climbing to quantify anteroposterior (AP) tibiofemoral translation, implant flexion and axial rotation angles using image-matching techniques. Outcomes were evaluated in 20 TKAs, which had been undergone with clinical success, including ten knees with CR types and ten knees with PS types. RESULTS There were no significant differences between the CR and PS TKA groups (p > 0.05) in isometric extensor torque (1.0 ± 0.2 and 1.1 ± 0.6 N m/kg, respectively) or patient-reported score for stair climbing function (4.0 ± 0.5 and 3.8 ± 0.9, respectively). Both types of TKAs showed stable AP translation in the mid range of knee flexion and paradoxical translation in the low range of flexion, with limited rotation, during stair climbing. There were no significant differences between the CR and PS TKA groups (P > 0.05) in anterior translation from 80° to 40° of knee flexion (4.2 ± 1.2 and 3.5 ± 1.6 mm, respectively), posterior translation from 40° to 10° of knee flexion (2.3 ± 1.9 and 2.0 ± 1.5 mm, respectively), and total external rotation (2.8° ± 4.9° and 0.5° ± 5.0°, respectively). CONCLUSIONS Both CR and PS types of rotating platform mobile-bearing TKAs provided reproducible knee joint kinematics during stair climbing and equivalent clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Koji Murakami
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Katai Orthopaedic Hospital, 132-1 Okuma Kasuya-machi, Kasuya-gun, Fukuoka, 811-2302, Japan
| | - Satoru Ikebe
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Hiroyuki Nakahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Takeshi Shimoto
- Department of Information and Systems Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka, 811-0295, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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11
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Bian Y, Zhai J, Peng H, Weng X, Lin J, Jin J, Qian W, Zhao L. [Effectiveness of condylar constrained knee prosthesis for destructive hemophilic arthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:266-270. [PMID: 29806252 PMCID: PMC8458125 DOI: 10.7507/1002-1892.201609108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/07/2017] [Indexed: 11/03/2022]
Abstract
Objective To investigate the clinical outcomes of total knee arthroplasty (TKA) by using the condylar constrained knee prosthesis in the treatment of destructive hemophilic arthritis. Methods Between September 2007 and July 2015, 8 cases (8 knees) of destructive hemophilic arthritis accepted TKA by using condylar constrained knee prosthesis. All patients were male, aged 22 to 56 years, with an average age of 35 years. The disease course of hemophilia A was 3-30 years (mean, 17.3 years). Preoperative range of motion (ROM) was (68.1±32.6)°; the flexion deformity was (14.38±16.13)°. Six patients had valgus of 7-35° (mean, 17.3°), of whom, one had fixed dislocation of patella; and one had varus of 15°. Hospital for Special Surgery (HSS) knee score was 52.5±12.9. Pre-operative X-ray film examination demonstrated narrowing of the knee gap and cystic degeneration of articular cartilage and subchondral bone. Results All patients achieved primary wound healing, and were followed up 1-9 years (mean, 5 years). Tense blister with common peroneal nerve damage and extension penetrating into distal tibial cortex occurred in 1 case respectively, which were cured corresponding treatment. At last follow-up, the knee ROM and the flexion deformity were significantly improved to (98.1±8.9)° and (0.63±1.77)° ( t=-2.527, P=0.036; t=2.396, P=0.047). At 2 weeks after operation and last follow-up, the HSS scores were significantly increased to 77.3±11.0 and 85.0±9.0 ( P<0.05). X-ray film showed that lower extremity alignment returned to normal in patients with varus and valgus. Conclusion Good curative effect can be get by using condylar constrained knee prosthesis in TKA for the treatment of destructive hemophilic arthritis.
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Affiliation(s)
- Yanyan Bian
- Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, P.R.China
| | - Jiliang Zhai
- Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, P.R.China
| | - Huiming Peng
- Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, P.R.China
| | - Xisheng Weng
- Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730,
| | - Jin Lin
- Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, P.R.China
| | - Jin Jin
- Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, P.R.China
| | - Wenwei Qian
- Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, P.R.China
| | - Lijuan Zhao
- Department of Orthopedics, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, P.R.China
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