PCL preservation or sacrifice does not influence clinical outcomes and survivorship at mid-term follow-up of a J-curve CR total knee replacement with a medial congruent liner and a functional coronal alignment

Condylar-Stabilized Designs in Total Knee Arthroplasty: A Classification System and Review of Outcomes

BACKGROUND

The increasing use of condylar-stabilized (CS) bearing designs in primary total knee arthroplasty (TKA) can be attributed to bony preservation with the option for posterior cruciate ligament (PCL) resection without compromising kinematics. Although there are a variety of CS designs, there is no system of nomenclature for them, making comparisons challenging. This study proposes a comprehensive classification system of differing CS designs based on articular surface and femoral component geometries and kinematic principles. We also review the literature for functional outcomes and survivorship associated with each CS design.

MATERIALS AND METHODS

There were 31 CS designs noted from 21 manufacturers identified using a combination of literature reviews, web searches, surgeon input, and manufacturer correspondence. The designs were subsequently categorized into distinct groups based on their geometry, the location of polyethylene buildup, conformity compared to their CR counterparts, and the radius of the femoral component. A scoping review was conducted to evaluate patient-reported outcome measures (PROMs), ranges of motion (ROM), and survivorships associated with each category. After exclusion, we reviewed 91 studies in the PubMed, Ovid MEDLINE, Embase, Cochrane, Web of Science, and Scopus databases.

RESULTS

We established five distinct categories: 1) anterior-stabilized; 2) ultracongruent; 3) medial-stabilized; 4) medial-pivot; and 5) lateral-stabilized. There were 12 studies describing anterior-stabilized designs, 15 describing ultracongruent, two describing medial-stabilized, 55 describing medial-pivot, and three describing lateral-stabilized designs. All CS designs demonstrated significant improvements in PROMs and ROM postoperatively, with survivorship of at least 90% and follow-up ranging from two to 18 years in some designs.

CONCLUSIONS

The classification developed in this study will allow for appropriate grouping and comparison of distinct condylar-stabilized implants. As presented in this review, there are favorable short-term functional outcomes across all CS subcategories. Although the data associated with these designs appears promising, it is limited. Further research comparing different designs to understand how differing geometries impact kinematic function and clinical outcomes may potentially inform implant selection and future design.

Medial Congruent and Medial Pivot Inserts in Total Knee Arthroplasty: A Scoping Review

Background and Objectives: Total knee arthroplasty (TKA) is one of the most common medical procedures worldwide. However, 10 to 20% of patients are still dissatisfied despite implants and surgical technique advancements. Recently, several medial-stabilized TKAs have been developed in attempts to replicate the native kinematics of the knee. The aim of this scoping review on medial-stabilized TKA inserts-medial congruent (MC) and medial pivot (MP)-is to focus on their clinical outcomes and the role of the posterior cruciate ligament (PCL), aiming to systematically map the existing research and highlight current knowledge gaps. Materials and Methods: A search of the PubMed, Embase and Cochrane databases was performed to identify relevant studies on the kinematics and outcomes of medial pivot (MP) or medial congruent (MC) inserts. The following Mesh terms were used in combination with the Boolean operators "AND" and "OR": "total knee arthroplasty", "total knee replacement", "medial pivot", "medial congruence", "outcomes" and "kinematic". Original studies reporting on clinical outcomes assessed with validated patient-reported scales, surgical techniques and reoperation rates for any reason with a minimum follow-up of 18 months were included. Results: A total of 39 articles met the inclusion criteria, accounting for 6143 total knee replacements. The overall reoperation-free survivorship rate was 98.4% (6047 out of 6143 knees) at a weighted average follow-up of 6.3 years (range 1.5-15.2 years, SD 0.7). Both MP and MC inserts demonstrated good outcomes, with no differences between groups. Few studies evaluated the role of the PCL in MP and MC inserts, with no differences in terms of clinical outcomes between retaining and sacrificing the PCL. Conclusions: MS-TKA demonstrated good outcomes in the literature independently of the specific design (medial pivot or medial congruent). Different possible biases may be present when evaluating the outcomes of these inserts, including different types of alignment and soft tissue balancing philosophies.

Evaluation of a novel robotic testing method for stability and kinematics of total knee arthroplasty

PURPOSE

This work developed a novel preclinical test of total knee replacements (TKRs) in order to explain TKR instability linked to patient dissatisfaction. It was hypothesized that stability tests on the isolated moving prostheses would provide novel comparative data on the stability and kinematics among TKR designs.

METHODS

Three TKR designs, DePuy Synthes Attune MS, Stryker Triathlon and Zimmer Biomet Persona MC, were assessed using a robotic arm while flexing-extending 0-140°. Tests imposed 710 N body weight combined with three tibial loads: no anterior-posterior (AP) force, 90 N anterior or 90 N posterior force. Other load effects were minimized and the kinematics was recorded. Each implant was tested six times to investigate the repeatability of the method. Data were analysed using statistical parametric mapping with one-way analysis of variance (ANOVA). If significance was found (p < 0.05), post hoc t tests with Bonferroni correction were used to contrast groups.

RESULTS

Significant differences were found throughout flexion-extension. Femoral rollback, AP stability, coupled internal-external rotation and AP position (roll-back) were all influenced by implant design. AP stability of the TKRs reduced with flexion reaching Attune 15 mm, Persona 13 mm and Triathlon 21 mm at 140° flexion. Tractive rolling significantly affected kinematics in the less congruent Triathlon design, with 6 mm different paths between flexion and extension motion (p < 0.05 across 5-100°). Paradoxical anterior femoral sliding in early flexion (0-40°) occurred in Persona and Triathlon designs.

CONCLUSIONS

The novel testing technique provides, for the first time, comparative data on the inherent stability and kinematics of the TKR implants themselves across the arc of flexion-extension, independent of variables including soft tissue behaviour and surgical technique. The data show how much each prosthesis can contribute to the stability and motion of the implanted knee. Similar data from a wider range of designs will enable more informed decisions regarding implant design choice, aiming to reduce the prevalence of TKR instability in patients.

LEVEL OF EVIDENCE

Controlled laboratory study.

Se-incorporated polycaprolactone spherical polyhedron enhanced vitamin B2 loading and prolonged release for potential application in proliferative skin disorders

Development of novel drug vehicles for vitamin B2 (VitB2) delivery is very important for designing controllable release system to improve epidermal growth and bone metabolism. In this work, selenium (Se)-incorporated polycaprolactone (PCL) spherical polyhedrons are successfully synthesized via a single emulsion solvent evaporation method which is utilized to load VitB2 to fabricate cell-responsive Se-PCL@VitB2 delivery systems. Their physicochemical properties are characterized by DLS, SEM, XRD, FTIR, and TGA-DSC. The release kinetics of VitB2 or Se from the samples are investigated in PBS solution (pH = 2.0, 5.0, 7.4, 8.0 and 12.0). The cytocompatibilities are also evaluated with normal BMSC and epidermal HaCat cells. Results exhibit that Se-PCL@VitB2 particles presents spherical polyhedral morphology (approximately (3.25 ± 0.46) μm), negative surface charge (-(54.03 ± 2.94) mV), reduced crystallinity and good degradability. Stability experiments imply that both VitB2 and Se might be uniformly dispersed in PCL matrix. And the incorporation of Se facilely promotes the loading of VitB2. The encapsulation efficiency and loading capacity are (98.42 ± 1.06)% and (76.25 ± 1.27) for Se-PCL@VitB2 sample. Importantly, it exhibits more prolonged release of both VitB2 and Se in neutral PBS solution (pH = 7.4) than other pH conditions. Presumably, the electrostatic interaction between Se, VitB2 and PCL contribute to its release mode. Cell experiments show that Se-PCL@VitB2 presents strong cytotoxicity to HaCat cells mainly due to the cytotoxic effect of Se anions and PCL degradation products. However, it exhibits weak inhibitory effect on BMSC cells. These note that the synthesized Se-PCL@VitB2 particles can be promising drug vehicles for potential application in epidermal proliferative disorders.

Comparison of accuracy and early outcomes in robotic total knee arthroplasty using NAVIO and ROSA

This study aimed to compare the cutting and component placement accuracies and early outcomes after total knee arthroplasty (TKA) between an image-free handheld robotic system (NAVIO) and a radiography-based robotic system (ROSA). This retrospective study included 88 patients (88 knees) who underwent TKA using the NAVIO (40 patients) or ROSA (48 patients) robotic systems. The accuracies of the robotic systems were compared. Clinical scores were evaluated using the Knee Society Score 2011 (KSS 2011) and the forgotten joint score (FJS)-12 at 1 year postoperatively. The femoral sagittal cutting error was smaller in the NAVIO group than in the ROSA group. The other cutting errors were not statistically different in both groups. Implantation errors did not differ between the groups. Regarding the clinical outcomes of the KSS 2011 subscales, the symptoms score was higher in knees operated using ROSA than in those using NAVIO. The other KSS 2011 subscales and the FJS-12 showed no differences between the two groups. In conclusion, the femoral sagittal cutting error was smaller in the NAVIO group than in the ROSA group, and the KSS 2011 symptom score subsection at one year was higher in the knees operated using ROSA than in those using NAVIO.