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Jones BK, Carlson BJ, Scott DF. Better flexion and early recovery with medial-stabilized vs single-radius total knee arthroplasty with kinematic alignment: Two-year clinical results. Knee 2023; 43:217-223. [PMID: 37467702 DOI: 10.1016/j.knee.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/27/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND There are few studies comparing outcomes in patients with posterior cruciate ligament-sacrificing single-radius (SR) versus medial-stabilized (MS) knee devices. Both types of implants are designed to maximize deep-flexion and to maintain stability throughout the knee flexion arc. The aim of this study was to determine whether two-year outcomes differ between these two implant groups. METHODS Two-hundred and ten patients took part in this retrospective cohort single center study. The SR patients (n = 109) were enrolled in one randomized trial, and the MS knees (n = 101) in another. Patient consent and Investigative Review Board approval was obtained. Radiographs and clinical outcomes were gathered preoperatively and at six weeks, six months, one year and two years. RESULTS There were no statistically significant differences between treatment groups in terms of preoperative demographic characteristics. The MS group had significantly better knee flexion starting at six months postoperative through two years postoperatively (p < 0.05 - p< 0.001). The Knee Society Pain/Motion score was better in the MS group at one year (95.41 vs 90.86, p < 0.002). The Knee Society Pain score was also better in the MS group starting at six weeks through one year (six weeks: 35.3 vs 30, p = 0.007; one year: 46.4 vs 42.4, p = 0.005, respectively). CONCLUSION The MS group had better clinical outcomes than the SR group, with significantly greater knee flexion from six months through two years, better Knee Society Pain scores at six weeks through one year, and higher Knee Society Pain/Motion scores at six weeks and one year postoperatively. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Brett K Jones
- Elson S. Floyd College of Medicine Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA.
| | - Brian J Carlson
- Elson S. Floyd College of Medicine Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA.
| | - David F Scott
- Elson S. Floyd College of Medicine Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202, USA; Spokane Joint Replacement Center, Inc., Spokane, WA, USA.
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2
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Waterson H, Walker R, Koopmans P, Stroud R, Phillips J, Mandalia V, Eyres K, Toms A. Gap balanced adjusted mechanical alignment versus measured resection mechanical alignment: a randomised controlled trial. Arch Orthop Trauma Surg 2023; 143:2141-2151. [PMID: 35690965 PMCID: PMC10030405 DOI: 10.1007/s00402-022-04487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Alignment goals in total knee replacement (TKR) is a topical subject. This study compares the short-term functional outcomes and patient reported outcome measures (PROMs) of two philosophies for knee arthroplasty alignment: measured resection (MR) and an individualised alignment philosophy, with the tibia mechanically aligned and an instrumented gap balancer (GB) to align the femur in both flexion and extension. PATIENTS AND METHODS 94 knees were enrolled in this randomised controlled trial. The surgical protocol used a MR technique for mechanical alignment or a GB technique for individualised alignment. Primary outcome was quadriceps strength. Secondary outcomes included validated functional tests and PROMs as well as patient satisfaction. Outcomes were assessed pre-operatively, at 6 weeks, 3, 6 and 12 months post-operatively. RESULTS At 12-month follow-up, there was no significant difference in the change from baseline mean quadriceps peak torque between the two groups (p = 0.988). Significant improvement in the change in range of motion (ROM) in the GB group compared to the MR group at 3 months (13° vs 6° p = 0.028) but this improvement was not significant at 1 year (20° vs 17° p = 0.21). The functional test of balance showed statistically significant improvement at 6 weeks (p = 0.03) in the GB group but this difference was not maintained. PROMs favoured the GB group, with the KOOS pain scoring statistically better (p ≤ 0.05) at 6 weeks, 3, 6 and 12 months. CONCLUSIONS Individualised alignment philosophy utilising a GB technique did not demonstrate an improvement in the primary outcome measure quadriceps peak torque. Improvement was seen in the GB group in PROM pain scores that was significant, both statistically and clinically, out to at least 1 year. Gains that were seen in functional assessment with GB, although significant at some time points, were no longer significant at 1 year and no difference was seen in quads strength. Compared to a MR technique, the individualised GB technique appears to confer some improvement in pain, ROM and some functional tests following TKR in the short-term.
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Affiliation(s)
- Hugh Waterson
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK.
| | - Robert Walker
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
| | | | - Rowenna Stroud
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
| | | | - Vipul Mandalia
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
| | - Keith Eyres
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
| | - Andrew Toms
- Exeter Knee Reconstruction Unit, RD+E Hospital, Exeter, UK
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Mehta N, Burnett RA, Kahlenberg CA, Miller R, Chalmers B, Cross MB. Mid-Flexion Instability After Total Knee Arthroplasty: Diagnosis, Implant Design, and Outcomes. Orthopedics 2023; 46:e13-e19. [PMID: 35876775 DOI: 10.3928/01477447-20220719-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mid-flexion instability (MFI) in total knee arthroplasty refers to a distinct clinical entity where the knee is stable at full extension and 90° of flexion, but unstable somewhere between these 2 points. The presentation of MFI is often vague, and studies defining objective clinical or intraoperative measurements are limited. In this review, we aim to properly define the condition, describe diagnostic criteria and risk factors contributing to MFI, review current implant design, and present outcomes of revision surgery performed for MFI. [Orthopedics. 2023;46(1):e13-e19.].
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Vij N, Leber C, Schmidt K. Current applications of gait analysis after total knee arthroplasty: A scoping review. J Clin Orthop Trauma 2022; 33:102014. [PMID: 36110510 PMCID: PMC9467867 DOI: 10.1016/j.jcot.2022.102014] [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] [Received: 04/12/2022] [Revised: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The biomechanics of the knee do not return to normal after knee replacement. The purpose of this scoping review is to summarize the current use of gait analysis in total knee arthroplasty and to identify the preoperative motion analysis parameters for which a systematic review aimed at determining the reliability and validity may be warranted. Materials and methods This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The 279 articles from the five search engines underwent a title/abstract and full-text screening. Included articles were categorized as either: the role of gait analysis as a research tool for operative decisions, other research applications for motion analysis in total knee arthroplasty, gait analysis as a tool in predicting radiologic outcomes, or gait analysis as a tool in predicting clinical outcomes. Results Eleven articles studied gait analysis as a research tool in studying operative decisions. Five articles studied other research applications for motion analysis in total knee arthroplasty. Other research applications for motion analysis currently include studying the role of the unicompartmental knee arthroplasty and novel physical therapy protocols aimed at optimizing post-operative care. Two articles studied motion analysis as a tool for predicting radiographic outcomes. 15 articles studied motion analysis in conjunction with clinical scores. Conclusions There is a broad range of research applications for motion analysis in knee reconstruction. Current limitations include vague definitions of 'gait analysis' or 'motion analysis' and a limited number of articles with preoperative and postoperative outcomes. Knee adduction moment, knee adduction impulse, total knee range of motion, varus angle, cadence, stride length, and velocity have the potential for integration into composite clinical scores. A systematic review to determine the psychometric properties of these variables is warranted.
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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine - Phoenix, Department of Orthopedic Surgery, 475 N. 5th Street, Phoenix, AZ, 85012, USA
| | - Christian Leber
- University of Arizona College of Medicine - Phoenix, Department of Orthopedic Surgery, 475 N. 5th Street, Phoenix, AZ, 85012, USA
| | - Kenneth Schmidt
- University of Arizona College of Medicine - Phoenix, Department of Orthopedic Surgery, 475 N. 5th Street, Phoenix, AZ, 85012, USA
- Department of Orthopedic Surgery, Banner University College of Medicine Phoenix, 1320 N 10th St. Ste A, Phoenix, AZ, 85006, USA
- OrthoArizona, 033 N 44th St. Suite 100, Phoenix, AZ, 85008, USA
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Lei T, Jiang Z, Qian H, Backstein D, Lei P, Hu Y. Comparison of Single-Radius with Multiple-Radius Femur in Total Knee Arthroplasty: A Meta-Analysis of Prospective Randomized Controlled Trials. Orthop Surg 2022; 14:2085-2095. [PMID: 35924690 PMCID: PMC9483041 DOI: 10.1111/os.13391] [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: 08/31/2020] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Whether there was clinical superiority for the single-radius prosthesis over the multi-radius prothesis in total knee arthroplasty (TKA) still remains to be clarified. We updated a meta-analysis including prospective randomized controlled trials (RCTs) to compare the clinical prognosis of patients receiving single-radius TKA (SR-TKA) or multi-radius TKA (MR-TKA). METHODS We searched the databases of PubMed, Web of Science, EMBASE, Cochrane Library, MEDLINE for eligible RCTs. Two reviewers evaluated the study quality according to the Risk of Bias tool of the Cochrane Library and extracted the data in studies individually. The extracted data included the baseline data and clinical outcome. The baseline data include the author's name, country, and year of included studies, the name of knee prosthesis used in studies, sample size, follow-up time, and BMI of patients. The clinical data comprised primary indicators including postoperative knee range of motion (ROM), sit-to-stand rest, severe postoperative scorings, such as visual analog scale (VAS), American Knee Society knee score (AKS), Oxford knee scoring (OKS), and SF-36 Quality of Life Scale, as well as various secondary indicators of complications including anterior knee pain, postoperative infection, aseptic prosthesis loosening, and prosthesis revision. The data analysis was performed using Review Manager 5.3 software and STATA 12.0. The sensitivity analysis was performed using STATA 12.0. RESULTS A total of 13 RCTs, along with 1720 patients and 1726 knees, were finally included in our present meta-analysis. We found that patients in SR-TKA group performed better in the sit-to-stand test (OR = 1.89, 95% CI: 1.05-3.41, p = 0.03) and satisfaction evaluation (OR = 3.27, 95% CI: 1.42-7.53, p = 0.005), which were only evaluated in two included RCTs. While no significant difference was found between SR-TKA and MR-TKA groups in terms of postoperative ROM, VAS scoring, AKS scoring, SF-36 scoring, OKS scoring, and various complications including anterior knee pain, postoperative infection, aseptic prosthesis loosening, and prosthesis revision. CONCLUSION In conclusion, our present meta-analysis indicated that SR implants were noninferior to MR implants in TKA, and SR implants could be an alternative choice over MR implants, since patients after SR-TKA felt more satisfied and performed better in the sit-to-stand test, with no significant difference in complications between SR-TKA and MR-TKA groups. While more relevant clinical trials with long-term follow-up time and specific tests evaluating the function of knee extension mechanism should be carried out to further investigate the clinical performance of SR implants.
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Affiliation(s)
- Ting Lei
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Zichao Jiang
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Hu Qian
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
| | | | - Pengfei Lei
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Yihe Hu
- Department of Orthopeadic Surgery, Xiangya Hospital Central South University, Changsha, China
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Li M, Zhang L, Zhang R, Ma Y, Liao J, Li Q, Deng Z, Zheng Q. Better quadriceps and hamstring strength is achieved after Total knee Arthroplasty with single radius femoral prostheses: a retrospective study based on isokinetic and isometric data. ARTHROPLASTY 2020; 2:5. [PMID: 35236469 PMCID: PMC8796515 DOI: 10.1186/s42836-020-0022-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Strength deficits, muscle imbalances, and quadriceps inhibition are common after the total knee arthroplasty (TKA). It was suggested that theoretically single radius (SR) femoral protheses could provide longer extensor moment arm compared to the multiple radius (MR) design. However, quantitative evidence has not yet been reported. Thus, the aim of the study was to investigate the differences in isokinetic data and to compare the patient-reported outcome scores between TKA SR and MR design. Method The present retrospective study included 36 TKA involving 16 knees (9 patients) using SR design implant and 20 knees (11 patients) using MR design implant. The mean follow-up time was longer than 1 year. Isokinetic knee flexion and extension torques of the operated leg were evaluated at 60°/s and 180°/s. Quadriceps and hamstring torques and ratios, work and power were recorded. Angle-specific torques were also collected at different extension or flexion angles. Results Both groups showed improvement in knee society scores (KSS) and knee injury, and osteoarthritis outcome score (KOOS) after operation. Patients in SR group had significantly higher scores in KSS-knee, symptoms and activities of daily living KOOS sub-score than those in the MR group at the end of the follow-up. The peak knee flexion torque, peak knee extension torque and maximum knee flexion work were greater in SR group at 180°/s and 60°/s. At 60°/s, and SR group had higher average knee flexion power and average knee extension power than MR group. In the isometric contraction test, the knee extension torque was higher in SR group than in MR group. At 180°/s, SR group showed higher flexion torques at 30°, 40°, 50°, 60° compared with MR group. At 60°/s, SR group showed higher flexion torques at 30°, 40°, 50°, 60°, 80° when compared with MR group. Additionally, SR group also provided higher extension torques at 40°, 50°, 60° than the MR group. There were no differences in other isokinetic and isometric parameters between the two groups. Conclusion Femoral design exerted an influence on quadriceps and hamstring strength after TKA, and SR design shows advantages, in terms of higher extension and flexion strength, over MR design.
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Dubin JA, Westrich GH. Preoperative activity levels are an important indicator of postoperative activity in cementless TKAs. J Orthop 2020; 22:602-605. [PMID: 33299273 DOI: 10.1016/j.jor.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/15/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction It is of interest if preoperative activity level has an impact on postoperative activity level following cementless TKA. Methods This review contained 127 patients who had a preoperative Lower Extremity Activity Scale (LEAS) score ≥ to 10 (active patients) and 121 patients <10 (inactive patients). Results Postoperatively, the results showed a difference in LEAS Activity (Active 10.5 vs. Inactive 8.7, p < 0.001). Active patients had a drop in their activity level by 1.2 on the LEAS score, yet inactive patients increased by 1.6 (p < 0.0001). Conclusion Preoperative activity levels are a good indicator for postoperative activity in cementless TKA.
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Affiliation(s)
- Jeremy A Dubin
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th, Street, NY, NY, 10021, USA
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th, Street, NY, NY, 10021, USA
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Kim J, Min KD, Lee BI, Kim JB, Kwon SW, Chun DI, Kim YB, Seo GW, Lee JS, Park S, Choi HS. Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Relat Res 2020; 32:52. [PMID: 33008475 PMCID: PMC7531164 DOI: 10.1186/s43019-020-00067-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. MATERIALS AND METHODS We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. RESULTS The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSS-knee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. CONCLUSIONS The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Kyung-Dae Min
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea
| | - Byung-Ill Lee
- Department of Orthopaedic Surgery, Smarton Hospital, Bucheon, South Korea
| | - Jun-Bum Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea
| | - Sai-Won Kwon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Yong-Beom Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Gi-Won Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Gumi, Gumi, South Korea
| | - Jeong Seok Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital Seoul, Seoul, South Korea
| | - Hyung-Suk Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea.
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Sumner B, McCamley J, Jacofsky DJ, Jacofsky MC. Comparison of Knee Kinematics and Kinetics during Stair Descent in Single- and Multi-Radius Total Knee Arthroplasty. J Knee Surg 2020; 33:1020-1028. [PMID: 31390673 DOI: 10.1055/s-0039-1692652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite continuing advances, nearly 20% of patients remain dissatisfied with their total knee arthroplasty (TKA) outcomes. Single-radius (SR) and multiradius (MR) TKA designs are two commonly used knee replacement designs based on competing theories of the flexion/extension axis of the knee. Our aim was to characterize stair descent kinematics and kinetics in SR and MR TKA subjects. We hypothesized that 1 year after TKA, patients who received SR TKA will more closely replicate the knee kinematics and kinetics of healthy age-matched controls during stair descent, than will MR TKA patients. SR subjects (n = 12), MR subjects (n = 12), and age-matched controls (n = 12) descended four stairs affixed to force platforms, while 10 infrared cameras tracked markers attached to the body to collect kinematic and kinetic data. Both patient groups had improvements in stair descent kinetics and kinematics at the 1-year postoperative time point. However, SR TKA subjects were indistinguishable statistically from age-matched controls, while MR TKA subjects retained many differences from controls. Similar to previous reports for level walking, the SR knee design performs closer to healthy controls than MR knees during stair descent. This study demonstrates that patients who receive SR TKA have more improved kinematic normalization during stair descent postoperatively than those who received an MR TKA.
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Affiliation(s)
- Bonnie Sumner
- Department of Research, MORE Foundation, Phoenix, Arizona
| | - John McCamley
- Department of Research, MORE Foundation, Phoenix, Arizona
| | - David J Jacofsky
- Department of Adult Reconstruction, The CORE Institute, Phoenix, Arizona
| | - Marc C Jacofsky
- Department of Research, MORE Foundation, Phoenix, Arizona.,Department of Research and Development, The CORE Institute, Phoenix, Arizona
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Li M, Fu G, Huang W, Lin B, Zhang R, Zhang Y, Ma Y, Zheng Q. Alterations of kinematics in knees after single versus multiple radius femoral prostheses total knee arthroplasty: a retrospective study. BMC Musculoskelet Disord 2020; 21:434. [PMID: 32622357 PMCID: PMC7334846 DOI: 10.1186/s12891-020-03425-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Design modifications in prostheses may cause alterations in gait kinematics, thus influencing functional restoration of knees after total knee arthroplasty (TKA). The aim of the study was to investigate the differences in gait kinematics and clinical outcomes after single radius (SR) versus multiple radius (MR) TKA. METHOD The present retrospective study included 38 unilateral TKA involving 20 knees using MR design implant and 18 knees using SR design implant. Thirty-six healthy volunteers were also recruited. The mean follow-up time was 16 ± 3 months. At the end of follow-up, the 6 degrees of freedom (DOF) kinematics of knees and range of motion (ROM) were measured with a portable optical tracking system. Knee society score (KSS) and knee injury, and osteoarthritis outcome score (KOOS) were also collected. RESULTS Patients in the SR group had significantly higher scores in activities of daily living (84.7 ± 15.9) and sports and recreation (67.5 ± 25.2) KOOS sub-score than MR group (69.9 ± 17.6, P = 0.012; 50.0 ± 20.8, P = 0.027, respectively). Significant differences were detected between MR knees and SR knees (1.82° ± 3.11° vs 4.93° ± 3.58°, P = 0.009), and MR knees and healthy knees (1.82° ± 3.11° vs 3.62° ± 3.52°, P = 0.032) in adduction/abduction ROM. The proximal/distal translation was significantly smaller in MR knees (0.58 ± 0.54 cm) compared with SR knees (1.03 ± 0.53 cm, P = 0.003) or healthy knees (0.84 ± 0.45 cm, P = 0.039). SR knees (0.24 ± 0.40 cm) had smaller translation compared with the MR group (0.54 ± 0.33 cm, P = 0.017) and control group (0.67 ± 0.36 cm, P = 0.028). No significant difference was detected in the other DOFs during the gait cycle. Significant difference was detected in extension/flexion, internal/external rotation, adduction/abduction, proximal/distal and medial/lateral among MR, SR and healthy knees. CONCLUSION After TKA, patients have altered gait kinematics compared with the control group. MR and SR design showed varied characteristics in 6 DOF gait kinematics, which could be the cause of the difference in functional outcome.
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Affiliation(s)
- Mengyuan Li
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Guangtao Fu
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Wenhan Huang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Bofu Lin
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
- Shantou University Medical College, Shantou, 515063, PR China
| | - Ruiying Zhang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Yu Zhang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Yuanchen Ma
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China.
| | - Qiujian Zheng
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China.
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11
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Elmasry SS, Sculco PK, Kia M, Kahlenberg CA, Cross MB, Pearle AD, Mayman DJ, Wright TM, Westrich GH, Imhauser CW. A geometric ratio to predict the flexion gap in total knee arthroplasty. J Orthop Res 2020; 38:1637-1645. [PMID: 32410240 PMCID: PMC7345479 DOI: 10.1002/jor.24719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 02/04/2023]
Abstract
Measured resection is a common technique for obtaining symmetric flexion and extension gaps in posterior-stabilized (PS) total knee arthroplasty (TKA). A known limitation of measured resection, however, is its reliance on osseous landmarks to guide bone resection and component alignment while ignoring the geometry of the surrounding soft tissues such as the medial collateral ligament (MCL), a possible reason for knee instability. To address this clinical concern, we introduce a new geometric proportion, the MCL ratio, which incorporates features of condylar geometry and MCL anterior fibers. The goal of this study was to determine whether the MCL ratio can predict the flexion gaps and to determine whether a range of MCL ratio corresponds to balanced gaps. Six computational knee models each implanted with PS TKA were utilized. Medial and lateral gaps were measured in response to varus and valgus loads at extension and flexion. The MCL ratio was related to the measured gaps for each knee. We found that the MCL ratio was associated with the flexion gaps and had a stronger association with the medial gap (β = -7.2 ± 3.05, P < .001) than with the lateral gap (β = 3.9 ± 7.26, P = .04). In addition, an MCL ratio ranging between 1.1 and 1.25 corresponded to balanced flexion gaps in the six knee models. Future studies will focus on defining MCL ratio targets after accounting for variations in ligament properties in TKA patients. Our results suggest that the MCL ratio could help guide femoral bone resections in measured resection TKA, but further clinical validation is required.
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Affiliation(s)
- Shady S. Elmasry
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Peter K. Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY
| | - Mohammad Kia
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Cynthia A. Kahlenberg
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY
| | - Michael B. Cross
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY
| | - Andrew D. Pearle
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY
| | - David J. Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY
| | - Timothy M. Wright
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Geoffrey H. Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY
| | - Carl W. Imhauser
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
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Joseph MN, Carmont MR, Tailor H, Stephen JM, Amis AA. Total knee arthroplasty reduces knee extension torque in-vitro and patellofemoral arthroplasty does not. J Biomech 2020; 104:109739. [DOI: 10.1016/j.jbiomech.2020.109739] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 01/14/2023]
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13
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Lee M, Chen JY, Ying H, Nee PH, Tay DKJ, Chin PL, Lu CS, Nung LN, Jin YS. Quality of life and functional outcome after single-radius and multi-radius total knee arthroplasty. J Orthop Surg (Hong Kong) 2019; 26:2309499018792417. [PMID: 30089417 DOI: 10.1177/2309499018792417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The main objective of this study was to compare quality of life and functional outcome in patients who have undergone a single-radius (SR) or multi-radius (MR) total knee arthroplasty (TKA). The secondary objective was to observe changes in knee range of movement (ROM) and standardized knee scores (KSCs) in these patients. The hypothesis was that there would be no statistically significant difference between the two patient groups in quality of life and functional outcome. METHODS One hundred three SR TKAs were performed by a single surgeon between August 2008 and December 2012. A propensity score matching algorithm was used to select 103 MR TKAs performed during the same period. Preoperative and postoperative variables such as standardized knee and quality of life scores were captured prospectively and then analyzed via both the Student's t-test and paired t-test to look for statistically significant differences between the SR and MR patient groups. RESULTS At 2 years postoperatively, there was no statistically significant difference between the SR and MR patient populations in knee extension, Oxford Knee Score, Knee Society Clinical Rating Scores, and the Physical Component Summary of the Short Form 36 Health Survey (SF-36). There was a statistically significant difference between the two patient groups in postoperative knee flexion in favor of the MR design ( p = 0.011). CONCLUSION While an SR femoral implant design has several theoretical biomechanical advantages, postoperative standardized KSCs and quality of life scores in this single-surgeon series do not show a clear advantage of one design over the other. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Merrill Lee
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hao Ying
- 2 Health Services Research Unit (HSRU), Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Pang Hee Nee
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren Keng Jin Tay
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Pak Lin Chin
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chia Shi Lu
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Lo Ngai Nung
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yeo Seng Jin
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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14
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Luo Z, Luo Z, Wang H, Xiao Q, Pei F, Zhou Z. Long-term results of total knee arthroplasty with single-radius versus multi-radius posterior-stabilized prostheses. J Orthop Surg Res 2019; 14:139. [PMID: 31097037 PMCID: PMC6521522 DOI: 10.1186/s13018-019-1183-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/03/2019] [Indexed: 02/05/2023] Open
Abstract
Background Single-radius (SR) prostheses and multi-radius (MR) prostheses have different theoretical advantages; however, there has been a paucity of evaluations comparing the two. This study was designed to compare the 10-year clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Methods In this retrospective cohort study, 220 consecutive patients undergoing TKA between October 2006 and October 2007 were divided into the SR group (106 patients, Stryker Scorpio NRG) and the MR group (114 patients, DePuy Sigma PFC), with a minimum follow-up of 10 years. Clinical, functional, and radiological outcomes, as well as satisfaction rates and survival results, were evaluated. Results Hospital for Special Surgery and Short Form-12 health survey scores were all significantly improved in both groups at the final follow-up (P < 0.05), but the groups did not differ. The SR group had significantly less anterior knee pain (AKP) and painless crepitation (P < 0.05). Radiological results in terms of radiolucent lines and component position angle showed no differences between groups. The Kaplan-Meier survival curve estimates at 10 years were not significantly different between the groups (P = 0.4172). Conclusion Both SR and MR posterior-stabilized prostheses can lead to satisfactory outcomes. The SR prosthesis design gave less anterior knee pain than did the MR prostheses. Two prostheses showed no differences in terms of clinical scales, radiological results, satisfaction rates, and survival results at a long-term follow-up. More accurate measurements are required.
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Affiliation(s)
- Zhenyu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Zeyu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Haoyang Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Qiang Xiao
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China.
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15
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Zapata G, Sanz-Pena I, Verstraete M, Walker PS. Effects of femoral component placement on the balancing of a total knee at surgery. J Biomech 2019; 86:117-124. [PMID: 30777340 DOI: 10.1016/j.jbiomech.2019.01.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
Misalignment and soft-tissue imbalance in total knee arthroplasty (TKA) can cause discomfort, pain, inadequate motion and instability that may require revision surgery. Balancing can be defined as equal collateral ligament tensions or equal medial and lateral compartmental forces during the flexion range. Our goal was to study the effects on balancing of linear femoral component misplacements (proximal, distal, anterior, posterior); and different component rotations in mechanical alignment compared to kinematic alignment throughout the flexion path. A test rig was constructed such that the position of a standard femoral component could be adjusted to simulate the linear and rotational positions. With the knee in neutral reference values of the collateral tensions were adjusted to give anatomic contact force patterns, measured with an instrumented tibial trial. The deviations in the forces for each femoral component position were then determined. Compartmental forces were significantly influenced by 2 mm linear errors in the femoral component placement. However, the errors were least for a distal error, equivalent to undercutting the distal femur. The largest errors mainly increase the lateral condyle force, occurred for proximal and posterior component errors. There were only small contact force differences between kinematic and mechanical alignment. Based on these results, surgeons should avoid overcutting the distal femur and undercutting the posterior femur. However, the 2-3 degrees varus slope of the joint line as in kinematic alignment did not have much effect on balancing, so mechanical or kinematic alignment were equivalent.
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Affiliation(s)
- Gabriela Zapata
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, USA; NYU Tandon School of Engineering, Department of Biomedical Engineering, New York, USA
| | - Inigo Sanz-Pena
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, USA; NYU Tandon School of Engineering, Department of Mechanical and Aerospace Engineering, New York, USA; Universidad de La Rioja, Department of Mechanical Engineering, La Rioja, Spain
| | - Matthias Verstraete
- Orthosensor Inc., Dania Beach, FL, USA; Ghent University, Department of Human Structure and Repair, Ghent, Belgium
| | - Peter S Walker
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, USA; NYU Tandon School of Engineering, Department of Mechanical and Aerospace Engineering, New York, USA.
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16
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Kurowicki J, Khlopas A, Sultan AA, Sodhi N, Samuel LT, Chughtai M, Roche M, Bonutti PM, Mont MA. Improvement in hamstring and quadriceps muscle strength following cruciate-retaining single radius total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2018; 5:S27. [PMID: 29299474 DOI: 10.21037/atm.2017.11.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The ability to reach full functional capacity following total knee arthroplasty (TKA) is reliant on the strength of the quadriceps and hamstring muscles. Weakness of these muscles can persist anywhere from 1 to 3 years post-operatively. There remains considerable controversy as to what factors influence restoration of muscle strength after TKA. Implant designs have been implicated in the ability of patients to recover. Currently there is a paucity of literature available describing the influence of patient characteristics, surgical factors, and clinical outcomes on quadriceps and hamstring muscle strength following TKA with a cruciate-retaining, single radius (SR) implant. For this reason, we sought to investigate TKA patients for: (I) quadriceps muscle strength; (II) hamstring muscle strength; (III) flexion/extension (F/E) ratio; (IV) clinical outcome scores; (V) influence of patient characteristics on muscle strength at one-year post-operatively. Methods A review of TKA patients who were assessed for hamstring and quadriceps muscle strength was conducted. A total of 39 patients (26 men and 13 women), who had a mean age of 68 years (range, 51 to 88 years) were included. Isokinetic dynamometer testing at 180 degree/second for 3 sets of 10 repetitions in extension and flexion were performed by an independent physical therapist to assess dynamic concentric torque of the hamstrings and quadriceps muscle. F/E ratios were calculated. TKA was performed via subvastus (n=20) or midvastus (n=19) approach. Subgroup analysis for surgical approach, concomitant spinal pathology (n=11), gender, age and body mass index (BMI) were performed. Knee Society Scores (KSS) and range of motion (ROM) were assessed at each visit. Comparisons of groups were performed using paired t-tests. Results Mean postoperative relative extension torque was 23 Nm/kg (range, 9 to 43 Nm/kg), representing a mean increase of 38% (range, -16% to 100%; P=0.0267) from pre-operative status. A mean increase of 27% (range, -15% to 100%; P=0.0433) in flexion strength and mean relative flexion torque of 19 Nm/kg (range, 8-37 Nm/kg) was observed. Pre-operative mean F/E ratio was 0.8 and 0.9 post-operatively (P=0.3028). Men demonstrated significantly greater improvements in flexion compared to women (22% vs. 12%; P<0.0001), but gender had no influence on improvement in extension (27% vs. 15%; P=0.0537). Postoperative F/E was similar for males (0.8) and females (0.9; P=0.4454). Surgical approach did not influence quadriceps muscle strength (P=0.1786) or hamstrings muscle strength (P=0.9592). History of spine pathology had no impact on muscles strength (hamstring, P=0.5684; quadriceps, P=0.7221). For the overall group, a mean KSS pain score was 96 points (range, 84 to 100 points), KSS function was 96 points (range, 80 to 100 points), and mean ROM of 0 to 114 degrees. Conclusions Restoration of quadriceps and hamstring muscle strength can be expected at 1 year post-operatively regardless of gender, surgical approach or concomitant spinal pathology. Further comparative investigation on the impact of implant design on hamstring and quadriceps muscle strength is warranted. However, the use of a SR, CR TKA system demonstrated significant improvements post-operatively in quadriceps and hamstring strength.
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Affiliation(s)
- Jennifer Kurowicki
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Martin Roche
- Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida, USA
| | - Peter M Bonutti
- Department of Orthopaedic Surgery, Bonutti Clinic, Effingham, Illinois, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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17
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Chang MJ, So S, Park CD, Seo JG, Moon YW. Long-term follow-up and survivorship of single-radius, posterior-stabilized total knee arthroplasty. J Orthop Sci 2018; 23:92-96. [PMID: 28911945 DOI: 10.1016/j.jos.2017.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 07/14/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND We sought to determine the 10-year survivorship of single-radius, posterior-stabilized total knee arthroplasty (TKA) in Asian patients. We also aimed to determine whether the long-term clinical and radiographic results differed between patients with and without patellar resurfacing. METHODS This retrospective study included 148 (115 patients) consecutive single-radius, posterior-stabilized TKAs. Ten-year survivorship analysis was performed using the Kaplan-Meier method with additional surgery for any reason as the end-point. Furthermore, long-term clinical and radiographic results of 109 knees (74%; 84 patients) with more than 10-year follow-up were analyzed. Ten-year survivorship and long-term outcomes after surgery were determined, and outcomes were compared between patients with and without patellar resurfacing. RESULTS The cumulative survival rate of the single-radius posterior-stabilized TKA of 148 knees was 97.7% (95% confidence interval, 93.1%-99.3%) at 10 years after surgery. Three knees required additional surgery during the 10-year follow-up because of one case of instability and two cases of periprosthetic infections. Mean postoperative Knee Society knee score and function score were 97 points and 75 points, respectively. There were no cases of aseptic loosening of the prosthesis, even though a non-progressive radiolucent line was found in 10 (9%) knees. There were no differences in postoperative scores and degree of patellar tilt and displacement between patients with and without patellar resurfacing. CONCLUSIONS Single-radius, posterior-stabilized TKA showed satisfactory long-term clinical and radiographic outcomes in Asian patients regardless of patellar resurfacing, with comparable survivorship to that reported in westerners.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sangyeon So
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan-Deok Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai Gon Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Ishii Y, Noguchi H, Sato J, Ishii H, Yamamoto T, Sakurai T, Toyabe SI. Clinical relevance of active straight leg raising, standing up, and walking after total knee arthroplasty in a cross-sectional study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:947-953. [DOI: 10.1007/s00590-017-2100-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 11/24/2022]
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19
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Collados-Maestre I, Lizaur-Utrilla A, Gonzalez-Navarro B, Miralles-Muñoz FA, Marco-Gomez L, Lopez-Prats FA, Gil-Guillen V. Better functional outcome after single-radius TKA compared with multi-radius TKA. Knee Surg Sports Traumatol Arthrosc 2017; 25:3508-3514. [PMID: 27522590 DOI: 10.1007/s00167-016-4273-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine whether the design of the femoral component influenced patient outcomes. METHODS Two hundred and thirty-seven patients were randomized to compare functional outcomes between single-radius TKA (SR, 118 patients) and multi-radius TKA (MR, 119 patients) with a minimum follow-up of 5 years. Prospective pre- and postoperative assessments were performed by the clinical and radiological criteria of the Knee Society Score (KSS), WOMAC and Short-Form 12 (SF12) questionnaires. The extension mechanism was assessed based on the quadriceps strength and chair test. Patient satisfaction was also assessed. RESULTS The median follow-up was 5.7 (range 5-7) years. At last follow-up, significant better KSSs (p = 0.001), range of motion (p = 0.001), extension lag (p = 0.020), quadriceps strength (p = 0.004), chair test (p = 0.032) and WOMAC pain (p = 0.002) were found in the SR group. Moreover, the improvements of these variables were early in the SR group (from 6 postoperative months). There were no significant differences in WOMAC function or SF12 physical and mental components. The revision rate and implant survival were similar in both groups. Satisfaction rate was significantly higher in SR group (p = 0.032). CONCLUSION This study shows better results with SR cruciate-retaining femoral component than MR component. The use of SR system is recommended because, although the clinically relevant differences were moderate, the functional improvement was earlier and the patient satisfaction higher with this design. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Isabel Collados-Maestre
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain. .,Traumatology and Orthopaedia, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain.
| | - Blanca Gonzalez-Navarro
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Luis Marco-Gomez
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Fernando A Lopez-Prats
- Traumatology and Orthopaedia, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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Xie X, Rusly R, DesJardins JD, Voss F, Chillag K, LaBerge M. Effect of rotational prosthetic alignment variation on tibiofemoral contact pressure distribution and joint kinematics in total knee replacement. Proc Inst Mech Eng H 2017; 231:1034-1047. [PMID: 28820012 DOI: 10.1177/0954411917727564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In total knee replacement surgery, implant alignment is one of the most important criteria for successful long-term clinical outcome. During total knee replacement implantation, femoral and tibial alignment are determined through appropriate bone resections, which could vary based on patient anatomy, implant design and surgical technique and further influence loading conditions and clinical outcomes. The current research focused on three critical alignment parameters for total knee replacement insertion: femoral component internal/external (I/E) rotation, varus-valgus tibiofemoral angulation and posterior tibial slope. A computational finite element model of total knee replacement implant was developed and validated comparing with kinematic outputs generated from experimentally simulated knee joint motion. The FE model was then used to assess 12 different alignment scenarios based on previous case reports. Postoperative knee kinematics and joint contact pressure during simulated gait motion were assessed. According to the parametric study, FE model cases with femoral rotation revealed extra tibial I/E rotation in the predefined direction but negligible change in tibial anterior-posterior translation; cases with increased tibial slope showed notably increased tibial external rotation and anterior translation; cases with varus tibiofemoral angle presented slightly more tibial external rotation, whereas cases with valgus angle presented an observable increase in tibial internal rotation at the middle phase of the gait cycle. Finally, the response surface obtained from the postprocessing study demonstrated good statistical correlation with existing case study results, providing reliable estimation of peak tibiofemoral contact pressure affected by combinations of alignment parameters. The observations indicate that femoral external alignment should be favored clinically for enhanced patellar tracking and reduced contact pressure concentration for better long-term performance. Posterior tibial slope enables deep knee flexion. Extra femoral internal rotation as well as tibiofemoral varus-valgus alignment could be avoided in surgery due to deficiency in patellar tracking and high pressure concentration.
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Affiliation(s)
- Xin Xie
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Roy Rusly
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - John D DesJardins
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Frank Voss
- 2 Department of Orthopaedic Surgery, School of Medicine Columbia, University of South Carolina, Columbia, SC, USA
| | - Kim Chillag
- 3 Moore Orthopaedic Clinic, Columbia, SC, USA
| | - Martine LaBerge
- 1 Department of Bioengineering, Clemson University, Clemson, SC, USA
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Hinarejos P, Puig-Verdie L, Leal J, Pelfort X, Torres-Claramunt R, Sánchez-Soler J, Monllau JC. No differences in functional results and quality of life after single-radius or multiradius TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24:2634-40. [PMID: 26658566 DOI: 10.1007/s00167-015-3894-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The main objective of this study was to compare the functional results and the impact on quality of life after a single-radius or a multiradius TKA implantation. The secondary objectives were to compare range of motion, satisfaction and the ability to perform daily life activities with both types of implant. It was hypothesized that the single-radius TKA would lead to better functional results and better quality of life than the multiradius TKA. METHODS This is a prospective non-randomized study that included 250 cases of a single-radius TKA and 224 of a multiradius posterior-stabilized TKA implanted with the same surgical and rehabilitation protocol. RESULTS In the 1- and 5-year follow-up, we found similar knee KSS scores (89.7 ± 12.1 in the multiradius group and 90.3 ± 11.7 in the single-radius group) and functional KSS scores (78.6 ± 21.4 in the multiradius group and 75.8 ± 20.9 in the single-radius group). The pain and the Physical SF-36 scores were also similar. Range of motion (112° ± 12° in the multiradius group and 112 ± 12° in the single-radius group), patients' satisfaction and the ability to perform daily life activities were also similar in both groups. CONCLUSION The use of a single-radius or a multiradius posterior-stabilized knee prosthesis can improve the function of the knee and the patients' quality of life in a similar way at the short-term and midterm follow-up. Moreover, range of motion, patient satisfaction and the ability to perform daily life activities are similar with both types of prosthesis. As both types of prosthesis can improve the function and quality of life of the patients in a similar way, the sagittal radius of the femoral component should not be considered the main factor when choosing the model of TKA. LEVEL OF EVIDENCE Therapeutic study: Prospective comparative study, Level II.
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Affiliation(s)
- Pedro Hinarejos
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain.
| | - Lluis Puig-Verdie
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Joan Leal
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Xavier Pelfort
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Joan C Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar. (Spain), Universitat Autònoma de Barcelona, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
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Liu S, Long H, Zhang Y, Ma B, Li Z. Meta-Analysis of Outcomes of a Single-Radius Versus Multi-Radius Femoral Design in Total Knee Arthroplasty. J Arthroplasty 2016; 31:646-54. [PMID: 26614746 DOI: 10.1016/j.arth.2015.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although the single-radius (SR) femoral design is known to have theoretical advantages in many aspects, studies of clinical outcomes that compare the SR with the multiple-radius (MR) femoral design are controversial. We performed a meta-analysis to address the hypothesis that a SR femoral design in primary total knee arthroplasty improves patient outcomes. METHODS The meta-analysis identified 15 articles reporting the clinical outcomes of 2212 knee replacements using the SR (n = 948) compared with the multiradius (MR; n = 1361) femoral design. Comparing SR with MR, we examined the Knee Society Score for the knee (KSS-knee), KSS-function, knee flexion, range of motion, complications, isometric peak torque of knee, and survival rate. RESULTS The range of motion of SR knees was lower than that of MR knees. No differences were found in the analyses of KSS-knee, KSS-function, knee flexion, complications, isometric peak torque of the knee, and survival rate. CONCLUSION Our meta-analysis does not provide clinical support for the previously reported theoretical advantages of the SR implant design.
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Affiliation(s)
- Shiluan Liu
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Hua Long
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Yinglong Zhang
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Baoan Ma
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
| | - Zhao Li
- Department of Orthopedics and Orthopedics Oncology Institute of Chinese PLA, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P.R.China
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Functional versus patient-reported outcome of the bicruciate and the standard condylar-stabilizing total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:305-10. [PMID: 26922063 DOI: 10.1007/s00590-016-1750-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/23/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The purpose of this retrospective comparative analysis in patients undergoing primary total knee arthroplasty (TKA) was to evaluate whether different TKA implant design would influence patient-rated outcomes, functioning, and range of motion (ROM). A secondary purpose of this study was to test for relationships between the patient-rated outcomes and the passive ROM. MATERIALS AND METHODS Thirty-one patients who had a primary bicruciate stabilized TKA performed between May 2010 and November 2012 were retrospectively reviewed and compared with a cohort of 30 patients who had condylar-stabilizing TKA during the same period. RESULTS No significant differences were observed between the two groups with respect to preoperative demographic characteristics, ROM and radiographic knee alignment. At a mean follow-up of 37 months (SD 7), the Triathlon group had higher mean Knee Injury and Osteoarthritis Outcome Score (KOOS) score in all subscales and a higher Knee Society Score (KSS) score than the Journey group. This difference was statistically significant for the KOOS subscales of pain (p = 0.0099) and activities of daily living (ADL) (p = 0.0003), as well as the KSS score (p = 0.03846). The ROM was significantly higher in the Journey group when compared to the Triathlon group (p = 0.0013). No significant correlation was observed between the ROM and KOOS pain, QOL and ADL subscores and KSS score. CONCLUSIONS Postoperative knee ROM and patient perception of knee function after primary TKA can be affected by the different prosthetic designs. However, functionality afforded by the bicruciate TKA is not equivalent to patient satisfaction. LEVEL OF EVIDENCE III.
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Kim DH, Kim DK, Lee SH, Kim KI, Bae DK. Is Single-Radius Design Better for Quadriceps Recovery in Total Knee Arthroplasty? Knee Surg Relat Res 2015; 27:240-6. [PMID: 26676282 PMCID: PMC4678245 DOI: 10.5792/ksrr.2015.27.4.240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/21/2015] [Accepted: 10/19/2015] [Indexed: 11/04/2022] Open
Abstract
Purpose Although single-radius (SR) designs have a theoretical advantage in quadriceps recovery following total knee arthroplasty (TKA), there has been a paucity of objective evaluation studies. Materials and Methods One hundred and twenty minimally invasive TKAs were prospectively randomized by a single surgeon into 2 groups: SR design TKA group and multi-radius design TKA group. Quadriceps force and power were assessed using a dynamometer, and clinical data were investigated preoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. Results There were no differences between two groups in quadriceps recovery and clinical results throughout the follow-up period. Furthermore, the proportion of patients whose postoperative quadriceps force and power reached preoperative level was similar in both groups. Conclusions Femoral component design itself would not significantly influence quadriceps recovery after TKA.
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Affiliation(s)
- Duk-Hyun Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dong-Kyoon Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dae-Kyung Bae
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
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Abstract
Introduction: Midflexion instability in primary total knee replacement (TKR) is an evolving concept. Successful treatment of instability requires an understanding of the different types of instability. Methods: A literature review was performed to identify information pertinent to midflexion instability in primary total knee replacement, utilising PRISMA guidelines. Databases searched included Embase, Medline, All of the Cochrane Library, PubMed and cross references. Results: Three factors, i.e., elevated joint line, multiradii femoral component and medial collateral ligament (MCL) laxity, were identified to influence midflexion instability. Literature suggested mediolateral instability at 30–60° of flexion as diagnostic of midflexion instability. Literature search also revealed paucity in clinical studies analysing midflexion instability. Most of the evidence was obtained from cadaveric studies for elevated joint line and MCL laxity. Clinical studies on multiradii femoral component were limited by their small study size and early followup period. Conclusion: Elevated joint line, multiradii femoral component and MCL laxity have been suggested to cause midflexion laxity in primary TKR. Due to limitations in available evidence, this review was unable to raise the strength of overall evidence. Future well-designed clinical studies are essential to make definitive conclusions. This review serves as a baseline for future researchers and creates awareness for routine assessment of midflexion instability in primary total knee replacement.
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Larsen B, Jacofsky MC, Jacofsky DJ. Quantitative, Comparative Assessment of Gait Between Single-Radius and Multi-Radius Total Knee Arthroplasty Designs. J Arthroplasty 2015; 30:1062-7. [PMID: 25677936 DOI: 10.1016/j.arth.2015.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 01/01/2015] [Accepted: 01/11/2015] [Indexed: 02/01/2023] Open
Abstract
Gait of single-radius (SR, n=16) and multi-radius (MR, n=16) posterior stabilized total knee arthroplasties was compared, along with controls (n=16), pre-op and 1 year post-op. Computer navigation and standard order sets controlled confounding variables. Post-operatively, SR knees did not differ from controls while MR knees continued to differ in important knee kinetic and kinematic properties. MR knees remained more extended (P=0.019) and had decreased power absorption (P=0.0001) during weight acceptance compared to the SR knees. Both surgical groups had similar KSS for Knee Scores (P=0.22) and Function Scores (P=0.58). The significant biomechanical differences are likely influenced by patella-femoral moment arm geometry and changing ligament laxity throughout the active range of motion.
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Ji HM, Ha YC, Baek JH, Ko YB. Advantage of minimal anterior knee pain and long-term survivorship of cemented single radius posterior-stabilized total knee arthroplasty without patella resurfacing. Clin Orthop Surg 2015; 7:54-61. [PMID: 25729519 PMCID: PMC4329533 DOI: 10.4055/cios.2015.7.1.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 04/07/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. METHODS Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. RESULTS Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. CONCLUSIONS The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.
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Affiliation(s)
- Hyung-Min Ji
- Department of Orthopedic Surgery, Ajou University Medical Center, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji-Hoon Baek
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young-Bong Ko
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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28
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A comparison of stability and clinical outcomes in single-radius versus multi-radius femoral design for total knee arthroplasty. J Arthroplasty 2014; 29:2402-6. [PMID: 24793892 DOI: 10.1016/j.arth.2014.03.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 02/01/2023] Open
Abstract
We compared the intraoperative varus-valgus stability from 0° to 90° of flexion and postoperative clinical outcomes in patients receiving TKA via either a single-radius femoral design (50 TKA, SR group) or multi-radius femoral design (50 TKA, MR group). We measured stabilities at 0°, 30°, 60° and 90° of flexion using a navigation system. The clinical outcomes including HSS scores, WOMAC scores and VAS score during stair climbing were compared after a minimum of 2-year follow-up. The single-radius femoral designs in TKA showed better intra-operative stability at 30° of flexion (7.6 vs. 8.3) compared with the multi-radius femoral design, but not at other angles. However, the clinical outcomes revealed no other significant differences in terms of HSS scores, WOMAC scores and VAS score between two groups.
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29
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Can TKA design affect the clinical outcome? Comparison between two guided-motion systems. Knee Surg Sports Traumatol Arthrosc 2014; 22:581-9. [PMID: 23632757 DOI: 10.1007/s00167-013-2509-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 04/15/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE In a retrospective comparative analysis in patients undergoing primary guided-motion total knee arthroplasty (TKA), the authors have evaluated whether different TKA implant design would influence the clinical and functional outcomes. METHODS Between 2007 and 2009, 227 computer-assisted primary TKAs were performed in 219 consecutive patients. Patients received one of the two different fixed-bearing guided-motion TKA designs assisted by navigation surgery: the Scorpio Non-Restrictive Geometry (NRG) knee system and the Journey Bi-Cruciate Stabilized (BCS) knee systems. RESULTS Data were available for 180 patients (187 knees). No significant differences were observed between the two groups with respect to preoperative demographic characteristics, range of motion (ROM) and radiographic knee alignment. At a mean follow-up of 29 months, the Journey BCS group had higher mean Knee Injury and Osteoarthritis Outcome Score (KOOS) in all subscales and a greater ROM than the Scorpio NRG group. This difference was statistically significant for the KOOS subscales of pain (p = 0.007) and knee-related quality of life (p = 0.045), as well as for postoperative ROM (p = 0.018). Considering the overall complications, 1 patient of Scorpio NRG group (0.5%) and 5 in Journey BCS (2.7%) had stiffness. Anterior knee pain was reported in 4 cases of Scorpio NRG group (2.1%). In the Journey BCS group were observed 2 cases (1.1%) of frontal plane instability and 1 case (0.5%) of synovitis pain. CONCLUSIONS The bearing geometry and kinematic pattern of different guided-motion prosthetic designs can affect the clinical-functional outcome and complications type in primary TKA. LEVEL OF EVIDENCE Clinical study, Level III.
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Hamilton DF, Simpson AHRW, Burnett R, Patton JT, Moran M, Clement ND, Howie CR, Gaston P. Lengthening the moment arm of the patella confers enhanced extensor mechanism power following total knee arthroplasty. J Orthop Res 2013; 31:1201-7. [PMID: 23512255 DOI: 10.1002/jor.22344] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 02/12/2013] [Indexed: 02/04/2023]
Abstract
We investigated whether a postulated biomechanical advantage conferred to the extensor mechanism by a change in knee implant design was detectable in patients by direct physical testing. 212 TKA patients were enrolled in a double blind randomized controlled trial to receive either a traditional implant or one which incorporated new design features. Extensor mechanism power output and physical performance on a battery of timed functional activities was assessed pre-operatively and then at 6, 26, and 52 weeks post-operatively. Significantly enhanced power output was observed in both groups post-arthroplasty; however, the new design implant group demonstrated a greater change in power output than the traditional implant group. Posthoc testing of between group differences highlighted greater improvement at all post-operative assessments. At 52 weeks, patients receiving the implant with the postulated biomechanical advantage achieved 116% of the power output of their contralateral limb, whereas patients with the traditional design achieved 90%. No between group difference was detected in the patient's time to complete functional tasks. Thus, patients receiving a knee implant of a modern design (theoretically able to confer a mechanical advantage to the extensor mechanism) were found to generate significantly greater extensor power than those receiving a traditional implant without the postulated mechanical advantage.
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Affiliation(s)
- David F Hamilton
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh and University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom.
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Harwin SF, Issa K, Given K, Hitt KD, Greene KA, Pivec R, Kester M, Mont MA. Clinical and patient-reported outcomes of primary TKA with a single-radius design. Orthopedics 2013; 36:e877-82. [PMID: 23823044 DOI: 10.3928/01477447-20130624-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Total knee arthroplasty (TKA) is a cost-effective procedure used to treat degenerative knee disease with excellent long-term outcomes. However, TKA has not always resulted in excellent functional and patient satisfaction outcomes, partly due to the use of prostheses that did not reproduce natural knee kinematics. Due to a paucity of reports on single-radius designs, the authors evaluated the clinical and patient-reported outcomes of primary TKA in patients who had received a single-radius prosthesis. A total of 287 TKAs from 7 centers were prospectively evaluated. Mean follow-up was 5 years, with each patient undergoing year re-evaluation. Kaplan-Meier implant survivorship was 99.7% at a final follow-up of 7 years. The total reoperation rate was 1.4%. Clinical outcomes demonstrated significant improvements in Knee Society, Short Form 36, and activity scores at a mean follow-up of 5 years. The authors believe that various features of this prosthesis may have contributed to these excellent outcomes. Further longer-term studies are necessary to better evaluate these outcomes.
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Affiliation(s)
- Steven F Harwin
- Adult Reconstruction and Total Joint Replacement Service, Beth Israel Medical Center, New York, New York, USA
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Molt M, Ljung P, Toksvig-Larsen S. Does a new knee design perform as well as the design it replaces? Bone Joint Res 2012; 1:315-23. [PMID: 23610663 PMCID: PMC3626188 DOI: 10.1302/2046-3758.112.2000064] [Citation(s) in RCA: 24] [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: 02/27/2012] [Accepted: 10/09/2012] [Indexed: 11/17/2022] Open
Abstract
Objectives The objective of this study was to compare the early migration
characteristics and functional outcome of the Triathlon cemented
knee prosthesis with its predecessor, the Duracon cemented knee
prosthesis (both Stryker). Methods A total 60 patients were prospectively randomised and tibial
component migration was measured by radiostereometric analysis (RSA)
at three months, one year and two years; clinical outcome was measured
by the American Knee Society score and the Knee Osteoarthritis and
Injury Outcome Score. Results There were no statistically significant differences in rotation
or translation around or along the three coordinal axes, or in the
maximum total point motion (MTPM) during the two-year follow-up. Conclusions The Triathlon cemented knee prosthesis has similar early stability
and is likely to perform at least as well as the Duracon cemented
knee prosthesis over the longer term.
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Affiliation(s)
- M Molt
- Hässleholm Hospital, Orthopaedic Clinic Hässleholm - Kristianstad - Ystad, Box 351, 281 25 Hässleholm, Sweden
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Siddiqui MMA, Yeo SJ, Sivaiah P, Chia SL, Chin PL, Lo NN. Function and quality of life in patients with recurvatum deformity after primary total knee arthroplasty: a review of our joint registry. J Arthroplasty 2012; 27:1106-10. [PMID: 22153947 DOI: 10.1016/j.arth.2011.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 10/16/2011] [Indexed: 02/01/2023] Open
Abstract
The aim of this paper is to assess function and quality of life in patients with recurvatum at 2 years after primary total knee arthroplasty. This prospective study involves 2587 total knee arthroplasty from 2004 to 2008 with 2-year follow-up. Patients' demographics, diagnosis, implants, range of motion, laxity, and knee and SF-36 scores were recorded. Recurvatum deformity of 0°, 1° to 5°, 6° to 10°, and more than 10° were classified as grades 0, 1, 2, and 3, respectively. Grade 1 had similar functional scores to grade 0 but significantly better SF1, SF4, SF5, and SF8 when compared with grades 2 and 3. Patients with mediolateral translation of more than 5 mm were more likely to have grades 2 and 3 recurvatum (P = .01), indicating global laxity. Postoperative recurvatum of more than 5° significantly impacts function and quality of life of patients.
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