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Patel SK, Buller LT, Deckard ER, Meneghini RM. Survivorship and Patient Outcomes of Conforming Bearings in Modern Primary Total Knee Arthroplasty: Mean 3.5 Year Follow-Up. J Arthroplasty 2024:S0883-5403(24)00435-2. [PMID: 38734325 DOI: 10.1016/j.arth.2024.04.084] [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: 11/07/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The use of conforming and congruent bearings in total knee arthroplasty (TKA) have rapidly increased due to the benefits of increased stability and the potential for replicating normal knee kinematics. However, limited data exist for these newly available bearings. This study evaluated revision-free survivorship and patient-reported outcome measures (PROMs) of a large granular database of primary TKAs using a single conforming bearing design. METHODS A total of 1,306 consecutive primary TKAs performed using a single conforming bearing design (85% cemented and 15% cementless) were retrospectively reviewed. Kaplan-Meier survivorship estimates were calculated based on the latest clinical follow-up. The PROMs and minimal clinically important differences were evaluated. A total of 93% of cases achieved minimum 1-year clinical follow-up (mean 3.5 years; range, 1 to 7), with a subset of 261 cases that achieved minimum 5-year follow-up (mean 5.8 years; range, 5 to 7). RESULTS All-cause and aseptic Kaplan-Meier survivorship estimates were 97.6 (95% CI [confidence interval], 97 to 99) and 98.1% (95% CI, 97 to 99) at 7.0 years. Revision-free survivorship did not differ by cemented or cementless fixation (98 versus 97%, P = .163). All PROM scores significantly improved from preoperative baseline (P < .001), and ≥ 86% of patients achieved minimal clinically important differences for Knee Society pain and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement total scores. A total of 89% of cases reported their knees to 'sometimes or always' feel normal. For cases with minimum 5-year PROMs, 93% were 'very satisfied' or 'satisfied.' CONCLUSIONS Conforming-bearing TKA demonstrated excellent survivorship up to 7.0 years. In addition, PROMs were comparable to other designs reported in the literature. While mid-term (mean 3.5-year) results are promising, long-term data are warranted on survivorship due to potential polyethylene wear in conforming bearings with more surface area in contact with articulating surfaces. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sohum K Patel
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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Hasegawa M, Tone S, Naito Y, Sudo A. Comparison of accuracy and early outcomes in robotic total knee arthroplasty using NAVIO and ROSA. Sci Rep 2024; 14:3192. [PMID: 38326363 PMCID: PMC10850152 DOI: 10.1038/s41598-024-53789-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/05/2024] [Indexed: 02/09/2024] Open
Abstract
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.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Rossi SMP, Sangaletti R, Jannelli E, Bova D, Montagna A, Benazzo F. 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. Arch Orthop Trauma Surg 2024; 144:307-313. [PMID: 37612567 DOI: 10.1007/s00402-023-05033-3] [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: 05/22/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND In recent years, increasing interest has arisen for medial pivoting TKA implants, designed to mimic the physiological knee kinematics, maximizing the contact area on the medial compartment of the knee, increasing anterior-posterior stability, and contributing to a ball-in-socket effect that allows the posterior cruciate sacrifice without a post-CAM mechanism. The medial congruent liner works with a J-curve cruciate-retaining (CR) femur without a real ball-in-socket design. The aim of this study was to evaluate the clinical outcomes and survival of these implants, with or without PCL sparing, at a medium follow-up. METHODS Between October 2016 and October 2018, 165 TKRs were performed in 161 patients (69.2% females and 30.8% males) and prospectively followed. Mean follow-up was 72 ± 12 months. All surgeries were performed using an extramedullary device and the same prosthetic implant. Patients were matched in two groups: in 80 patients, the PCL was preserved; in 85 patients, the PCL was sacrificed with a reduction of the tibial slope. RESULTS The OKS and KSS improved in both groups. The difference between the two groups at the final follow-up was not statistically significant. Good-to-excellent clinical results according to the KSS were achieved in 93% of the knees in the PCP group and in 95% in the PCS group. At final follow-up, the Forgotten Joint Score (FJS) was 73.6 in the PCP group and 74.1 in the PCS group with no statistical difference between the two groups (P > 0.05). CONCLUSIONS TKA with a medially congruent insert, showed promising results at mid-term follow-up, PCL preservation or sacrifice did not affect the clinical outcomes and survival. Further follow-up will be needed to evaluate these results at long term.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy.
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
| | - Eugenio Jannelli
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Davide Bova
- U.O. Ortopedia e Traumatologia, Humanitas Mater Domini, Castellanza, Italy
| | - Alice Montagna
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
- IUSS, Istituto Universitario di Studi Superiori, Pavia, Italy
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Munir S, Suzuki L, Hellman J. The Early Clinical Outcomes Following Unrestricted Caliper Verified Kinematic Alignment Using a Medial Stabilized Design Total Knee Arthroplasty With a Cruciate Retaining Insert. Arthroplast Today 2023; 24:101250. [PMID: 37920544 PMCID: PMC10618423 DOI: 10.1016/j.artd.2023.101250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/03/2023] [Accepted: 09/19/2023] [Indexed: 11/04/2023] Open
Abstract
Background Although various total knee arthroplasty (TKA) implant designs are widely used, the ideal TKA design is yet to be agreed upon. Although the benefits of cruciate-retaining (CR) TKA and medial stabilized (MS) TKA have been reported in literature, the early clinical outcomes of an MS TKA with CR inserts have not been reported. This study aims to report on the patient-reported clinical and radiological outcomes of MS-TKA combined with a CR insert. Methods A prospective single-surgeon series evaluated the clinical- and patient-reported outcomes of 115 patients implanted with GMK Sphere CR. Patient outcomes were assessed with the Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Scores (KOOS), Forgotten Joint Score, and Visual Analogue Scale for Satisfaction. Radiological assessment for alignment along with active flexion and extension were also assessed. Results Improvement in all scores was observed between the preoperative and 1-year follow-up timepoints, with statistical significance seen for Oxford Knee Score as well as KOOS Symptoms, Pain, Sport, quality of life, and activities of daily living subscales. The mean active flexion between the preoperative and both postoperative timepoints at 6 months and 1 year was also statistically significant (P = .021 and P = .001). Conclusions MS-TKA with a CR insert can facilitate symptom relief and improve overall function of the knee after surgery. Both the patient and clinical outcomes were comparable to 1-year outcomes utilizing other MS-TKA designs and were superior to those at 1-year follow-up following implantation of CR-TKA. Most notability, the KOOS symptoms and sports score were higher for the MS-TKA with a CR insert than for an MS-TKA design.
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Affiliation(s)
- Selin Munir
- Medacta Australia, Lane Cove, New South Wales, Australia
| | - Leina Suzuki
- Medacta Australia, Lane Cove, New South Wales, Australia
| | - Jorgen Hellman
- Orthopaedic Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- Orthopaedic Department, Lingard Private Hospital, Merewether, New South Wales, Australia
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Czerwonka N, Gupta P, Desai SS, Hickernell TR, Neuwirth AL, Trofa DP. Patient-reported outcomes measurement information system instruments in knee arthroplasty patients: a systematic review of the literature. Knee Surg Relat Res 2023; 35:27. [PMID: 38041197 PMCID: PMC10690965 DOI: 10.1186/s43019-023-00201-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/07/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The purpose of this study is to provide a systematic review of the literature pertaining to Patient-Reported Outcome Measurement Information System (PROMIS) validation and utilization as an outcomes metric in total knee arthroplasty (TKA) patients. This is the first systematic review on PROMIS use in total knee arthroplasty patients. METHODS A systematic search of the Pubmed/MEDLINE and Embase databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study characteristics, patient demographics, psychometric properties (Pearson and Spearman correlation) with legacy patient-reported outcome measurement (PROM) instruments, floor and ceiling effects, responsiveness, and minimum clinically important difference (MCID) and PROMIS outcomes were recorded and analyzed. RESULTS Fifteen studies investigating PROMIS in 11,140 patients were included. The weighted-average Pearson correlation coefficient comparing PROMIS domains with legacy patient-reported outcome measurements in total knee arthroplasty patients was 0.62 [standard error (SE) = 0.06] and the weighted-average Spearman correlation comparing PROMIS domains with legacy patient-reported outcome measurements in total knee arthroplasty patients was 0.59 (SE = 0.06), demonstrating moderate-to-strong correlation and validity. There were no differences in weighted average floor [0.03% (SE = 3.1) versus 0% (SE = 0.1) versus 0.01% (SE = 1.1); p = 0.25] or ceiling effects [0.01% (SE = 0.7) versus 0.02% (SE = 1.4) versus 0.04% (SE = 3.5); p = 0.36] between PROMIS and legacy instruments. The weighted average for percentage of patients achieving MCID was 59.1% for global physical health (GPH), 26.0% for global mental health (GMH), 52.7% for physical function (PF), 67.2% for pain interference (PI), and 37.2% for depression. CONCLUSION Notably, PROMIS global physical health, physical function, and pain interference were found to be significantly responsive, with PROMIS pain interference most effectively capturing clinical improvement as evidenced by the achievement of MCID.
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Affiliation(s)
- Natalia Czerwonka
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA.
| | - Puneet Gupta
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
- George Washington University School of Medicine, 2300 I St NW, Washington, DC, 20052, USA
| | - Sohil S Desai
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
| | - Thomas R Hickernell
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St., PH11-Center Wing, New York, NY, 10032, USA
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Rajgopal A, Kumar S, Singh MK, Aggarwal K. PCL retention demonstrates better functional scores and gait patterns in total knee arthroplasty using a medial congruent insert-a prospective study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4741-4746. [PMID: 37393561 DOI: 10.1007/s00167-023-07499-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Despite Total Knee Arthroplasty (TKA) being one of the most successful procedures for end stage arthritis, nearly 20% of patients undergoing this procedure remain dissatisfied. Various design options have been introduced to reduce this cohort of patients. One such option has been the introduction of the medial congruent (MC) polyethylene design. This study was undertaken to evaluate outcome measures and gait analysis in patients undergoing bilateral single stage TKA where the posterior cruciate ligament (PCL) was retained or excised in contralateral knees. METHODS 60 bilateral TKA's were performed by a single surgeon using a MC design option from July to Sep 2021. The study lots included patients between the ages of 55 and 70 years with fixed varus deformity of degenerative aetiology, and Kellgren Lawrence Grade 3 and 4 radiological changes. Exclusion criteria were previous surgery to the lower extremities, sero positive arthropathies, post traumatic arthritis, valgus deformity, flexion contractures > 20°, and any pre-existing pathology impacting gait, e.g., poliomyelitis, or neuromuscular disorders. The PCL was retained or sacrificed on contralateral sides for the purpose of this study. Functional scores, outcomes and gait analysis on level and gradient walking were evaluated at a follow-up of 18 months. RESULTS At 18, months the Range of Motion (ROM) improved from a preoperative value of 97.3 ± 11.5 to 110.3 ± 6.1 on the PCL retained side (MC-PCL) and from 96.5 ± 10.8 to 113 ± 5.8 on the PCL excised side (MC-PCLX). Knee Society Score (KSS-2011) improved from a preoperative value of 21.2 ± 4.5 to 89.8 ± 3.4 at 18 months postoperatively on the MC-PCL side and from 21.5 ± 4 to 88.2 ± 3.7 on the MC-PCLX side. Forgotten Joint Score (FJS-12) was 8.8 ± 0.7 on the MC-PCL side and 8.1 ± 0.9 on the MC-PCLX side 18 months after surgery. Our gait analysis evaluation demonstrated a lower forefoot pressure in the MC-PCL group in comparison to the MC-PCLX group when subjects were made to walk on a 30° upward incline. This difference was found to be statistically significant. CONCLUSION In this study, while ROM was greater in the MC-PCLX study lot, patient satisfaction was higher in the MC-PCL study lot. Gait assessment demonstrated lower forefoot pressure while ascending an incline of 30° in the MC-PCL study lot as compared to the MC-PCLX study lot approximating normal gait patterns. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ashok Rajgopal
- Medanta- The Medicity Hospital, Gurugram, Haryana, 122001, India.
| | - Sumit Kumar
- Medanta- The Medicity Hospital, Gurugram, Haryana, 122001, India
| | | | - Kalpana Aggarwal
- Medanta- The Medicity Hospital, Gurugram, Haryana, 122001, India
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Indelli PF, Giuntoli M, Zepeda K, Ghirardelli S, Valtanen RS, Iannotti F. Native knee kinematics is not reproduced after sensor guided cruciates substituting total knee arthroplasty. J Exp Orthop 2023; 10:17. [PMID: 36786878 PMCID: PMC9929011 DOI: 10.1186/s40634-023-00567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Gait analysis was used to evaluate knee kinematics in patients who underwent successful primary total knee arthroplasty (TKA) using two modern bi-cruciate substituting designs. The knee joint was balanced intraoperatively using real-time sensor technology, developed to provide dynamic feedback regarding stability and tibiofemoral load. The authors hypothesized that major differences exist in gait parameters between healthy controls and post-TKA patients. METHODS Ten patients who underwent successful TKA using bi-cruciate substituting designs were evaluated at a minimum of 9 months postoperatively using three-dimensional knee kinematic analysis; a multi-camera optoelectronic system and a force platform were used. Sensor-extracted kinematic data included knee flexion angle at heel-strike (KFH), peak midstance knee flexion angle (MSKFA), maximum and minimum knee adduction angle (KAA) and knee rotational angle at heel-strike. Multiple gait analysis data from the study group were compared to a group of ten healthy controls who were matched by age, sex and BMI. Clinical outcome in the TKA group was also measured using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS Clinically, at final follow-up, a statistically significant difference in pain, general symptoms, and activities of daily living was seen between the groups. From a gait analysis standpoint, TKA patients had significantly less rotation at heel strike (p = 0.04), lower late stance peak extension moments (p = 0.02), and less Knee Adduction Angle excursion during swing phase (p = 0.04) compared to the control group. No statistically significant difference was observed for knee flexion angle at heel strike, knee adduction moment, or peak knee flexion moment between the groups. CONCLUSIONS Modern bi-cruciate substituting TKA designs failed to reproduce normal knee kinematics. The lack of full knee extension during the stance phase, absence of the "screw-home mechanism" typical of an ACL functioning knee, and the reduced fluctuation in knee adduction angle during the swing phase still represent major proprioceptive and muscular recruitment differences between normal and replaced knees.
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Affiliation(s)
- Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA. .,Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, Redwood City, CA, 94063, USA.
| | - Michele Giuntoli
- grid.5395.a0000 0004 1757 3729Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Karlos Zepeda
- grid.430773.40000 0000 8530 6973Touro College of Osteopathic Medicine, New York, USA
| | | | - Rosa Susanna Valtanen
- grid.168010.e0000000419368956Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA
| | - Ferdinando Iannotti
- Department of Orthopaedic and Trauma Surgery, San Paolo Hospital, Civitavecchia, Italy
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Medially congruent total knee arthroplasty in valgus knee deformities yields satisfactory outcomes: a multicenter, international study. Knee Surg Sports Traumatol Arthrosc 2023; 31:407-412. [PMID: 34596693 DOI: 10.1007/s00167-021-06754-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/19/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Postoperative instability represents one of the most common complications following primary total knee arthroplasty (TKA). To prevent this outcome, valgus deformities have been historically treated using more constrained implants. The purpose of this study was to evaluate the outcome of treating a moderate valgus deformity by combining a surgical technique used to release the postero-lateral soft tissue envelope with the use of a medially congruent (MC) TKA design without using classical, semi-constrained inserts. METHODS Seventy-nine MC TKAs were performed by three surgeons at three institutions between 2016 and 2018 as part of a multicenter, international study. Inclusion criteria were: radiographic late-stage osteoarthritic knees with Ranawat's type 1 or 2 classification of valgus deformity and integrity of the medial capsular-ligament complex (less than 10 mm of medial opening during valgus stress test at 10° of knee flexion). Exclusion criteria were: BMI > 40; neuromuscular, metabolic, or immunologic disorders; or the inability to complete outcome measures or radiographic assessment. RESULTS Seventy-seven patients (79 knees), 59 males and 18 females, were evaluated at 2-year minimum follow-up according to the Knee Society Score (KSS) and Forgotten Joint Score (FJS). Mean age at surgery was 70 years (range 48-91). The mean range of motion (ROM) improved from 110° (range 85°-130°) preoperatively to 121° (range 105°-135°) (p < 0.001) at the time of the last follow-up. Preoperative knee extension significantly improved from 3° (range - 15° to 20°) to 1° (range - 5° to 5°) of flexion at the last follow-up in all the patients. KSS and KSS Functional scores were 89 (range 65-100) and 82 points (range 55-100), respectively. The FJS obtained at the last follow-up was 72 (range 49-88). Two patients (2.5%) had major postoperative complications (one periprosthetic joint infection; one postoperative patellar fracture) requiring surgical interventions. CONCLUSIONS In different surgeon's hands, the use of a modern medially congruent TKA design yielded good clinical outcomes at 2 years in a consecutive series of TKA in valgus arthritic knees. Postoperative instability was not recorded in this series and this finding was related to the high conformity design of the MC polyethylene insert, which significantly differs from classical posterior-stabilized (PS) designs. LEVEL OF EVIDENCE IV.
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Massé V, Cholewa J, Shahin M. Personalized alignment™ for total knee arthroplasty using the ROSA ® Knee and Persona ® knee systems: Surgical technique. Front Surg 2023; 9:1098504. [PMID: 36733674 PMCID: PMC9888495 DOI: 10.3389/fsurg.2022.1098504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Total knee arthroplasty (TKA) procedures are expected to increase up to 565% in the United States over the next 3 decades. TKAs were traditionally performed with neutral mechanical alignments that provided equal medial and lateral gaps in extension and flexion to reduce implant wear but were less successful at restoring native knee function and associated with high patient dissatisfaction. Kinematic alignment (KA) restores native anatomy and minimizes soft tissue release; however, KAs that recreate severe deformities and/or biomechanically inferior alignments result in significant increases in implant stress and risk of aseptic loosening. Restricted kinematic alignment (rKA) recreates pre-arthritic anatomy within a range of acceptable alignment boundaries, and improved patient clinical scores and faster recoveries have been reported with rKA techniques. Personalized Alignment™ is an evolution of rKA that relies heavily upon robotic assistance to reliably recreate patient anatomy, native soft tissue laxity, and accurate component placement to improve patients' clinical outcomes. The purpose of this surgical technique report is to describe the Personalized Alignment TKA method using the ROSA® Knee System and Persona® The Personalized Knee® implants. Herein we provide specific procedures for pre-operative planning, anatomical landmarking and evaluation, intra-operative planning and adjustment of resections and cuts, cut validation and soft tissue evaluation with robotic-assisted personalized TKA.
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Affiliation(s)
- Vincent Massé
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada,Personalized Arthroplasty Society, Atlanta, GA, United States,Duval Orthopaedic Clinic, Laval, Québec, Canada,Correspondence: Vincent Massé
| | | | - Maged Shahin
- Personalized Arthroplasty Society, Atlanta, GA, United States,Duval Orthopaedic Clinic, Laval, Québec, Canada
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Press-Fit Dual-Pivot Total Knee Arthroplasty: Early Results With a Minimum 2-Year Follow-Up. J Arthroplasty 2022; 37:S238-S244. [PMID: 35197199 DOI: 10.1016/j.arth.2022.01.038] [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: 11/16/2021] [Revised: 12/24/2021] [Accepted: 01/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ultracongruent (UC) tibial bearings are being used with increasing frequency in the United States. Evidence suggests that the use of certain UC bearings may lead to improved patient satisfaction when compared with using conventional inserts. However, little is known as to what effect the use of UC tibial inserts has on bone ingrowth in uncemented total knee arthroplasty (TKA). The purpose of this study was to determine the early clinical and radiographic results of TKA using a press-fit dual-pivot design. METHODS Between 2017 and 2019, a consecutive series of 232 TKAs were implanted using a press-fit tibial and femoral component and a UC dual-pivot tibial insert. Sixty-two percent of patients were male. The average age was 56 years. Patients were followed for a minimum of 2 years (range, 24-42 months) using KOOS-JR and Knee Society clinical and radiographic evaluation. RESULTS No patient had more than mild knee stiffness at the final follow-up. Two patients reported moderate knee pain with stair climbing. All other patients reported either mild or no pain with activity. Knee Society pain scores averaged 42 points. Flexion averaged 118 degrees. Three knees (1.3%) were revised (one each for flexion instability, tibial plateau fracture, and suspected femoral component loosening). No other cases of femoral or tibial loosening were identified. CONCLUSION Although the success of uncemented TKA is determined by a variety of factors, the use of this dual-pivot knee design did not appear to influence tibial or femoral component fixation at early follow-up, yielding acceptable clinical and radiographic outcomes.
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