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Jeong HW, Yoo HJ, Park SY, Lee YS. Clinical Relevance of Posterior Osteophyte Formation in Ultra-congruent Total Knee Arthroplasty: Midterm Radiographic Rollback and Impingement Analysis. Clin Orthop Surg 2024; 16:413-421. [PMID: 38827750 PMCID: PMC11130627 DOI: 10.4055/cios23061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/04/2024] Open
Abstract
Background Posterior femoral condylar osteophytes were frequently observed in patients with the ultra-congruent (UC) deep-dish design prosthesis. Therefore, the purpose of the present study was to verify the clinical relevance of osteophyte formation in the UC design. Methods From March 2014 to February 2018, a comparative study was conducted on 96 knees using the UC design. They were divided into 2 groups (group 1: osteophyte +, group 2: osteophyte -). Intraoperative findings, indirect femoral rollback assessment using 30° flexion and active full flexion lateral radiographs, serial change of the osteophyte, and outcomes were compared. Results The mean follow-up period was 49.35 ± 3.47 months in group 1 and 47.52 ± 3.37 months in group 2. Posterior component coverage was significantly different between the groups: group 1 exhibited more underhang and group 2 exhibited more overhang (p = 0.022). On the indirect assessment of the femoral rollback, there was a statistically significant difference in deep flexion and change in distance (p < 0.001 and p < 0.001, respectively). There was no statistical difference between the 2 groups in the American Knee Society knee and function score, and group 2 showed significant improvement in pain compared to group 1 in Western Ontario and McMaster University Arthritis Index pain score (p = 0.029). Conclusions Posterior condylar osteophyte formation was related to posterior impingement. It was more frequently observed in the underhang of the femoral component and insufficient femoral rollback. In addition, it changed with time and caused negative effects, including a gradual decrease in flexion and more pain.
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Affiliation(s)
- Ho Won Jeong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Jin Yoo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Tzanetis P, de Souza K, Robertson S, Fluit R, Koopman B, Verdonschot N. Numerical study of osteophyte effects on preoperative knee functionality in patients undergoing total knee arthroplasty. J Orthop Res 2024. [PMID: 38602446 DOI: 10.1002/jor.25850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/20/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024]
Abstract
Osteophytes are routinely removed during total knee arthroplasty, yet the preoperative planning currently relies on preoperative computed tomography (CT) scans of the patient's osteoarthritic knee, typically including osteophytic features. This complicates the surgeon's ability to anticipate the exact biomechanical effects of osteophytes and the consequences of their removal before the operation. The aim of this study was to investigate the effect of osteophytes on ligament strains and kinematics, and ascertain whether the osteophyte volume and location determine the extent of this effect. We segmented preoperative CT scans of 21 patients, featuring different osteophyte severity, using image-based active appearance models trained to identify the osteophytic and preosteophytic bone geometries and estimate the cartilage thickness in the segmented surfaces. The patients' morphologies were used to scale a template musculoskeletal knee model. Osteophytes induced clinically relevant changes to the knee's functional behavior, but these were variable and patient-specific. Generally, severe osteophytic knees significantly strained the oblique popliteal ligament (OPL) and posterior capsule (PC) relative to the preosteophytic state. Furthermore, there was a marked effect on the lateral collateral ligament and anterolateral ligament (ALL) strains compared to mild and moderate osteophytic knees, and concurrent alterations in the tibial lateral-medial translation and external-internal rotation. We found a strong correlation between the OPL, PC, and ALL strains and posterolateral condylar and tibial osteophytes, respectively. Our findings may have implications for the preoperative planning in total knee arthroplasty, toward reproducing the physiological knee biomechanics as close as feasibly possible.
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Affiliation(s)
- Periklis Tzanetis
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | | | | | - René Fluit
- Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Bart Koopman
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Nico Verdonschot
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Sappey-Marinier E, Fernandez A, Shatrov J, Batailler C, Servien E, Huten D, Lustig S. Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review. SICOT J 2024; 10:11. [PMID: 38530205 DOI: 10.1051/sicotj/2024007] [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: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture. MATERIALS AND METHODS Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded. RESULTS Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model. DISCUSSION This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elliot Sappey-Marinier
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Andréa Fernandez
- Service de chirurgie Orthopédique, Centre chirurgical Emile Gallé, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jobe Shatrov
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Cécile Batailler
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Elvire Servien
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Université Claude Bernard Lyon 1, Lyon, France
| | - Denis Huten
- Chirurgie Orthopédique, Réparatrice et Traumatologique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sébastien Lustig
- Département de chirurgie orthopédique et de médecine du sport, FIFA medical center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France - Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
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Sadoghi P, Hirschmann MT, Karlsson J, Klasan A. The neglected factor of constitutional sagittal alignment and its implications for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:10-12. [PMID: 38226765 DOI: 10.1002/ksa.12013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/10/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Jon Karlsson
- Department of Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Antonio Klasan
- AUVA UKH Steiermark, Graz, Austria
- Johannes Kepler University, Linz, Austria
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Yoo HJ, Kim YB, Jeong HW, Park SB, Nam HS, Lee YS. Clinical relevance of roll-back replacement of ultra congruent total knee arthroplasty: comparison of mid-term outcomes with posterior stabilizing design. Arch Orthop Trauma Surg 2023; 143:6805-6813. [PMID: 37488457 DOI: 10.1007/s00402-023-04918-7] [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: 08/31/2022] [Accepted: 05/21/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The outcomes of total knee arthroplasty (TKA) remain controversial, and we do not know which factors are important for successful outcomes. This study aimed to compare the mid-term outcomes of different conceptual designs by evaluating the radiological and clinical outcomes. MATERIALS AND METHODS A total of 478 total knee arthroplasties (TKAs) were enrolled and allocated into groups I [posterior stabilizing (PS) with anterior referencing (AR)], II [PS with posterior referencing (PR), and III [ultra-congruent (UC) TKA)]. Preoperative findings, last follow-up clinical outcomes, and final follow-up radiological and indirect assessments of the femoral rollback were compared between the groups. RESULTS The mean follow-up period was 72.6 ± 12.9 months. The tourniquet was used samely applied to every group. Flexion contracture was significantly larger in group III than in groups I and II (3.3 ± 2.7, p < 0.001), and further flexion was significantly smaller in group III (130.0° ± 2.7°, p < 0.001). Among the radiological parameters, posterior osteophyte formation was the most common in group III (67.8%). The rollback distance was significantly smaller in group III than in groups I and II (p < 0.001). The active deep flexion angle was affected by the posterior condylar offset (PCO) ratio, and the contact point changed the distance (p < 0.05). CONCLUSION PS TKAs showed better ROMs than UC TKAs; however, no differences were noted in the clinical outcome scales. The flexion angle was affected by the PCOR and rollback at both PS and UC TKAs. However, rollback negatively affected the flexion angle during UC TKAs. An inappropriate femoral rollback was identified, and femoral osteophyte formation was determined to be the most prominent in UC TKAs. Level of evidence Level III comparative study.
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Affiliation(s)
- Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Yong Beom Kim
- Department of Orthopaedic Surgery, Soonchunyang University Hospital, Seoul, Korea
| | - Ho Won Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Sung Bae Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Hee Seung Nam
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Lee JH, Jung HJ, Lee JK, Hwang JH, Kim JI. Large Osteophytes over 10 mm at Posterior Medial Femoral Condyle Can Lead to Asymmetric Extension Gap Following Bony Resection in Robotic Arm-Assisted Total Knee Arthroplasty with Pre-Resection Gap Balancing. J Clin Med 2023; 12:5980. [PMID: 37762920 PMCID: PMC10531677 DOI: 10.3390/jcm12185980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Robotic arm-assisted total knee arthroplasty (TKA) involves a pre-resection gap balancing technique to obtain the desired gap. However, the expected gap may change owing to the soft-tissue release effect of unreachable osteophytes. This study evaluated the effect of unreachable osteophytes of the posterior medial femoral condyle on gap changes following bony resection. We retrospectively analysed 129 robotic arm-assisted TKAs performed for varus knee osteoarthritis. Knees were classified according to the size of osteophytes on the posterior medial femoral condyle using preoperative computed tomography measurement. After the removal of reachable osteophytes, the robotic system measured pre- and post-resection medial extension (ME), lateral extension (LE), medial flexion (MF), and lateral flexion (LF) gaps. No extension gap changes were observed for 25 (19.4%), and no flexion gap changes were observed 41 (31.8%) knees, following bone cuts. ME, LE, MF, and LF gaps increased with the osteophyte size (p < 0.05). For osteophytes <10 mm, all the gaps increased symmetrically. However, for osteophytes >10 mm, the ME gap increased asymmetrically more than LE, MF, and LF gaps (p < 0.05). The gap changes due to bony resection were correlated to the osteophyte sizes of the posterior medial femoral condyle. Surgeons should plan a slightly tight medial extension gap to attain the desired gaps for >10 mm osteophytes.
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Affiliation(s)
- Jong Hwa Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.H.L.); (J.H.H.)
| | - Ho Jung Jung
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
| | - Ji Hyo Hwang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.H.L.); (J.H.H.)
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.H.L.); (J.H.H.)
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Risk factors of de novo hyperextension developed after posterior cruciate ligament substituting total knee arthroplasty: a matched case-control study. Knee Surg Sports Traumatol Arthrosc 2023; 31:1123-1131. [PMID: 34028564 DOI: 10.1007/s00167-021-06618-4] [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: 03/16/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate factors contributing to the de novo hyperextension after posterior cruciate ligament substituting (PS) total knee arthroplasty (TKA). METHODS Through a retrospective case-control study, de novo hyperextension patients were compared with patients without hyperextension after primary PS TKA. Eighty-five hyperextension patients were compared with 85 patients in a control group matched by age, sex, surgeon and implant. The clinical and radiographic parameters, including the mechanical axis (MA), joint line convergence angle (JLCA), posterior tibial slope angle (PTSA), posterior condylar offset (PCO), and the gamma angle, were evaluated preoperatively and immediate postoperatively. Comparisons between the two groups and logistic regression analysis were performed to investigate factors contributing to de novo hyperextension. RESULTS Among the clinical factors, preoperative flexion contracture was less (5° ± 6° vs. 11° ± 6°, p < 0.001) and the range of motion was greater (125° ± 12° vs. 118° ± 5°, p = 0.041) in the de novo hyperextension group than in the control group. Among the radiographic parameters, preoperative and postoperative JLCA were greater (8.1° ± 4.4° vs. 6.1° ± 3.5°, p < 0.001, 1.0° ± 1.3° vs. 0.2° ± 0.8°, p = 0.002, respectively), postoperative PTSA was greater (3.7° ± 2.0° vs. 3.3° ± 1.6°, p < 0.001) and preoperative and postoperative PCO were less in the hyperextension group than in the control group (26.3 mm ± 3.3 mm vs. 29.1 mm ± 3.2 mm, p < 0.001, 26.4 mm ± 3.2 mm vs. 29.1 mm ± 3.0 mm, p < 0.001, respectively), whereas, change in PCO was greater in the hyperextension group (1.1 mm ± 7.7 mm vs. - 0.1 mm ± 3.3 mm, p < 0.001). In multivariate analysis, the degree of medial soft tissue release [odds ratio (OR) 2.83, p = 0.003], flexion contracture [OR 0.86, p = 0.028], postoperative JLCA [OR 2.45, p = 0.004], preoperative PCO and a change in PCO [OR 0.74, p = 0.002, OR 1.89, p = 0.001, respectively] were the factors associated with de novo hyperextension. CONCLUSIONS An increased degree of medial soft tissue release, small preoperative flexion contracture, increased postoperative JLCA, decreased preoperative PCO and increased change in PCO were risk factors of de novo hyperextension. LEVEL OF EVIDENCE III.
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Ishida K, Shibanuma N, Hayashi S, Kurosaka M, Kuroda R, Matsumoto T. Robotic arm‐assisted posterior‐stabilised total knee arthroplasty reduces the amount of tibial bone resection thickness without increasing the rate of postoperative flexion contracture in varus knees in the short term: Comparison with image‐free navigated total knee arthroplasty. Int J Med Robot 2022; 18:e2370. [DOI: 10.1002/rcs.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Kazunari Ishida
- Department of Orthopaedic Surgery Kobe Kaisei Hospital Kobe Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery Kobe Kaisei Hospital Kobe Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan
| | | | - Ryosuke Kuroda
- Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan
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Motesharei A, Batailler C, De Massari D, Vincent G, Chen AF, Lustig S. Predicting robotic-assisted total knee arthroplasty operating time. Bone Jt Open 2022; 3:383-389. [PMID: 35532348 PMCID: PMC9134836 DOI: 10.1302/2633-1462.35.bjo-2022-0014.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims No predictive model has been published to forecast operating time for total knee arthroplasty (TKA). The aims of this study were to design and validate a predictive model to estimate operating time for robotic-assisted TKA based on demographic data, and evaluate the added predictive power of CT scan-based predictors and their impact on the accuracy of the predictive model. Methods A retrospective study was conducted on 1,061 TKAs performed from January 2016 to December 2019 with an image-based robotic-assisted system. Demographic data included age, sex, height, and weight. The femoral and tibial mechanical axis and the osteophyte volume were calculated from CT scans. These inputs were used to develop a predictive model aimed to predict operating time based on demographic data only, and demographic and 3D patient anatomy data. Results The key factors for predicting operating time were the surgeon and patient weight, followed by 12 anatomical parameters derived from CT scans. The predictive model based only on demographic data showed that 90% of predictions were within 15 minutes of actual operating time, with 73% within ten minutes. The predictive model including demographic data and CT scans showed that 94% of predictions were within 15 minutes of actual operating time and 88% within ten minutes. Conclusion The primary factors for predicting robotic-assisted TKA operating time were surgeon, patient weight, and osteophyte volume. This study demonstrates that incorporating 3D patient-specific data can improve operating time predictions models, which may lead to improved operating room planning and efficiency. Cite this article: Bone Jt Open 2022;3(5):383–389.
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Affiliation(s)
| | - Cecile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | | | | | - Antonia F. Chen
- Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
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Holst DC, Doan GW, Angerame MR, Roche MW, Clary CW, Dennis DA. What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study. Arthroplast Today 2021; 11:127-133. [PMID: 34522740 PMCID: PMC8427272 DOI: 10.1016/j.artd.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 01/14/2023] Open
Abstract
Background Posterior compartment knee osteophytes may pose a challenge in achieving soft-tissue balance during total knee arthroplasty (TKA). Obtaining symmetry of flexion and extension gaps involves balance of both bony and soft-tissue structures. We hypothesize that space-occupying posteromedial femoral osteophytes affect soft-tissue balance. Methods Five cadaveric limbs were acquired. Computed tomography scans were obtained to define the osseous contours. Three-dimensionally printed, specimen-specific synthetic posterior femoral osteophytes were fabricated in 10-mm and 15-mm sizes. TKAs were implanted. Medial and lateral compartment contact forces were measured during passive knee motion using pressure-sensing technology. For each specimen, trials were completed without osteophytes and with 10-mm and 15-mm osteophytes affixed to the posteromedial femoral condyle. Contact forces were obtained at full extension, 10°, 30°, 45°, 60°, and 90° of flexion. These were recorded across each specimen in each condition for three trials. Tukey post hoc tests were used with a repeated measures ANOVA for statistical data analysis. Results The presence of posteromedial osteophytes increased asymmetric loading from full extension to 45° of flexion, with statistically significant differences observed at full extension and 30°. A reduction in lateral compartment forces was noted. The 25%-75% bounds of variability in the contact force was less than 3.5 lbs. Conclusions Posteromedial femoral osteophytes caused an asymmetric increase in medial contact forces from full extension continuing into mid-flexion. The soft-tissue imbalance created from these osteophytes supports their removal before performing ligament releases to obtain desired soft-tissue balancing during TKA.
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Affiliation(s)
- David C Holst
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Gary W Doan
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO
| | | | | | - Chadd W Clary
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO
| | - Douglas A Dennis
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO.,Colorado Joint Replacement, Denver, CO.,Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO.,Department of Biomedical Engineering, University of Tennessee, Knoxville, TN
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Kato K, Ogawa H, Matsumoto K, Akiyama H. Surgical procedures for the prevention of extension-flexion gap imbalance in total knee arthroplasty. J Orthop 2021; 25:224-229. [PMID: 34045827 DOI: 10.1016/j.jor.2021.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/01/2021] [Accepted: 05/09/2021] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to identify preoperative and intraoperative factors that influence extension-flexion gap imbalance in total knee arthroplasty (TKA). Ninety-three knees undergoing TKA with the modified gap balancing technique were included. Preoperative range of motion, intraoperative extension-flexion gap balance, thickness of the resected bone and radiological parameters were investigated. The preoperative flexion contracture, bone resection thickness in the medial proximal tibia, and the medial distal femur all correlated with the extension-flexion gap balance in TKA. Bone resection thickness in the medial proximal tibia and the medial distal femur were predictive of extension-flexion imbalance.
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Affiliation(s)
- Koki Kato
- Department of Orthopaedic Surgery, Matsunami General Hospital, 185-1 Tashiro, Kasamatsu-Cho, Hashima-Gun, Gifu, 501-6062, Japan
| | - Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. 6-85-1 Hayashi-Machi, Ogaki City, Gifu, 503-0015, Japan.,Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. 1-1Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. 1-1Yanagido, Gifu City, Gifu, 501-1194, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. 1-1Yanagido, Gifu City, Gifu, 501-1194, Japan
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12
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Cho BW, Kwon HM, Lee KY, Park KK, Yang IH, Lee WS. The effect of hamstring tightness on intraoperative extension gap in posterior stabilized total knee arthroplasty. Sci Rep 2021; 11:3655. [PMID: 33574467 PMCID: PMC7878469 DOI: 10.1038/s41598-021-83221-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/01/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to determine the factors related to intraoperative extension gap (EG) in patients who underwent posterior-stabilized total knee arthroplasty (TKA). A total of 106 TKAs in 84 patients were retrospectively reviewed. Only patients who underwent the same method of bone resection were included consecutively. Bilateral popliteal angle (BPA) was used as an indicator of hamstring tightness. EG and extension space angle were measured using an offset type tensor. The associations between patient variables and EG were analyzed using multivariable linear regression and Pearson's correlation coefficients. The average EG was 12.9 ± 2.1 mm, and the average extension space angle was 2.8° ± 3.2°. BPA was greater than flexion contracture in most cases (94.3%), and no difference was found in only six cases (5.7%). According to multivariable linear regression analysis which was conducted after modifying the BPA into a categorical variable by 5°, EG was correlated with BPA (p < 0.001). Pearson’s correlation coefficient between EG and BPA was − 0.674 (p < 0.001). No other factors were significantly correlated with intraoperative EG. The present study found that popliteal angle is a different entity from flexion contracture, and that it is a predictable factor for EG in osteoarthritis patients. Smaller BPAs led to larger EG in patients who underwent the same degree of bone resection.
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Affiliation(s)
- Byung Woo Cho
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Hyuck Min Kwon
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Koo Yeon Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Kwan Kyu Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Ick Hwan Yang
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea.
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