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Bae K, Lee BS, Kim JM, Bin SI, Lee J, Kim D, Jeon T. Preoperative phenotype has no significant impact on the clinical outcomes and long-term survival of mechanically aligned total knee arthroplasty in Asian patients with osteoarthritis. Bone Joint J 2024; 106-B:460-467. [PMID: 38688498 DOI: 10.1302/0301-620x.106b5.bjj-2023-1110.r1] [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: 05/02/2024]
Abstract
Aims The aim of this study was to investigate the distribution of phenotypes in Asian patients with end-stage osteoarthritis (OA) and assess whether the phenotype affected the clinical outcome and survival of mechanically aligned total knee arthroplasty (TKA). We also compared the survival of the group in which the phenotype unintentionally remained unchanged with those in which it was corrected to neutral. Methods The study involved 945 TKAs, which were performed in 641 patients with primary OA, between January 2000 and January 2009. These were classified into 12 phenotypes based on the combined assessment of four categories of the arithmetic hip-knee-ankle angle and three categories of actual joint line obliquity. The rates of survival were analyzed using Kaplan-Meier methods and the log-rank test. The Hospital for Special Surgery score and survival of each phenotype were compared with those of the reference phenotype with neutral alignment and a parallel joint line. We also compared long-term survival between the unchanged phenotype group and the corrected to neutral alignment-parallel joint line group in patients with Type IV-b (mild to moderate varus alignment-parallel joint line) phenotype. Results The most common phenotype was Type I-b (mild to moderate varus alignment-medial joint line; 27.1% (n = 256)), followed by Type IV-b (23.2%; n = 219). There was no significant difference in the clinical outcomes and long-term survival between the groups. In Type IV-b phenotypes, the neutrally corrected group showed higher 15-year survival compared with the unchanged-phenotype group (94.9% (95% confidence interval (CI) 92.0 to 97.8) vs 74.2% (95% CI 98.0 to 100); p = 0.020). Conclusion Constitutional varus was confirmed in more than half of these patients. Mechanically aligned TKA can achieve consistent clinical outcomes and long-term survival, regardless of the patient's phenotype. The neutrally corrected group had better long-term survival compared with the unchanged phenotype group.
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Affiliation(s)
- Kinam Bae
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Il Bin
- Orthopaedic Surgery, Inbone Hospital, Paju-si, South Korea
| | - Jongjin Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Donghyok Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Taehyeon Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kanna R, Kumar VS, Karthikeyan V, Anand S, Ravichandran C, Murali SM. Influence of Preoperative Deformity on Flexion Gap Asymmetry in Measured Resection Technique: A Theoretical Study in Navigated Gap Balancing Total Knee Arthroplasties, Done for Varus Knee Osteoarthritis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00007. [PMID: 38354198 PMCID: PMC11136515 DOI: 10.5435/jaaosglobal-d-23-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Disagreement exists on (a) achieving a symmetrical flexion gap and (b) the influence of varus deformity on the flexion gap asymmetry (FGA) in measured resection (MR) total knee arthroplasty (TKA). We aimed to determine the FGA and influence of preoperative deformity on the FGA, based on the MR technique, in varus knee osteoarthritis. METHODS In 321 navigated TKAs, we released the soft tissues in extension. In 90° flexion, with the tensioner in situ, we calculated the FGA, the angle between the posterior femoral cut (planned 3° external rotation to the posterior condylar line, parallel to the surgical transepicondylar axis, or perpendicular to the Whiteside line) and the proximal tibial resection plane. RESULTS The FGA values varied widely, and the risk of >2° and >3° FGA was present in at least 60% and 40% knees, respectively. These risks were high in knees with moderate and severe varus deformity. CONCLUSIONS In varus knee osteoarthritis, the risk of FGA (based on the MR technique) was high, especially when the deformity was moderate to severe. Caution is required in MR TKA, and surgeons must consider safer alternatives (gap balancing or hybrid technique) to achieve a symmetrical flexion gap in these knees.
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Affiliation(s)
- Raj Kanna
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - V. Senthil Kumar
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - Vijaya Karthikeyan
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - Sumit Anand
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - Chandramohan Ravichandran
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
| | - S. M. Murali
- From the Madha Medical College and Research Institute, Chennai, Tamil Nadu, India (Dr. Kanna); Department of Orthopaedics, Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India (Dr. Kanna); Government Headquarters Hospital, Perambalur, Tamil Nadu, India (Dr. Kumar); Department of Radiodiagnosis, Bhaarath Medical College Hospital, Chennai, Tamil Nadu, India (Dr. Karthikeyan); Department of Orthopaedics, Primus Hospital, Delhi, India (Dr. Anand); WYE Valley NHS Trust, The County Hospital, Hereford, Herefordshire, UK (Dr. Ravichandran), Department of Orthopaedics,SMMCH&RI, Chennai, Tamil Nadu, India (Dr. Murali)
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Bum Kwon J, Woo Bae J, Jin Bae D, Eun Jeong J, Choi WK. The degree of C-reactive protein elevation after total knee arthroplasty is related to bone and medullary injury rather than soft tissue. Medicine (Baltimore) 2023; 102:e35472. [PMID: 37832115 PMCID: PMC10578698 DOI: 10.1097/md.0000000000035472] [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: 07/30/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
First, we want to find out whether computer-assisted surgery (CAS) for total knee arthroplasty (TKA), which does not require opening the femoral medullary canal, results in a lesser C-reactive protein (CRP) level increase postoperatively compared to manual TKA. Second, they seek to examine whether the CRP reduction in CAS TKA and manual TKA follows a similar pattern within the first 2 weeks after surgery. Third, the study aims to compare and analyze the CRP levels in 3 different groups: CRP levels in CAS TKA with surgeons who started TKA surgery by CAS, CRP levels in manual TKA by surgeons with little experience, and CRP levels in skillful manual TKA performed after conducting over 200 cases. The 3 patient groups were as follows. Group 1: Patients who underwent non expertized surgeon CAS TKA (N = 63). Group 2: Patients who underwent manual TKA after surgeon CAS TKA experience (N = 108). Group 3: Patients who underwent manual TKA after surgeon 200 cases or more of either CAS TKA or manual TKA experience (more skillful manual TKA) (N = 66). CRP levels were analyzed using electronic medical records for 3 time points: within 3 months before surgery, 5 days after surgery, and 11 days after surgery. There were no statistically significant differences in pre operative CRP values among the 3 groups. At 5 days after surgery, the CRP level were 48.59 ± 32.75 for CAS TKA, 69.82 ± 42.76 for early manual TKA, and 67.73 ± 44.00 for skillful manual TKA, indicating a statistically significant lower CRP level in the CAS TKA group compared to the manual TKA groups (P = .01). At 11 days after surgery, there were no statistically significant differences in CRP level among the 3 groups, with was 12.12 ± 9.74 for CAS TKA, 14.07 ± 13.18 for early manual TKA, and 11.43 ± 11.45 for skillful manual TKA. The degree of CRP elevation after TKA is related to bone and medullary injury rather than soft tissue.
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Affiliation(s)
- Jae Bum Kwon
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Jin Woo Bae
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Dong Jin Bae
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Ji Eun Jeong
- Departhment of Pediatrics, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Won-Kee Choi
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
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Lee SH, Cho YJ, Choi WK. Comparison of femoral sagittal axis between navigated total knee arthroplasty and conventional total knee arthroplasty in patients with knee osteoarthritis. Medicine (Baltimore) 2022; 101:e30085. [PMID: 35984181 PMCID: PMC9387982 DOI: 10.1097/md.0000000000030085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To compare femoral sagittal axis between navigated total knee arthroplasty (TKA) and conventional TKA. A total of 136 cases were assigned to group 1 (navigated TKA) and 77 cases were assigned to group 2 (conventional TKA). Specifically, this study targeted patients with degenerative osteoarthritis. Only patients with primary TKA were analyzed. Hip knee ankle angle and lateral femoral bowing were measured using preoperative scanogram. Anterior femoral bowing was measured using preoperative femoral lateral X rays. The presence of anterior femoral notching and the insertion angle of the femoral implant with respect to the anatomical sagittal plane of the distal femur were checked using postoperative lateral knee X rays. Student t-test was used to compare the difference in the position of the sagittal plane of the femoral implant between the navigated TKA group and the conventional TKA group. When comparing the 2 groups, the sagittal axis of the femoral implant was more extended than the anatomical sagittal plane axis of the distal femur in group 1 than in group 2 (P = .01). There was a significant negative correlation between the value of anterior femoral bowing and the degree of flexion to the sagittal plane of the femoral implant in group 1 (correlation coefficient: -0.40, P = .01). The occurrence of anterior femoral notching was significantly higher in group 1 than in group 2. During navigated TKA, imageless navigation does not consider the anatomical variation of the femoral shaft. Therefore, surgeons should take into consideration that when performing navigated TKA, a femoral implant could be inserted more extended for the anatomical sagittal axis of the distal femur than for the conventional TKA. Also, surgeon should know that the degree of extension insertion of the femoral implant increases as femoral anterior bowing increases.
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Affiliation(s)
- Sung ho Lee
- Department of Orthopedic and Traumatic Surgery, Cheju Halla General Hospital, Jeju Province, Korea
| | - Young Jae Cho
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu city, Korea
| | - Won Kee Choi
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu city, Korea
- *Correspondence: Won-Kee Choi, MD, Department of Orthopaedic Surgery, Daegu Catholic University Hospital, 3056-6, Daemyung-4-dong, Nam-gu, Daegu, Korea. (e-mail: )
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Kim JH, Kim KI, Park KC, Shon OJ, Sim JA, Kim GB. New Classification for Periprosthetic Distal Femoral Fractures Based on Locked-Plate Fixation Following Total Knee Arthroplasty: A Multicenter Study. J Arthroplasty 2022; 37:966-973. [PMID: 35121090 DOI: 10.1016/j.arth.2022.01.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to establish a new classification using locked-plate fixation for periprosthetic distal femoral fracture (PDFF) following total knee arthroplasty (TKA) and to determine when dual locked-plate fixation is necessary through defining this classification. METHODS One-hundred fifteen consecutive PDFFs that underwent operative treatment were reviewed from 2011 to 2019 with minimum 1-year follow-up. Most PDFFs were fixed with single or dual locked-plate fixations using the minimally invasive plate osteosynthesis technique. Based on preoperative radiographs, PDFFs were classified according to the level of main fracture line relative to the anterior flange of femoral component: type I and II, main fracture line located proximal and distal to the anterior flange; and type III, component instability regardless of fracture line requiring revisional TKA. Furthermore, type II fractures were subclassified based on the direction of fracture beak as follows: type IIL, lateral-beak; type IIM, medial-beak. The incidence, treatment methods, and complications were analyzed according to the classification. RESULTS Incidences of type I, IIL, IIM, and III were 64.4%, 8.7%, 24.3%, and 2.6%, respectively. Meanwhile, most PDFFs in type I and II were treated with lateral single locked-plate fixations, except for type IIM, which was treated with either single or dual locked-plate fixations. Overall complications were significantly higher in type II (28.9%) than in type I (10.8%, P = .019). In type IIM, bone union-related complications were significantly higher in single locked-plate fixation (50.0%) than in dual locked-plate fixation (5.6%; P = .013). CONCLUSION The new classification provides practical and obvious strategies for the treatment of PDFF following TKA using locked-plate fixation. For type IIM fracture, dual plate fixation is necessary to prevent fixation failure or nonunion.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ki Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Gyeonggi-do, Korea
| | - Oog-Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Jae Ang Sim
- Department of Orthopaedics Surgery, Gachon University College of Medicine, Incheon, Korea
| | - Gi Beom Kim
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
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