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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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Banks SA, Catani F, Deckard ER, Mahoney OM, Matsuda S, Meneghini RM, Victor JMK. Total Knee Arthroplasty Kinematics Predict Patient-Reported Outcome Measures: Implications for Clinical Kinematic Examinations. J Arthroplasty 2024:S0883-5403(24)00113-X. [PMID: 38360280 DOI: 10.1016/j.arth.2024.02.014] [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: 11/14/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND A core tenet of total knee arthroplasty (TKA) is that achieving more natural kinematics will lead to superior patient outcomes. Yet this relationship has not been proven for large representative cohorts of TKA patients because accurately measuring 3-dimensional TKA kinematics is time-consuming and expensive. But advanced imaging systems and machine learning-enhanced analysis software will soon make it practical to measure knee kinematics preoperatively and postoperatively in the clinic using radiographic methods. The purpose of this study was to assess the reported relationships between TKA kinematics and outcomes and distill those findings into a proposal for a clinically practical protocol for a clinical kinematic exam. METHODS This study reviewed the recent literature relating TKA kinematics to patient outcomes. There were 10 studies that reported statistical associations between TKA kinematics and patient outcome scores utilizing a range of functional activities. We stratified these activities by the complexity of the radiographic examination to create a proposed examination protocol, and we generated a list of requirements and characteristics for a practical TKA clinical kinematic examination. RESULTS Given considerations for a clinically practical kinematic exam, including equipment, time and other resources, we propose 3 exam levels. With basic radiographs, we suggest studying single-leg stance in extension, lunge or squat, and kneeling. For fluoroscopic systems with X-ray pulses up to 20 ms, we propose chair-rise or stair ascent to provide additional dynamic information. For fluoroscopic systems with X-ray pulses of less than 10 ms, we propose rapid open-chain knee flexion-extension to simulate the highly dynamic swing phase of gait. CONCLUSIONS It is our hope that this proposed examination protocol spurs discussion and debate so that there can be a consensus approach to clinical examination of knee and TKA kinematics when the rapidly advancing hardware and software capabilities are in place to do so.
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Affiliation(s)
- Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - Ormonde M Mahoney
- Athens Orthopedic Clinic, Athens, Georgia; Department of Orthopedics, Medical College of Georgia, Augusta, Georgia
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Robert M Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jan M K Victor
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Hodge PE, Rabak OJ, Perriman DM, Scarvell JM, Smith PN, Lynch JT. Are Kinematics an Indicator of Outcome After Total Knee Arthroplasty? J Arthroplasty 2024; 39:343-349.e1. [PMID: 37572724 DOI: 10.1016/j.arth.2023.08.010] [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: 03/14/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND A proportion of total knee arthroplasty (TKA) patients are dissatisfied postoperatively, particularly with their ability to perform higher-demand activities including deep-kneeling and step-up where kinematic parameters are more demanding. The purpose of this study was to examine the relationship between knee kinematics of step-up and deep-kneeling and patient-reported outcome measures following TKA. METHODS Sixty-four patients were included at minimum 1-year follow-up. Participants performed a step-up and deep-kneeling task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Associations between kinematics and patient-reported outcome measures, including Oxford Knee Score, American Knee Society Score, surgical satisfaction, and pain were assessed using log-transformed step-wise linear regressions. RESULTS A higher total Oxford Knee Score was associated with more external rotation and more adduction at maximal flexion during kneeling and more external rotation and minimum flexion during step-up. Improved American Knee Society Score was associated with increased internal-external rotation during step-up. Improved surgical satisfaction was associated with greater maximum flexion and more external rotation at maximal flexion during deep-kneeling and more femoral internal rotation at terminal extension during step-up. An improved pain score was associated with greater maximum flexion and more femoral external rotation during deep-kneeling, as well as greater internal femoral rotation during step-up. CONCLUSION The ability to move through full flexion/extension range and end-of-range rotation is important kinematic parameters that influence patient-reported outcome measures. Implant designs and postoperative rehabilitation should continue to focus on achieving these kinematic targets for enhanced outcomes after TKA.
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Affiliation(s)
- Phillipa E Hodge
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Owen J Rabak
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Diana M Perriman
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Jennie M Scarvell
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Paul N Smith
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Joseph T Lynch
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
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Sumida Y, Fujimoto E, Masuda Y, Ishibashi S, Sasashige Y. Intraoperative Kinematics in Posterior Cruciate Ligament Retaining Total Knee Arthroplasty Using Different Inserts. J Knee Surg 2024. [PMID: 38191009 DOI: 10.1055/a-2240-3336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
We analyzed the intraoperative kinematics of total knee arthroplasty (TKA) using a navigation system to investigate the influence of different inserts on kinematics. This was a retrospective observational study. The Vanguard individualized design (33 patients, 33 knees) XP and anterior-stabilized (AS) inserts were used in TKA for osteoarthritis. Kinematic data were intraoperatively recorded. The range of motion, tibiofemoral rotational angle, anteroposterior translation of the femur, and varus-valgus laxity were compared between the two inserts (XP vs. AS). There was no significant difference in the range of motion (extension: XP, 3.7° ± 3.3° vs. AS, 3.8° ± 3.3°, p = 0.84; flexion: XP, 138.1° ± 10.2° vs. AS, 139.0° ± 13.3°, p = 0.73). With the AS insert, the tibia was gradually internally rotated as the knee was flexed. At maximum extension, the internal rotation was smallest with AS (XP 6.5° ± 4.0° vs. AS 5.1° ± 3.4°, p = 0.022), which was also associated with smaller anterior femoral translation (maximum extension: XP, 14.1 ± 4.8 mm vs. AS, 11.3 ± 4.7 mm, p = 0.00036; 30°: XP, 23.7 ± 5.6 mm vs. AS, 20.7 ± 5.1 mm, p = 0.000033; 45°: XP, 24.4 ± 4.9 mm vs. AS, 23.2 ± 4.5 mm, p = 0.0038). The AS was associated with a lower varus-valgus laxity (30° XP 4.1° ± 3.4 vs. AS 3.3° ± 2.7°, p = 0.036; 60°: XP, 3.2° ± 3.0° vs. AS, 2.4° ± 3.3°, p = 0.0089). The AS insert facilitated sequential tibiofemoral rotation with varus-valgus stability in mid-flexion without restricting the range of motion.
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Affiliation(s)
- Yoshikazu Sumida
- Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Eisaku Fujimoto
- Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yasuji Masuda
- Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Saori Ishibashi
- Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yoshiaki Sasashige
- Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
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Ueyama H, Nakagawa S, Fukunaga K, Koyanagi J, Takemura S, Nakamura S, Yamamura M, Minoda Y. Improvement of rotational arc during deep flexion range of a novel designed polyethylene insert for posterior-stabilised total knee arthroplasty. Knee 2024; 46:108-116. [PMID: 38071923 DOI: 10.1016/j.knee.2023.11.007] [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: 06/07/2023] [Revised: 09/29/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND One of the remaining issues in total knee arthroplasty (TKA) is achieving sufficient rotational arc during deep flexion range of the knee for specific postures such as the 'seiza' or cross-legged sitting. This study aimed to evaluate whether there was a change in the actual in vivo rotational arc during deep flexion range before and after a design change of polyethylene (PE) inserts. METHODS In 50 posterior-stabilised TKA cases, knee kinematics, including rotational movement, were measured intraoperatively using an image-free navigation system to compare a newly designed PE insert with reduced the posterior lip with a conventional PE insert. Femoral-tibial rotational angles at 30°, 45°, 60°, 90°, 120°, and 130° knee flexion were evaluated. Varus/valgus instability, knee range of motion, and femoral rollback were also measured. Obtained parameters were compared between new and conventional PE inserts. The independent factors associated with rotational arc during deep flexion range (120° and 130° knee flexion) were analysed using multivariate analysis. RESULTS The newly designed PE insert demonstrated a significant increase in the rotational arc at 120° (22.9 ± 8.7° vs. 30.1 ± 11.9°, P < 0.001) and 130° (24.3 ± 9.5° vs. 32.5 ± 12.4°, P < 0.001) knee flexion compared with that with the conventionally designed posterior-stabilised insert. Multivariate analysis demonstrated that using the newly designed PE insert was an independent predictor of improved rotational arc during deep flexion range: regression coefficient was 11.2 (95% confidence interval 7.1-15.3, P < 0.001). CONCLUSION The design change, which reduced the posterior lip of the PE insert, contributed to improved rotational arc in 120° and 130° deep flexion ranges.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
| | - Shigeru Nakagawa
- Department of Orthopaedic Surgery, Hanwa Memorial Hospital, Osaka, Japan
| | - Kenji Fukunaga
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | | | - Susumu Takemura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Suguru Nakamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | | | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine Osaka, Japan
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Xu C, Aloi N, Gale T, Nishida K, Fu F, Anderst W. Symmetry in knee arthrokinematics in healthy collegiate athletes during fast running and drop jump revealed through dynamic biplane radiography. Osteoarthritis Cartilage 2023; 31:1501-1514. [PMID: 37394227 DOI: 10.1016/j.joca.2023.06.009] [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: 02/01/2023] [Revised: 05/17/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Changes in cartilage contact area and/or contact location after knee injury can initiate and exacerbate cartilage degeneration. Typically, the contralateral knee is used as a surrogate for native cartilage contact patterns on the injured knee. However, symmetry in cartilage contact patterns between healthy knees during high-impact activities is unknown. METHOD Tibiofemoral kinematics were measured on 19 collegiate athletes during fast running and drop jump using dynamic biplane radiography and a validated registration process that matched computed tomography (CT)-based bone models to the biplane radiographs. Cartilage contact area and location were measured with participant-specific magnetic resonance imaging (MRI)-based cartilage models superimposed on the CT-based bone models. Symmetry in cartilage contact area and location was assessed by the absolute side-to-side differences (SSD) within participants. RESULTS The SSD in contact area during running (7.7 ± 6.1% and 8.0 ± 4.6% in the medial and lateral compartments, respectively) was greater than during drop jump (4.2 ± 3.7% and 5.7 ± 2.6%, respectively) (95% CI of the difference: medial [2.4%, 6.6%], lateral [1.5%, 4.9%]). The average SSD in contact location was 3.5 mm or less in the anterior-posterior (AP) direction and 2.1 mm or less in the medial-lateral (ML) direction on the femur and tibia for both activities. The SSD in AP contact location on the femur was greater during running than during drop jump (95% CI of the difference: medial [1.6 mm, 3.6 mm], lateral [0.6 mm, 1.9 mm]). CONCLUSION This study provides context for interpreting results from previous studies on tibiofemoral arthrokinematics. Previously reported differences between ligament-repaired and contralateral knee arthrokinematics fall within the range of typical SSDs observed in healthy athletes. Previously reported arthrokinematics differences that exceed SSDs found in these healthy athletes occur only in the presence of anterior cruciate ligament (ACL) deficiency or meniscectomy.
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Affiliation(s)
- Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas Aloi
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA; Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tom Gale
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Kyohei Nishida
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Freddie Fu
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - William Anderst
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA.
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Ueno A, Hashimoto S, Oshima A, Ohsawa T, Takase R, Kaneko S, Shimada T, Chikuda H. Postoperative Medial Tilting of the Joint Line and Preoperative Kinematics Influence Postoperative Medial Pivot Pattern Reproduction in Total Knee Arthroplasty. Arthroplast Today 2023; 23:101178. [PMID: 37712071 PMCID: PMC10498393 DOI: 10.1016/j.artd.2023.101178] [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: 03/29/2023] [Revised: 06/02/2023] [Accepted: 07/03/2023] [Indexed: 09/16/2023] Open
Abstract
Background Reproducing the medial pivot pattern after total knee arthroplasty (TKA) is known to improve patient satisfaction. However, the factors affecting the postoperative medial pivot pattern in TKA are controversial. The purpose of this study was to examine the factors affecting the postoperative medial pivot pattern in posterior-stabilized TKA. Methods This study involved 30 cases with knee osteoarthritis who underwent primary posterior-stabilized TKA. The preoperative and postoperative kinematics were measured using a computed tomography-free navigation system, and the patients were divided into the following 2 groups: the medial pivot pattern (MP) group and non-medial pivot pattern (non-MP) group. In addition, we measured each of the following angles on X-ray films (preoperative and postoperative femorotibial angle, hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle). We examine the factors affecting the postoperative medial pivot pattern. Results There were 14 cases in the MP group and 16 cases in the non-MP group at the preoperative knee kinematic assessment and 17 cases in the MP group and 13 cases in the non-MP group at the postoperative knee kinematic assessment. The preoperative kinematic pattern was conserved after the surgery at a rate of 76.7%. The postoperative MP-group showed a significantly smaller preoperative femorotibial angle and hip-knee-ankle and a significantly smaller postoperative mechanical lateral distal femoral angle and medial proximal tibial angle in comparison to the postoperative non-MP group. Conclusions Preoperative kinematics and postoperative mechanical lateral distal femoral angle and medial proximal tibial angle may be important factors that affect the postoperative medial pivot pattern.
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Affiliation(s)
- Akira Ueno
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Shogo Hashimoto
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Atsufumi Oshima
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Ryota Takase
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Soya Kaneko
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Takeshi Shimada
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
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Hariri M, Hagemann M, Koch KA, Reiner T, Panzram B, Merle C, Renkawitz T, Walker T. Short- to mid-term results of minimally invasive lateral unicompartmental knee replacement: 133 cases in a non-designer series. Arch Orthop Trauma Surg 2023; 143:5849-5856. [PMID: 36917240 PMCID: PMC10450018 DOI: 10.1007/s00402-023-04841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION The aim of the current study was to demonstrate short- to mid-term survivorship as well as clinical outcome of lateral unicompartmental knee replacement (UKR) with a fixed-bearing (FB) design from a non-designer center using the Oxford Fixed Lateral prosthesis. MATERIALS AND METHODS This single-center retrospective cohort study reports the results of 133 consecutive lateral FB-UKR. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford-Knee-Score (OKS), American-Knee-Society-Score (AKSS-O), range-of-motion (ROM) and visual-analog-scale for pain (VAS). RESULTS There were two revision surgeries with conversion to total knee replacements (TKR) due to persistent pain resulting in a survival rate of 98.5% (95% CI 93.5-99.6) with a mean follow-up (FU) of 3.3 ± 1.8 years (range 1-8.5). All outcome scores, VAS and ROM showed a significant improvement at final FU (p < 0.001). The OKS improved from 26 ± 7.8 (range 11-45) preoperatively to 39 ± 8.3 (range 13-48), the AKSS-O from 49.2 ± 14.6 (range 18-90) to 81.8 ± 15.1 (range 40-100), the AKSS-F from 53 ± 23.7 (range 0-100) to 80.4 ± 21.4 (range 5-100) and the ROM from 118 ± 17 (range 90-160) to 134 ± 9.5 (range 100-155). CONCLUSIONS The short- to mid-term results following lateral FB-UKR demonstrate a high survivorship and good clinical outcome from an independent series. We, therefore, suggest that FB-UKR is a safe treatment option for isolated lateral OA if sufficient surgical experience is provided. LEVEL OF EVIDENCE Retrospective cohort study, level IV.
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Affiliation(s)
- Mustafa Hariri
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Merlin Hagemann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Kevin-Arno Koch
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Benjamin Panzram
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christian Merle
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Hariri M, Zahn N, Mick P, Jaber A, Reiner T, Renkawitz T, Innmann M, Walker T. Fixed-bearing is superior to mobile-bearing in lateral unicompartmental knee replacement: a retrospective matched-pairs analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:3947-3955. [PMID: 37093235 PMCID: PMC10435651 DOI: 10.1007/s00167-023-07417-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE Due to low incidence of isolated lateral osteoarthritis (OA), there are limited data on whether a fixed-bearing (FB) or a mobile-bearing (MB) design is superior for lateral unicompartmental knee replacement (UKR). The aim of this matched-pairs analysis was to compare both designs in terms of implant survival and clinical outcome. METHODS Patients who received MB-UKR (Group A) and FB-UKR (Group B) at a single centre were matched according to gender, age at time of surgery and body mass index (BMI). Survivorship analysis was performed with the endpoint set as "revision for any reason". Clinical outcome was assessed using the Oxford knee score (OKS), visual analogue scale for pain (VAS), patients' satisfaction, University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS). RESULTS A total of 60 matched pairs were included with a mean follow-up (FU) of 3.4 ± 1.3 (range 1.2-5.0) years in Group A and 2.7 ± 1.2 (range 1.0-5.0) years in Group B. Survivorship between both groups differed significantly (Group A: 78.7%; Group B: 98.3%, p = 0.003) with bearing dislocation being the most common reason for revision in Group A (46.2%). The relative and absolute risk reduction were 92.2% and 20%, respectively, with 5 being the number needed to treat. There were no differences in OKS (Group A: 41.6 ± 6.5; Group B: 40.4 ± 7.7), VAS (Group A: 2.9 ± 3.2; Group B: 1.6 ± 2.2), UCLA (Group A: 5.7 ± 1.3; Group B: 5.9 ± 1.8) and TAS (Group A: 3.0 ± 1.0; Group B: 3.1 ± 1.2) between both groups on follow-up. CONCLUSION Despite modern prosthesis design and surgical technique, implant survival of lateral MB-UKR is lower than that of FB-UKR on the short- to mid-term due to bearing dislocation as the most common cause of failure. Since clinical results are equivalent in both groups, FB-UKR should be preferred in treatment of isolated lateral OA. LEVEL OF EVIDENCE Retrospective case-control study, Level III.
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Affiliation(s)
- Mustafa Hariri
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Niklas Zahn
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Paul Mick
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Ayham Jaber
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Reiner
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz Innmann
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Westhauser F, Doll J, Bangert Y, Walker T, Reiner T, Renkawitz T. [Treatment of unicompartmental osteoarthritis of the knee]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04391-5. [PMID: 37318534 DOI: 10.1007/s00132-023-04391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/16/2023]
Abstract
Osteoarthritis of the knee is one of the most important degenerative joint diseases in the clinical routine. The treatment of knee osteoarthritis is not only based on the stage, symptoms and duration of the joint disease, but also depends on the existing arthrosis pattern. In the case of unicompartmental arthrosis, damage typical for osteoarthritis is limited to just one joint compartment. Both the conservative and the surgical treatment of unicompartmental osteoarthritis of the knee have to respect the individual characteristics of the respective forms of osteoarthritis. In the context of this manuscript, the genesis, the diagnostics and the guideline-based stage-adapted conservative and operative treatment of unicompartmental osteoarthritis of the knee are addressed.
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Affiliation(s)
- F Westhauser
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - J Doll
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Y Bangert
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Walker
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Reiner
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - T Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
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Physical Activity of Young Patients following Minimally Invasive Lateral Unicompartmental Knee Replacement. J Clin Med 2023; 12:jcm12020635. [PMID: 36675564 PMCID: PMC9865423 DOI: 10.3390/jcm12020635] [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: 12/09/2022] [Revised: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 01/14/2023] Open
Abstract
Unicompartmental knee replacement (UKR) has increased in popularity in recent years, especially in young patients with high demands on their athletic ability. To date, there are no data available on the physical activity of young patients following lateral UKR. The aim of this study was to demonstrate return-to-activity rate and sporting activity of patients aged 60 years or younger following lateral UKR with a fixed-bearing (FB) prosthesis. Thirty-seven patients aged 60 years or younger after lateral FB-UKR were included. Sporting activities were assessed using the University of California Los Angeles activity scale (UCLA) and the Tegner activity score (TAS). Clinical outcome was measured using the Oxford Knee Score (OKS), range of motion (ROM) and visual analogue scale (VAS). The mean follow-up (FU) was 3.1 ± 1.5 years and the mean age at surgery was 52.8 ± 3.1 years. The return-to-activity rate was 87.5% and 49% of patients were highly active postoperatively as defined by an UCLA score of 7 or higher. All clinical parameters increased significantly postoperatively. We demonstrated a high return-to-activity rate with nearly half of the patients achieving high activity levels. Longer FU periods are necessary to evaluate the effect of activity on implant survival.
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Giordano L, Maffulli N, Morenghi E, Quaglia A, Prospero E, Rosa F, Volpi P. A BMI above 30 results in satisfying outcomes in patients undergoing fixed-bearing lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:1106-1112. [PMID: 36478285 PMCID: PMC9734769 DOI: 10.1007/s00167-022-07253-3] [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: 07/28/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study is to analyse the effect of BMI on clinical outcomes of cemented fixed-bearing lateral unicompartmental knee arthroplasty (UKA) on a 2- to 12-year follow-up. METHODS Between January 2010 and January 2020, a total of 103 lateral UKAs were implanted. The Oxford Knee Score (OKS) and the Western Ontario and McMaster University Osteoarthritis Index for pain, stiffness, function, and total score were administered to estimate patients' overall health status pre- and post-operatively. Results were considered good or excellent for WOMAC values > 85 points and OKS > 40 points. Survivorship, described with Kaplan-Meier method, was defined as the lack of revision at the latest follow-up. Complications or further operations were recorded. p values of < 0.05 were considered significant. RESULTS One hundred one lateral UKAs were assessed at a mean follow-up of 77.8 months. No patients underwent revision, but 2 patients (2, 0%) developed aseptic loosening of the implant 2 and 5 years after surgery but for clinical reasons neither undergo revision (5-year survivor 97.2%). Overall satisfaction was generally high, with excellent scores in all WOMAC subscales and OKS for all BMI groups. Considering the pain subscale (WOMAC pain), patients with normal weight and overweight achieve excellent results more frequently [10 (25.64%) vs 10 (23.81%) p = 0.026] than obese patients (n = 0); on the other hand, considering the quality of life (WOMAC QoL), obese patients most frequently reach excellent values, even statistically significant [n = 15 (75.00%) p = 0.040]. CONCLUSION Although obesity has historically been described as a contraindication to UKA, improved outcomes with modern UKA implant designs have challenged this perception. Therefore, the classic contraindication of UKAs in patients with BMI > 30 kg/m2 may not be justified. According to the present study, lateral UKA patients with BMI > 30 kg/m2 had satisfactory patient-reported outcome measures compared to non-obese patients on a long term with survival rates comparable to medial UKA. Obese patients should not be excluded from the benefit of lateral UKA surgery.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy. .,Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK. .,UKSchool of Pharmacy and Bioengineering, Keele University School of Medicine, Staffordshire, UK.
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Research Hospital, IRCCS, Rozzano, 20089 Milan, Italy ,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, PieveEmanuele, 20090 Milan, Italy
| | - Alessandro Quaglia
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Emanuele Prospero
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Francesco Rosa
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Piero Volpi
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
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Li JS, Tsai TY, Clancy MM, Lewis CL, Felson DT, Li G. Cartilage contact characteristics of the knee during gait in individuals with obesity. J Orthop Res 2022; 40:2480-2487. [PMID: 35076128 PMCID: PMC9309196 DOI: 10.1002/jor.25288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Obesity increases the risk of knee osteoarthritis (OA). Knee joint contact characteristics have been thought to provide insights into the pathogenesis of knee OA; however, the cartilage contact characteristics in individuals with obesity have not been fully described. We conducted cartilage-to-cartilage contact analyses through high-precision fluoroscopy imaging with subject-specific magnetic resonance cartilage models. Twenty-five individuals with obesity were recruited for this study, and previously published data consisted of eight nonobese individuals who were used as the comparator group. In both groups, knees were imaged by a dual fluoroscopic imaging system during treadmill walking, and the tibiofemoral cartilage contact locations were analyzed and described on the tibial plateau in the medial-lateral (ML) and anterior-posterior (AP) directions and on femoral condyle surfaces using contact angles in the sagittal plane and deviation angles in a plane perpendicular to the sagittal plane. On the medial tibial plateau, the ML contact locations in the individuals with obesity were located more medially than in the nonobese group throughout the stance phase. The medial plateau AP contact locations in individuals with obesity showed a different pattern compared with the nonobese group. The ML contact excursions on the medial plateau in the individuals with obesity were larger than in the nonobese group. These findings suggest that obesity affects the contact location mainly in the medial compartment, which explains, in part, the high prevalence of medial knee OA in the obese population.
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Affiliation(s)
- Jing-Sheng Li
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Margaret M. Clancy
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Cara L. Lewis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David T. Felson
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
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Zambianchi F, Franceschi G, Banchelli F, Marcovigi A, Ensini A, Catani F. Robotic Arm-Assisted Lateral Unicompartmental Knee Arthroplasty: How Are Components Aligned? J Knee Surg 2022; 35:1214-1222. [PMID: 33511590 DOI: 10.1055/s-0040-1722346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this multicenter, retrospective, observational study was to investigate the association between intraoperative component positioning and soft tissue balancing, as reported by robotic technology for a cohort of patients who received robotic arm-assisted lateral unicompartmental knee arthroplasty (UKA) as well as short-term clinical follow-up of these patients. Between 2013 and 2016, 78 patients (79 knees) underwent robotic arm-assisted lateral UKAs at two centers. Pre- and postoperatively, patients were administered the Knee Injury and Osteoarthritis Score (KOOS) and the Forgotten Joint Score-12 (FJS-12). Clinical results were dichotomized based upon KOOS and FJS-12 scores into either excellent or fair outcome, considering excellent KOOS and FJS-12 to be greater than or equal to 90. Intraoperative, postimplantation robotic data relative to computed tomography-based components placement were collected and classified. Following exclusions and loss to follow-up, a total of 74 subjects (75 knees) who received robotic arm-assisted lateral UKAs were taken into account with an average follow-up of 36.3 months (range: 25.0-54.2 months) postoperative. Of these, 66 patients (67 knees) were included in the clinical outcome analysis. All postoperative clinical scores showed significant improvement compared with the preoperative evaluation. No association was reported between three-dimensional component positioning and soft tissue balancing throughout knee range of motion with overall KOOS, KOOS subscales, and FJS-12 scores. Lateral UKA three-dimensional placement does not seem to affect short-term clinical performance. However, precise boundaries for lateral UKA positioning and balancing should be taken into account. Robotic assistance allows surgeons to acquire real-time information regarding implant alignment and soft tissue balancing.
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Affiliation(s)
- Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy
| | - Giorgio Franceschi
- Department of Knee Surgery, Policlinico Abano Terme, Piazza Cristoforo Colombo, Abano Terme (PD), Italy
| | - Federico Banchelli
- Department of Diagnostics, Statistic Unit, Clinical and Public Health Medicine, University of Modena and Reggio-Emilia, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy
| | - Andrea Ensini
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy
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15
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Evaluation of double-high insert mid-term outcomes in cruciate-retaining medial-pivotal total knee arthroplasty - a propensity score-matched analysis with averaged 8-year follow-up. BMC Musculoskelet Disord 2022; 23:571. [PMID: 35701774 PMCID: PMC9195354 DOI: 10.1186/s12891-022-05484-6] [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: 09/16/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to compare the mid-term clinical and radiographic outcomes between medial-pivotal (MP) insert and double-high (DH) insert used under the cruciate-retaining condition in ADVANCE® total knee arthroplasty (TKA). METHODS The follow-up was conducted for 158 consecutive patients who underwent unilateral ADVANCE® TKA from January 2011 to April 2014. Eighty-four MP inserts and 74 DH inserts were used under cruciate-retaining conditions. A 1:1 propensity score matching (PSM) analysis was performed between MP inserts and DH inserts to compare the clinical and radiographic outcomes. RESULTS After a 1:1 PSM, 120 patients (60 pairs) were matched between the MP and DH inserts groups. The baseline demographic parameters and clinical scores were comparable between the two groups. The postoperative clinical outcomes at an averaged 8-year follow-up of both groups were significantly improved. The range of motion (ROM) of the DH group was better than that of the MP group, and equivalent Knee Society Function Score (KSFS) between the two groups was found. However, the Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and Forgotten Joint Score (FJS) of the MP group were found to be significantly superior to those of the DH group. Comparable complication and revision rates were observed between the two groups. The radiographic results were also equally good between MP and DH groups. CONCLUSIONS Although the mid-term clinical and radiographic outcomes of the DH inserts are fairly good, the clinical scores of the DH group were worse than those of the MP group.
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Meneghini RM, Deckard ER, Banks SA. The Effect of Posterior Cruciate Ligament Release on Kinematics and Outcomes in Primary Total Knee Arthroplasty With a Dual-Pivot Conforming Polyethylene. J Arthroplasty 2022; 37:S231-S237. [PMID: 35217184 DOI: 10.1016/j.arth.2022.02.061] [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: 11/17/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ultracongruent bearings are increasingly utilized in total knee arthroplasty (TKA); however, implications of surgical technique on knee kinematics and outcomes with these bearings are not well understood. This study's purpose was to evaluate the relationship of 3-dimensional knee kinematics and patient-reported outcome measures (PROMs) in a dual-pivot congruent bearing TKA with and without posterior cruciate ligament (PCL) release. METHODS Forty patients undergoing TKA with an asymmetric ultracongruent bearing were prospectively enrolled for gait analysis preoperatively and 4 months postoperatively. Three-dimensional gait analysis was performed utilizing infrared motion capture. Knee kinematic data and PCL disposition were analyzed for correlations with PROMs. RESULTS The PCL was fully released in 52.5% (21/40) of cases. Greater maximum anteroposterior femoral translation correlated with lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (rho = -0.596, P = .012), greater Knee Society Score pain with level walking (rho = 0.411, P = .101), and greater Knee Society Score pain while climbing stairs (rho = 0.469, P = .058) at 4-month follow-up. The PCL-release group was associated with greater maximum femoral anteroposterior translation (9.8 vs 5.5 mm, P = .053) and greater maximum internal tibial rotation (-6.2° vs -3.0°, P = .040), supporting a more anterior-based position of the medial condyle. The PCL released group had lower median Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores (70.7 vs 76.3, P = .031) and reported that their knees "sometimes or always" feel normal less frequently (81.8% vs 92.3%, P = .576). CONCLUSION With this asymmetric ultracongruent bearing TKA, preservation or partial titration release of the PCL, as opposed to full PCL release, appears to minimize deleterious anterior femoral translation and internal tibial rotation, which is correlated with optimized patient-reported outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery; Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, Indiana
| | - Evan R Deckard
- Department of Orthopaedic Surgery; Indiana University School of Medicine, Indianapolis, Indiana
| | - Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida
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Kawaguchi K, Inui H, Taketomi S, Yamagami R, Kono K, Sameshima S, Kage T, Tanaka S. Effects of a 1-mm difference in bearing thickness on intraoperative bearing movement and kinematics in Oxford unicompartmental knee arthroplasty. BMC Musculoskelet Disord 2022; 23:341. [PMID: 35397577 PMCID: PMC8994313 DOI: 10.1186/s12891-022-05203-1] [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] [Received: 07/30/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background The choice of mobile bearing (MB) thickness is essential for obtaining successful results after mobile-bearing Oxford unicompartmental knee arthroplasty (UKA). This study aimed to investigate the effects of a 1-mm difference in bearing thickness on intraoperative MB movement and intraoperative knee kinematics in Oxford UKAs. Methods We prospectively investigated the effects of a 1-mm difference in bearing thickness on intraoperative MB movement and knee kinematics in 25 patients who underwent Oxford UKAs when surgeons didn’t know which bearing thickness to choose with 1-mm difference. A trial tibial component that was scaled every 2 mm was used to measure the intraoperative MB movement, and the tibial internal rotation relative to the femur and the knee varus angle was simultaneously evaluated using the navigation system as the knee kinematics. We separately evaluated sets of two MB thicknesses with 1-mm differences, and we compared the intraoperative parameters at maximum extension; 30º, 45º, 60º, and 90º flexion; and maximum flexion between the thicker MB (thick group) and the thinner MB (thin group). Results The MB in the thin group was located significantly posteriorly at 90º flexion compared with that in the thick group; however, there were no differences at the other flexion angles. There was significantly less tibial internal rotation in the thin group at 90º flexion than that in the thick group; however, there were no differences at the other flexion angles. The knee varus angles in the thick group were significantly smaller than those in the thin group by approximately one degree at all angles other than at 30º and 45º flexion. Conclusion The thicker MB could bring the less posterior MB movement and the more tibial internal rotation at 90º flexion, additionally the valgus correction angle in the thicker MB should be paid attention. These results could help surgeons to decide the thickness of MBs when they wonder the thickness of MB.
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18
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Medial stabilised total knee arthroplasty achieves comparable clinical outcomes when compared to other TKA designs: a systematic review and meta-analysis of the current literature. Knee Surg Sports Traumatol Arthrosc 2022; 30:638-651. [PMID: 33247352 PMCID: PMC8866298 DOI: 10.1007/s00167-020-06358-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to perform a systematic review and meta-analysis to compare clinical and patient-reported outcome measures of medially stabilised (MS) TKA when compared to other TKA designs. METHODS The Preferred Reporting Items for Systematic Review and Meta-Analyses algorithm was used. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and EMCARE databases were searched to June 2020. Studies with a minimum of 12 months of follow-up comparing an MS TKA design to any other TKA design were included. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. RESULTS The 22 studies meeting the inclusion criteria included 3011 patients and 4102 TKAs. Overall Oxford Knee Scores were significantly better (p = 0.0007) for MS TKA, but there was no difference in the Forgotten Joint Scores (FJS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS)-Knee, KSS-Function, and range of motion between MS and non-MS TKA designs. Significant differences were noted for sub-group analyses; MS TKA showed significantly worse KSS-Knee (p = 0.02) and WOMAC (p = 0.03) scores when compared to Rotating Platform (RP) TKA while significantly better FJS (p = 0.002) and KSS-knee scores (p = 0.0001) when compared to cruciate-retaining (CR) TKA. CONCLUSION This review and meta-analysis show that MS TKA designs result in both patient and clinical outcomes that are comparable to non-MS implants. These results suggest implant design alone may not provide further improvement in patient outcome following TKA, surgeons must consider other factors, such as alignment to achieve superior outcomes. LEVEL OF EVIDENCE III.
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Yang I, Gammell JD, Murray DW, Mellon SJ. The Oxford Domed Lateral Unicompartmental Knee Replacement implant: Increasing wall height reduces the risk of bearing dislocation. Proc Inst Mech Eng H 2021; 236:349-355. [PMID: 34696644 PMCID: PMC8822200 DOI: 10.1177/09544119211048558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to lateral ligament laxity, bearing dislocation occurs in 1%–6% of Oxford Domed
Lateral replacements. Most dislocations are medial but they do rarely occur anteriorly or
posteriorly. The aim was to decrease the risk of dislocation. For a bearing to dislocate
the femoral component has to be distracted from the tibial component. A
robotic-path-planning-algorithm was used with a computer model of the implant in different
configurations to determine the Vertical Distraction needed for Dislocation (VDD). With
current components, VDD anteriorly/posteriorly was 5.5 to 6.5 mm and medially was 3.5 to
5.75 mm. A thicker bearing increased VDD medially and decreased VDD anteriorly/posteriorly
(0.1 mm/1 mm thickness increase). VDD medially increased with the bearing closer to the
tibial wall (0.5 mm/1 mm closer), or by increasing the tibial wall height (1 mm/1 mm
height increase). VDD anteriorly/posteriorly was not influenced by bearing position or
wall height. To prevent collision between the femoral and tibial components an increase in
wall height must be accompanied by a similar increase in minimum bearing thickness.
Increasing the wall height and minimum bearing thickness by 2 mm and ensuring the bearing
is 4 mm or less from the wall increased the minimum VDD medially to 5.5 mm. The lower VDD
medially than anteriorly/posteriorly explains why medial dislocation is more common. If
the wall height is increased by 2 mm, the minimum bearing thickness is 5 mm and the
surgeon ensured the bearing is 4 mm or less from the wall, the medial dislocation rate
should be similar to the anterior/posterior dislocation rate, which should be
acceptable.
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Affiliation(s)
- Irene Yang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jonathan D Gammell
- Oxford Robotics Institute, Department of Engineering Sciences, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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20
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Yamamoto T, Taneichi H, Seo Y, Yoshikawa K. MRI-based kinematics of the menisci through full knee range of motion. J Orthop Surg (Hong Kong) 2021; 29:23094990211017349. [PMID: 34027726 DOI: 10.1177/23094990211017349] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The meniscal kinematics in the full knee range of motion (ROM) have not been demonstrated by MRI, because the narrow bore of the superconducting magnet prevents full knee motion. The purpose of this study was to the investigate meniscal kinematics associated with femorotibial kinematics using an open-structure MRI unit that allows kinematic analysis of the menisci in full knee ROM. METHODS Non-weight-bearing MR images of the right knee of 10 subjects were acquired at six angles of knee flexion (0°, 30°, 60°, 90°, 120°, and full flexion) using a compact 0.2-T MRI system. The positions of the anterior and posterior horns of the medial and lateral menisci (MM/LM) and the medial and lateral femoral condyles (MFC/LFC) were measured at each angle of flexion. RESULTS Significant posterior LFC movement was observed in all sets of adjacent flexion angles of 60°-90° or more, indicating medial pivot motion of the femur. Significant differences in LM position were observed between adjacent flexion angles of 60°-90° or more. The positional relationship between the posterior horn of MM and the MFC was statistically significant in all but 60° flexion. The positional relationship between LM and LFC was significant at flexion angles of ≤90° in the anterior horn and at 60°, 90°, and full flexion in the posterior horn. CONCLUSION Motion patterns of the menisci were analogous to those of the femoral condyle. Medial pivot motion of the femur caused the greatest posterior movement of the LM. Meniscal kinematics followed the femorotibial kinematics. Comprehension of meniscal kinematics in full knee ROM is important for understanding of injury mechanisms, planning meniscus transplant, and making postoperative care program for meniscus surgery.
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Affiliation(s)
- Tadashi Yamamoto
- Department of Orthopaedic Surgery, 12756Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, 12756Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Yoshiteru Seo
- Department of Regulatory Physiology, 12756Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Katsuhisa Yoshikawa
- Department of Orthopaedic Surgery, 12756Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
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Bonanzinga T, Tanzi P, Altomare D, Dorotei A, Iacono F, Marcacci M. High survivorship rate and good clinical outcomes at mid-term follow-up for lateral UKA: a systematic literature review. Knee Surg Sports Traumatol Arthrosc 2021; 29:3262-3271. [PMID: 32621040 DOI: 10.1007/s00167-020-06129-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this paper is to systematically review the available literature to understand the effectiveness, the survivorship, the clinical outcomes and the complications of lateral UKA. METHODS A review of the current literature available about lateral UKA was performed in March 2020, according to the PRISMA guidelines. Selection was based on the following inclusion criteria: (1) clinical reports of any level of evidence, (2) written in English language, (3) published from 1996 to 2020, (4) dealing with clinical data on lateral UKA. A total of 47 articles, published between 1996 and 2020, were included in the review. Quality of every article was assessed using the Modified Coleman Methodology Score. RESULTS A total of 47 studies were included. Mean mCMS was 45.27 (range 30-62). Mean age at surgery was 64.5 years (range 34.1-88.0 years). In 1741 patients (65.5%) a metal back implant was used and in 421 patients (15.8%) an all poly design was used. Several scores were used to evaluate clinical results (OKS, AKSS, IKS, KOOS, WOMAC, VAS). Range of motion improved with an overall mean value of 120.3° (range: 105.9°-143.3°). The mean follow-up was 60.7 months (range, 7-204 months), mean survivorship (absence of a revision) with a minimum 60 months of follow-up was 88.6% (range 74.5-100) and mean satisfaction of patients was 78.5% (range 41.0-97.9). CONCLUSIONS Lateral UKA seems to be an effective solution to manage lateral osteoarthritis (OA), based on preliminary results, with survivorship and satisfaction rate comparable to medial UKA and total knee arthroplasty (TKA). Nonetheless, this review highlights that the quality of studies available in current literature is low. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- Tommaso Bonanzinga
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | | | - Daniele Altomare
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
| | - Andrea Dorotei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Francesco Iacono
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Maurilio Marcacci
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
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Existence of Gender-Based Difference in Morphology of Convex Lateral Tibial Plateau in Korean Population Primary Knee Joint Osteoarthritis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6641717. [PMID: 34485524 PMCID: PMC8410385 DOI: 10.1155/2021/6641717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/29/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
Purpose Morphological differences in the knee joints of females and males have been reported in a previous study. These differences have realized the need of developing a gender-specific prosthesis. However, anatomical studies on gender-based differences in the proximal tibial plateau's sagittal curvature have rarely been conducted. Therefore, this study is aimed at evaluating the geometry of the sagittal curvature of the proximal tibial plateau in the Korean population. Methods Three-dimensional data for the sagittal curvature of the tibial plateau morphology from 1976 patients (i.e., 299 male and 1677 female) were assessed using magnetic resonance imaging. The sagittal profiles of the tibial plateaus were also evaluated. The independent t-test and paired t-test were used for statistical analysis. Results The proximal tibia had concave and convex surfaces in the medial and lateral plateaus, respectively, for both genders. In addition, the medial diameter of the tibial plateau was significantly greater than the lateral diameter for both genders. Gender-based difference was not found in the medial diameter of the tibial plateau but was observed in the lateral diameter. Conclusion These results may provide guidelines for a suitable knee implant design for the Korean patients. The incorporation of this shape information in the medial and lateral sides in the prosthetics for a total knee arthroplasty and a lateral unicompartmental knee arthroplasty can improve knee range motion.
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Takemura S, Ikawa T, Ohyama Y, Kim M, Takaoka K, Minoda Y, Kadoya Y. The posterior tibial slope does not influence the flexion angle in posterior-stabilized mobile-bearing total knee arthroplasty. ARTHROPLASTY 2021; 3:28. [PMID: 35236482 PMCID: PMC8796609 DOI: 10.1186/s42836-021-00085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
Background It remains uncertain whether an increase in the tibial slope leads to better flexion in posterior-stabilized (PS) total knee prostheses. Purpose To compare the intra-operative flexion angle between standard and an additional 10° posterior slope inserts. Patients and methods Between December 2014 and February 2015, 22 patients (25 knees) who underwent PS mobile-bearing primary total knee arthroplasty (TKA) were included. Flexion angles were measured using either standard or specially-made inserts. Differences in flexion angles between the two situations were analyzed to determine the relationship between changes in flexion angle and pre-operative flexion angle or body mass index (BMI), and between intra- and post-operative flexion angle. Results The difference between the average flexion angle of standard inserts and specially-made inserts was not statistically significant. Although the correlations between changes in flexion angle due to insert difference and flexion angle, pre-operative flexion angle or BMI were not significant, there was a positive correlation between intra-operative and post-operative flexion at 2 years. Conclusion The results showed an additional posterior tibial slope by 10° did not affect the intra-operative flexion angle. Surgeons performing PS mobile-bearing TKA do not need to excessively slope the tibial bone cutting to improve the post-operative flexion angle. Level of evidence I, Experimental study. Supplementary Information The online version contains supplementary material available at 10.1186/s42836-021-00085-5.
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Affiliation(s)
- Susumu Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Tessyu Ikawa
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital Osaka, 2-10-39, Shibata, Kita-ku, Osaka, 530-0012, Japan
| | - Yohei Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Mitsunari Kim
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
| | - Kunio Takaoka
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshinori Kadoya
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
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24
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Lower Limb Movement Pattern Differences Between Males and Females in Squatting and Kneeling. J Appl Biomech 2021; 37:204-214. [PMID: 33690162 DOI: 10.1123/jab.2020-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/15/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
Movement pattern differences may contribute to differential injury or disease prevalence between individuals. The purpose of this study was to identify lower limb movement patterns in high knee flexion, a risk factor for knee osteoarthritis, and to investigate kinematic differences between males and females, as females typically develop knee osteoarthritis more commonly and severely than males. Lower extremity kinematic data were recorded from 110 participants completing 4 variations of squatting and kneeling. Principal component analysis was used to identify principal movements associated with the largest variability in the sample. Across the tasks, similar principal movements emerged at maximal flexion and during transitions. At maximal flexion, females achieved greater knee flexion, facilitated by a wider base of support, which may alter posterior and lateral tibiofemoral stress. Principal movements also detected differences in movement temporality between males and females. When these temporal differences occur due to alterations in movement velocity and/or acceleration, they may elicit changes in muscle activation and knee joint stress. Movement variability identified in the current study provides a framework for potential modifiable factors in high knee flexion, such as foot position, and suggests that kinematic differences between the sexes may contribute to differences in knee osteoarthritis progression.
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Alesi D, Marcheggiani Muccioli GM, Roberti di Sarsina T, Bontempi M, Pizza N, Zinno R, Di Paolo S, Zaffagnini S, Bragonzoni L. In vivo femorotibial kinematics of medial-stabilized total knee arthroplasty correlates to post-operative clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29:491-497. [PMID: 32253483 DOI: 10.1007/s00167-020-05975-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/30/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate if there was a correlation between in vivo kinematics of a medial-stabilized (MS) total knee arthroplasty (TKA) and post-operative clinical scores. We hypothesized that (1) a MS-TKA would produce a medial pivot movement and that (2) this specific pattern would be correlated with higher clinical scores. METHODS 18 patients were evaluated through clinical and functional scores evaluation (Knee Society Score clinical and functional, Womac, Oxford), and kinematically through dynamic radiostereometric analysis (RSA) at 9 months after MS-TKA, during the execution of a sit-to-stand and a lunge motor task. The anteroposterior (AP) Low Point translation of medial and lateral femoral compartments was compared through Student's t test (p < 0.05). A correlation analysis between scores and kinematics was performed through the Pearson's correlation coefficient r. RESULTS A significantly greater (p < 0.0001) anterior translation of the lateral compartment with respect to the medial one was found in both sit-to-stand (medial 2.9 mm ± 0.7 mm, lateral 7.1 mm ± 0.6 mm) and lunge (medial 5.3 mm ± 0.9 mm, lateral 10.9 mm ± 0.7 mm) motor tasks, thus resulting in a medial pivot pattern in about 70% of patients. Significant positive correlation in sit-to-stand was found between the peak of AP translation in the lateral compartment and clinical scores (r = 0.59 for Knee Society Score clinical and r = 0.61 for Oxford). Moreover, we found that the higher peak of AP translation of the medial compartment correlated with lower clinical scores (r = - 0.55 for Knee Society Score clinical, r = - 0.61 for Womac and r = - 0.53 for Oxford) in the lunge. A negative correlation was found between Knee Society Score clinical and VV laxity during sit-to-stand (r = - 0.56) and peak of external rotation in the lunge motor task (r = - 0.66). CONCLUSIONS The MS-TKA investigated produced in vivo a medial pivot movement in about 70% of patients in both examined motor tasks. There was a correlation between the presence of medial pivot and higher post-operative scores. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
| | - Tommaso Roberti di Sarsina
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Marco Bontempi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Raffaele Zinno
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Stefano Di Paolo
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Bologna, Italy
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The Mid- to Long-Term Outcomes of the Lateral Domed Oxford Unicompartmental Knee Replacement: An Analysis From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2021; 36:107-111. [PMID: 32773270 DOI: 10.1016/j.arth.2020.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Lateral unicompartmental knee replacement (UKR) is an alternative to total knee replacement for isolated lateral unicompartmental knee arthritis. The geometry and mechanics of the lateral compartment differ to the medial compartment with the Lateral Domed Oxford UKR designed to address this. We used the National Joint Registry (NJR) data to report the mid- to long-term outcomes of this device. METHODS We performed a retrospective observational study using NJR data on 992 Lateral Domed Oxford UKRs implanted between 1st January 2005 and 31st December 2017. Outcomes of interest were implant survival and revision indications. RESULTS The 10 year cumulative implant survival rates were 88.6% (CI 85.3-91.2). When compared with <55 year age group, the 55-64, 65-74 and ≥75 groups had significantly lower revision rates (hazard ratio (HR) = 0.56 (CI 0.32-0.98, P = .04), HR 0.40 (CI 0.22-0.72, P = .003), and HR 0.27 (CI 0.12-0.58, P = .001), respectively). The obese group had significantly (P = .04) increased revision risk compared with normal BMI (HR 2.33, CI 1.06-5.12). The commonest reasons for revision surgery were dislocation (n = 23, 2.3%), pain (n = 15, 1.5%), and aseptic loosening (n = 14, 1.4%). CONCLUSION The Lateral Domed Oxford UKR provides a good option for isolated lateral compartment osteoarthritis. However, dislocation of the mobile bearing remains a problem, occurring in 2.3% of the patients and accounting for 30% of the revisions. To help prevent dislocation, it is now possible to assess bearing stability intraoperatively and if very unstable to implant a compatible fixed bearing tibial component, without the need for further bone preparation.
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27
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Lateral femoral condyle insufficiency fractures: imaging findings, demographics, and analysis of outcomes. Skeletal Radiol 2021; 50:189-199. [PMID: 32699952 DOI: 10.1007/s00256-020-03548-z] [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: 03/09/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe imaging characteristics and demographics of lateral femoral condyle insufficiency fractures (LFCIFs) and identify characteristics associated with progression to epiphyseal collapse. MATERIALS AND METHODS A retrospective review of 105 consecutive patients with LFCIF was performed (mean age 58.1 years) after excluding post-traumatic and pathological fractures. Lesion size and location, presence of bone marrow edema-like signal, soft tissue edema, chondrosis grade, and meniscus pathology were documented. Demographics were recorded from the electronic patient record. Follow-up MRI and/or radiographs were evaluated for healing/stability or progression to epiphyseal collapse. Bone mineral density was assessed from dual-energy x-ray absorptiometry (DEXA) scans and/or radiographs. RESULTS Fifty-six female and 49 male subjects were included. Female subjects were older at presentation (60.5 versus 56.3 years, p = .02). A total of 61.7% of the subjects with available DEXA and/or radiographs had osteopenia/osteoporosis. The central weight-bearing (61%) and outer condyle (54.3%) were most involved. High-grade chondrosis was present in ≥ 1 compartment in 70.5% including 42% in the lateral compartment. A total of 67.6% had ≥ 1 meniscus tear with similar frequency of medial and lateral tears (47.6% versus 41%). Bone marrow edema-like signal was present in all cases; soft tissue edema was present in 83.8%. Fifty-three subjects had available follow-up MRI (n = 24) and/or radiographs (n = 29). Increased age, fracture dimensions, presence of medial meniscus tears, and high-grade patellofemoral chondrosis were associated with progression (p ≤ .05). CONCLUSION LFCIFs are associated with meniscus tears, high-grade chondrosis, and osteopenia/osteoporosis with more global knee pathology present when compared with medial femoral condyle insufficiency fracture. Increased age, medial meniscus tears, fracture dimensions, and high-grade patellofemoral chondrosis were associated with progression.
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Kamenaga T, Hida Y, Hiranaka T, Tanaka T, Okimura K, Tsubosaka M, Kuroda Y, Nakano N, Hayashi S, Niikura T, Kuroda R, Matsumoto T. Extent of in vivo sagittal bearing movement and its relationship with tibial posterior slopes in Oxford mobile-bearing unicompartmental knee arthroplasty. Clin Biomech (Bristol, Avon) 2020; 80:105148. [PMID: 32829237 DOI: 10.1016/j.clinbiomech.2020.105148] [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: 06/01/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effect of increased tibial slope on the bearing movement and clinical results in mobile-bearing unicompartmental knee arthroplasty has not been well discussed. We aimed to clarify the extent of in vivo sagittal bearing movement and bearing overhang using fluoroscopy and their relationship with the tibial posterior slopes and clinical results. METHODS This retrospective study included 40 patients who underwent Oxford unicompartmental knee arthroplasty for anteromedial osteoarthritis or osteonecrosis of the knee. Intraoperative posterior translation and posterior overhang of the bearing were assessed during flexion. The tibial posterior slopes were evaluated before and 2 weeks after surgery, and its increment was recorded. Clinical evaluations were also performed preoperatively and at 2 years postoperatively (maximum flexion angle, Oxford Knee Score). Single linear regression analysis was performed to assess the correlation between the tibial posterior slopes and the posterior translation and the posterior overhang and determine if these could affect the clinical outcomes. FINDINGS The average posterior translation was 10.7 ± 4.3 mm, and posterior overhang of the mobile bearing was found in 35% of overall patients. They were associated with increased tibial slope as well as poorer improvement in Oxford Knee Score at 2 years postoperatively. INTERPRETATION In Oxford unicompartmental knee arthroplasty, mobile bearing can probably move posteriorly beyond the posterior margin of the tibial component during flexion when the tibial posterior slope increases more than the original magnitude. Additionally, the posterior translation and posterior overhang closely correlated with the poorer improvement in Oxford Knee Score at 2 years postoperatively.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka 569-1192, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Kobe 650-0017, Japan
| | - Yuichi Hida
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka 569-1192, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka 569-1192, Japan.
| | - Toshikazu Tanaka
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka 569-1192, Japan
| | - Kenjiro Okimura
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka 569-1192, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Kobe 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Kobe 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Kobe 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Kobe 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Kobe 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Kobe 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Kobe 650-0017, Japan
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MR imaging pattern of tibial subchondral bone structure: considerations of meniscal coverage and integrity. Skeletal Radiol 2020; 49:2019-2027. [PMID: 32591855 PMCID: PMC7658005 DOI: 10.1007/s00256-020-03517-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare regional differences in subchondral trabecular structure using high-resolution MRI in meniscus-covered/meniscus-uncovered tibia in cadaveric knees with intact/torn menisci. MATERIALS AND METHODS 3D proton density CUBE MRI of 6 cadaveric knees without significant osteoarthritis (OA) was acquired, 0.25-mm resolution. Menisci were evaluated and classified intact or torn. MR data were transferred to ImageJ program to segment tibial 3D volume of interest (VOI). Data was subdivided into meniscus-covered/meniscus-uncovered regions. Segmented VOI was classified into binary data, trabeculae/bone marrow. The trabecular bone data was used to measure MR biomarkers (apparent subchondral plate-connected bone density (adapted from spine MR), apparent trabecular bone volume fraction, apparent mean trabecular thickness, apparent connectivity density, and structure model index (SMI)). Mean value of parameters was analyzed for the effects of meniscal tear/tibial coverage. RESULTS Nine torn menisci and 3 intact menisci were present. MR measures of bone varied significantly due to meniscal coverage/tear. Subchondral plate-connected bone density under covered meniscus regions increased from 10.9 to 23.5% with meniscal tear. Values increased in uncovered regions, 19.3% (intact) and 32.4% (torn). This reflects higher density when uncovered (p = 0.048) with meniscal tear (p = 0.007). Similar patterns were found for trabecular bone fraction (coverage p < 0.001, tear p = 0.047), trabecular thickness (coverage p = 0.03), connectivity density (coverage p = 0.002), and SMI (coverage p = 0.015). CONCLUSION Quantitative trabecular bone evaluation emphasizes intrinsic structural differences between meniscus-covered/meniscus-uncovered tibias. Results offer insight into bone adaptation with meniscal tear and support the hypothesis that subchondral bone plate-connected bone density could be important in early subchondral bone adaptation.
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Kingston DC, Acker SM. Development of a Full Flexion 3D Musculoskeletal Model of the Knee Considering Intersegmental Contact During High Knee Flexion Movements. J Appl Biomech 2020; 36:444-456. [PMID: 32846408 DOI: 10.1123/jab.2019-0335] [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: 10/17/2019] [Revised: 03/12/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
A musculoskeletal model of the right lower limb was developed to estimate 3D tibial contact forces in high knee flexion postures. This model determined the effect of intersegmental contact between thigh-calf and heel-gluteal structures on tibial contact forces. This model includes direct tracking and 3D orientation of intersegmental contact force, femoral translations from in vivo studies, wrapping of knee extensor musculature, and a novel optimization constraint for multielement muscle groups. Model verification consisted of calculating the error between estimated tibial compressive forces and direct measurements from the Grand Knee Challenge during movements to ∼120° of knee flexion as no high knee flexion data are available. Tibial compression estimates strongly fit implant data during walking (R2 = .83) and squatting (R2 = .93) with a root mean squared difference of .47 and .16 body weight, respectively. Incorporating intersegmental contact significantly reduced model estimates of peak tibial anterior-posterior shear and increased peak medial-lateral shear during the static phase of high knee flexion movements by an average of .33 and .07 body weight, respectively. This model supports prior work in that intersegmental contact is a critical parameter when estimating tibial contact forces in high knee flexion movements across a range of culturally and occupationally relevant postures.
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Shi W, Jiang Y, Wang C, Zhang H, Wang Y, Li T. Comparative study on mid- and long-term clinical effects of medial pivot prosthesis and posterior-stabilized prosthesis after total knee arthroplasty. J Orthop Surg Res 2020; 15:421. [PMID: 32943092 PMCID: PMC7500020 DOI: 10.1186/s13018-020-01951-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/09/2020] [Indexed: 01/31/2023] Open
Abstract
Objective The purpose of this study was to explore the mid-and long-term clinical effects of Chinese patients with medial pivot (MP) prosthesis and posterior-stabilized (PS) prosthesis after total knee arthroplasty (TKA), to provide a reference for the recommendation of clinical prostheses. Methods A retrospective analysis of 802 patients who received TKA was performed from June 2010 to December 2013. A total of 432 patients received a MP prosthesis (MP group) and 375 patients received a PS prosthesis (PS group). Postoperative range of motion (ROM), clinical scores including the knee scoring system (KSS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the forgotten joint score (FJS), and postoperative complications were compared between the two groups. Results A total of 527 patients were followed up, including 290 in the MP group and 237 in the PS group. Both groups achieved satisfactory results in terms of KSS score, WOMAC score, and postoperative ROM, which were significantly improved compared with those before surgery, but the difference between the groups was not statistically significant (P > 0.05). The FJS scores of the MP group and the PS group were satisfactory and no significant difference was observed (P = 0.426). Postoperative complications occurred in 5 and 11 patients in the MP group and PS group, respectively. Conclusion The clinical results of TKA with MP or PS in Chinese patients at mid- and long-term are encouraging, and no significant differences were observed between the two types of prostheses. Studies have also shown that both prostheses are safe for Chinese patients.
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Affiliation(s)
- Weipeng Shi
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.,Medical Department of Qingdao University, Qingdao, 266071, Shandong, China
| | - Yaping Jiang
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Changyao Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.
| | - Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao, 266000, China.
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Kennedy JA, Mohammad HR, Yang I, Mellon SJ, Dodd CAF, Pandit HG, Murray DW. Oxford domed lateral unicompartmental knee arthroplasty. Bone Joint J 2020; 102-B:1033-1040. [PMID: 32731833 DOI: 10.1302/0301-620x.102b8.bjj-2019-1330.r2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To report mid- to long-term results of Oxford mobile bearing domed lateral unicompartmental knee arthroplasty (UKA), and determine the effect of potential contraindications on outcome. METHODS A total of 325 consecutive domed lateral UKAs undertaken for the recommended indications were included, and their functional and survival outcomes were assessed. The effects of age, weight, activity, and the presence of full-thickness erosions of cartilage in the patellofemoral joint on outcome were evaluated. RESULTS Median follow-up was seven years (3 to 14), and mean age at surgery was 65 years (39 to 90). Median Oxford Knee Score (OKS) was 43 (interquartile range (IQR) 37 to 47), with 260 (80%) achieving a good or excellent score (OKS > 34). Revisions occurred in 34 (10%); 14 (4%) were for dislocation, of which 12 had no recurrence following insertion of a new bearing, and 12 (4%) were revised for medial osteoarthritis (OA). Ten-year survival was 85% (95% confidence interval (CI) 79 to 90, at risk 72). Age, weight, activity, and patellofemoral erosions did not have a significant effect on the clinical outcome or survival. CONCLUSION Domed lateral UKA provides a good alternative to total knee arthroplasty (TKA) in the management of lateral compartment OA. Although dislocation is relatively easy to treat successfully, the dislocation rate of 4% is high. It is recommended that the stability of the bearing is assessed intraoperatively. If the bearing can easily be displaced, the fixed rather than the mobile bearing version of the Oxford lateral tibial component should be inserted instead. Younger age, heavier weight, high activity, and patellofemoral erosions did not detrimentally affect outcome, so should not be considered contraindications. Cite this article: Bone Joint J 2020;102-B(8):1033-1040.
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Affiliation(s)
- James A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Irene Yang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Christopher A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Koh YG, Lee JA, Chung HS, Kim HJ, Kang KT. Restoration of normal knee kinematics with respect to tibial insert design in mobile bearing lateral unicompartmental arthroplasty using computational simulation. Bone Joint Res 2020; 9:421-428. [PMID: 32864113 PMCID: PMC7437519 DOI: 10.1302/2046-3758.97.bjr-2019-0384.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aims Mobile-bearing unicompartmental knee arthroplasty (UKA) with a flat tibial plateau has not performed well in the lateral compartment, leading to a high rate of dislocation. For this reason, the Domed Lateral UKA with a biconcave bearing was developed. However, medial and lateral tibial plateaus have asymmetric anatomical geometries, with a slightly dished medial and a convex lateral plateau. Therefore, the aim of this study was to evaluate the extent at which the normal knee kinematics were restored with different tibial insert designs using computational simulation. Methods We developed three different tibial inserts having flat, conforming, and anatomy-mimetic superior surfaces, whereas the inferior surface in all was designed to be concave to prevent dislocation. Kinematics from four male subjects and one female subject were compared under deep knee bend activity. Results The conforming design showed significantly different kinematics in femoral rollback and internal rotation compared to that of the intact knee. The flat design showed significantly different kinematics in femoral rotation during high flexion. The anatomy-mimetic design preserved normal knee kinematics in femoral rollback and internal rotation. Conclusion The anatomy-mimetic design in lateral mobile UKA demonstrated restoration of normal knee kinematics. Such design may allow achievement of the long sought normal knee characteristics post-lateral mobile UKA. However, further in vivo and clinical studies are required to determine whether this design can truly achieve a more normal feeling of the knee and improved patient satisfaction. Cite this article: Bone Joint Res 2020;9(7):421–428.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Hyun-Seok Chung
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
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Wada K, Hamada D, Takasago T, Goto T, Tonogai I, Tsuruo Y, Sairyo K. Rotational and varus-valgus laxity affects kinematics of the normal knee: A cadaveric study. J Orthop Surg (Hong Kong) 2020; 27:2309499019873726. [PMID: 31533546 DOI: 10.1177/2309499019873726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the relationship between soft tissue laxity and kinematics of the normal knee using a navigation system. METHODS Fifteen cadaveric knees from 11 fresh frozen whole-body specimens were included in this study. The navigation system automatically recorded the rotation angle of the tibia as the internal-external (IE) kinematics and the coronal alignment of the lower limb as the varus-valgus (VV) kinematics. These measurements were made with the joint in maximal extension, at 10° intervals from 0° to 120° of flexion, and at maximal flexion during passive knee motion. For evaluation of laxity, the examiner gently applied maximum manual IE and VV stress to the knee at 0°, 30°, 60°, and 90° of flexion. RESULTS The measurements showed almost perfect reliability. The mean correlation coefficient between the intraoperative tibial rotation angle and the intermediate angle of IE laxity was 0.82, while that between the coronal alignment of the lower limb and the intermediate angle of the VV laxity was 0.96. There was a statistically significant correlation between kinematics and laxity at all degrees of knee flexion. CONCLUSION The present study revealed that the rotation angle of the tibia was correlated to the intermediate angle of IE laxity at 0°, 30°, 60°, and 90° of knee flexion and the coronal alignment of the lower limb also correlated to the intermediate angle of VV laxity. These findings provide important reference data on soft tissue laxity and kinematics of the normal knee.
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Affiliation(s)
- Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | - Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | - Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto, Tokushima, Japan
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Unikondylärer Gelenkersatz medial und lateral. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Walker T, Hariri M, Eckert J, Panzram B, Reiner T, Merle C, Gotterbarm T, Moradi B. Minimally invasive lateral unicompartmental knee replacement: Early results from an independent center using the Oxford fixed lateral prosthesis. Knee 2020; 27:235-241. [PMID: 31806510 DOI: 10.1016/j.knee.2019.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/17/2019] [Accepted: 09/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the present study was to assess clinical outcome as well as short-term survivorship of fixed-bearing lateral unicompartmental knee replacement (UKR) from a non-designer centre using the Oxford Fixed Lateral prosthesis. METHODS This single-centre retrospective cohort study reports the short-term results of 51 consecutive patients (52 knees) after fixed-bearing lateral UKR with a minimum follow-up of one year. Survivorship analysis was performed with different endpoints and clinical outcome was measured using the Oxford Knee Score (OKS), objective American Knee Society Score (AKSS-O), range-of-motion (ROM), visual analog scale for pain (VAS), Tegner activity score and UCLA score. RESULTS There was no revision surgery, defined as exchange of at least one of the components resulting in a survival rate of 100% at two years. Three patients required further surgical treatment resulting in a survival rate of 94.2% (95% confidence interval (CI): 83.2-98.1%) with the endpoint 'any reoperation'. Outcome scores, VAS and ROM showed a statistically significant improvement at final follow-up (P < .001). The OKS improved from 26.4 ± 6.9 (12-41) preoperatively to 39.7 ± 8.4 (15-48), the AKSS-O from 54.3 ± 15.3 (18-90) to 82.2 ± 15.6 (40-100), the American Knee Society Functional Score from 56.4 ± 21.3 (10-100) to 83.1 ± 20.2 (five to 100) and the ROM from 123.5 ± 13.5 (90-140) to 134 ± 10.3 (95-150). CONCLUSION Early results of fixed-bearing lateral UKR using the Oxford-Fixed-Lateral prosthesis were encouraging with a significant improvement in pain and knee function as well as an excellent survivorship of 100% at a mean follow-up of two years. Further follow-up is necessary to evaluate the long-term effectiveness of this device and the surgical technique. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Tilman Walker
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Mustafa Hariri
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Johannes Eckert
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Benjamin Panzram
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Tobias Reiner
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Christian Merle
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Tobias Gotterbarm
- Center for Orthopaedics and Trauma Surgery, University of Linz, Krankenhausstr. 7a, 4020 Linz, Austria
| | - Babak Moradi
- Center for Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
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Sandberg R, Deckard ER, Ziemba-Davis M, Banks SA, Meneghini RM. Dual-pivot bearings improve ambulation and promote increased activity levels in Total knee arthroplasty: A match-controlled retrospective study. Knee 2019; 26:1243-1249. [PMID: 31477331 DOI: 10.1016/j.knee.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Modern understanding of native knee kinematics reveals more complex pattern of lateral-pivot in early flexion activities, and medial-pivot in deeper flexion (i.e. dual-pivot). The purpose of this study was to compare patient outcomes with a contemporary dual-pivot TKA, designed to replicate anterior-cruciate substitution and stability, with a traditional TKA. METHODS One hundred and eighty-three dual-pivot TKAs were matched with 183 traditional non-conforming TKAs. All TKAs were cemented and performed with identical perioperative protocols. Patients were matched on age, sex, BMI, and ASA score. Patient-reported outcome measures were prospectively obtained and compared at minimum one-year follow-up. RESULTS Study cohorts were identical with 72% female, average age of 68 years, and BMI of 33 kg/m2. There were no differences in prevalence of fibromyalgia, depression, preoperative narcotic use, or femoral component alignment (p ≥ 0.105). Dual-pivot TKA patients had a greater prevalence of lumbar spine disease (p = 0.012) and more reported their knee never feels normal preoperatively (p = 0.012). Dual-pivot TKA patients reported less walking pain at latest follow-up (p = 0.022). Trends for greater level of participation in very active activities or impact sports (p = 0.067) and more reporting their knee feels normal (p = 0.091) were observed in dual-pivot TKAs. CONCLUSION Patients with dual-pivot knees reported less walking pain despite greater lumbar spine disease, supporting the potential benefit of lateral-pivot motion in early flexion activities. However, the groups were similar in overall satisfaction suggesting the nuances and potential ceiling-effect of patient satisfaction warrants further study.
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Affiliation(s)
- Rory Sandberg
- Pinnacle Surgical Orthopedics, 5651 Frist Blvd #400, Hermitage, TN 37076, USA
| | - Evan R Deckard
- Indiana University School of Medicine, Department of Orthopaedic Surgery, 1120 West Michigan Street, Suite 600, Indianapolis, IN 46202, USA
| | - Mary Ziemba-Davis
- Indiana University Health Physicians, Indiana University Health Hip & Knee Center, 13100 East 136(th) Street, Suite 2000, Fishers, IN 46037, USA
| | - Scott A Banks
- University of Florida, Department of Mechanical & Aerospace Engineering, 939 Center Drive, Gainesville, FL 32603, USA
| | - R Michael Meneghini
- Indiana University School of Medicine, Department of Orthopaedic Surgery, 1120 West Michigan Street, Suite 600, Indianapolis, IN 46202, USA; Indiana University Health Physicians, Indiana University Health Hip & Knee Center, 13100 East 136(th) Street, Suite 2000, Fishers, IN 46037, USA.
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Kamenaga T, Hiranaka T, Takayama K, Tsubosaka M, Kuroda R, Matsumoto T. Adequate Positioning of the Tibial Component Is Key to Avoiding Bearing Impingement in Oxford Unicompartmental Knee Arthroplasty. J Arthroplasty 2019; 34:2606-2613. [PMID: 31235342 DOI: 10.1016/j.arth.2019.05.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bearing dislocation is a serious complication of unicompartmental knee arthroplasty (UKA) with the Oxford knee prosthesis equipped with a mobile bearing. We aimed to clarify the extent of intraoperative movement of the mobile bearing and its relationship with the positioning of prosthesis components in patients undergoing Oxford UKA. METHODS This retrospective study included 50 patients (50 knees) who underwent Oxford UKA for anteromedial osteoarthritis or osteonecrosis of the knee. Intraoperative bearing movement was assessed at various angles of knee flexion (0°, 30°, 60°, 90°, and 120°). We stratified patients according to the extent of bearing movement posteriorly during intraoperative knee flexion, with or without contacting the lateral wall of the tibial component (with contact, 20 knees; without contact, 30 knees). Postoperative radiographic evaluations were conducted at 1 week postoperatively to assess the positional parameters of the tibial and femoral components (varus/valgus alignment, rotation, mediolateral position). Clinical evaluations were conducted at 1 year postoperatively (maximum flexion angle, Oxford Knee Score). RESULTS Abnormal intraoperative movement of the mobile bearing resulting in contact with the lateral wall of the tibial component was associated with a significantly more medial position and external rotation of the tibial component, as well as poorer improvement in knee flexion angle at 1 year postoperatively. CONCLUSION In Oxford UKA recipients, the bearing may impinge on the lateral wall of the tibial component during flexion above 60° if the tibial component is placed too medially or exhibits pronounced external rotation, which may limit knee function improvement postoperatively.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery, Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- 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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Wada K, Hamada D, Takasago T, Kamada M, Goto T, Tsuruo Y, Sairyo K. Intraoperative analysis of the kinematics of the native knee including two-dimensional translation of the femur using a navigation system : a cadaveric study. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:367-371. [PMID: 31656308 DOI: 10.2152/jmi.66.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aim of this cadaveric study was to evaluate the intraoperative kinematics of the native knee including two-dimensional translation of the femur using a navigation system. Eight native knees of 4 fresh-frozen whole-body cadavers were used for the study. The kinematics of each knee were analyzed intraoperatively using the navigation system. Although anterior-posterior translation could not be assessed directly, it could be calculated using a formula derived from the parameters in the navigation system. The native knee showed external rotation of the femur in early knee flexion, transient internal rotation in mid flexion, and gradual external rotation in late flexion. There was no marked change in the coronal rotation angle of the mechanical axis during knee flexion. The femoral center moved anteriorly in early knee flexion and posteriorly in late flexion. The distance moved in the medial-lateral direction was relatively smaller than that in the anterior-posterior direction. Two-dimensional translation of the surgical epicondylar axis showed a medial pivot-like motion. In this cadaveric study, the kinematics of the native knee, including two-dimensional translation of the femur, could be satisfactorily assessed intraoperatively using a navigation system. The intraoperative kinematics of the knee can be analyzed in more detail using this methodology. J. Med. Invest. 66 : 367-371, August, 2019.
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Affiliation(s)
- Keizo Wada
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Mitsuhiro Kamada
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, Japan
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Angerame MR, Holst DC, Jennings JM, Komistek RD, Dennis DA. Total Knee Arthroplasty Kinematics. J Arthroplasty 2019; 34:2502-2510. [PMID: 31229370 DOI: 10.1016/j.arth.2019.05.037] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023] Open
Abstract
Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted knees, and various prosthetic knee designs. Unfortunately, a consensus between implanted knee kinematics and outcomes has not been reached. One might hypothesize that the kinematic variances between the nonimplanted and implanted knee might play a role in patient dissatisfaction following TKA. There is a wide range of TKA designs available today. With such variety, it is important for surgeons and engineers to understand the various geometries and kinematic profiles of available prostheses. The purpose of this review is to provide readers with the pertinent information related to TKA kinematics.
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Affiliation(s)
| | - David C Holst
- Department of Orthopedic Surgery, Duke University, Raleigh, NC
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO
| | - Richard D Komistek
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Department of Orthopaedics, University of Colorado Health School of Medicine, Aurora, CO
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Li Z, Liu P, Ge J, Huang C, Chen G, Lu Y, Cai X, Xu F, Sun J, Li J, Wang Z. Kinematic parameter analysis and pilot clinical trial of dual-mobility semi-Knee prosthesis. Surg Oncol 2019; 30:13-21. [PMID: 31500776 DOI: 10.1016/j.suronc.2019.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 12/15/2018] [Accepted: 05/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND To address large tumor-related defects and lower limb-length discrepancies during limb-salvage surgery in children with malignant tumors in the distal femur, a new custom-made dual-mobility semi-knee prosthesis (DMK) was made. This study aimed to provide a theory and references for further clinical applications of this prosthesis. METHODS Based on computed tomography data from adult knee joint samples, we used Mimics/Geomagic/Pro-E software and computer numerical control milling technology to design and manufacture the DMK. An in vitro study was carried out to examine the related kinematic parameters in the normal knee, total knee arthroplasty and DMK groups of cadaveric specimens. Then, a pilot clinical trial was performed. RESULTS The in vitro study revealed that the kinematics of the novel custom-made DMK are more similar to those of the normal knee than the total knee prosthesis. The pilot clinical trial showed that patients recovered well, and postoperative serial X-ray films did not demonstrate any disfigurations, loosening, dislocations or breaks in the prosthesis after a follow-up period ranging from 11 months to 5 years. CONCLUSION The DMK is a novel concept and method for the treatment of malignant tumors in the distal femur in children, and the device used for ligament reattachment provides a solution for knee ligament reconstruction. However, DMK might be replaced by a total knee prosthesis after epiphyseal closure, because of incompatibility of tibial plateau with the prosthesis.
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Affiliation(s)
- Zhi Li
- Department of Orthopedics, General Hospital of Chinese PLA Central Theater Command, Wuhan, 430070, China
| | - Peng Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong, University Health Science Center, Xi'an, 715400, China
| | - Jun Ge
- Department of Orthopedics, No.986 Hospital of Chinese PLA, Xi'an, 715400, China
| | - Chen Huang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Guojing Chen
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Yajie Lu
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xianhua Cai
- Department of Orthopedics, General Hospital of Chinese PLA Central Theater Command, Wuhan, 430070, China
| | - Feng Xu
- Department of Orthopedics, General Hospital of Chinese PLA Central Theater Command, Wuhan, 430070, China
| | - Jiuwei Sun
- Beijing Weigao Yahua Artificial Joint Development Co., Ltd, Beijing, 101300, China
| | - Jing Li
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Zhen Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
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Martin BR, Pegg EC, van Duren BH, Mohammad HR, Pandit HG, Mellon SJ, Murray DW. Posterior Bearing Overhang Following Medial and Lateral Mobile Bearing Unicompartmental Knee Replacements. J Orthop Res 2019; 37:1938-1945. [PMID: 31058359 DOI: 10.1002/jor.24339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/16/2019] [Indexed: 02/04/2023]
Abstract
This study explores the extent of bearing overhang following mobile bearing Oxford unicompartmental knee replacement (OUKR) (Oxford Phase 3, Zimmer Biomet). The Oxford components are designed to be fully congruent, however knee movements involve femoral rollback, which may result in bearing overhang at the posterior margin of the tibial implant, with potential implications for; pain, wear, and dislocation. Movement is known to be greater, and therefore posterior overhang more likely to occur, with; lateral compared to medial implants, anterior cruciate ligament (ACL) deficiency (ACLD) compared to ACL intact (ALCI), and at extremes of movement. Twenty-four medial, and 20 domed lateral, OUKRs underwent sagittal plane knee fluoroscopy during step-up and forward lunge exercises. The bearing position was inferred from the relative position of the femoral and tibial components. On the basis of the individual component sizes and geometry the extent the posterior part of the bearing which overhung the posterior part of the tibial component was calculated. There was no significant posterior overhang in knees with medial implants. Knees with lateral domed implants exhibited overhang at flexion angles beyond 60°, the magnitude of which increased with increasing flexion angle, reaching a maximum of 50% of the bearing length at 140° (range 0-140°). This demonstrates a clear difference between the kinematics, and prevalence and extent of posterior bearing overhang between medial and lateral OUKRs. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1938-1945, 2019.
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Affiliation(s)
- Benjamin Richard Martin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Elise C Pegg
- Department of Mechanical Engineering, Centre for Orthopaedic Biomechanics, University of Bath, Bath, United Kingdom
| | - Bernard H van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Hemant G Pandit
- Department of Mechanical Engineering, Centre for Orthopaedic Biomechanics, University of Bath, Bath, United Kingdom
| | - Stephen J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
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Bragonzoni L, Marcheggiani Muccioli GM, Bontempi M, Roberti di Sarsina T, Cardinale U, Alesi D, Iacono F, Neri MP, Zaffagnini S. New design total knee arthroplasty shows medial pivoting movement under weight-bearing conditions. Knee Surg Sports Traumatol Arthrosc 2019; 27:1049-1056. [PMID: 30368560 DOI: 10.1007/s00167-018-5243-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess, using model-based dynamic radiostereometric analysis (RSA), the biomechanical behaviour of a new design posterior-stabilized (PS) fixed-bearing (FB) total knee arthroplasty (TKA) in vivo while patients performing two common motor tasks. The hypothesis was that model-based dynamic RSA is able to detect different behaviour of the implant under weight-bearing and non-weight-bearing conditions. METHODS A cohort of 15 non-consecutive patients was evaluated by dynamic RSA 9 months after TKA implantation. The mean age of patients was 73.4 (65-72) years. The kinematic evaluations were performed using an RSA device (BI-STAND DRX 2) developed in our Institute. The patients were asked to perform two active motor tasks: sit-to-stand in weight-bearing condition; range of motion (ROM) while sitting on the chair. The motion parameters were evaluated using the Grood and Suntay decomposition and the low-point kinematics methods. RESULTS The dynamic RSA evaluation showed a significant difference (p < 0.05) between the biomechanical behaviour of the prosthesis during the two motor tasks. When subjected to the patient weight (in the sit-to-stand) the low point of the medial compartment had a shorter motion (5.7 ± 0.2 mm) than the lateral (11.0 ± 0.2 mm). This realizes a medial pivot motion as in the normal knee. In the ROM task, where the patient had no weight on the prosthesis, this difference was not present: the medial compartment had a displacement of 12.7 ± 0.2 mm, while the lateral had 17.3 ± 0.2 mm. CONCLUSIONS Model-based RSA proved to be an effective tool for the evaluation of TKA biomechanics. In particular, it was able to determine that the fixed-bearing posterior-stabilized TKA design evaluated in this study showed a medial pivoting movement under weight-bearing conditions that was not present when load was not applied. Under loading conditions what drives the pattern of movement is the prosthetic design itself. By the systematic use of this study protocol future comparisons among different implants could be performed, thus contributing significantly to the improvement of TKA design. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
| | | | - Tommaso Roberti di Sarsina
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy
| | | | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy
| | - Francesco Iacono
- Prosthetic Surgery and Articular Biological Reconstruction, Humanitas Clinical Institute, Milan, Italy
| | - Maria Pia Neri
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy
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Achieving More Natural Motion, Stability, and Function With a Dual-Pivot ACL-substituting Total Knee Arthroplasty Design. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kono K, Tomita T, Futai K, Yamazaki T, Tanaka S, Yoshikawa H, Sugamoto K. In vivo three-dimensional kinematics of normal knees during different high-flexion activities. Bone Joint J 2018; 100-B:50-55. [PMID: 29305450 PMCID: PMC5842511 DOI: 10.1302/0301-620x.100b1.bjj-2017-0553.r2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aims In Asia and the Middle-East, people often flex their knees deeply
in order to perform activities of daily living. The purpose of this
study was to investigate the 3D kinematics of normal knees during
high-flexion activities. Our hypothesis was that the femorotibial
rotation, varus-valgus angle, translations, and kinematic pathway
of normal knees during high-flexion activities, varied according
to activity. Materials and Methods We investigated the in vivo kinematics of eight
normal knees in four male volunteers (mean age 41.8 years; 37 to
53) using 2D and 3D registration technique, and modelled the knees
with a computer aided design program. Each subject squatted, kneeled,
and sat cross-legged. We evaluated the femoral rotation and varus-valgus
angle relative to the tibia and anteroposterior translation of the
medial and lateral side, using the transepicodylar axis as our femoral
reference relative to the perpendicular projection on to the tibial
plateau. This method evaluates the femur medially from what has
elsewhere been described as the extension facet centre, and differs
from the method classically applied. Results During squatting and kneeling, the knees displayed femoral external
rotation. When sitting cross-legged, femurs displayed internal rotation
from 10° to 100°. From 100°, femoral external rotation was observed.
No significant difference in varus-valgus angle was seen between
squatting and kneeling, whereas a varus position was observed from
140° when sitting cross-legged. The measure kinematic pathway using
our methodology found during squatting a medial pivoting pattern
from 0° to 40° and bicondylar rollback from 40° to 150°. During
kneeling, a medial pivot pattern was evident. When sitting cross-legged,
a lateral pivot pattern was seen from 0° to 100°, and a medial pivot
pattern beyond 100°. Conclusion The kinematics of normal knees during high flexion are variable
according to activity. Nevertheless, our study was limited to a
small number of male patients using a different technique to report
the kinematics than previous publications. Accordingly, caution
should be observed in generalizing our findings. Cite this article: Bone Joint J 2018;100-B:50–5.
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Affiliation(s)
- K Kono
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan and Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - T Tomita
- Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - K Futai
- Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - T Yamazaki
- Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama 369-0293, Japan
| | - S Tanaka
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - H Yoshikawa
- Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - K Sugamoto
- Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
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Yamasaki S, Hashimoto Y, Takigami J, Terai S, Takahashi S, Nakamura H. Risk Factors Associated With Knee Joint Degeneration After Arthroscopic Reshaping for Juvenile Discoid Lateral Meniscus. Am J Sports Med 2017; 45:570-577. [PMID: 28272930 DOI: 10.1177/0363546516668623] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although arthroscopic meniscal reshaping for discoid lateral meniscus (DLM) has better outcomes than total or subtotal meniscectomy, degenerative changes on radiographs are still seen in some patients with meniscal reshaping. PURPOSE To assess the risk factors associated with knee joint degeneration after reshaping surgery for juvenile DLM. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Forty patients (45 knees) with a mean age of 12.0 years who underwent arthroscopic meniscal reshaping for DLM were enrolled at a mean of 39.6 months after surgery. For all patients, meniscal saucerization was performed first. Then, if the residual meniscus was unstable, stabilization was provided with suture fixation. At final follow-up, we obtained radiographs to assess degenerative changes to the knee joint using the classification by Tapper and Hoover. Residual meniscal width and meniscal extrusion (defined as a relative percentage of extrusion [RPE]) were measured with magnetic resonance imaging (MRI). Then, the correlation between radiographic evidence of degenerative changes (Tapper and Hoover grade), residual meniscal width, and RPE were assessed with Pearson and Spearman correlation analyses. Logistic regression analysis was used to examine whether preoperative characteristics correlated with degeneration and residual meniscal width. RESULTS The mean residual meniscal width was 4.6 mm (range, 3.8-6.0 mm), and the mean ± SD RPE was 25.5% ± 21.8% at the final follow-up. There were 28 knees with Tapper and Hoover grade 0, 10 knees with grade 1, and 7 knees with grade 2. The residual meniscal width and RPE were significantly correlated with Tapper and Hoover grade (ρ = -0.489, P = .0007; ρ = 0.414, P = .005, respectively). The residual meniscal width was also significantly correlated with RPE ( r = -0.416, P = .004). The receiver operating characteristic curve showed that a 5.0-mm residual meniscal width was the cutoff value leading to evidence of degeneration. Multiple logistic regression analysis showed that an anterocentral shift on preoperative MRI was a risk factor for degeneration (odds ratio, 27.2; 95% CI, 1.1-360.5; P = .012) and residual meniscal width less than 5.0 mm (odds ratio, 20.9; 95% CI, 1.5-281; P = .022). CONCLUSION Smaller meniscal width and greater severity of meniscal extrusion correlated with knee joint degeneration. An anterocentral shift on preoperative MRI was a risk factor for degenerative changes and smaller residual meniscal width.
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Affiliation(s)
- Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Orthopaedic Surgery, Shimada Hospital, Osaka, Japan
| | - Shozaburo Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Abstract
Although subchondral impaction fractures have already been reported in the non-weight-bearing portion of the lateral femoral condyle, this study reveals the presence of an intra-articular impaction fracture of the postero-superior region of the non-weight-bearing portion of the medial femoral condyle recognized in 5 of a group of 22 representatives of the Polish national Olympic weightlifting team, who underwent 1.5T magnetic resonance imaging examination. Articular cartilage lesions varied with regard to the type of injury and its severity ranging from healed or subchronic injuries to acute trauma. All described individuals had no clinical history of acute knee trauma and only 3 of them had minor pain symptoms. The accumulation of microtraumas occurring during participation in particular activities associated with weightlifting training seems to be responsible for the development of this type of contusion. This is the first description of impaction fracture observed in this location in professional weightlifters.
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Zuiderbaan HA, Khamaisy S, Thein R, Nawabi DH, Pearle AD. Congruence and joint space width alterations of the medial compartment following lateral unicompartmental knee arthroplasty. Bone Joint J 2015; 97-B:50-5. [DOI: 10.1302/0301-620x.97b1.33057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Progressive degenerative changes in the medial compartment of the knee following lateral unicompartmental arthroplasty (UKA) remains a leading indication for revision surgery. The purpose of this study is to evaluate changes in the congruence and joint space width (JSW) of the medial compartment following lateral UKA. The congruence of the medial compartment of 53 knees (24 men, 23 women, mean age 13.1 years; sd 62.1) following lateral UKA was evaluated pre-operatively and six weeks post-operatively, and compared with 41 normal knees (26 men, 15 women, mean age 33.7 years; sd 6.4), using an Interactive closest point algorithm which calculated the congruence index (CI) by performing a rigid transformation that best aligns the digitised tibial and femoral surfaces. Inner, middle and outer JSWs were measured by sub-dividing the medial compartment into four quarters on pre- and post-operative, weight bearing tunnel view radiographs. The mean CI of knees following lateral UKA significantly improved from 0.92 (sd 0.06) pre-operatively to 0.96 (sd 0.02) (p < 0.001) six weeks post-operatively. The mean CI of the healthy control group was 0.99 sd 0.01. Post-operatively, the mean inner JSW increased (p = 0.006) and the outer decreased (p = 0.002). The JSW was restored post-operatively as no significant differences were noted in all three locations compared with the control group (inner JSW p = 0.43; middle JSW p = 0.019, outer JSW p = 0.51). Our data suggest that a well conducted lateral UKA may improve the congruence and normalise the JSW of the medial compartment, potentially preventing progression of degenerative change. Cite this article: Bone Joint J 2015;97-B:50–5.
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Affiliation(s)
- H. A. Zuiderbaan
- Computer Assisted Surgery Center, Department
of Orthopaedic Surgery, Hospital for Special Surgery, 535
East 70th Street, New York, New
York, 10021, USA
| | - S. Khamaisy
- Computer Assisted Surgery Center, Department
of Orthopaedic Surgery, Hospital for Special Surgery, 535
East 70th Street, New York, New
York, 10021, USA
| | - R. Thein
- Computer Assisted Surgery Center, Department
of Orthopaedic Surgery, Hospital for Special Surgery, 535
East 70th Street, New York, New
York, 10021, USA
| | - D. H. Nawabi
- Computer Assisted Surgery Center, Department
of Orthopaedic Surgery, Hospital for Special Surgery, 535
East 70th Street, New York, New
York, 10021, USA
| | - A. D. Pearle
- Computer Assisted Surgery Center, Department
of Orthopaedic Surgery, Hospital for Special Surgery, 535
East 70th Street, New York, New
York, 10021, USA
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Weston-Simons JS, Pandit H, Kendrick BJL, Jenkins C, Barker K, Dodd CAF, Murray DW. The mid-term outcomes of the Oxford Domed Lateral unicompartmental knee replacement. Bone Joint J 2014; 96-B:59-64. [DOI: 10.1302/0301-620x.96b1.31630] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mobile-bearing unicompartmental knee replacements (UKRs) with a flat tibial plateau have not performed well in the lateral compartment, owing to a high dislocation rate. This led to the development of the Domed Lateral Oxford UKR (Domed OUKR) with a biconcave bearing. The aim of this study was to assess the survival and clinical outcomes of the Domed OUKR in a large patient cohort in the medium term. We prospectively evaluated 265 consecutive knees with isolated disease of the lateral compartment and a mean age at surgery of 64 years (32 to 90). At a mean follow-up of four years (sd 2.2, (0.5 to 8.3)) the mean Oxford knee score was 40 out of 48 (sd 7.4). A total of 12 knees (4.5%) had re-operations, of which four (1.5%) were for dislocation. All dislocations occurred in the first two years. Two (0.8%) were secondary to significant trauma that resulted in ruptured ligaments, and two (0.8%) were spontaneous. In four patients (1.5%) the UKR was converted to a primary TKR. Survival at eight years, with failure defined as any revision, was 92.1% (95% confidence interval 81.3 to 100). The Domed Lateral OUKR gives good clinical outcomes, low re-operation and revision rates and a low dislocation rate in patients with isolated lateral compartmental disease, in the hands of the designer surgeons. Cite this article: Bone Joint J 2014;96-B:59–64.
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Affiliation(s)
- J. S. Weston-Simons
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - H. Pandit
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - B. J. L. Kendrick
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
| | - C. Jenkins
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - K. Barker
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - C. A. F. Dodd
- Nuffield Orthopaedic Centre, Oxford
University Hospitals Trust, Headington, Oxford, OX3 7LD, UK
| | - D. W. Murray
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences,, Botnar Research
Centre, University of Oxford, Windmill
Road, Headington, Oxford, OX3
7LD, UK
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Niki Y, Takeda Y, Udagawa K, Enomoto H, Toyama Y, Suda Y. Is greater than 145{degrees} of deep knee flexion under weight-bearing conditions safe after total knee arthroplasty?: a fluoroscopic analysis of Japanese-style deep knee flexion. Bone Joint J 2013; 95-B:782-7. [PMID: 23723272 DOI: 10.1302/0301-620x.95b6.30757] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated the characteristics of patients who achieved Japanese-style deep flexion (seiza-sitting) after total knee replacement (TKR) and measured three-dimensional positioning and the contact positions of the femoral and tibial components. Seiza-sitting was achieved after surgery by 23 patients (29 knees) of a series of 463 TKRs in 341 patients. Pre-operatively most of these patients were capable of seiza-sitting, had a lower body mass index and a favourable attitude towards the Japanese lifestyle (27 of 29 knees). According to two-/three-dimensional image registration analysis in the seiza-sitting position, flexion, varus and internal rotation angles of the tibial component relative to the femoral component had means of 148° (SD 8.0), 1.9° (SD 3.2) and 13.4° (SD 5.9), respectively. Femoral surface contact positions tended to be close to the posterior edge of the tibial polyethylene insert, particularly in the lateral compartment, but only 8.3% (two of 24) of knees showed femoral subluxation over the posterior edge. The mean contact positions of the femoral cam on the tibial post were located 7.8 mm (sd 1.5) proximal to the lowest point of the polyethylene surface and 5.5 mm (SD 0.9) medial to the centre of the post, indicating that the post-cam contact position translated medially during seiza-sitting, but not proximally. Collectively, the seiza-sitting position seems safe against component dislocation, but the risks of posterior edge loading and breakage of the tibial polyethylene post remain.
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Affiliation(s)
- Y Niki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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