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Aljuhani W, Alsalman M, Alsalman H, Aljurayyad FO, Alsubaie MN, Alanazi A, Ahmed B. Measurement of Condylar Offset and Posterior Condylar Cartilage Thickness in Normal Knees: An MRI Study From Saudi Arabia. Cureus 2024; 16:e52244. [PMID: 38352107 PMCID: PMC10862533 DOI: 10.7759/cureus.52244] [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] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Background The maximum amount of knee flexion after total knee replacement is largely determined by the knee's posterior condylar offset (PCO). Using magnetic resonance imaging (MRI), this study examined the relationship between PCO and the thickness of the femoral posterior condylar cartilage (PCC) in healthy people. Methodology We reviewed the medical records of 300 skeletally mature patients who did not exhibit symptoms of knee arthritis and had undergone MRI for traumatic soft tissue knee injuries that did not affect the femoral PCC. Results The study cohort consisted of 300 participants, of whom 68.3% (205) were male, and 31.7% (95) were female aged between 18 and 59 years, with a mean age of 31.13 ± 8.83 years. Most participants were under 30 years of age (45.7%), and the mean body mass index was 27.52 ± 5.64 kg/m2. The total medial distance was 28.50 ± 3.11 mm, ranging from 21.20 to 39.80 mm. The medial PCC was 1.71 ± 0.63 mm, ranging from 0.60 to 4.00 mm. The medial bony PCO was 38.40 mm, ranging from 18.80 to 38.40 mm. The total lateral distance was 25.24 ± 3.16 mm, ranging from 13.50 to 34.90 mm. The lateral PCC was 1.48 ± 0.75 mm, ranging from 0.30 to 10.70 mm. Finally, the lateral bony PCO was 23.76 ± 3.19 mm, ranging from 11.99 to 32.8 mm. There was a statistically significant weak positive relationship between the bony lateral PCO and the patients' age in females only (p = 0.016; r = 0.00-0.39). There was a statistically significant mean difference in the total medial distance, medial PCC, and lateral PCC between the two knees (p < 0.05). Conclusions These findings shed light on the factors influencing these parameters, offer insightful information about the associations between particular patient characteristics and knee measurements, and may help guide clinical evaluations and treatment decisions.
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Affiliation(s)
| | | | | | - Feras O Aljurayyad
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammed N Alsubaie
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdullah Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Bandar Ahmed
- Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Riyadh, SAU
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Shekhar A, Chowdhry M, Subramaniam D, Dipane MV, Michael Mynatt H, Tapasvi SR, McPherson EJ. CT scan analysis of implant mating comparing APA versus TEA in simultaneous bilateral TKA: One technique per knee. Knee 2023; 43:89-96. [PMID: 37343354 DOI: 10.1016/j.knee.2023.05.013] [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: 06/09/2022] [Revised: 04/17/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The optimal landmark for setting femoral component rotation in primary TKA remains a debate. This study compares the Anterior-Posterior Axis (APA) versus the Transepicondylar Axis (TEA) in patients undergoing simultaneous bilateral TKA, where one reference line was randomized to each knee. Implant mating was assessed via post-operative CT scans. METHOD The study included 32 patients with osteoarthritis in both knees with similar varus deformities. All patients underwent the same surgical procedure on both knees, aside from the selected femoral rotation axis line: APA randomized to one side and TEA to the contralateral. Post-operative CT scans were performed in extension to assess in-vivo mating. RESULTS CT scan analysis showed mean rotation of the femoral implant externally rotated relative to the radiographic TEA with no significant difference between the APA and TEA groups (p = 0.28). Tibial implant rotation was also externally rotated to the radiographic TEA with no significant difference (p = 0.59). Femoral-tibial implant mating showed a mean external rotation of the tibia relative to the femur in both groups: 0.86 ± 4.0° external rotation in the APA group and 0.23 ± 3.7° external rotation in the TEA group. There was no significant difference between groups (p = 0.52). The range of mating mismatch was 15° in the APA group and 16.5° in the TEA group. CONCLUSIONS When using a measured resection, posterior referencing technique, post-operative femoral-tibial implant mating measured by CT scan showed no superiority comparing the APA method versus the TEA method. LEVEL OF EVIDENCE 2 Randomized prospective study.
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Affiliation(s)
- Anshu Shekhar
- Department of Arthroplasty and Arthroscopy, The Orthopaedic Speciality Clinic, Tehmi Terace, Bund Garden Rd, Sangamvadi, Pune, Maharashtra 411001, India
| | - Madhav Chowdhry
- Nuffield Department of Primary Care Health Sciences & Department of Continuing Education, Kellogg College, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, United Kingdom
| | - Dhiyaneswaran Subramaniam
- Department of Arthroplasty and Arthroscopy, The Orthopaedic Speciality Clinic, Tehmi Terace, Bund Garden Rd, Sangamvadi, Pune, Maharashtra 411001, India
| | - Matthew V Dipane
- David Geffen School of Medicine at UCLA, Department of Orthopaedic Surgery, 1250 16th Street, Suite 2100, Santa Monica, CA 90404, USA.
| | - H Michael Mynatt
- Joint Replacement Institute, 1300 North Vermont Avenue, Doctors Tower, Suite 100, Los Angeles, CA 90027, USA
| | - Sachin R Tapasvi
- Department of Arthroplasty and Arthroscopy, The Orthopaedic Speciality Clinic, Tehmi Terace, Bund Garden Rd, Sangamvadi, Pune, Maharashtra 411001, India
| | - Edward J McPherson
- David Geffen School of Medicine at UCLA, Department of Orthopaedic Surgery, 1250 16th Street, Suite 2100, Santa Monica, CA 90404, USA
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Park HJ, Chang MJ, Kim TW, Chang CB, Kang KS, Kang SB. Subchondral Bone Condition and Intraoperative Grading of Cartilage Degeneration Underneath Patella Unrelated to the Clinical Outcome after TKA with Unresurfaced Patella. J Knee Surg 2022; 35:1417-1424. [PMID: 33607675 DOI: 10.1055/s-0041-1723980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The degree of cartilage degeneration assessed intraoperatively may not be sufficient as a criterion for patellar resurfacing in total knee arthroplasty (TKA). However, single-photon emission tomography/computed tomography (SPECT/CT) is useful for detecting osteoarthritic involvement deeper in the subchondral bone. The purpose of the study was to determine whether SPECT/CT reflected the cartilage lesion underneath the patella in patients with end-stage osteoarthritis (OA) and whether clinical outcomes after TKA without patellar resurfacing differed according to the severity of patellofemoral (PF) OA determined by visual assessment and SPECT/CT findings. This study included 206 knees which underwent TKA. The degree of cartilage degeneration was graded intraoperatively according to the International Cartilage Repair Society grading system. Subjects were classified into low and high uptake groups according to the degree of bone tracer uptake (BTU) on SPECT/CT in the PF joint. The Feller's patella score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed preoperatively and postoperative 1 and 2 years. The increased BTU in the PF joint was associated with more severe degenerative cartilage changes underneath the patella (p < 0.001). The risk for the presence of denudated cartilage was greater in the high uptake group (odds ratio = 5.89). There was no association between clinical outcomes and visual grading of patellar cartilage degeneration or the degree of BTU on SPECT/CT. The visual assessment of the degree of cartilage degeneration underneath the patella and preoperative SPECT/CT evaluation of the PF joint were not predictive of clinical outcome after TKA with unresurfaced patella.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kee Soo Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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Tapasvi SR, Shekhar A, Chowdhry M, Dipane MV, McPherson EJ. Comparison of Anterior-Posterior Axis Versus Transepicondylar Axis in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee. J Arthroplasty 2022; 37:1283-1288. [PMID: 35240285 DOI: 10.1016/j.arth.2022.02.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In primary total knee arthroplasty (TKA), the preferred reference line for setting femoral component rotation is debatable. This study compared the anterior-posterior axis line (APAL) versus the transepicondylar axis line (TEAL) in patients undergoing simultaneous bilateral TKA using a measured resection technique where one reference line was randomized to each knee. METHODS This prospective study compared the two reference lines using posterior knee referencing with a cemented posterior stabilized knee. The study included 32 patients with osteoarthritis with both knees having similar varus knee deformities. All patients had the same surgical procedure with the only change being the selected femoral rotation axis line. Patients were followed up for a minimum of two years. RESULTS There was no significant difference in any of the measured radiographic, operative, and clinical parameters, except for a postoperative radiographic limb alignment (APAL 179.7° vs TEAL 180.1° P = .04). The mean femoral external rotation relative to the posterior condylar axis line (PCAL) was 3.0 degrees (0-7 degrees) using the APAL and 3.3 degrees (2-7 degrees) using the TEAL (P = .46). Two-year knee flexion and revised Oxford Knee Scores showed no difference. Seventy-five percent of patients stated no preference for either knee technique. CONCLUSION When using a measured resection, a posterior referencing technique, we found no difference in knee function and scores when setting femoral component rotation using the APAL versus TEAL. LEVEL OF EVIDENCE 2, Randomized prospective study.
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Affiliation(s)
- Sachin R Tapasvi
- Department of Arthroplasty and Arthroscopy, The Orthopaedic Specialty Clinic, Pune, Maharashtra, India
| | - Anshu Shekhar
- Department of Arthroplasty and Arthroscopy, The Orthopaedic Specialty Clinic, Pune, Maharashtra, India
| | - Madhav Chowdhry
- Nuffield Department of Primary Care Health Sciences, Kellogg College, University of Oxford, Oxford, UK
| | - Matthew V Dipane
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Edward J McPherson
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Clark G, Quinn M, Murgier J, Wood D. Tibial component rotation alters soft tissue balance in a cruciate retaining total knee arthroplasty. Comput Assist Surg (Abingdon) 2022; 27:35-40. [PMID: 35649126 DOI: 10.1080/24699322.2022.2078738] [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: 10/18/2022] Open
Abstract
Our aim was to understand whether using different landmarks for tibial component rotation influenced articular contact pressures in a balanced total knee arthroplasty (TKA). Twelve patients underwent TKA (Triathlon CR, Stryker Inc., Mahwah, NJ) and contact pressures were assessed using a wireless sensor. Robotic arm assisted TKA using a functional alignment technique was performed, with balanced gaps between medial and lateral compartments. Compartment pressures were measured with the trial tibial component rotated to Akagi's line and to Insall's axis respectively. Rotating the tibial component to Akagi's line resulted in a significantly greater proportion of knees being balanced and lower contact pressures than when the tibial component was rotated to Insall's axis at 10°, 45° and 90° of flexion (p < 0.05). Medial compartment pressures were significantly increased in 10° of flexion, as were lateral compartment pressures in all positions when the tibial component was aligned to Insall's axis (p < 0.05). The mean difference in rotation observed with the two landmarks was 6.9° (range 4.1-9.1°). Rotational alignment of the tibial component using Akagi's line reduced contact pressures, improved balance and reduced the need for soft tissue release when compared with Insall's axis in robotic arm assisted TKA.
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Affiliation(s)
- Gavin Clark
- Perth Hip and Knee Clinic, Subiaco, Australia.,St John of God Subiaco Hospital, Subiaco, Australia.,University of Western Australia, Perth, Australia
| | - Mark Quinn
- Tallaght University Hospital, Dublin, Ireland
| | - Jerome Murgier
- Aguilera Private Clinic, Ramsey générale de Santé, Biarritz, France
| | - David Wood
- University of Western Australia, Perth, Australia
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Dupraz I, Thorwächter C, Grupp TM, Hammerschmid F, Woiczinski M, Jansson V, Müller PE, Steinbrück A. Impact of femoro-tibial size combinations and TKA design on kinematics. Arch Orthop Trauma Surg 2022; 142:1197-1212. [PMID: 34021794 DOI: 10.1007/s00402-021-03923-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The variability in patients' femoral and tibial anatomy requires to use different tibia component sizes with the same femoral component size. These size combinations are allowed by manufacturers, but the clinical impact remains unclear. Therefore, the goals of our study were to investigate whether combining different sizes has an impact on the kinematics for two well-established knee systems and to compare these systems' kinematics to the native kinematics. MATERIALS AND METHODS Six fresh frozen knee specimens were tested in a force controlled knee rig before and after implantation of a cruciate retaining (CR) and a posterior-stabilized (PS) implant. Femoro-tibial kinematics were recorded using a ultrasonic-based motion analysis system while performing a loaded squat from 30° to 130°. In each knee, the original best fit inlay was then replaced by different inlays simulating a smaller or bigger tibia component. The kinematics obtained with the simulated sizes were compared to the original inlay kinematics using descriptive statistics. RESULTS For all size combinations, the difference to the original kinematics reached an average of 1.3 ± 3.3 mm in translation and - 0.1 ± 1.2° in rotation with the CR implant. With the PS implant, the average differences reached 0.4 ± 2.7 mm and - 0.2 ± 0.8°. Among all knees, no size combination consistently resulted in significantly different kinematics. Each knee showed a singular kinematic pattern. For both knee systems, the rotation was smaller than in the native knee, but the direction of the rotation was preserved. The PS showed more rollback and the CR less rollback than the native knee. CONCLUSION TKA systems designed with a constant tibio-femoral congruency among size combinations should enable to combine different sizes without having substantial impact on the kinematics. The rotational pattern was preserved by both TKA systems, while the rollback could only be maintained by the PS design.
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Affiliation(s)
- Ingrid Dupraz
- Aesculap AG, Research and Development, Am Aesculap Platz 1, 78532, Tuttlingen, Germany.
| | - Christoph Thorwächter
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Thomas M Grupp
- Aesculap AG, Research and Development, Am Aesculap Platz 1, 78532, Tuttlingen, Germany
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Florian Hammerschmid
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
| | - Arnd Steinbrück
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany
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Klasan A, Twiggs JG, Fritsch BA, Miles BP, Heyse TJ, Solomon M, Parker DA. Correlation of tibial component size and rotation with outcomes after total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140:1819-1824. [PMID: 32748043 DOI: 10.1007/s00402-020-03550-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/15/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Tibial component design and positioning contribute more to patient satisfaction than previously realized. A surgeon needs to decide on the size and rotation, bearing in mind that coverage should be as high as possible, whilst malrotation and overhang should be avoided. No study investigates the impact of each of these components on clinical outcomes in a single cohort. MATERIALS AND METHODS This is a retrospective analysis of 1-year postoperative outcomes measured with the Knee Injury and Osteoarthritis Outcome (KOOS) Score, as well as a previously validated rotational CT protocol. Coverage, rotation from Insall's axis, and overhang of an asymmetric tibial baseplate were measured, and positive and negative correlations to clinical outcomes were calculated. RESULTS A total of 499 knees were analyzed. Patient average age was 68.4 years. Rotation within 7° internal and 5° external from Insall's axis was a "safe zone". Mean coverage was 76%. A total of 429 knees (94%) had a coverage of at least 70% and 102 knees (22%) greater than 80%. Overhang was detected in 23% of the cohort. Increased coverage was correlated to increased KOOS score and overhang correlated with a decreased KOOS score (p = 0.008). CONCLUSIONS This study demonstrates the individual role of three aspects of tibial component implantation properties in postoperative pain and short-term functional outcomes. Upsizing to the point of overhang with rotational tolerance of 7° internal and 3° external to Insall's axis demonstrates best patient reported outcomes. Overhang decreases the clinical outcome by the same margin as loss of 16% of coverage.
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Affiliation(s)
- Antonio Klasan
- Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Ave, Chatswood, NSW, 2067, Australia.
| | | | - Brett A Fritsch
- Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Ave, Chatswood, NSW, 2067, Australia
| | | | | | | | - David A Parker
- Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Ave, Chatswood, NSW, 2067, Australia
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Optimal rotational positioning of tibial component in total knee arthroplasty: determined by linker surgical technique using a high definition CT. Arch Orthop Trauma Surg 2020; 140:401-408. [PMID: 31965282 DOI: 10.1007/s00402-020-03340-7] [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: 04/15/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The rotational alignment of femoral and tibial components is an important determinant of the success of Total Knee Arthroplasty (TKA). The optimal rotational position of the tibial component is still unclear. The purpose of this study was (1) to determine the pre-operative S-TEA (surgical-transepicondylar axis) derived tibialanteroposterior (AP) axis angle and postoperative tibial component axis angle using a "Bird's eye" high-definition CT image in TKA performed by Linker surgical technique; (2) to determine the femorotibial mismatch angle; and (3) to determine the optimal tibial component rotation in a well-aligned femoral and tibial components. MATERIALS AND METHODS 55 knees in 49 osteoarthritis patients who underwent primary TKA by Linker surgical technique were evaluated. Preoperative tibial AP axis angle, and the postoperative tibial component axis angle were measured. Rotational mismatch between femoral and tibial components was also measured. RESULTS The mean angle of the pre-operative tibial AP axis was 17.8° ± 4.0°, ranging from 4.3° to 25.4°. The mean angle of the post-operative tibial component axis was 16.2° ± 4.9°, ranging from 3.8° to 25.2°. The mean postoperative tibial component axis line was at 14.2% ± 11.9%. CONCLUSION Because of the variability of pre-operative S-TEA derived tibial AP axis angle, the tibial component axis angle was also variable among the knees, but the two angles bore a strong correlation to each other. Based on our results, the optimal axis of the tibial component passes about halfway through the medial edge and medial one-third of the tibial tuberosity. LEVEL OF EVIDENCE Level II.
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Abstract
Total knee arthroplasty (TKA) has been associated with notable improvements in health-related quality of life of patients with end-stage knee arthritis. Although most patients experience substantial symptomatic relief after TKA, up to 19% of patients are unsatisfied with their outcome. With the dramatic, projected increase in the number of TKAs performed annually, it is crucial to appreciate the various modes of failure associated with this procedure. A comprehensive understanding of the symptomatology and thorough clinical examination aid in identifying the etiology of ongoing knee pain. Ancillary testing including conventional laboratory analyses, imaging studies, and diagnostic injections supplement a thorough history and physical examination. In addition, novel laboratory markers, RNA/DNA-based tests, and novel imaging modalities are emerging as beneficial tools in evaluating patients with a painful TKA. A well-structured, algorithmic approach in the management of these patients is essential in correctly diagnosing the patient and optimizing clinical outcomes.
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Nodzo SR, Franceschini V, Cruz DS, Gonzalez Della Valle A. The flexion space is more reliably balanced when using the transepicondylar axis as compared to the posterior condylar line. Knee Surg Sports Traumatol Arthrosc 2018; 26:3265-3271. [PMID: 29417169 DOI: 10.1007/s00167-018-4855-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 02/02/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the differences in flexion space balance when the femoral component is implanted parallel to the surgical transepicondylar axis (TEA) or with 3° of external rotation from the posterior condylar line (PoCoLi). It was hypothesized that implantation parallel to the TEA will produce a more reliably balanced flexion space. METHODS Forty-eight consecutive patients with a varus deformity were prospectively randomized to undergo total knee arthroplasty with a femoral component implanted parallel the TEA, or with 3° of external rotation from the PoCoLi. The posterior condylar angle (PCA) was measured. Intraoperative load measurements were taken at 10°, 45°, and 90° of flexion. RESULTS The PCA was similar between groups (TEA group: 4.2° ± 1.5° and PoCoLi group: 4.0° ± 1.3°; n.s.). The mean difference in load values between the medial and lateral compartments was significantly lower in the TEA group than in the PoCoLi group at the 45 (0 ± 8 vs. 9 ± 13 lbs; respectively, p = 0.008) and 90° flexion angles (1 ± 9 vs. 10 ± 15 lbs; respectively, p = 0.01). The PoCoLi group had a linear increase in the difference of load values between the medial and lateral compartments with increasing magnitude of the posterior condylar angle (45°, p = 0.0013; 90°, p = 0.0006), but this was not observed in the TEA group. CONCLUSION Femoral component implantation parallel to the TEA resulted in a more balanced flexion gap as compared to implantation at 3° of external rotation from the PoCoLi. The intraoperative use of the TEA rather than the PoCoLi to set femoral component rotation may provide a more balanced flexion space and decrease the need for extensive soft tissue releases. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Scott R Nodzo
- Department of Orthopedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Vincenzo Franceschini
- Department of Orthopaedics and Traumatology, Sapienza University of Rome, ICOT, Via F. Faggiana 1668, 04100, Latina, LT, Italy
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Computed tomography evaluation of total knee arthroplasty implants position after two different surgical methods of implantation. INTERNATIONAL ORTHOPAEDICS 2018; 43:139-149. [DOI: 10.1007/s00264-018-4180-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
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Deehan DJ, Ghosh KM, Blain A, Longstaff L, Rushton S. Sagittal flexion arc evaluation for a modern generation single-radius femoral component design. Proc Inst Mech Eng H 2018; 232:412-417. [PMID: 29473455 DOI: 10.1177/0954411918759136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Single-radius femoral total knee design aims to deliver improved kinematic behaviour when compared to the standard two-radii geometry. This study has evaluated the behaviour, through a functional range of motion in the sagittal plane, of a single-radius femoral component compared to a dual-radius standard knee construct. Particular focus was placed on how the flexion axes of the native and replaced knee approximated to the transepicondylar axis through a loaded navigated knee design. Significant differences in flexion arcs were noted between the native and total knee arthroplasty state. These arcs were not uniform in all knees and did not display single-radius behaviour. There were no significant differences in the location of flexion axes in the native and total knee arthroplasty knee. Both exhibited similar posterior and inferior transverse axes of motion with respect to the anatomical epicondylar axis. This work has cast doubt on the reliability under loaded conditions of the single-radius concept, but the close proximity of the flexion axes of each replaced knee in relation to the functional flexion axis of the native knee may be the true basis of this purported improved kinematic performance.
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Affiliation(s)
- David John Deehan
- 1 Freeman Hospital, Newcastle upon Tyne, UK
- 2 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alasdair Blain
- 3 School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | | | - Steven Rushton
- 3 School of Biology, Newcastle University, Newcastle upon Tyne, UK
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13
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Manning WA, Ghosh KM, Blain A, Longstaff L, Rushton SP, Deehan DJ. Internal femoral component rotation adversely influences load transfer in total knee arthroplasty: a cadaveric navigated study using the Verasense device. Knee Surg Sports Traumatol Arthrosc 2018; 26:1577-1585. [PMID: 28712028 PMCID: PMC5907629 DOI: 10.1007/s00167-017-4640-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/07/2017] [Indexed: 12/02/2022]
Abstract
PURPOSE AND HYPOTHESIS Correct femoral component rotation at knee arthroplasty influences patellar tracking and may determine function at extremes of movement. Additionally, such malrotation may deleteriously influence flexion/extension gap geometry and soft tissue balancing kinematics. Little is known about the effect of subtle rotational change upon load transfer across the tibiofemoral articulation. Our null hypothesis was that femoral component rotation would not influence load across this joint in predictable manner. METHODS A cadaveric study was performed to examine load transfer using the orthosensor device, respecting laxity patterns in 6° of motion, to examine load across the medial and lateral compartments across a full arc of motion. Mixed-effect modelling allowed for quantification of the effect upon load with internal and external femoral component rotation in relation to a datum in a modern single-radius cruciate-retaining primary knee design. RESULTS No significant change in maximal laxity was found between different femoral rotational states. Internal rotation of the femoral component resulted in significant increase in medial compartment load transfer for knee flexion including and beyond 60°. External rotation of the femoral component within the limits studied did not influence tibiofemoral load transfer. CONCLUSIONS Internal rotation of the femoral component will adversely influence medial compartment load transfer and could lead to premature polyethylene wear on the medial side.
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Affiliation(s)
- William A. Manning
- 0000 0004 0641 3308grid.415050.5Newcastle Surgical Training Centre Research Centre, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Kanishka M. Ghosh
- 0000 0004 0641 3308grid.415050.5Newcastle Surgical Training Centre Research Centre, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Alasdair Blain
- 0000 0001 0462 7212grid.1006.7School of Biology, University of Newcastle Upon Tyne, Newcastle upon Tyne, NE1 7RU UK
| | - Lee Longstaff
- 0000 0004 0641 3308grid.415050.5Newcastle Surgical Training Centre Research Centre, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK ,0000 0004 0634 2159grid.414158.dDepartment of Orthopaedics, University Hospital of North Durham, Durham, DH1 5TW UK
| | - Steven P. Rushton
- 0000 0001 0462 7212grid.1006.7School of Biology, University of Newcastle Upon Tyne, Newcastle upon Tyne, NE1 7RU UK
| | - David J. Deehan
- 0000 0004 0641 3308grid.415050.5Newcastle Surgical Training Centre Research Centre, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK ,0000 0001 0462 7212grid.1006.7Institute of Cellular Medicine 4th Floor William Leech Building, Medical School, Newcastle upon Tyne, NE2 4HH UK
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14
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Manning WA, Ghosh KM, Blain AP, Longstaff LM, Rushton SP, Deehan DJ. Does Maximal External Tibial Component Rotation Influence Tibiofemoral Load Distribution in the Primary Knee Arthroplasty Setting: A Comparison of Neutral vs Maximal Anatomical External Rotatory States. J Arthroplasty 2017; 32:2005-2011. [PMID: 28236553 DOI: 10.1016/j.arth.2017.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/08/2017] [Accepted: 01/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tibial component rotation at time of knee arthroplasty can influence conformity, load transmission across the polyethylene surface, and perhaps ultimately determined survivorship. Optimal tibial component rotation on the cut surface is reliant on standard per operative manual stressing. This subjective assessment aims to balance constraint and stability of the articulation through a full arc of movement. METHODS Using a cadaveric model, computer navigation and under defined, previously validated loaded conditions mimicking the in vivo setting, the influence of maximal tibial component external rotation compared with the neutral state was examined for changes in laxity and tibiofemoral continuous load using 3D displacement measurement and an orthosensor continuous load sensor implanted within the polyethylene spacer in a simulated single radius total knee arthroplasty. RESULTS No significant difference was found throughout arc of motion (0-115 degrees of flexion) for maximal varus and/or valgus or rotatory laxity between the 2 states. The neutral state achieved equivalence for mediolateral load distribution at each point of flexion. We have found that external rotation of the tibial component increased medial compartment load in comparison with the neutral position. Compared with the neutral state, external rotation consistently effected a marginal, but not significant reduction in lateral load under similar loading conditions. The effects were most pronounced in midflexion. CONCLUSION On the basis of these findings, we would advocate for the midtibial tubercle point to determine tibial component rotation and caution against component external rotation.
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Affiliation(s)
- William A Manning
- Newcastle Surgical Training Centre Research Unit 1, Freeman Hospital, Newcastle upon Tyne, England, United Kingdom
| | - Kanishka M Ghosh
- Newcastle Surgical Training Centre Research Unit 1, Freeman Hospital, Newcastle upon Tyne, England, United Kingdom
| | - Alasdair P Blain
- School of Biology, University of Newcastle upon Tyne, England, United Kingdom
| | - Lee M Longstaff
- Department of Orthopaedic Surgery, University Hospital of North Durham, England, United Kingdom
| | - Steven P Rushton
- School of Biology, University of Newcastle upon Tyne, England, United Kingdom
| | - David J Deehan
- Newcastle Surgical Training Centre Research Unit 1, Freeman Hospital, Newcastle upon Tyne, England, United Kingdom
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15
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Steinbrück A, Schröder C, Woiczinski M, Müller T, Müller PE, Jansson V, Fottner A. Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2395-401. [PMID: 25577221 DOI: 10.1007/s00167-015-3503-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Although continuous improvements have been made, there is still a considerable amount of unsatisfied patients after total knee arthroplasty (TKA). A main reason for this high percentage is anterior knee pain, which is supposed to be provoked by post-operative increased retropatellar peak pressure. Since rotational malalignment of the implant is believed to contribute to post-operative pain, the aim of this study was to examine the influence of tibial component rotation on knee kinematics and retropatellar pressure. METHODS Eight fresh-frozen knee specimens were tested in a weight-bearing knee rig after fixed-bearing TKA under a loaded squat from 20° to 120° of flexion. To examine tibial components with different rotations, special inlays with 3° internal rotation and 3° external rotation were produced and retropatellar pressure distribution was measured with a pressure-sensitive film. The kinematics of the patella and the femorotibial joint were recorded with an ultrasonic-based motion analysis system. RESULTS Retropatellar peak pressure decreased significantly from 3° internal rotation to neutral position and 3° external rotation of the tibial component (8.5 ± 2.3 vs. 8.2 ± 2.4 vs. 7.8 ± 2.5 MPa). Regarding knee kinematics femorotibial rotation and anterior-posterior translation, patella rotation and tilt were altered significantly, but relative changes remained minimal. CONCLUSION Changing tibial rotation revealed a high in vitro influence on retropatellar peak pressure. We recommend the rotational alignment of the tibial component to the medial third of the tibial tuberosity or even more externally beyond that point to avoid anterior knee pain after TKA.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Tatjana Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
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16
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Wernecke GC, Seeto BG, Chen DB, MacDessi SJ. Posterior condylar cartilage thickness and posterior condylar offset of the femur: a magnetic resonance imaging study. J Orthop Surg (Hong Kong) 2016; 24:12-5. [PMID: 27122505 DOI: 10.1177/230949901602400105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To measure the femoral posterior condylar cartilage (PCC) thickness and the posterior condylar offset (PCO) and determine the correlation between the 2 parameters in 530 normal subjects using magnetic resonance imaging (MRI). METHODS Records of 287 male and 243 female patients (mean age, 40.7 years) who underwent MRI for traumatic soft tissue knee injuries not involving the femoral PCC and did not have symptomatic knee arthritis were reviewed. RESULTS The PCC thickness was comparable in the lateral and medial sides (2.04 vs. 1.99 mm, p=0.13). Males had thicker PCC in the medial (2.05 vs. 1.92 mm, p=0.0006) and lateral (2.16 vs. 1.86, p<0.0001) sides than females. Age did not correlate with PCC thickness. The bony PCO was larger in the medial than lateral side (25.8 vs. 22.6 mm, p<0.0001). Males had a larger PCO than females in the medial side only (26.1 vs. 25.5 mm, p = 0.0195). The bony PCO did not correlate with PCC thickness. CONCLUSION Femoral PCC thickness was comparable in the medial and lateral sides. Males had thicker PCC in the medial and lateral sides than females.
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17
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Beckmann J, Steinert A, Zilkens C, Zeh A, Schnurr C, Schmitt-Sody M, Gebauer M. Patientenspezifische Instrumente und Implantate beim Teilgelenkersatz des Kniegelenkes (ConforMIS iUni, iDuo). DER ORTHOPADE 2016; 45:322-30. [DOI: 10.1007/s00132-016-3237-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Indelli PF, Graceffa A, Marcucci M, Baldini A. Rotational alignment of the tibial component in total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:3. [PMID: 26855939 DOI: 10.3978/j.issn.2305-5839.2015.12.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Many surgical techniques, correlated to different anatomical landmarks, have been proposed to allow a satisfactory rotational alignment of the tibial component in primary total knee arthroplasty (TKA). Unfortunately, an accurate landmark has not yet been established although many computer models using CT reconstructions and standard radiologic studies have been performed. In this review article, the authors propose a new anatomical rotational reference for a correct positioning of the tibial component during primary TKA; the authors compared the results of their studies with the current literature on rotational alignment references and previously proposed surgical techniques. The authors also analyzed the correlation between classic and newer tibial baseplate designs and different tibial rotational landmarks.
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Affiliation(s)
- Pier Francesco Indelli
- 1 Department of Orthopaedic Surgery, Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA 94304, USA ; 2 Clinica Ortopedica Universita' degli Studi di Firenze - CESAT, Fucecchio, Italy ; 3 Orthopaedics Unit, IFCA Clinic, Firenze, Italy
| | - Angelo Graceffa
- 1 Department of Orthopaedic Surgery, Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA 94304, USA ; 2 Clinica Ortopedica Universita' degli Studi di Firenze - CESAT, Fucecchio, Italy ; 3 Orthopaedics Unit, IFCA Clinic, Firenze, Italy
| | - Massimiliano Marcucci
- 1 Department of Orthopaedic Surgery, Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA 94304, USA ; 2 Clinica Ortopedica Universita' degli Studi di Firenze - CESAT, Fucecchio, Italy ; 3 Orthopaedics Unit, IFCA Clinic, Firenze, Italy
| | - Andrea Baldini
- 1 Department of Orthopaedic Surgery, Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA 94304, USA ; 2 Clinica Ortopedica Universita' degli Studi di Firenze - CESAT, Fucecchio, Italy ; 3 Orthopaedics Unit, IFCA Clinic, Firenze, Italy
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19
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Chen JY, Lo NN, Chong HC, Pang HN, Tay DKJ, Chin PL, Chia SL, Yeo SJ. Cruciate retaining versus posterior stabilized total knee arthroplasty after previous high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2015; 23:3607-13. [PMID: 25173507 DOI: 10.1007/s00167-014-3259-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 08/20/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to investigate the clinical outcome of total knee arthroplasty (TKA) after previous high tibial osteotomy (HTO) using cruciate retaining (CR) versus posterior stabilized (PS) prostheses. METHODS Between 2001 and 2010, 133 patients who underwent TKA after previous HTO were included in this study and prospectively followed up for two years. Two independent assessors recorded the range of motion of the operated knee, anterior-posterior (AP) laxity, medial-lateral (ML) laxity, Oxford Knee Score (OKS), Knee Society Function Score (KSFS) and Knee Society Knee Score (KSKS). RESULTS Thirty-three patients received CR prostheses, while 100 patients received PS prostheses. The median (inter-quartile range) knee flexion at 6 months and 2 years post-TKA was 101° (90, 116) and 110° (90, 118), respectively for the CR group, compared to 115° (100, 121) and 118° (108, 125) for the PS group (p = 0.010 and p = 0.009, respectively). AP and ML laxities were comparable in both groups of patients. While both groups of patients showed improvement in OKS, KSFS and KSKS at 6 months and 2 years post-TKA, there was no significant difference in these clinical scores between the two groups at both time points of follow-up. None of the 133 patients required revision surgery. CONCLUSIONS Although PS prostheses offer better knee flexion in TKA after previous HTO, the knee stability, clinical scores and revision rate at 6 months and 2 years post-TKA are comparable between CR and PS prostheses. The authors conclude that CR is an alternative to PS prostheses in patients undergoing TKA after previous HTO. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 119228, Singapore.
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 119228, Singapore
| | - Hwei Chi Chong
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 119228, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 119228, Singapore
| | - Pak Lin Chin
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 119228, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 119228, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Academia Building Level 4, Singapore, 119228, Singapore
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20
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Cottino U, Rosso F, Pastrone A, Dettoni F, Rossi R, Bruzzone M. Painful knee arthroplasty: current practice. Curr Rev Musculoskelet Med 2015; 8:398-406. [PMID: 26400422 DOI: 10.1007/s12178-015-9296-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary total knee arthroplasty is the treatment for end-stage arthritis of the knee; in the last years, it is becoming more common and reliable, due to technical and implant improvement. With larger implant rates, the overall complications will increase and pain is the most common sign of implant failure. Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis; if surgery is performed for the wrong reason, this will surely lead to a failure. In this paper, the authors revised the more common causes of failure that can have a painful onset proposing an approach for diagnosis and treatment.
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Affiliation(s)
- Umberto Cottino
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Federica Rosso
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Antonio Pastrone
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Federico Dettoni
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Roberto Rossi
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Matteo Bruzzone
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
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21
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Relationship between Tibial Baseplate Design and Rotational Alignment Landmarks in Primary Total Knee Arthroplasty. ARTHRITIS 2015; 2015:189294. [PMID: 26491564 PMCID: PMC4600913 DOI: 10.1155/2015/189294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
Abstract
This study evaluated the influence of modern tibial baseplate designs when using the anterior tibial cortex as a primary rotational landmark for the tibial baseplate in TKA. Eighty patients undergoing TKA were randomized in two groups. Group 1 included 25 females and 15 males receiving a posterior-stabilized (PS) symmetric tibial baseplate while Group 2 included 24 females and 16 males receiving a PS anatomical tibial component. Identical surgical technique, including the use of the surgical transepicondylar femoral axis (sTEA) and the anterior tibial cortex (“Curve-on-Curve”) as rotational alignment landmarks, was used. All patients underwent CT evaluation performed with the knee in full extension. Three observers independently measured the rotational alignment of the tibial component in relation to the sTEA. The rotational alignment of the symmetric baseplate showed an average external rotation of 1.3° (minimum 5°, maximum −1°): 91% of the knees showed 0 ± 3° with respect to the surgical sTEA, being internally rotated in 20%. The rotational alignment of the anatomical baseplate showed an average external rotation of 4.1° (minimum 0.4°, maximum 8.9°): only 47.5% of the knees showed 0 ± 3°, being externally rotated in 100%. The difference between the two groups was statistically significant. This study confirms the reliability of the “Curve-on-Curve” technique as an adequate rotational alignment anatomical landmark in TKA: the use of an asymmetric tibial baseplate might lead to external rotation of the tibial component when this technique is intraoperatively chosen.
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22
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Hunt NC, Ghosh KM, Blain AP, Rushton SP, Longstaff LM, Deehan DJ. No statistically significant kinematic difference found between a cruciate-retaining and posterior-stabilised Triathlon knee arthroplasty. Bone Joint J 2015; 97-B:642-8. [DOI: 10.1302/0301-620x.97b5.34999] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to compare the maximum laxity conferred by the cruciate-retaining (CR) and posterior-stabilised (PS) Triathlon single-radius total knee arthroplasty (TKA) for anterior drawer, varus–valgus opening and rotation in eight cadaver knees through a defined arc of flexion (0º to 110º). The null hypothesis was that the limits of laxity of CR- and PS-TKAs are not significantly different. The investigation was undertaken in eight loaded cadaver knees undergoing subjective stress testing using a measurement rig. Firstly the native knee was tested prior to preparation for CR-TKA and subsequently for PS-TKA implantation. Surgical navigation was used to track maximal displacements/rotations at 0º, 30º, 60º, 90º and 110° of flexion. Mixed-effects modelling was used to define the behaviour of the TKAs. The laxity measured for the CR- and PS-TKAs revealed no statistically significant differences over the studied flexion arc for the two versions of TKA. Compared with the native knee both TKAs exhibited slightly increased anterior drawer and decreased varus-valgus and internal-external roational laxities. We believe further study is required to define the clinical states for which the additional constraint offered by a PS-TKA implant may be beneficial. Cite this article: Bone Joint J 2015; 97-B:642–8.
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Affiliation(s)
- N. C. Hunt
- Newcastle University, Newcastle-upon-Tyne
NE1 7RU, UK
| | - K. M. Ghosh
- Freeman Hospital, High
Heaton, Newcastle-upon-Tyne NE7 7DN, UK
| | - A. P. Blain
- Newcastle University, Newcastle-upon-Tyne
NE1 7RU, UK
| | - S. P. Rushton
- Newcastle University, Newcastle-upon-Tyne
NE1 7RU, UK
| | | | - D. J. Deehan
- Freeman Hospital, High
Heaton, Newcastle-upon-Tyne NE7 7DN, UK
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23
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Hernandez-Vaquero D, Noriega-Fernandez A, Fernandez-Carreira JM, Fernandez-Simon JM, Llorens de los Rios J. Computer-assisted surgery improves rotational positioning of the femoral component but not the tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22:3127-34. [PMID: 25155048 DOI: 10.1007/s00167-014-3233-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Computer-assisted surgery (CAS) may facilitate better positioning of total knee arthroplasty (TKA) along the coronal and lateral axes; however, there are doubts as to its usefulness in the rotational plane. METHODS This is a prospective study of 95 TKAs comparing two groups: the CAS group and the standard equipment group. The series comprises 95 cases. A radiography of the lower limb and computer tomographies (CTs) of the femoral condylar region, the proximal end of the tibia and the ankle were performed to measure rotational angulation. A month after TKA surgery, the radiography and the CTs were repeated to analyze the position of the prosthetic components in the rotational plane. RESULTS In the coronal axis, both CAS and mechanical technique improved femoro-tibial alignment, but when there are preexisting deformities ≥4°, CAS obtains better results. A strong correlation (R = 0.94, p = 0.001) was observed between the mean rotational axis measured with CT in the tibial plateau and that measured from the axis of the ankle. The mean initial femoral rotation of the complete series was 6.7° and 2.7° at 1-month follow-up (p < 0.001). In the standard instrumentation group, the femoral rotation went from 6.8° to 2.3°, whereas in the CAS group the femoral rotation went from 6.5° to 3.1° (p = 0.039), which is very close to the ideal 3° angle of external rotation. Tibial rotation changed by 5.28° for the entire patient population, but no differences were found when comparing CAS and standard instrumentation. CONCLUSION CAS improves frontal alignment in TKA, especially in the presence of preoperative deformities. In the femoral component, navigation most closely replicated the ideal 3° external rotation of the femoral component, but tibial rotation did not differ when comparing CAS to standard instrumentation. LEVEL OF EVIDENCE II.
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24
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Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A. What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop 2014; 85:480-7. [PMID: 25036719 PMCID: PMC4164865 DOI: 10.3109/17453674.2014.940573] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Surgeon-dependent factors such as optimal implant alignment are thought to play a significant role in outcome following primary total knee arthroplasty (TKA). Exact definitions and references for optimal alignment are, however, still being debated. This overview of the literature describes different definitions of component alignment following primary TKA for (1) tibiofemoral alignment in the AP plane, (2) tibial and femoral component placement in the AP plane, (3) tibial and femoral component placement in the sagittal plane, and (4) rotational alignment of tibial and femoral components and their role in outcome and implant survival. METHODS We performed a literature search for original and review articles on implant positioning following primary TKA. Definitions for coronal, sagittal, and rotational placement of femoral and tibial components were summarized and the influence of positioning on survival and functional outcome was considered. RESULTS Many definitions exist when evaluating placement of femoral and tibial components. Implant alignment plays a role in both survival and functional outcome following primary TKA, as component malalignment can lead to increased failure rates, maltracking, and knee pain. INTERPRETATION Based on currently available evidence, surgeons should aim for optimal alignment of tibial and femoral components when performing TKA.
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Affiliation(s)
- Kirill Gromov
- Department of Orthopaedic Surgery,Clinical Orthopedic Research Hvidovre, Hvidovre University Hospital, Copenhagen, Denmark
| | - Mounim Korchi
- Clinical Orthopedic Research Hvidovre, Hvidovre University Hospital, Copenhagen, Denmark
| | - Morten G Thomsen
- Department of Orthopaedic Surgery,Clinical Orthopedic Research Hvidovre, Hvidovre University Hospital, Copenhagen, Denmark
| | - Henrik Husted
- Department of Orthopaedic Surgery,Clinical Orthopedic Research Hvidovre, Hvidovre University Hospital, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery,Clinical Orthopedic Research Hvidovre, Hvidovre University Hospital, Copenhagen, Denmark
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