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Obermayr S, Klasan A, Rasic L, Hauer G, Leitner L, Leithner A, Sadoghi P. Correlation of revision rate of unicompartmental knee arthroplasty with total knee arthroplasty: a meta-analysis of clinical studies and worldwide arthroplasty registers. Arch Orthop Trauma Surg 2024; 144:4873-4886. [PMID: 39404769 PMCID: PMC11582169 DOI: 10.1007/s00402-024-05574-1] [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: 07/12/2024] [Accepted: 09/09/2024] [Indexed: 11/22/2024]
Abstract
INTRODUCTION The purpose of this study was to elucidate differences and similarities in revision rates amongst studies and national registers featuring total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Thereby comparability and reproducibility between study and register findings should be created. MATERIALS AND METHODS Clinical studies published between 2004 and September 2023 involving TKA or UKA were reviewed for total arthroplasty numbers, revision rates and demographic data. Findings were calculated as "revisions per 100 component years (CY)" and divided according to the nationality of the center. National arthroplasty registers were searched for numbers of arthroplasties and revisions alongside with demographic data. Revision rates in registers were compared to one another and comparison to revision rates from collected studies was drawn. RESULTS After evaluation, 98 studies and seven registers met our inclusion criteria and were included in this study. Cumulative percent revision rate in studies was 3.35% after a mean follow-up of 5.7 years, corresponding to 0.71 revisions per 100 CY for TKA and 7.67% after a mean follow-up of 4.9 years, corresponding to 1.3 revisions per 100 CY for UKA. Registers showed mean overall revision rates of 5.63% for TKA and 11.04% for UKA. CONCLUSIONS A positive correlation of revision rates of TKA and UKA in studies and registers was found, with overall revision rates of UKA comparted to TKA being 2.29 times higher in clinical studies and 1.96 times higher in registers. Revision rates in registers were 1.56 times higher than presented in clinical studies.
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Affiliation(s)
- Stephan Obermayr
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Antonio Klasan
- AUVA UKH Steiermark, Graz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Laura Rasic
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Georg Hauer
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Lukas Leitner
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Munich, Germany
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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Abdelbadie A, Toreih AA, El-Adawy MF, Arafa MS. Saw-box osteotomy versus reamer-box osteotomy in posterior stabilized total knee arthroplasty: a retrospective study of an average five year follow-up. INTERNATIONAL ORTHOPAEDICS 2024; 48:1209-1215. [PMID: 38383764 PMCID: PMC11001703 DOI: 10.1007/s00264-024-06119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE The purpose of this study is to compare the difference of results between two methods of femoral box osteotomy adopted by two designs of posterior stabilized total knee prostheses. PATIENTS AND METHODS Retrospective analysis of the results of two groups of patients operated upon using two primary PS TKA systems, PFC Sigma (DePuy Synthes, Johnson and Johnson®) and Genesis II prosthesis (Smith and Nephew®), with an average of five year follow-up was done. Group 1 included 152 knees in 121 patients and group 2 included 122 knees in 111 patients. The average follow-up period in both groups was five years. The box osteotomy method depends on bone saw in group 1, and bone reamer in group 2. RESULTS The KSS score of group 2 was better in the first six months postoperatively. Then, no significant differences were seen in the remaining follow-up visits. The risk of periprosthetic fractures was significantly higher in group 1 (p-value 0.040). Survival analysis showed a significantly shorter time for reoperation in group 1 than in group 2 as described by log-rank test, (p < 0.006). CONCLUSION The method of box cutting has an impact on the function and longevity of posterior stabilized primary knee implants. The risk of periprosthetic fractures can be reduced by proper patient selection, decreasing the box sizes, and development of more "controlled" box osteotomy instruments.
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Affiliation(s)
- Ahmed Abdelbadie
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospital, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt.
| | - Ahmed A Toreih
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospital, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt
| | - Moawed F El-Adawy
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospital, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt
| | - Mohamed S Arafa
- Department of Orthopedic Surgery, Fayoum University Hospital, Fayoum, Egypt
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Pitsaer E, Chergui S, Lavoie F. Long-term results of a rotationally unconstrained fixed-bearing total knee prosthesis. INTERNATIONAL ORTHOPAEDICS 2024; 48:965-970. [PMID: 38308765 DOI: 10.1007/s00264-024-06097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Introduced in the market in 1990 by Ceraver (France), the posterior-stabilised (PS) Hermes prosthesis has limited literature regarding long-term survivability. The purpose of the study is to evaluate the survival and functional outcomes of the prosthesis. METHODS A retrospective case series was performed including 164 patients (176 knees) having undergone total knee arthroplasty with the Hermes prosthesis between 1997 and 2000 with a follow-up period of 18 years. RESULTS Kaplan-Meier analysis showed a survival rate of 99.4% (95% CI. 96.0-100.0%) at 18.4 years with one revision. At final follow-up, the International Knee Society (IKS) functional score was 93.2 ± 15.6 and IKS knee score was 99.1 ± 2.5. CONCLUSION The Hermes PS model is a low conformity prosthesis that offers reliable durability that is comparable to other popular designs while minimizing rotational constraints and having an approachable learning curve for new users.
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Affiliation(s)
- E Pitsaer
- Division of Orthopaedic Surgery, Denain Hospital Center, 25 Bis Avenue Jean Jaurès, 59220, Denain, France
| | - S Chergui
- Division of Orthopaedic Surgery, McGill University Health Center, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada.
| | - F Lavoie
- Division of Orthopaedic Surgery, University of Montreal Health Center, 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
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Bakircioglu S, Aksoy T, Caglar O, Mazhar Tokgozoglu A, Atilla B. Joint awareness after fixed and mobile-bearing total knee arthroplasty with minimum 12 years of follow-up: A propensity matched-pair analysis. Knee 2023; 42:130-135. [PMID: 37001329 DOI: 10.1016/j.knee.2023.03.004] [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: 10/04/2022] [Revised: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Many comparative articles studied mobile-bearing (MB) and fixed-bearing (FB) total knee arthroplasties (TKAs). Meta-analyses found no difference in survival or biomechanical outcome. This study aimed to compare long-term clinical results between fixed-bearing (FB) and mobile-bearing (MB) total knee arthroplasty (TKA) as well as patients' adaptation to their artificial joints. METHOD TKAs performed with the same surgical protocol divided into categories according to the insert design preferred. 70 MB design TKAs were compared with 70 FB design TKAs utilizing propensity matching for parameters; gender, age, body mass index, coronal plane deformity, range of motion (ROM) and appropriateness criteria. Forgotten Joint Score-12 (FJS-12) was used to assess patients' ability to forget their artificial joints in daily life. RESULTS Patients had a mean follow-up of 15.6 (±2.2) years. No difference was observed between groups for post-operative ROM, WOMAC, Knee Society Knee and Function Scores. The FJS-12 in the MB and FB groups were 66.1 and 72.8, respectively (P = 0.026). There was no significant difference in survival between both designs. CONCLUSION This study suggests that in TKA, joint awareness is higher in MB compared to FB design. FJS-12 appears to be a sensitive measuring tool when comparing two designs and should be implemented in long-term follow-up.
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Affiliation(s)
- Sancar Bakircioglu
- TOBB Economy and Technology University, Department of Orthopedics and Traumatology, Turkey.
| | - Taha Aksoy
- Hacettepe University, Department of Orthopedics and Traumatology, Turkey.
| | - Omur Caglar
- Hacettepe University, Department of Orthopedics and Traumatology, Turkey.
| | | | - Bulent Atilla
- Hacettepe University, Department of Orthopedics and Traumatology, Turkey.
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No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3138-3154. [PMID: 35861866 PMCID: PMC9418337 DOI: 10.1007/s00167-022-07065-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA. METHODS This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered. RESULTS Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis. CONCLUSION There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA. LEVEL OF EVIDENCE Level I.
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Wang K, Zhang FF, Yan X, Shen Y, Cai W, Xu J, Mei J. Superior Mid- to Long-Term Clinical Outcomes of Mobile-Bearing Total Knee Arthroplasty Compared to Fixed-Bearing: A Meta-Analysis Based on a Minimum of 5 Years of Study. J Knee Surg 2021; 34:1368-1378. [PMID: 32503063 DOI: 10.1055/s-0040-1709490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As more patients undergo total knee arthroplasty (TKA) each year, and the average age of patients gets younger, the patients are generally more active requiring a greater physiological demand and increasing range of motion on the prosthesis than the previous patients. However, there is no consensus on the optimal TKA tibial bearing design. We performed this systematic review to compare the clinical differences between mobile and fixed bearing constructs used in contemporary TKA. We searched PubMed, EMBASE, and Cochrane Library databases, identifying 515 total publications, including 17 randomized controlled trials (RCTs). A meta-analysis was performed, while the quality and bias of the evidence were rated according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) guidelines and the Cochrane Database questionnaire. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seventeen studies were included, with a total of 1505 knees receiving a mobile bearing TKA and 1550 knees receiving a fixed bearing TKA. The meta-analysis compared clinical outcomes between mobile bearing (MB)-TKA and fixed bearing (FB)-TKA using postoperative Knee Society Score, postoperative ROM, and survivorship and showed that there was a distinct difference in Knee Society Score between the mobile-bearing and fixed-bearing groups (overall standardized mean difference = 1.38; 95% confidence interval (CI): 0.50-2.25; p = 0.002; I2 = 60%). Patients treated with mobile-bearing prostheses were more likely to report good or excellent range of motion results (overall standardized mean difference = 2.06; 95% CI: 0.65-3.47; p = 0.004). No difference in implant survivorship or reoperation rate were identified. The fixed-bearing and mobile-bearing TKA designs are both capable of producing excellent long-term results with excellent clinical outcomes if properly implanted; however, the mobile-bearing TKA have superiority in mid- to long-term clinical results. Trial registration number for PROSPERO was CRD42019126402.
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Affiliation(s)
- Kaiyang Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Fang Zhang
- Department of Orthopedic Surgery, Tongji University School of Medicine, Tongji Hospital, Shanghai, China
| | - Xu Yan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yifan Shen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weijie Cai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiaming Xu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiong Mei
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Romagnoli S, Petrillo S, Marullo M. Knee resurfacing with double unicompartimental arthroplasty: rationale, biomechanics, indications, surgical technique and outcomes. J Exp Orthop 2021; 8:78. [PMID: 34524568 PMCID: PMC8443736 DOI: 10.1186/s40634-021-00402-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Sergio Romagnoli
- Department of Joint Replacement, IRCCS Istituto Ortopedico Galeazzi, via R. Galeazzi 4, 20161, Milan, Italy
| | - Stefano Petrillo
- Department of Joint Replacement, IRCCS Istituto Ortopedico Galeazzi, via R. Galeazzi 4, 20161, Milan, Italy
| | - Matteo Marullo
- Department of Joint Replacement, IRCCS Istituto Ortopedico Galeazzi, via R. Galeazzi 4, 20161, Milan, Italy.
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Pécora JR, Romero V. Evaluation of Polyethylene Wear in a Brazilian Ultracongruent Knee Prosthesis with a Rotating Platform. Rev Bras Ortop 2021; 56:42-46. [PMID: 33627898 PMCID: PMC7895618 DOI: 10.1055/s-0040-1712491] [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: 02/04/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the wear of polyethylene in a Brazilian ultracongruent knee prosthesis with a rotating platform (Rotaflex, Víncula, Rio Claro, SP, Brasil). Methods We used the test method with the loading and preparation parameters mentioned in the standards regulation ISO 14243-1:2009 , and the measurement methods mentioned in the standards regulation ISO 14243-2:2009 , for the evaluation of the wear behavior of a Brazilian prosthesis with a rotating platform. The equipment used for the wear test was the ISO 14243-1 gait simulator (EndoLab, Riedering, Germany). Results After 10 million cycles, the evaluation of the polyethylene wear showed a regular appearance of surface wear at a mean rate of 2.56 mg per million cycles. Conclusion The wear of the polyethylene of the evaluated prosthesis was minimal after the tests performed and with safety limits higher than those recommended by biomechanical engineering.
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Affiliation(s)
- José Ricardo Pécora
- Grupo do Joelho, Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Valéria Romero
- Faculdade de Medicina, Universidade de Campinas, Campinas, SP, Brasil
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Robotic Total Knee Arthroplasty vs Conventional Total Knee Arthroplasty: A Nationwide Database Study. Arthroplast Today 2020; 6:1001-1008.e3. [PMID: 33385042 PMCID: PMC7772451 DOI: 10.1016/j.artd.2020.09.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background As robot-assisted equipment is continuously being used in orthopaedic surgery, the past few decades have seen an increase in the usage of robotics for total knee arthroplasty (TKA). Thus, the purpose of the present study is to investigate the differences between robotic TKA and nonrobotic TKA on perioperative and postoperative complications and opioid consumption. Methods An administrative database was queried from 2010 to Q2 of 2017 for primary TKAs performed via robot-assisted surgery vs non-robot-assisted surgery. Systemic and joint complications and average morphine milligram equivalents were collected and compared with statistical analysis. Results Patients in the nonrobotic TKA cohort had higher levels of prosthetic revision at 1-year after discharge (P < .05) and higher levels of manipulation under anesthesia at 90 days and 1-year after discharge (P < .05). Furthermore, those in the nonrobotic TKA cohort had increased occurrences of deep vein thrombosis, altered mental status, pulmonary embolism, anemia, acute renal failure, cerebrovascular event, pneumonia, respiratory failure, and urinary tract infection during the inpatient hospital stay (all P < .05) and at 90 days after discharge (all P < .05). All of these categories remained statistically increased at the 90-days postdischarge date, except pneumonia and stroke. Patients in the nonrobotic TKA cohort had higher levels of average morphine milligram equivalents consumption at all time periods measured (P < .001). Conclusions In the present study, the use of robotics for TKA found lower revision rates, lower incidences of manipulation under anesthesia, decreased occurrence of systemic complications, and lower opiate consumption for postoperative pain management. Future studies should look to further examine the long-term outcomes for patients undergoing robot-assisted TKA. Level of Evidence Level III.
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Abstract
Total knee arthroplasty (TKA) is a successful and cost-effective treatment for end-stage degenerative arthritis. The aging of society and an increase in the prevalence of obesity has led to increases in the prevalence of arthritis and the incidence of TKA. Currently, the total number of procedures in Korea per year has reached 90,000. With the rapid growth, we need to know about the current state of TKA. The purpose of this review is to summarize the recent literature regarding TKA. The main indication for TKA is end-stage arthritis with severe pain, reduced function, and no response to conservative management. Metal on the polyethylene-bearing surface and cobalt alloy are used in most TKAs. Despite good clinical outcomes and long-term survival rates after TKA in many papers, 20% of patients are dissatisfied with the outcome of surgery. To improve the patient’s satisfaction, surgeons should understand factors affecting patient’s satisfaction, including patient’s expectations, age, and preoperative mental state. Navigation-assisted surgery and robotic surgery have been introduced in knee arthroplasty to achieve more precise and accurate alignment. There is some evidence to suggest that computer-assisted surgery reduces revision rates. However, clinical efficacy is also controversial, and a long-term follow-up study is required. The common complications of TKA include infection, polyethylene wear, loosening, stiffness, periprosthetic fracture, and thromboembolism. An understanding of the potential complications and pitfalls of TKA is essential for prevention.
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Kim YH, Park JW. Comparison of Modular Conventional and High-Flexion Posterior-Stabilized Total Knee Arthroplasties in the Same Patients at a Mean Follow-Up of 15 Years. J Arthroplasty 2020; 35:1262-1267. [PMID: 31902619 DOI: 10.1016/j.arth.2019.12.022] [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: 10/02/2019] [Revised: 11/26/2019] [Accepted: 12/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As previous studies are limited to short-term clinical data on conventional and high-flexion total knee arthroplasties (TKAs), long-term clinical data on these TKAs remain unclear. Therefore, we evaluated long-term functional outcome, range of knee motion, revision rate, implant survival, and the prevalence of osteolysis after conventional and high-flexion TKAs in the same patients. METHODS The authors evaluated a cohort of 1206 patients with a mean age of 65.3 ± 7 years (range: 22-70) who underwent bilateral simultaneous sequential TKAs. One knee received a conventional TKA and the other received a high-flexion TKA. The mean duration of follow-up was 15.6 years (range: 14-17). RESULTS No significant differences were found between the 2 groups at the latest follow-up with respect to Knee Society score (93 vs 92 points, P = .765), pain score (45 vs 44 points, P = .641), range of knee motion (125° vs 126°, P = .712), and radiographic and computed tomography scan results. Furthermore, no significant revision rate differences were found between the 2 groups (1.3% for conventional TKA vs 1.6% for high-flexion TKA; P = .137). There was no osteolysis recorded in either group. The rate of survivorship free of implant revision or aseptic loosening was 98.7% (95% CI = 91-100) for conventional TKA and 98.4% (95% CI = 91-100) for high-flexion TKA at 17 years. CONCLUSION At the latest follow-up, we were not able to demonstrate any significant difference between conventional and high-flexion TKAs with respect to functional outcome scores, range of knee motion, revision rate, implant survival, and prevalence of osteolysis.
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Affiliation(s)
- Young-Hoo Kim
- Joint Replacement Center, Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
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12
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Song SJ, Lee HW, Bae DK, Park CH. High Incidence of Tibial Component Loosening After Total Knee Arthroplasty Using Ceramic Titanium-Nitride-Coated Mobile Bearing Prosthesis in Moderate to Severe Varus Deformity: A Matched-Pair Study Between Ceramic-Coated Mobile Bearing and Fixed Bearing Prostheses. J Arthroplasty 2020; 35:1003-1008. [PMID: 31859013 DOI: 10.1016/j.arth.2019.11.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We compared the incidence of aseptic component loosening and subsequent revision, and the survival rate between ceramic titanium-nitride-coated mobile bearing (MB) and fixed bearing total knee arthroplasties (TKAs) performed in patients with moderate to severe varus deformities. METHODS In total, 200 TKAs using advanced coated system posterior stabilized prostheses in varus deformity of mechanical axis >8° between 2012 and 2016 were retrospectively reviewed. One hundred MB (ceramic-m group) and 100 fixed bearing (ceramic-f group) prostheses were included. The matches were made according to preoperative demographics, range of motion, and severity of deformity. The mean follow-up period was not different (ceramic-m vs ceramic-f = 4.8 vs 5.1 years; P = .104). The incidence of revision TKA due to aseptic component loosening and the survival rate (failure: revision due to aseptic loosening) was investigated. RESULTS The incidence of revision TKA due to aseptic component loosening was 7 (7%) in the ceramic-m group and 1 (1%) in the ceramic-f group (P = .032). All cases of aseptic loosening occurred at the tibial component. The overall survival rate was 91.3% in the ceramic-m group and 98.9% in the ceramic-f group (P = .025). CONCLUSION Considering the higher revision incidence and lower survival rate due to tibial component loosening, caution should be taken in tibial component fixation when using advanced coated system MB prosthesis in moderate to severe varus deformity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, South Korea
| | - Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
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Yong TM, Young EC, Molloy IB, Fisher BM, Keeney BJ, Moschetti WE. Long-Term Implant Survivorship and Modes of Failure in Simultaneous Concurrent Bilateral Total Knee Arthroplasty. J Arthroplasty 2020; 35:139-144. [PMID: 31500911 PMCID: PMC6910974 DOI: 10.1016/j.arth.2019.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/21/2019] [Accepted: 08/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is limited evidence describing long-term implant survivorship and modes of failure in simultaneous concurrent bilateral total knee arthroplasty (TKA). METHODS We performed a retrospective review of 266 consecutive patients (532 knees) who underwent simultaneous concurrent bilateral TKA. We reviewed medical records for preoperative characteristics, perioperative complications, and revision surgeries. The primary outcome was TKA survivorship. Secondary outcomes included indication and type of revision surgery. We used the Kaplan-Meier method to estimate survivorship and characterize risk of revision up to 20 years post-TKA. RESULTS Our cohort had median follow-up of 9.8 years (interquartile range, 3.9-15.9). Forty-four patients (17%) underwent revision. Revision was more common among younger and male patients. The cumulative incidence of first-time revision per knee (n = 532) was 1.27 per 100 component-years. Implant survival was 99% (confidence interval, 97%-99%) at 5 years, 92% (89%-95%) at 10 years, 83% (77%-87%) at 15 years, and 62% (50%-73%) at 20 years. Five and 10-year survivorship compared favorably to estimates of TKA survivorship in the literature. The cumulative incidence of revision surgery per patient was 1.91 per 100 component-years. Implant survival at 5-, 10-, 15-, and 20-year time points was 96% (CI, 92%-98%), 84% (77%-89%), 71% (62%-79%), and 59% (46%-70%), respectively. Aseptic loosening (40%), polyethylene wear (34%), and infection (11%) were the most common indications for revision. CONCLUSION Simultaneous concurrent bilateral TKA is associated with a higher risk of reoperation for the patient when both knees are evaluated but similar implant survivorship to the literature when each knee was evaluated in isolation.
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Affiliation(s)
- Taylor M. Yong
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH,Reprint requests: Taylor M. Yong, MD, MS, Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756
| | - Emily C. Young
- Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Ilda B. Molloy
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Brian M. Fisher
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH
| | - Benjamin J. Keeney
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH,Berkley Medical Management Solutions, Overland Park, KS
| | - Wayne E. Moschetti
- Department of Orthopaedics, Dartmouth–Hitchcock Medical Center, Lebanon, NH,Geisel School of Medicine, Dartmouth College, Hanover, NH
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Killen CJ, Murphy MP, Hopkinson WJ, Harrington MA, Adams WH, Rees HW. Minimum twelve-year follow-up of fixed- vs mobile-bearing total knee arthroplasty: Double blinded randomized trial. J Clin Orthop Trauma 2020; 11:154-159. [PMID: 32002005 PMCID: PMC6985168 DOI: 10.1016/j.jcot.2019.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) with fixed-bearing (FB) implants have demonstrated impressive functional results and survival rates. Meanwhile, rotating-platform (RP) constructs have biomechanically shown to reduce polyethylene wear, lower the risk of component loosening, and better replicate anatomic knee motion. There is growing question of the clinical impact these design changes have long-term.Questions/purposes: The aim of this double-blinded prospective randomized trial was to compare function and implant survival in patients who received either FB or RP press-fit condylar Sigma (PFC Sigma, DePuy, Warsaw, IN) total knee replacements at a minimum follow-up of twelve years. PATIENTS AND METHODS Patient reported outcome measures used included the functional Knee Society Score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, Medical Outcomes Short Form-36 (SF-36) score, and satisfaction assessment on a four-point Likert scale. The data was collected from times preoperative, two-years, and final encounter (mean 13.95 years). A total of 28 RP and 19 FB knees (58.8%) were analyzed at the final follow-up. RESULTS Among all patients, KSS and WOMAC scores statistically improved from pre-op to 2-year, while KSS statistically worsened from 2-year to final follow-up. The RP group averaged better follow-up scores in all assessments at the final follow-up with exception of overall satisfaction. There was no statistically significant difference in the functional Knee Society Score, Short Form-36, WOMAC scores, patient satisfaction or implant survival between the two groups at any measured period. CONCLUSIONS The use of a fixed-bearing or rotating-platform design does not convey significant superiority in terms of function or implant longevity at a minimum twelve years after total knee arthroplasty. LEVEL OF EVIDENCE Level I, Experimental study, randomized controlled trial (RCT).
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Affiliation(s)
- Cameron J. Killen
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Michael P. Murphy
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA,Corresponding author.
| | - William J. Hopkinson
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Melvyn A. Harrington
- Baylor College of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - William H. Adams
- Loyola University Medical Center, Department of Clinical Research, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Harold W. Rees
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
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Yoon JR, Ko SN, Jung KY, Lee Y, Park JO, Shin YS. Risk of Revision Following Total Knee Arthroplasty or High Tibial Osteotomy: A Nationwide Propensity-Score-Matched Study. J Bone Joint Surg Am 2019; 101:771-778. [PMID: 31045664 DOI: 10.2106/jbjs.18.00980] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is often performed to postpone or avoid the need for subsequent total knee arthroplasty (TKA). We designed the present study to investigate the incidence rate and risk factors for subsequent revision in patients treated with HTO compared with those managed with TKA. METHODS In this retrospective nationwide cohort study, we reviewed the South Korean National Health Insurance claims database from January 1, 2009, to August 31, 2017. We evaluated patients ≥41 years old who had undergone TKA or HTO as the primary surgical procedure without a history of having undergone either procedure during the preceding 2 years. By including only new interventions without such prior surgery, we could eliminate the influence of previous TKA and HTO treatments. Multivariable logistic regression models were used to compare the risk of revision between the groups after propensity score matching with inverse probability of treatment weighting (IPTW). Revision was defined as conversion to revision TKA after primary TKA and conversion to TKA after HTO. RESULTS After applying the IPTW, a total of 436,538 patients with TKA and 452,724 patients with HTO were identified. The risk of revision during the entire study period was higher for patients with HTO than for patients with TKA (adjusted hazard ratio [HR], 2.47). The Kaplan-Meier 8-year survival was 97.8% in the TKA group and 91.5% in the HTO group. Compared with patients with TKA, patients with HTO had an increased risk of revision in cases of advanced age (HR of 1.85 for patients who were ≥61 to 69 years old and HR of 4.17 for those who were ≥70 years old), female sex (HR, 2.90), recipients of Medical Aid program benefits (HR, 4.77), the presence of hyperlipidemia (HR, 3.70), the presence of diabetes (HR, 4.86), and the presence of osteoporosis (HR, 3.53). However, younger patients with HTO (≤60 years old) had a lower risk of subsequent revision (HR, 0.64). CONCLUSIONS The risk of revision was higher for patients with HTO than for patients with TKA. The risk factors for subsequent revision in patients with HTO in our cohort of patients were advanced age (>60 years), female sex, receipt of Medical Aid, and the presence of comorbidities, such as diabetes, osteoporosis, and hyperlipidemia. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Seung-Nam Ko
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Kwang-Young Jung
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Young Lee
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Jae-Ok Park
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, South Korea
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16
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Park CH, Kang SG, Bae DK, Song SJ. Mid-term clinical and radiological results do not differ between fixed- and mobile-bearing total knee arthroplasty using titanium-nitride-coated posterior-stabilized prostheses: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:1165-1173. [PMID: 30088030 DOI: 10.1007/s00167-018-5095-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/03/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE This study was performed to prospectively compare the clinical and radiographic results between mobile-bearing (MB) and fixed-bearing (FB) TKAs using ceramic titanium nitride (TiN)-coated prostheses. METHODS Seventy MB and 70 FB TKAs using TiN-coated prostheses (ACS®) were prospectively evaluated. There were no differences in demographic characteristics between the two groups. Clinically, the Knee Society knee and function scores, WOMAC, and range of motion (ROM) were compared. Considering the possibility of a kinematic change in the polyethylene (PE) insert and a decrease in ROM following MB TKA, serial changes in the ROM were also compared. The thickness of the PE insert was compared according to the size of the femoral component. Radiographically, the alignment and positions of the components were compared. RESULTS There were no differences between the two groups in clinical scores or ROM (n.s.). The maximum flexion increased from 133.5° ± 8.3° to 137.6° ± 5.5° across all time points in the MB group. The serial maximum flexion angles did not differ between the two groups over time (n.s.). The average thickness of the PE insert was greater in the MB group (12.0 ± 1.9 vs. 11.2 ± 1.6 mm, respectively, p = 0.008), especially when a large femoral component was used (12.7 ± 1.9 vs. 11.0 ± 1.5 mm, p = 0.005). The pre- and postoperative mechanical axes and positions of the components did not differ between the two groups (n.s.). CONCLUSIONS TiN-coated MB TKA showed no significant advantage over FB TKA. The selection of bearing design would be clinically insignificant when using the TiN-coated TKA prosthesis. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea
| | - Se Gu Kang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea
| | - Sang Jun Song
- Department of Medicine, Graduate School, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea. .,Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea.
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17
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Kim YH, Park JW, Kim JS. The Long-Term Results of Simultaneous High-Flexion Mobile-Bearing and Fixed-Bearing Total Knee Arthroplasties Performed in the Same Patients. J Arthroplasty 2019; 34:501-507. [PMID: 30503307 DOI: 10.1016/j.arth.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our study determined the long-term clinical, radiographic, and computed tomography scanning results of high-flexion mobile-bearing and fixed-bearing total knee arthroplasties (TKAs) in the same younger patients. In addition, the survivorship and complication rates of both groups were evaluated. METHODS Bilateral simultaneous sequential TKAs were performed in 164 patients (328 knees). There were 142 women and 22 men with a mean age of 63 ± 9 years (range 41-65), who received a high-flexion mobile-bearing prosthesis in one knee and a high-flexion fixed-bearing prosthesis in the other. The mean follow-up was 16.9 years (range 15-18). RESULTS At the latest follow-up, the mean Knee Society knee scores (94 ± 8 vs 95 ± 9 points, P = .7), Western Ontario and McMaster Universities Osteoarthritis Index (20 ± 11 vs 20 ± 11 points, P = 1.0), range of knee motion (125° ± 10° vs 127° ± 9°, P = .8), and University of California, Los Angeles activity scores (7.8 vs 7.8 points, P = 1.0) were below the level of clinical significance between the 2 groups. Survival rate of high-flexion mobile-bearing TKA was 98.2% and that of high-flexion fixed-bearing TKA was 97% at 16 years. No osteolysis was identified in either group. CONCLUSION After a minimum duration of follow-up of 13 years, we found no significant difference between these 2 groups with regard to functional outcome, knee motion, prevalence of osteolysis, or survivorship. This study does not clearly direct the surgeon toward either arm of treatment. Longer term follow-up is needed to prove the superiority of one type of implant over the other one.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Seoul Metropolitan Seonam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
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18
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Powell AJ, Crua E, Chong BC, Gordon R, McAuslan A, Pitto RP, Clatworthy MG. A randomized prospective study comparing mobile-bearing against fixed-bearing PFC Sigma cruciate-retaining total knee arthroplasties with ten-year minimum follow-up. Bone Joint J 2018; 100-B:1336-1344. [PMID: 30295539 DOI: 10.1302/0301-620x.100b10.bjj-2017-1450.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS This study compares the PFC total knee arthroplasty (TKA) system in a prospective randomized control trial (RCT) of the mobile-bearing rotating-platform (RP) TKA against the fixed-bearing (FB) TKA. This is the largest RCT with the longest follow-up where cruciate-retaining PFC total knee arthroplasties are compared in a non-bilateral TKA study. PATIENTS AND METHODS A total of 167 patients (190 knees with 23 bilateral cases), were recruited prospectively and randomly assigned, with 91 knees receiving the RP and 99 knees receiving FB. The mean age was 65.5 years (48 to 82), the mean body mass index (BMI) was 29.7 kg/m2 (20 to 52) and 73 patients were female. The Knee Society Score (KSS), Knee Society Functional Score (KSFS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and 12-Item Short-Form Health Survey Physical and Mental Component Scores (SF-12 PCS, SF-12 MCS) were gathered and recorded preoperatively, at five-years' follow-up, and at ten years' follow-up. Additionally, Knee Injury and Osteoarthritis Outcome Scores (KOOS) were collected at five- and ten-year follow-ups. The prevalence of radiolucent lines (RL) on radiographs and implant survival were recorded at five- and ten-year follow-ups. RESULTS At the ten-year follow-up, the RP group (n = 39) had a statistically significant superior score in the OKS (p = 0.001), WOMAC (p = 0.023), SF-12 PCS (p = 0.019), KOOS Activities of Daily Living (ADL) (p = 0.010), and KOOS Sport and Recreation (Sport/Rec) (p = 0.006) compared with the FB group (n = 46). The OKS, SF-12 PCS, and KOOS Sport/Rec at ten years had mean scores above the minimal clinically important difference (MCID) threshold. There was no significant difference in prevalence of radiolucency between groups at five-years' follow-up (p = 0.449), nor at ten-years' follow-up (p = 0.08). Implant survival rate at 14 years postoperative was 95.2 (95% CI 90.7 to 99.8) and 94.7 (95% CI 86.8 to 100.0) for the RP and FB TKAs, respectively. CONCLUSION At ten-year follow-up, the mobile-bearing knee joint arthroplasty had statistically and clinically relevant superior OKS, SF-12 PCS, and KOOS (Sport/Rec) than the fixed-bearing platform. No difference was seen in prevalence of radiolucent lines. There was a greater than 94% implant survival rate for both cohorts at 14 years. Cite this article: Bone Joint J 2018;100-B:1336-44.
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Affiliation(s)
- A J Powell
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
| | - E Crua
- Department of Trauma and Orthopaedic Surgery, Ascot Hospital, Auckland, New Zealand
| | - B C Chong
- University of Auckland, School of Medicine, Auckland, New Zealand
| | - R Gordon
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
| | - A McAuslan
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
| | - R P Pitto
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
| | - M G Clatworthy
- Department of Trauma and Orthopaedic Surgery, Middlemore and Ascot Hospitals, Auckland, New Zealand
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19
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Comparison of Kinematics in Cruciate Retaining and Posterior Stabilized for Fixed and Rotating Platform Mobile-Bearing Total Knee Arthroplasty with respect to Different Posterior Tibial Slope. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5139074. [PMID: 29992149 PMCID: PMC6016153 DOI: 10.1155/2018/5139074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022]
Abstract
Reconstructed posterior tibial slope (PTS) plays a significant role in kinematics restoration after total knee arthroplasty (TKA). However, the effect of increased and decreased PTS on prosthetic type and design has not yet been investigated. We used a finite element model, validated using in vitro data, to evaluate the effect of PTS on knee kinematics in cruciate-retaining (CR) and posterior-stabilized (PS) fixed TKA and rotating platform mobile-bearing TKA. Anterior-posterior tibial translation and internal-external tibial rotation were investigated for PTS ranging from -3° to 15°, with increments of 1°, for three different designs of TKA. Tibial posterior translation and external rotation increased as the PTS increased in both CR and PS TKAs. In addition, there was no remarkable difference in external rotation between CR and PS TKAs. However, for the mobile-bearing TKA, PTS had less effect on the kinematics. Based on our computational simulation, PTS is the critical factor that influences kinematics in TKA, especially in the CR TKA. Therefore, the surgeon should be careful in choosing the PTS in CR TKAs.
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20
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Heesterbeek PJC, van Houten AH, Klenk JS, Eijer H, Christen B, Wymenga AB, Schuster AJ. Superior long-term survival for fixed bearing compared with mobile bearing in ligament-balanced total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1524-1531. [PMID: 28389879 DOI: 10.1007/s00167-017-4542-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/04/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Only few long-term data on ligament-balanced cruciate-retaining total knee arthroplasty (CR TKA) are currently available. Either a mobile- or fixed-bearing insert can be chosen, which showed good mid-term outcome and few complications and revisions. This multi-centre retrospective cross-sectional cohort study investigated the 12-year results of primary TKA using a balancing gap technique and compared survival and clinical outcome between fixed and mobile inserts. METHODS In this retrospective cross-sectional cohort study, 557 cases of three clinics (2 Swiss, 1 Dutch) operated between 1998 and 2003 with the first series of a TKA implanted with a balanced gap technique (433 (77.7%) fixed, 124 (22.3%) mobile (anterior-posterior gliding (7-9 mm) and rotational (15°) degrees of freedom) inserts) were included for survival analysis (Kaplan-Meier, by insert type). At the 12-year follow-up (FU) examination of 189 cases, range of motion, knee society score (KSS), numeric rating scale (NRS) for pain and satisfaction were determined and radiographs were evaluated by median tests, by insert type. RESULTS Of 521 cases available for analysis, 28 (5.4%; 11 fixed, 17 mobile bearing) were revised. Mean cumulative survival after 12.4 years was 97.0% (95% CI 94.7-98.4) for fixed bearings and 85.4% (95% CI 77.5-90.7) after 12.2 years for mobile bearings, p < 0.0001. Patients' mean age at 11.0 years FU (n = 189) was 78.0 (range 54.5-97.3) years. Mean total KSS was 157.8 (24-200) points, and mean passive flexion was 114° (45-150); no clinical score differed significantly between fixed and mobile bearings. CONCLUSION This study showed a superior survival for fixed bearing compared with mobile bearing in a CR TKA using a ligament-balanced technique after more than 12 years. Clinical outcomes are excellent to good after long-term follow-up, and similar for fixed and mobile bearing. LEVEL OF EVIDENCE Therapeutic studies-retrospective cohort study, Level III.
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Affiliation(s)
| | | | - J S Klenk
- Orthopädische Klinik orthosiloah Bern-Gümligen, Bern, Switzerland
| | - H Eijer
- Regionalspital Emmental AG, Burgdorf, Switzerland
| | - B Christen
- Orthopädische Klinik Bern, Bern, Switzerland
| | - A B Wymenga
- Sint Maartenskliniek, Nijmegen, The Netherlands
| | - A J Schuster
- Orthopädische Klinik orthosiloah Bern-Gümligen, Bern, Switzerland
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21
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Brockett CL, Carbone S, Fisher J, Jennings LM. Influence of conformity on the wear of total knee replacement: An experimental study. Proc Inst Mech Eng H 2018; 232:127-134. [PMID: 29251167 PMCID: PMC5808816 DOI: 10.1177/0954411917746433] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 10/26/2017] [Indexed: 11/21/2022]
Abstract
Wear of total knee replacement continues to be a significant factor influencing the clinical longevity of implants. Historically, failure due to delamination and fatigue directed design towards more conforming inserts to reduce contact stress. As new generations of more oxidatively stable polyethylene have been developed, more flexibility in bearing design has been introduced. The aim of this study was to investigate the effect of insert conformity on the wear performance of a fixed bearing total knee replacement through experimental simulation. Two geometries of insert were studied under standard gait conditions. There was a significant reduction in wear with reducing implant conformity. This study has demonstrated that bearing conformity has a significant impact on the wear performance of a fixed bearing total knee replacement, providing opportunities to improve clinical performance through enhanced material and design selection.
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Affiliation(s)
- Claire L Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Silvia Carbone
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Louise M Jennings
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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22
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Kim YH, Park JW, Kim JS. Comparison of High-Flexion Fixed-Bearing and High-Flexion Mobile-Bearing Total Knee Arthroplasties-A Prospective Randomized Study. J Arthroplasty 2018; 33:130-135. [PMID: 28844767 DOI: 10.1016/j.arth.2017.07.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is none, to our knowledge, about comparison of high-flexion fixed-bearing and high-flexion mobile-bearing total knee arthroplasties (TKAs) in the same patients. The purpose of this study was to determine whether clinical results; radiographic and computed tomographic scan results; and the survival rate of a high-flexion mobile-bearing TKA is better than that of a high-flexion fixed-bearing TKA. METHODS The present study consisted of 92 patients (184 knees) who underwent same-day bilateral TKA. Of those, 17 were men and 75 were women. The mean age at the time of index arthroplasty was 61.5 ± 8.3 years (range 52-65 years). The mean body mass index was 26.2 ± 3.3 kg/m2 (range 23-34 kg/m2). The mean follow-up was 11.2 years (range 10-12 years). RESULTS The Knee Society knee scores (93 vs 92 points; P = .531) and function scores (80 vs 80 points; P = 1.000), WOMAC scores (14 vs 15 points; P = .972), and UCLA activity scores (6 vs 6 points; P = 1.000) were not different between the 2 groups at 12 years follow-up. There were no differences in any radiographic and CT scan parameters between the 2 groups. Kaplan-Meier survivorship of the TKA component was 98% (95% confidence interval, 93-100) in the high-flexion fixed-bearing TKA group and 99% (95% confidence interval, 94-100) in the high-flexion mobile-bearing TKA group 12 years after the operation. CONCLUSION We found no benefit to mobile-bearing TKA in terms of pain, function, radiographic and CT scan results, and survivorship. Longer-term follow-up is necessary to prove the benefit of the high-flexion mobile-bearing TKA over the high-flexion fixed-bearing TKA.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Centers, Ewha Womans University, SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Centers, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Centers, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
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Influence of Component Rotation in Total Knee Arthroplasty on Tibiofemoral Kinematics-A Cadaveric Investigation. J Arthroplasty 2017; 32:2869-2877. [PMID: 28434698 DOI: 10.1016/j.arth.2017.03.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Physiological tibiofemoral kinematics have been shown to be important for good knee function after total knee arthroplasty (TKA). The purpose of the present study was to investigate the influence of component rotation on tibiofemoral kinematics during knee flexion. We asked which axial component alignment best reconstructs physiological tibiofemoral kinematics and which combinations should be avoided. METHODS Ten healthy cadaveric knees were examined. By means of a navigational device, tibiofemoral kinematics between 0° and 90° of flexion were assessed before and after TKA using the following different rotational component alignment: femoral components: ligament balanced, 6° internal, 3° external rotation, and 6° external rotation in relation to the posterior condylar line; tibial components: self-adapted, 6° internal rotation, and 6° external rotation. RESULTS Physiological tibiofemoral kinematics could be partly reconstructed by TKA. Ligament-balanced femoral rotation and 6° femoral external rotation both in combination with 6° tibial component external rotation, and 3° femoral external rotation in combination with 6° tibial component internal rotation or self-aligning tibial component were able to restore tibial longitudinal rotation. Largest kinematical differences were found for the combination femoral component internal and tibial component external rotations. CONCLUSION From a kinematic-based view, surgeons should avoid internal rotation of femoral components. However, even often recommended combinations of rotational component alignment (3° femoral external and tibial external rotation) significantly change tibiofemoral kinematics. Self-aligning tibial components solely restored tibiofemoral kinematics with the combination of 3° femoral component of external rotation. For the future, navigational devices might help to axially align components to restore patient-specific and natural tibiofemoral kinematics.
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Jin C, Song EK, Prakash J, Kim SK, Chan CK, Seon JK. How Much Does the Anatomical Tibial Component Improve the Bony Coverage in Total Knee Arthroplasty? J Arthroplasty 2017; 32:1829-1833. [PMID: 28109759 DOI: 10.1016/j.arth.2016.12.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/05/2016] [Accepted: 12/20/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recently, anatomical designs in total knee arthroplasty are introduced to address asymmetry of the resected tibia cutting surface. It is still not well known how much improvement would be achieved in total knee arthroplasty, especially in Asian knees. METHODS We evaluated the bony coverage of 4 commercially available posterior-stabilized tibial designs (3 symmetrical: NexGen, Attune, and Vega; 1 anatomical: Persona) by measuring uncovered areas over 3 different regions: lateroposterior (LP), medioposterior (MP), and mediolateral (ML) areas. The implant size was chosen based on lateral anteroposterior dimension of the implant that most closely matched the corresponding surface of tibia. The knee with over coverage <1 mm and under coverage <2 mm was regarded as having optimal fit. RESULTS The optimal fit of anatomical design in LP dimension was achieved in 76% of the cases, which was not significantly different from other symmetrical designs (P > .05). The anatomical tibial implant had a more optimal fit in MP and ML dimensions (48% and 42%, respectively) compared to all symmetric designs (P < .05). All symmetrical tibial designs had significant absolute underhang in MP (62%-78%) and ML (24%-34%) areas without difference. The anatomical tibial design had significant improvement for posteromedial coverage by about 69.8%-74.3% compared with the symmetrical designs. CONCLUSION Recently introduced anatomical tibial design improves surface coverage at the medioposterior dimension in Asian knees. Moreover, there is small improvement in ML fit compared with the symmetrical designs.
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Affiliation(s)
- Cheng Jin
- Center for Joint Disease, Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea; Department of Orthopedic Surgery, Chinese People's Armed Police Force, Zhejiang Corps Hospital, Jiaxing, China
| | - Eun-Kyoo Song
- Center for Joint Disease, Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jatin Prakash
- Center for Joint Disease, Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Sung-Kyu Kim
- Center for Joint Disease, Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Chee Ken Chan
- Center for Joint Disease, Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jong-Keun Seon
- Center for Joint Disease, Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Murakami K, Hamai S, Okazaki K, Ikebe S, Nakahara H, Higaki H, Shimoto T, Mizu-Uchi H, Kuwashima U, Iwamoto Y. Kinematic analysis of stair climbing in rotating platform cruciate-retaining and posterior-stabilized mobile-bearing total knee arthroplasties. Arch Orthop Trauma Surg 2017; 137:701-711. [PMID: 28289890 DOI: 10.1007/s00402-017-2662-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of our study was to compare and contrast the effects of two types of mobile-bearing total knee arthroplasties (TKA), namely, the cruciate-retaining (CR) and posterior-stabilized (PS) TKAs, on clinical outcomes and in vivo kinematics during stair climbing. MATERIALS AND METHODS The Press-Fit Condylar Sigma rotating platform was used for both CR and PS TKAs. Patient-reported outcomes were assessed using the 2011 Knee Society Score. Quadriceps muscle strength was evaluated by isokinetic dynamometry. In vivo kinematics were evaluated using periodic sagittal plane radiographic images obtained during stair climbing to quantify anteroposterior (AP) tibiofemoral translation, implant flexion and axial rotation angles using image-matching techniques. Outcomes were evaluated in 20 TKAs, which had been undergone with clinical success, including ten knees with CR types and ten knees with PS types. RESULTS There were no significant differences between the CR and PS TKA groups (p > 0.05) in isometric extensor torque (1.0 ± 0.2 and 1.1 ± 0.6 N m/kg, respectively) or patient-reported score for stair climbing function (4.0 ± 0.5 and 3.8 ± 0.9, respectively). Both types of TKAs showed stable AP translation in the mid range of knee flexion and paradoxical translation in the low range of flexion, with limited rotation, during stair climbing. There were no significant differences between the CR and PS TKA groups (P > 0.05) in anterior translation from 80° to 40° of knee flexion (4.2 ± 1.2 and 3.5 ± 1.6 mm, respectively), posterior translation from 40° to 10° of knee flexion (2.3 ± 1.9 and 2.0 ± 1.5 mm, respectively), and total external rotation (2.8° ± 4.9° and 0.5° ± 5.0°, respectively). CONCLUSIONS Both CR and PS types of rotating platform mobile-bearing TKAs provided reproducible knee joint kinematics during stair climbing and equivalent clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Koji Murakami
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Katai Orthopaedic Hospital, 132-1 Okuma Kasuya-machi, Kasuya-gun, Fukuoka, 811-2302, Japan
| | - Satoru Ikebe
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Hiroyuki Nakahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Takeshi Shimoto
- Department of Information and Systems Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka, 811-0295, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Zürcher AW, Stiehl JB, Pöll RG. Low-Contact-Stress Knee Arthroplasty: Past History or Ahead of Time? Orthopedics 2016; 39:e402-12. [PMID: 27135454 DOI: 10.3928/01477447-20160427-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/25/2015] [Indexed: 02/03/2023]
Abstract
Low-contact-stress mobile-bearing (MB) total knee arthroplasty (TKA) can rely on a long history. Its concept comprises a combination of high condylar congruency and compensatory bearing rotation to promote load sharing. However, other MB designs have become available, and critical points have been raised about the benefit of MB in general. Although there is kinematic and kinetic support for the low-contact-stress concept, there is no tribologic or clinical proof of its superiority over fixed-bearing concepts. Further study should be controlled for differences in polyethylene quality and need to provide a measure of condylar congruency to differentiate authentic low-contact-stress variants form others. [Orthopedics. 2016; 39(3):e402-e412.].
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Angelini FJ, Helito CP, Veronesi BA, Guimarães TM, Pécora JR, Demange MK. KNEE ARTHROPLASTY REVISION WITH A CONSTRAINED IMPLANT USING HINGE AND ROTATING TIBIAL BASIS. ACTA ORTOPEDICA BRASILEIRA 2016; 24:22-6. [PMID: 26997909 PMCID: PMC4775484 DOI: 10.1590/1413-785220162401153984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: To evaluate the results of total knee arthoplasty revisions performed in high complexity cases, with large bone defects or serious ligament deficiencies using a constrained implant hinge associated to a rotating tibial basis. Methods: We evaluated 11 patients in which we used the constrained implant hinge associated to rotating tibial basis, with minimum follow-up of two years. The indications for the procedure included instability, septic loosening, late postoperative infection without loosening and periprosthetic fracture. We evaluated the knee range of movement and functional outcomes by the Knee Society Score (KSS) e Knee Injury and Osteoarthritis Outcome Score (KOOS), besides the presence of complications. Results: All patients achieved 5o to 85o minimum range of motion at 1 year postoperatively and, in the present evaluation, KSS ranged from 67 to 95. Three patients had no complications until the last evaluation and two patients required implant revision. Conclusion: Despite the complications rate observed, the functional result were acceptable for most patients, and it proved being a viable alternative, especially for patients with low functional demand. Level of Evidence IV, Case Series.
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Lee WC, Kwan YH, Yeo SJ. Severe Bilateral Fixed Flexion Deformity-Simultaneous or Staged Total Knee Arthroplasty? J Arthroplasty 2016; 31:128-31. [PMID: 26404849 DOI: 10.1016/j.arth.2015.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 02/01/2023] Open
Abstract
Outcomes of 29 simultaneous (SimBTKA) and 38 staged bilateral total knee arthroplasty (StaBTKA) subjects with severe (≥16°) bilateral fixed flexion deformity (FFD) were retrospectively investigated. SimBTKA patients were significantly younger (63 ± 8 vs 68 ± 7, P > .01). At 2 years, SimBTKA subjects had significantly better residual FFD (2.5° ± 5.1° vs 5.4° ± 6.6°, P = .02) and Knee Society function score (75.7 ± 25.7 vs 69.3 ± 24.1, P = .02). However, Knee Society knee scores, Oxford Knee Scores, and Short Form-36 scores were similar. These suggest no large clinical advantage of SimBTKA over StaBTKA. We feel that severe bilateral FFD is not an absolute indication for SimBTKA.
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Affiliation(s)
- Wu Chean Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yu Heng Kwan
- Centre of Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Republic of Singapore; Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Republic of Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Kim DK, Seo MC, Song SJ, Kim KI. Are Korean Patients Different from Other Ethnic Groups in Total Knee Arthroplasty? Knee Surg Relat Res 2015; 27:199-206. [PMID: 26675374 PMCID: PMC4678240 DOI: 10.5792/ksrr.2015.27.4.199] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 01/14/2023] Open
Abstract
Most of the implants used for total knee arthroplasty (TKA) in Asian patients have been produced based on anthropometry of Western people. Since anatomic features and life styles are different between Western and Eastern people, there would be ethnic differences in terms of conformity of implants to the patient's anatomy or clinical results after TKA. Therefore, surgeons in Asia are particularly interested in related surgical techniques and implant designs used in TKA for improved clinical results and patient satisfaction. In this review, we investigated the anthropometric differences of Koreans from Westerners. Koreans are of shorter stature, less weight, and smaller skeletal structure and have a higher incidence of constitutional varus alignment of the lower extremity. Moreover, compared to Westerner TKA populations, the proportion of female patients was large and primary osteoarthritis was prevalent in preoperative diagnosis in Korean TKA patients. Culturally, Koreans have life styles that demand high flexion positions of the knee such as squatting, kneeling, and cross-legged sitting. Although there were no notable differences in the complication and revision rates following TKA between Westerners and Koreans, the incidence of postoperative deep vein thrombosis and pulmonary thromboembolism was lower in Koreans than Westerners. We hope that further research on implant designs and more interest in TKA will improve outcomes in Korean patients.
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Affiliation(s)
- Dong-Kyoon Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Min-Chul Seo
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Joon Song
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea. ; Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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