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Zhou H, Wu ZR, Chen XY, Zhang LS, Zhang JC, Hidig SM, Feng S, Yang Z. Does mild flexion of the femoral prosthesis in total knee arthroplasty result in better early postoperative outcomes? BMC Musculoskelet Disord 2023; 24:711. [PMID: 37674188 PMCID: PMC10483864 DOI: 10.1186/s12891-023-06840-w] [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: 03/21/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The purpose of this study was to measure the femoral prosthesis flexion angle (FPFA) in total knee arthroplasty (TKA) using three-dimensional reconstruction, and to assess the differences in early clinical efficacy between patients with different degrees of flexion. METHODS We conducted a prospective cohort study. From June 2019 to May 2021, 113 patients admitted for TKA due to osteoarthritis of the knee were selected. The patients' postoperative knee joints were reconstructed in three dimensions according to postoperative three-dimensional computed tomography (CT) scans. The FPFA was measured, and the patients were divided into 4 groups: anterior extension group (FPFA < 0°), mildly flexed group (0° ≤ FPFA < 3°), moderately flexed group (3° ≤ FPFA < 6°) and excessively flexed group (6° ≤ FPFA). The differences in the Knee Society Score (KSS), knee Range of Motion (ROM), and visual analogue scale (VAS) scores were measured and compared between the four groups at each postoperative time point. RESULTS Postoperative KSS, ROM, and VAS were significantly improved in all groups compared to the preoperative period. At 1 year postoperatively, the ROM was significantly greater in the mildly flexed group (123.46 ± 6.51°) than in the anterior extension group (116.93 ± 8.05°) and the excessively flexed group (118.76 ± 8.20°) (P < 0.05). The KSS was significantly higher in the mildly flexed group (162.68 ± 12.79) than in the other groups at 6 months postoperatively (P < 0.05). The higher KSS (174.17 ± 11.84) in the mildly flexed group was maintained until 1 year postoperatively, with a statistically significant difference (P < 0.05). No significant difference in VAS scores was observed between groups at each time point. CONCLUSIONS A femoral prosthesis flexion angle of 0-3° significantly improved postoperative knee mobility, and patients could obtain better Knee Society Scores after surgery, which facilitated the postoperative recovery of knee function. TRIAL REGISTRATION ChiCTR2100051502, 2021/09/24.
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Affiliation(s)
- Hang Zhou
- Department of Orthopedics, The People’s Hospital of Rugao, Rugao, 226500 Jiangsu China
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Ze-Rui Wu
- Department of Orthopedics, Central Laboratory, Changshu Hospital Affiliated to Soochow University, First People’s Hospital of Changshu City, Changshu, 215500 Jiangsu China
| | - Xiang-Yang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Le-Shu Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Jin-Cheng Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Sakarie Mustafe Hidig
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Shuo Feng
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
| | - Zhi Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002 Jiangsu China
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He R, Sun M, Xiong R, Yang J, Guo L, Yang L. Semiactive robotic-arm system versus patient-specific instrumentation in primary total knee arthroplasty: Efficacy and accuracy. Asian J Surg 2023; 46:742-750. [PMID: 35835672 DOI: 10.1016/j.asjsur.2022.06.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare the difference in efficacy and accuracy during total knee arthroplasty (TKA) among robotic-arm system, patient-specific instrumentation (PSI) and conventional TKA (COTKA). METHODS Retrospective analysis of 90 advanced knee osteoarthritis (OA) patients in our hospital between June 2019 and December 2020 was conducted. Patients were divided into robotic arm-assisted (RA)TKA (group A), PSITKA (group B) and COTKA (group C), 30 cases in each group. The operation time, intraoperative bleeding, and length of hospital stay were counted. Imaging data of hip-knee-ankle angle (HKA), posterior condylar angle (PCA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and sagittal tibial component angle (sTCA) were statistically analyzed. The postoperative recovery of the patients was evaluated by Knee Society Score (KSS) and the Western Ontario Mac Master University Index Score (WOMAC). RESULTS Group A had the least intraoperative bleeding. For operation time, group A was the longest compared with group B and group C (P < 0.05), while group B was longer than group C (P < 0.05). There was no significant difference in HKA, LDFA, and MPTA among the three groups, and the lower limb alignments were all restored to the neutral position. PCA of group A and B were both smaller than that of group C and closer to 0° (P < 0.05), but the difference between group A and B was not statistically significant. The sTCA in group A was significantly better than group B, and group B was significantly better than group C (P < 0.05). There were no significant differences in function scores among the three groups. CONCLUSION Compared to the PSI and CO, RA is more minimally invasive and more accurate in radiographic results.
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Affiliation(s)
- Rui He
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Maolin Sun
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Ran Xiong
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Junjun Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Zeng X, Yang Y, Jia Z, Chen J, Shen H, Jin Y, Lu Y, Li P. The position of entry point in total knee arthroplasty is associate with femoral bowing both in coronal and sagittal planes. Front Surg 2022; 9:935840. [PMID: 35923443 PMCID: PMC9339686 DOI: 10.3389/fsurg.2022.935840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the femoral entry point of the intramedullary (IM) guiding rod applied to total knee arthroplasty (TKA) in Chinese subjects and the relationship with femoral bowing in the coronal and sagittal planes through three-dimensional (3D) validation methods. Methods Computed tomography (CT) images of 80 femurs in Chinese subjects were imported into Mimics 19.0 to construct 3D models. All operations were conducted by Rhinoceros software 5.0. The position of the IM rod entry point was assessed by calculating the distance between the entry point and the apex of the intercondylar notch (AIN) in the coronal and sagittal planes. The coronal femoral bowing angle (cFBA) and sagittal femoral bowing angle (sFBA) were also measured. Results The average optimal entry point was 0.17 mm medial and 12.37 mm anterior to the AIN in males, while it was 0.02 mm lateral and 16.13 mm anterior to the AIN in females. There was a significant difference between males and females in the sagittal plane (t = -6.570, p = 0.000). The mean cFBA was 1.68 ± 2.29°, and the mean sFBA was 12.66 ± 1.98°. The sFBA was strongly correlated with the anterior distance of the proper entry point, and the cFBA was moderately correlated with the lateral distance of the proper entry point. Conclusions There was a strong correlation between the position of the entry point and the femoral bowing angle in both the coronal and sagittal planes. Thus, to achieve better alignment, the position of the entry point should be measured individually based on femoral bowing.
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Affiliation(s)
- Xianli Zeng
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yiming Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Zhenyu Jia
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Jiarong Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hongyuan Shen
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yan Jin
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yao Lu
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- Department of Joint and Orthopedics, Orthopedic Center, Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Correspondence: Yao Lu Pingyue Li
| | - Pingyue Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- Correspondence: Yao Lu Pingyue Li
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Sun M, Yang L, Guo L, He R. [Effect of robotic-arm assisted total knee arthroplasty on femoral rotation alignment and its short-term effectiveness]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:807-812. [PMID: 34308585 DOI: 10.7507/1002-1892.202102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the improvement of femoral rotation alignment in total knee arthroplasty (TKA) by robotic-arm assisted positioning and osteotomy and its short-term effectiveness. Methods Between June 2020 and November 2020, 60 patients (60 knees) with advanced osteoarthritis of the knee, who met the selection criteria, were selected as the study subjects. Patients were randomly divided into two groups according to the random number table method, with 30 patients in each group. Patients were treated with robotic-arm assisted TKA (RATKA) in trial group, and with conventional TKA in control group. There was no significant difference in gender, age, side and course of osteoarthritis, body mass index, and the preoperative hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior condylar angle (PCA), knee society score-knee (KSS-K) and KSS-function (KSS-F) scores between the two groups ( P>0.05). The clinical (KSS-K, KSS-F scores) and imaging (HKA, LDFA, MPTA, PCA) evaluation indexes of the knee joints were compared between the two groups at 3 months after operation. Results All patients were successfully operated. The incisions in the two groups healed by first intention, with no complications related to the operation. Patients in the two groups were followed up 3-6 months, with an average of 3.9 months. KSS-K and KSS-F scores of the two groups at 3 months after operation were significantly higher than those before operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). X-ray re-examination showed that the prosthesis was in good position, and no prosthesis loosening or sinking occurred. HKA, MPTA, and PCA significantly improved in both groups at 3 months after operation ( P<0.05) except LDFA. There was no significant difference in HKA, LDFA, and MPTA between the two groups ( P>0.05). PCA in trial group was significantly smaller than that in control group ( t=2.635, P=0.010). Conclusion RATKA can not only correct knee deformity, relieve pain, improve the quality of life, but also achieve the goal of restoring accurate femoral rotation alignment. There was no adverse event after short-term follow-up and the effectiveness was satisfactory.
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Affiliation(s)
- Maolin Sun
- Center for Joint Surgery, the First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, 400038, P.R.China
| | - Liu Yang
- Center for Joint Surgery, the First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, 400038, P.R.China
| | - Lin Guo
- Center for Joint Surgery, the First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, 400038, P.R.China
| | - Rui He
- Center for Joint Surgery, the First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, 400038, P.R.China
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Ou YL, Li PY, Xia H. Optimal Sagittal Insertion Depth and Direction of Femoral Intramedullary Rod in Total Knee Arthroplasty in Chinese Osteoarthritis Patients. Orthop Surg 2020; 12:1238-1244. [PMID: 32677327 PMCID: PMC7454151 DOI: 10.1111/os.12753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/22/2020] [Accepted: 06/18/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To identify the optimal femoral intramedullary rod insertion depth and direction on the sagittal plane in total knee arthroplasty (TKA) of Chinese osteoarthritis (OA) patients. Methods From January to December 2019, CT data were collected for 85 consecutive entire lower extremity Chinese OA patients. A three‐dimensional method was used to simulate intramedullary rod penetration. The intramedullary rods were inserted toward the anterior (TA), center (TC), and posterior (TP) of the femoral canal, respectively. Four penetration depths of 150, 200, 250, and 300 mm from the joint line were set. The intersection angle was measured between the simulated intramedullary rod and the mechanical axis of the femur (FMA) on the sagittal plane. Results Our study included 85 Chinese OA patients: 46 women, with a mean age of 65.7 ± 8.4 years (range, 51–85 years) and 39 men, with a mean age of 65.6 ± 8.1 years (range, 46–86 years). The intersection angle between the FMA and the femoral anatomical axis was smaller in men, 2.4° ± 1.6° (range, 0°–4.8°), than in women, 3.5° ± 2.3° (range, 0.7º–8.2°), with a significant statistical difference (P < 0.01). In the comparison of the intersection angle between the simulated intramedullary rod and the FMA, there was no statistical difference between TA200 and TC200 in women (P > 0.05). The proportions were up to 91% and 96% of TA200 at 0°–3° and 0°–5° intervals, respectively, but just 63% and 78% in TC200. In TA150, 76% of intersection angles were greater than 5°. Only approximately 60% in TA250 and TA300 were within the 0°–5° interval and 40% were less than 0°. Only 57% of intersection angles in TC150 were in the 0°–3° interval. TC250, TC300, and TP150 were mostly below 0°. In men, there were statistical differences between all groups. All intersection angles were greater than 5° in TA150. TA200 and TA250 were mostly greater than 5° (87% and 59%, respectively) and 72% of intersection angles were within 0°–5° interval in TA300. TC150 had 92% of intersection angles within the 0°–5° interval but only 62% between the 0° and 3° interval. In the TC200, up to 90% and 97% were within 0°–3° and 0°–5° intervals, respectively. TC300, TP150, and TP200 were mostly below 0°. Conclusion We described an innovative method for rapidly, simply, and accurately identifying the sagittal insertion depth and direction of the femoral intramedullary rod in TKA, which can optimize the position of the femoral prosthetic component on the sagittal plane in TKA.
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Affiliation(s)
- Yong-Liang Ou
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou, China
| | - Ping-Yue Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Hong Xia
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Guangdong Key Lab of Orthopaedic Technology and Implant, Guangzhou, China
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Sun ML, Zhang Y, Peng Y, Fu DJ, Fan HQ, He R. Accuracy of a Novel 3D-Printed Patient-Specific Intramedullary Guide to Control Femoral Component Rotation in Total Knee Arthroplasty. Orthop Surg 2020; 12:429-441. [PMID: 32087620 PMCID: PMC7189049 DOI: 10.1111/os.12619] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Total knee arthroplasty (TKA) is one of the most universal and effective means for treating terminal stage osteoarthritis (OA) of knee. Accurate intramedullary guide of femur is the basis for the distal femoral cuts. Determining the surgical transepicondylar axis (sTEA) is the key to reconstruction of the femoral rotational alignment, because the correct rotational alignment can place the femoral component in the right position, balance the flexion gap so that the inner and outer tension is equal, get stability during the flexion process of the knee, and enhance the quality of life of patients. With the development of three‐dimensional printing (3DP) technology in the medical domain, the application of patient‐specific instrumentation (PSI) in arthroplasty has become more common. The aim of this study was to evaluate the accuracy of a novel 3D‐printed patient‐specific intramedullary guide to control femoral component rotation in TKA. Methods Eighty patients (65 females and 15 males) with knee OA were included in this prospective randomized study. The patients were divided into two groups by random number table method, 40 in each group. TKA assisted by PSI (PSI group) and conventional TKA (conventional group) was performed respectively. Clinical outcomes [operation time, postoperative drainage volume, duration of drainage, Hospital for Special Surgery knee score (HSS), American Knee Society knee score (AKS)] and radiological outcomes [hip‐knee‐ankle angle (HKA), posterior condylar angle (PCA), patella transverse axis‐femoral transepicondylar axis angle (PFA), depth of intramedullary guide] were compared between and within the two groups. Results PSI group had less postoperative drainage volume but longer operation time than the conventional group (P < 0.05). The AKS and HSS scores after surgery were improved compared with those before surgery in each group (P < 0.05). However, there was no significant difference in the duration of drainage and range of motion (ROM) after surgery between the two groups. For the radiological results, the HKA and PFA were improved after surgery in both groups (P < 0.05).The postoperative PFA and PCA of the PSI group were closer to 0°, which was better than that of the conventional group (P < 0.05). The depth of intramedullary guide in the PSI group was less than the conventional group (P < 0.05). But there was no significant difference in HKA before and after surgery between the two groups as well as the preoperative PFA. Conclusion The short‐term clinical efficacy of TKA assisted by PSI was similar to the conventional TKA. Although TKA assisted by PSI spent more time during operation, it could assist in intramedullary guide and align femoral rotation more accurately.
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Affiliation(s)
- Mao-Lin Sun
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Peng
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - De-Jie Fu
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua-Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Rui He
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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