|
1
|
Rao RP, Lim ATT, Ho JPY, Ong LH, Kamaruddin F. An MRI-Derived Formula for Estimating the Native Joint Line Position in the Presence of Distal Femoral Bone Loss. Cureus 2024; 16:e73707. [PMID: 39677165 PMCID: PMC11646141 DOI: 10.7759/cureus.73707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2024] [Indexed: 12/17/2024] Open
Abstract
Background In the presence of distal femoral condyle bone loss, estimation and restoration of the joint line (JL) position can be guided by extraarticular bony landmarks with the aid of mathematical formulas that rely on the innate correlations between periarticular measurements. To prevent JL elevation, the formula should incorporate the thickness of distal femoral articular cartilage. The aim of this study was to derive a formula to estimate native JL position. Methods One hundred and fifty knee magnetic resonance imaging (MRI) studies belonging to 150 patients were chosen from a database of scans. Multiple periarticular measurements were taken. Based on the strongest correlation between measurements, linear regression analysis was used to derive a regression equation to estimate the JL position. This formula was then tested to determine its accuracy and reliability in estimating the JL. Results Using the Pearson correlation test, the strongest correlation was identified to be between adductor tubercle to joint line distance (ATJL) and transepicondylar width (TEW) with r = 0.723, p <.001. Using linear regression analysis, the following regression equation was obtained: ATJL in millimetres = 0.53 (TEW in millimetres) + 2.4mm. This formula estimated the JL within 4 mm of the native JL in 86% of measured knees and within 8 mm in 100% of measured knees. The mean difference between calculated ATJL and measured ATJL was 2.43 mm with a standard deviation of 1.94 mm. Conclusion The current formula (ATJL = 0.53(TEW) + 2.4mm) reliably estimates native JL distance from the adductor tubercle (AT) to within a clinically significant range, using femoral TEW.
Collapse
Affiliation(s)
- Reuben P Rao
- Department of Orthopaedics, Sarawak General Hospital, Kuching, MYS
| | | | - Jade Pei Yuik Ho
- Department of Orthopaedics, Kuala Lumpur Hospital, Kuala Lumpur, MYS
| | - Lik Han Ong
- Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kuching, MYS
| | - Faris Kamaruddin
- Department of Orthopaedics, Sarawak General Hospital, Kuching, MYS
| |
Collapse
|
|
2
|
Hirakawa M, Miyazaki M, Sato M, Kaku N. Prediction of Distal Femoral and Posterior Articular Surfaces in Total Knee Arthroplasty With Severe Bone Defects Using Computed Tomography-Based Templating Software. Cureus 2024; 16:e61546. [PMID: 38962584 PMCID: PMC11219248 DOI: 10.7759/cureus.61546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Optimal repair of the joint line (JL) in total knee arthroplasty (TKA) is critical for knee joint motion reconstruction and ligament balance. Identification of JL may be difficult, particularly in revision or primary cases of severe femoral condylar bone loss. We aimed to define the relationship between the epicondyles and the articular surface (AS) of the femur using computed tomography-based three-dimensional digital templating software. Methods The study included 127 knees with osteoarthritis of the knee below grade 2 on the Kellgren-Lawrence index. A perpendicular line was drawn from the medial and lateral femoral epicondylar processes to the most distal point of the AS, and the distance was measured in the axial and coronal planes. Femoral width was measured as the distance between the medial and lateral epicondyles. All distances described above were converted to a ratio by division with femoral width. Results On the axial plane, the distance from epicondyles to the posterior ASs was 29.4 ± 2.2 mm medially and 21.3 ± 2.1 mm laterally. The width of the distal femur was 75.2 ± 4.2 mm. On the coronal plane, the distances from epicondyles to the distal ASs were 25.2 ± 2.9 mm on the medial side and 21.3 ± 2.5 mm on the lateral side. The ratio of the distance from epicondyles to the distal and posterior ASs divided by the width of the femur was 0.39 ± 0.02, 0.28 ± 0.03, 0.34 ± 0.03, and 0.28 ± 0.03. Conclusions The distance from the epicondyles to the distal and posterior JLs correlates with the distal femur width. These findings may be useful in determining an appropriate JL.
Collapse
Affiliation(s)
| | | | - Miyuki Sato
- Orthopaedic Surgery, Miyuki Clinic, Oita, JPN
| | | |
Collapse
|
|
3
|
Hou Y, Jiang J, Liu H, Wang R, Wu J, Wang Y, Lin J. Identification of the joint line in revision total knee arthroplasty using a multiple linear regression model: a cadaveric study. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04792-3. [PMID: 36971801 DOI: 10.1007/s00402-023-04792-3] [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: 08/20/2022] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The results of revision total knee arthroplasty (rTKA) may be compromised by excessive joint line (JL) elevation. It is critical but challenging in reestablishing the JL in rTKA. Previous studies have confirmed that, biomechanically and clinically, JL elevation should not exceed 4 mm. Image-based studies described several approaches to locate the JL intraoperatively, however magnification errors could occur. In this cadaveric study, we aim to define an accurate and reliable method to determine the JL. MATERIALS AND METHODS Thirteen male and eleven female cadavers were used, with an average age of death being 48.3 years. The transepicondylar width (TEW), the distance from the medial (MEJL) and lateral (LEJL) epicondyle, adductor tubercle (ATJL), fibular head (FHJL) and tibial tubercle (TTJL) to the JL were measured in 48 knees. Intra- and interobserver reliability and validity were tested prior to any additional analysis. Pearson correlation and linear regression analysis were used to examine the correlations between landmark-JL distances (LEJL, MEJL, ATJL, FHJL and TTJL) and the TEW, and to further derive models for intraoperative JL determination. The accuracy of different models, quantified by errors between estimated and measured landmark-JL distances, was compared using the Friedman and post hoc Dunn tests. RESULTS The intra- and inter-observer measurements for TEW, MEJL, LEJL, ATJL, TTJL and FHJL did not differ significantly (p > 0.05). Between genders, significant differences were found on TEW, MEJL, LEJL, ATJL, FHJL and TTJL (p < 0.05). There was no association between TEW and either FHJL or TTJL (p > 0.05), while ATJL, MEJL, and LEJL were found to be correlated with TEW (p < 0.05). Six models were derived: (1) MEJL = 0.37*TEW (r = 0.384), (2) LEJL = 0.28*TEW (r = 0.380), (3) ATJL = 0.47*TEW (r = 0.608), (4) MEJL = 0.413*TEW - 4.197 (R2 = 0.473), (5) LEJL = 0.236*TEW + 3.373 (R2 = 0.326), (6) ATJL = 0.455*TEW + 1.440 (R2 = 0.556). Errors were defined as deviations between estimated and actual landmark-JL distances. The mean absolute value of the errors, created by Model 1-6 was 3.18 ± 2.25, 2.53 ± 2.15, 2.64 ± 2.2, 1.85 ± 1.61, 1.60 ± 1.59 and 1.71 ± 1.5, respectively. The error could be limited to 4 mm in 72.9%, 83.3%, 72.9%, 87.5%, 87.5%, and 93.8% of the cases by referencing Model 1-6, respectively. CONCLUSION Compared to previous image-based measurements, the current cadaveric study most closely resembles a realistic view of intraoperative settings and could circumvents magnification errors. We recommend using Model 6, the JL can be best estimated by referencing the AT and the ATJL can be calculated as ATJL (mm) = 0.455*TEW (mm) + 1.440 (mm).
Collapse
Affiliation(s)
- Yunfei Hou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Jun Jiang
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Han Liu
- Department of Orthopedics, Jin Xiang People's Hospital, Jining Medical University, No. 117, Jinfeng East Road, Jinxiang County, 272100, Shandong Province, People's Republic of China
| | - Ruikang Wang
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Jingyu Wu
- Department of Orthopedics, The Affiliated Zhengzhou Central Hospital of Zhengzhou University, 16 Tongbai North Road, Zhongyuan District, Zhengzhou City, 450000, Henan Province, People's Republic of China
| | - Yixiong Wang
- Department of Orthopedics, Jincheng General Hospital, Chang'an Road, Beishidian Town, Jincheng City, 048000, Shanxi Province, People's Republic of China
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
| |
Collapse
|
|
4
|
Tantavisut S, Amarase C, Ngarmukos S, Tanavalee C, Tanavalee A. Knee joint line related to bony landmarks of the knee: a radiologic study in a Thai population. Knee Surg Relat Res 2022; 34:5. [PMID: 35168654 PMCID: PMC8845375 DOI: 10.1186/s43019-022-00135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
During revision total knee arthroplasty (TKA), knee joint line restoration may be difficult due to bone loss or structural changes. Although bony landmarks are consistent and can be used as references, there are limited data in Asian patients. We studied the knee joint line related to bony landmarks of the knee in a Thai population.
Materials and methods
Magnetic resonance imaging (MRI) of 140 healthy knees of Thai patients (70 males, 70 females) were investigated. In all knees, a perpendicular line from knee joint line to the medial epicondyle (distance A) and the lateral epicondyle (distance B) in the coronal plane were measured. In the sagittal plane, a perpendicular line from the knee joint line to the fibular head (distance C), the tibial tubercle (distance D), and the inferior patellar pole (distance E) were measured. The femoral transepicondylar width (FW) was measured along the transepicondylar axis. The ratios of distances A, B, C, D, and E related to FW were evaluated (epicondylar ratio).
Results
The mean and standard deviation (SD) of distances A, B, C, D, E, and FW were 27.1 ± 2.7 mm, 21.7 ± 2.5 mm, 12.6 ± 3 mm, 21.3 ± 3.6 mm, 7.6 ± 4.8 mm, and 76.7 ± 3.99, respectively. There was wide variation of measured values, with statistically significant differences between genders in distances A, B, C, and FW. The mean and SD of epicondylar ratios A/FW, B/FW, C/FW, D/FW, and E/FW were 0.35 ± 0.02, 0.29 ± 0.02, 0.16 ± 0.05, 0.28 ± 0.04, and 0.09 ± 0.04, respectively. All epicondylar ratios demonstrated less variation than all measured distances, with statistical differences between genders in the A/FW and D/FW ratios. However, the B/FW ratio had the highest consistent mean value. In addition, it had narrower SD than the rest (0.29 ± 0.02; range, 0.22–0.33).
Conclusions
In Thai knees, the measured distances from bony landmarks to the knee joint line had higher variation than the epicondylar ratio. Among all studied epicondylar ratios, the ratio between lateral epicondyle to joint line distance (distance B)/FW demonstrated the narrowest range of mean and SD values; therefore, this could be the most reliable landmark for intraoperative knee joint line verification by multiplying the FW of the patient by 0.29 to get distance B in that patient.
Collapse
|
|
5
|
Gao Z, Mao X, Xiang C, Gao Y, Zhang X, Guo Z. An accurate method for locating the joint line during revision total knee arthroplasty: A radiologic study in the Chinese population. Knee 2021; 29:510-519. [PMID: 33756261 DOI: 10.1016/j.knee.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The systems for precisely locating the joint line during primary and revision total knee arthroplasty are still controversial, and they should be better evaluated in the Chinese population. METHODS A total of 451 standard anteroposterior knee radiographs from 451 healthy Chinese people (283 males and 168 females, the average age of 33.26 years, range 20-50 years) were included to measure the femoral width (FW) and the distances from the adductor tubercle (AT), the medial epicondyle (ME), the lateral epicondyle (LE), and the fibular head (FH) to the joint line (JL). Correlation between FW and distances from landmarks to the joint line was evaluated using Pearson correlation coefficient, and the ratios of ATJL, MEJL, LEJL, FHJL to FW were calculated. RESULTS The average distances from the AT, the ME, the LE, the FH to the JL were 49.4 ± 5.0 mm, 28.3 ± 3.1 mm, 26.9 ± 2.9 mm, 20.0 ± 4.0 mm, respectively. An excellent linear correlation was found between FW and the distance from AT to the joint line (R = 0.836, R2 = 0.698); it was more reliable than the LE (R = 0.686, R2 = 0.471) and the ME (R = 0.672, R2 = 0.452). The average ratios of ATJL/FW, MEJL/FW, LEJL/FW were 0.553, 0.317, and 0.302, respectively. There were significant differences between our results and the studies based on the Western people. CONCLUSION The AT can be used as a reliable landmark to locate the JL precisely by the formula (ATJL = 0.548 × FW in males; ATJL = 0.562 × FW in females) in the Chinese population. The LE and ME can be the second choices. Moreover, it may be better to use ratios from the research based on the same race.
Collapse
Affiliation(s)
- Zhenzhong Gao
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xingjia Mao
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chuan Xiang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, China.
| | - Yingjie Gao
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaopu Zhang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zijian Guo
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
|
6
|
Graulich T, Kranz C, Zhang D, Oergel M, Pacha TO, Haertle M, Omar M, Krettek C, Panzica M. Reduction of Patella-baja and Pseudo-patella-baja Does Not Improve Range of Motion in Patients After Mega-TKA. In Vivo 2020; 34:1153-1158. [PMID: 32354904 DOI: 10.21873/invivo.11887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Patella baja (PB) and pseudo-patella baja (PPB) have been shown to negatively influence outcomes after total knee arthroplasty. We hypothesized that there is a high incidence of PB and PPB after megaprosthetic total knee arthroplasty (M-TKA), and that this is associated with reduced range of motion. PATIENTS AND METHODS We retrospectively analysed all patients in our Orthopaedic Trauma Department after distal femur or proximal tibia replacement. Preoperative and one-year postoperative follow-up included measurement of range of motion and detection of PB and PPB using radiological indices. RESULTS We included 44 patients (age: 73±19 years). Preoperative PB detected by ISI could be reduced from 13 (36%) to 11 (25%) (p<0.01). Preoperative vs. postoperative ISI was 0.88±0.23 vs. 1.06±0.45 (p=0.03). PPB was observed preoperatively in 23 (63%) patients vs. 24 (54%) postoperatively. Preoperative vs. postoperative CDI was 0.70±0.24 vs. 0.95±0.43 (p=0.002). Preoperative flexion was 91°±30° vs. 85°±24° postoperatively (p>0.05). CONCLUSION Both PB and PPB are frequently observed after M-TKA. A reduction in PB and PPB alone does not improve postoperative range of motion.
Collapse
Affiliation(s)
- Tilman Graulich
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Caroline Kranz
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, U.S.A.,Brigham and Women's Hospital, Boston, MA, U.S.A
| | - Marcus Oergel
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Marco Haertle
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Martin Panzica
- Trauma Department, Hannover Medical School, Hannover, Germany
| |
Collapse
|
|
7
|
Sarpong NO, Sonnenfeld JJ, LiArno S, Rajaravivarma R, Donde S, Sneddon E, Kaverina T, Cooper HJ, Shah RP, Geller JA. Virtual reconstruction of the posterior cruciate ligament for mechanical testing of total knee arthroplasty implants. Knee 2020; 27:151-156. [PMID: 31761707 DOI: 10.1016/j.knee.2019.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/26/2019] [Accepted: 10/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) design continues to be refined. As part of the pre-clinical design process, kinematic evaluation under ideal circumstances must be simulated. Previously, this was accomplished mechanically through the use of elastomeric bumpers and human cadaver models, which can be costly and time-intensive. With improved technology, a six-axis joint simulator now allows for virtual ligament reconstruction. The aim of this study was to create and evaluate a virtual posterior cruciate ligament (PCL) model to simulate native knee kinematics for component testing in TKA. METHODS Three human cadaveric knee specimens were utilized, each mounted in a six-axis joint simulator and the femoral and tibial ligament insertion points digitized. Ligament stiffness and kinematics were first tested with the intact knee, followed by retesting after PCL transection. Knee kinematic testing was then repeated, and the virtual PCL was reconstructed until it approximated that of the intact knee by achieving less than 10% random mean square (RMS) error. RESULTS A virtual three-bundle PCL was created. The RMS error in anterior-posterior motion between the virtually reconstructed PCL and the intact knee ranged from six to eight percent for simulated stair climbing in the three knee specimens tested, all within our target goal of less than 10%. CONCLUSION This study indicated that a virtually reconstructed three-bundle PCL with a joint simulator can replicate knee kinematics. Such an approach is valuable to obtain clinically relevant kinematics when testing cruciate-retaining total knee arthroplasty under force control.
Collapse
Affiliation(s)
- Nana O Sarpong
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America.
| | - Julian J Sonnenfeld
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America
| | - Sally LiArno
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - Raga Rajaravivarma
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - Sonia Donde
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - Emily Sneddon
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - Tatyana Kaverina
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - H John Cooper
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America
| | - Roshan P Shah
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America
| | - Jeffrey A Geller
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America
| |
Collapse
|
|
8
|
Fan A, Xu T, Li X, Li L, Fan L, Yang D, Li G. Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study. J Orthop Surg Res 2018; 13:261. [PMID: 30340645 PMCID: PMC6194602 DOI: 10.1186/s13018-018-0963-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/02/2018] [Indexed: 12/04/2022] Open
Abstract
Background Restoring the normal joint line (JL) is an important goal to achieve in total knee arthroplasty (TKA). We intended to study the veracity of several landmarks used to level the normal JL in Chinese people. Methods Two hundred fifteen standard CT scans of knee joint were included to measure the distances from landmarks to distal JL (DJL) and posterior JL (PJL), along with femoral width (FW) in order to calculate the ratios. Landmarks included adductor tubercle (AT), medial epicondyle (ME), lateral epicondyle (LE), tibial tubercle (TT), fibular head (FH) and the inferior pole of the patella (IPP). Ratios were calculated between distances and FW (e.g. FHDJL/FW). Linear regression analysis and t test were used to determine the accuracy and the differences amongst sides of the leg, genders and races. Results The average of IPPDJL/FW, TTDJL/FW, FHDJL/FW, LEDJL/FW, LEPJL/FW, MEDJL/FW, MEPJL/FW, ATDJL/FW and ATPJL/FW were 0.165, 0.295, 0.232, 0.297, 0.281, 0.327, 0.3PJL, 0.558 and 0.313, respectively. No significant difference had been found between the left and right leg. A gender difference was only found statistically on the ratio of IPP, and also, no linear correlation was observed only between IPP and FW. Most of the difference values lain in a 4-mm threshold for MEDJL (95.81%), LEDJL (94.88%), MEPJL (97.21%), LEPJL (94.88%), ATPJL (93.49%) and ATDJL (100%). Significant differences were observed amongst different races. Conclusions AT, ME and LE can be used as reliable landmarks to locate the normal JL in Chinese population intraoperatively. It is meaningful to come up with a set of ratios to different races.
Collapse
Affiliation(s)
- Aoyuan Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Tongji University School of Medicine, Shanghai, China
| | - Tianyang Xu
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Tongji University School of Medicine, Shanghai, China
| | - Xifan Li
- Tongji University School of Medicine, Shanghai, China.,Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Lei Li
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Department of Neurosurgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Lin Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Tongji University School of Medicine, Shanghai, China
| | - Dong Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Tongji University School of Medicine, Shanghai, China
| | - Guodong Li
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China. .,Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
|
9
|
Abstract
The cases of revision total knee arthroplasty (TKA) are increasing. In this report, snapping phenomenon after final implantation of revision TKA has been presented. Snapping was caused by adhered iliotibial band (ITB) impinging against the lateral part of femoral component. Fractional lengthening the ITB by puncture resolved the snapping phenomenon. Surgeons should be aware of the presence of such a case which should be identified during operation to avoid secondary operations.
Collapse
Affiliation(s)
- Jae-Hyuk Yang
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea,Address correspondence : Prof. Jae-Hyuk Yang, Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153, Gyeongchunro, Guri, Gyeonggi-Do, 11923, South Korea. E-mail:
| | - Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| |
Collapse
|
|
10
|
Boya H, Araç SŞ. Does severe osteoarthritis in knees with varus deformity alter the adductor ratio? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:437-441. [PMID: 29029868 PMCID: PMC6197182 DOI: 10.1016/j.aott.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/28/2017] [Accepted: 09/26/2017] [Indexed: 11/24/2022]
Abstract
Objective In our retrospective study, we aimed to investigate the differences between the adductor ratio (AR) in knees with and without osteoarthritis, and its validity in determining the articular level. Methods Data from 80 knees of 80 patients were retrospectively evaluated. Anteroposterior weight-bearing knee radiographs of the patients with and without osteoarthritis (40 knees in each group) were obtained. The adductor ratio was determined using the following formula: ATJL/FW (adductor tubercle-joint line distance/femoral width). All radiographs were evaluated at the baseline and at one-month intervals afterwards. Intraobserver reliability of the two measurements was assessed using interclass correlations (ICC). Pearson's correlation test was used to evaluate the correlation between the ATJL and the FW. The differences between the adductor ratios of the two groups were evaluated by the independent samples two-tailed t-test. Results Most of the ICC values were well above 0.95, indicating a very high intraobserver reliability. The adductor ratio was significantly greater in Group 2 in comparison to Group 1 (Mean AR in Group 2: 0.522 ± 0.031 and Mean AR in Group 1: 0.502 ± 0.032; p = 0.005). There was a significant correlation between the ATJL and FW in the groups when assessed both separately and combined. Conclusion In conclusion, we can assert that if the AR is used to determine the articular level in revision arthroplasty cases, it may be sensible to measure the FW intraoperatively rather than measuring it on primary or contralateral radiographs of arthritic patients. Level of evidence Level III, Diagnostic study.
Collapse
|
|
11
|
Khan WS, Bhamra J, Williams R, Morgan-Jones R. "Meniscal" scar as a landmark for the joint line in revision total knee replacement. World J Orthop 2017; 8:57-61. [PMID: 28144580 PMCID: PMC5241546 DOI: 10.5312/wjo.v8.i1.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/17/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether tissue identified at the joint line was actually remnant "meniscal" scar tissue or not. METHODS Nine patients undergoing revision knee surgery following informed consent had meniscal scar tissue sent to the histology department for analyses. All revisions were performed where joint line had been raised or lowered at earlier surgery. Although preoperative radiographic evaluations suggested that the joint line had been altered, intraoperatively there was scar tissue at the level of the recreated joint line. This scar tissue has traditionally been described as meniscal scar, and to identify the origins of this tissue, samples were sent for histological analyses. The tissue samples were stored in formalin, and embedded and sectioned before undergoing histochemical staining. All samples underwent macroscopic and microscopic examination by a histopathologist who was blind to the study aims. The specific features that were examined included tissue organisation, surface and central composition, cellular distribution including histiocytes, nuclear ratio and vasculature. Atypical and malignant features, inflammation and degeneration were specifically looked for. A statistical review of the study was performed by a biomedical statistician. RESULTS The histological findings for the nine patients showing the macroscopic and microscopic findings, and the conclusion are outlined in a Table. The histological analyses were reviewed to determine whether the tissue samples were likely to be meniscal scar tissue. The response was yes (2, 22%), no (6, 67%) and maybe (1, 11%) based on the conclusions. The results were "yes" when on macroscopy, firm cream tissue was identified. In these two "yes" samples, microscopic analyses showed organised fibrous tissue with focal degenerative areas with laminated pattern associated with histiocytes peripherally but no inflammation. The "no" samples were assessed macroscopically and microscopically and were deemed to have appearances representing fibrous synovial tissue and features in keeping with degenerate scar tissue or connective tissue. One sample was indeterminate and microscopically contained fibro-collagenous tissue with synovial hyperplasia. It also contained some degenerate hyalinised tissue that may represent cartilage, but the appearances were not specific. CONCLUSION Based on our pilot study, we recommend reliance on a number of markers to identify the joint line as outlined above, and to exercise caution in using the "meniscal" scar.
Collapse
|
|
12
|
Chen IH, Wu WT, Wang CC, Liu KL, Yeh KT, Peng CH. An unambiguous technique for locating the adductor tubercle and using it to identify the joint line. Knee 2016; 23:960-963. [PMID: 27802923 DOI: 10.1016/j.knee.2016.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/13/2016] [Accepted: 05/26/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND If the adductor tubercle could be accurately located, it would be a useful landmark for identifying the joint line during knee arthroplasty. This study aimed to develop an intraoperative technique to improve its locating accuracy. METHODS Evaluation of bone specimens and cadaveric knees revealed that the proximal slope of the adductor tubercle (PSAT) turns from the medial surface vertically into the superior surface of the medial condyle, which forms a distinctive edge. This provided an ideal landmark that could be unambiguously engaged using a tipped instrument. Using the PSAT as a reference point, we measured the distance to the joint line (the proximal-distal condylar length; PDCL) in eight pairs of cadaveric knees, and evaluated the inter-observer variability. Next, we measured 120 knees undergoing total knee arthroplasty to test this technique in a normal population. Finally, we divided each PDCL by the respective anterior-posterior condylar length (APCL) to create a ratio that could predict the PDCL regardless of knee size. RESULTS The intra-class correlation coefficient (ICC) was 0.86 for the cadaveric measurements. The mean PDCL from the operated knees was 46mm (coefficient of variance (CV): eight percent). The mean PDCL/APCL ratio was 0.77 (CV: six percent). The high ICC and low CV indicated that using the PSAT was a reliable technique. CONCLUSION The PSAT is an ideal surgical landmark. The tipped instrument engagement technique with it may help to unambiguously locate the adductor tubercle in order to identify the joint line during knee arthroplasty.
Collapse
Affiliation(s)
- Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chen-Chie Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Orthopedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Kuan-Lin Liu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Huan Peng
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
|
13
|
Pereira GC, von Kaeppler E, Alaia MJ, Montini K, Lopez MJ, Di Cesare PE, Amanatullah DF. Calculating the Position of the Joint Line of the Knee Using Anatomical Landmarks. Orthopedics 2016; 39:381-386. [PMID: 27482732 DOI: 10.3928/01477447-20160729-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/14/2016] [Indexed: 02/03/2023]
Abstract
Restoration of the joint line of the knee during primary and revision total knee arthroplasty is a step that directly influences patient outcomes. In revision total knee arthroplasty, necessary bony landmarks may be missing or obscured, so there remains a lack of consensus on how to accurately identify and restore the joint line of the knee. In this study, 50 magnetic resonance images of normal knees were analyzed to determine a quantitative relationship between the joint line of the knee and 6 bony landmarks: medial and lateral femoral epicondyles, medial and lateral femoral metaphyseal flares, tibial tubercle, and proximal tibio-fibular joint. Wide variability was found in the absolute distance from each landmark to the joint line of the knee, including significant differences between the sexes. Normalization of the absolute distances to femoral or tibial diameters revealed reliable spatial relationships to the joint line of the knee. The joint line was found to be equidistant from the lateral femoral epicondyle and the proximal tibio-fibular joint, representing a reproducible point of reference for joint line restoration. The authors propose a simple 3-step algorithm that can be used with magnetic resonance imaging, computed tomography, or radiography to reliably determine the anatomical location of the joint line of the knee relative to the surrounding bony anatomy. [Orthopedics. 2016; 39(6):381-386.].
Collapse
|
|
14
|
FLORIO CS. MUSCLE FORCE MAGNITUDES IN THE HUMAN LEG FOR ISOMETRIC EXERCISES WITH VARIOUS RESULTANT FORCE DIRECTIONS AND JOINT ANGLES. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Using a gradient-based numerical optimization routine, the force magnitudes required of 10 major sagittal plane leg muscles to create a constant magnitude isometric resultant force against a fixed surface at the toe directed anteriorly, posteriorly, superiorly, and inferiorly were quantitatively predicted for three sets of joint angles: a straight leg configuration, with the knee flexed, and with both the hip and knee flexed. Comparisons over the conditions studied for each individual system muscle found that the maximum variation occurred in knee and hip extensor forces (up to two orders of magnitude). Comparisons within the set of active muscles for each studied condition identified dominant muscles and muscle functions. All anteriorly-directed and posteriorly-directed resultants required a small number of muscles with common functions (mainly knee or hip extensors) and large force magnitudes (O(1000[Formula: see text]N)). In contrast, a large number of muscles, with wide-ranging synergistic and antagonistic functions, acting across multiple joints with relatively small magnitudes (O(100[Formula: see text]N)) were needed to create the superiorly-directed resultant with flexed hip and knee. With good correlation to experimentally measured trends in the interrelationships between leg joint angles and isometric forces, the systematic muscle force prediction and analysis presented in this work can be used to guide the design of targeted muscle strengthening exercises and study of muscle-specific injury.
Collapse
Affiliation(s)
- C. S. FLORIO
- Department of Mechanical and Industrial Engineering, New Jersey Institute of Technology, University Heights, Newark, NJ 07102, USA
| |
Collapse
|
|
15
|
Ozkurt B, Sen T, Cankaya D, Kendir S, Basarır K, Tabak Y. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016; 5:280-6. [PMID: 27388715 PMCID: PMC4969630 DOI: 10.1302/2046-3758.57.bjr-2016-0002.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022] Open
Abstract
Objectives The purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty. Methods The transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated. Results The mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation (sd) 7.74), 28.95 mm (sd 3.3), 28.57 mm (sd 3), 23.97 mm (sd 3.27) and 24.42 mm (sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 (sd 0.02), 0.34 (sd 0.02), 0.28 (sd 0.03) and 0.29 (sd 0.03), respectively. Conclusion This method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty. Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarır, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280–286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1.
Collapse
Affiliation(s)
- B Ozkurt
- Orthopaedic Department, Ankara Numune Research and Training Hospital, Talatpasa Bulvarı Samanpazarı Ankara, Turkey
| | - T Sen
- School of Medicine Anatomy Department Ankara University, Sıhhiye Ankara, Turkey
| | - D Cankaya
- Orthopaedic Department, Ankara Numune Research and Training Hospital, Talatpasa Bulvarı Samanpazarı Ankara, Turkey
| | - S Kendir
- School of Medicine Anatomy Department Ankara University, Sıhhiye Ankara, Turkey
| | - K Basarır
- School of Medicine Anatomy Department Ankara University, Sıhhiye Ankara, Turkey
| | - Y Tabak
- Orthopaedic Department, Ankara Numune Research and Training Hospital, Talatpasa Bulvarı Samanpazarı Ankara, Turkey
| |
Collapse
|
|
16
|
Ji SJ, Zhou YX, Jiang X, Cheng ZY, Wang GZ, Ding H, Yang ML, Zhu ZL. Effect of Joint Line Elevation after Posterior-stabilized and Cruciate-retaining Total Knee Arthroplasty on Clinical Function and Kinematics. Chin Med J (Engl) 2016; 128:2866-72. [PMID: 26521783 PMCID: PMC4756894 DOI: 10.4103/0366-6999.168043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Joint line (JL) is a very important factor for total knee arthroplasty (TKA) to restore. The objective of this study was to evaluate the early clinical and kinematic results of TKAs with posterior-stabilized (PS) or cruciate retaining (CR) implants in which the JL was elevated postoperatively. METHODS Data were collected from patients who underwent TKA in our department between April 2011 and April 2014. The patients were divided into two groups based on the prosthesis they received (PS or CR). At 1-year postoperatively, clinical outcomes were evaluated by the American Knee Society (AKS) knee score, AKS function score, and patella score. In vivo kinematic analysis after TKA was performed on all patients and a previously validated three-dimensional to two-dimensional image registration technique was used to obtain the kinematic data. Anteroposterior (AP) translation of the medial and lateral femoral condyles, and axial rotation relative to the tibial plateau, were analyzed. The data were assessed using the Mann-Whitney test. RESULTS At time of follow-up, there were differences in the AKS knee scores (P = 0.005), AKS function scores (P = 0.025), patella scores (P = 0.015), and postoperative range of motions (P = 0.004) between the PS group and the CR group. In the PS group, the magnitude of AP translation for the medial and lateral condyle was 4.9 ± 3.0 mm and 12.8 ± 3.3 mm, respectively. Axial rotation of the tibial component relative to the femoral component was 12.9 ± 4.5°. In the CR group, the magnitude of AP translation for the medial and lateral condyle was 4.3 ± 3.5 mm and 7.9 ± 4.2 mm, respectively. The axial rotation was 6.7 ± 5.9°. There were statistically different between PS group and CR group in kinematics postoperatively. CONCLUSION Our results demonstrate that postoperative JL elevation had more adverse effects on the clinical and kinematic outcomes of CR TKAs than PS TKAs.
Collapse
Affiliation(s)
| | - Yi-Xin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China
| | | | | | | | | | | | | |
Collapse
|
|
17
|
Clavé A, Le Henaff G, Roger T, Maisongrosse P, Mabit C, Dubrana F. Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up. INTERNATIONAL ORTHOPAEDICS 2016; 40:1655-1662. [PMID: 26744167 DOI: 10.1007/s00264-015-3096-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It has been shown that the distance between the joint line (JL) and the fibular head is constant in both knees in a given individual. We analysed the influence of the JL level difference between the revised knee and the native knee from the functional outcomes after TKR revision. METHODS This multicentre study assessed retrospectively a consecutive series of 177 revised total knee replacements. Patients with contralateral knees that had undergone previous major surgery or trauma were excluded. The JL level difference between both knees was measured on Knee's AP standing X-rays and compared to the KSS Knee and Function scores at the final follow-up. RESULTS Eighty-five cases were analysed at a mean of seven years follow-up. There was a significant increase in KSS Knee and Function scores after surgery. The average elevation of the JL was 2.2 mm (s.d. 2.66 mm) compared with the healthy contralateral knee. When the JL was elevated more than 4 mm this correlated with a decreased KSS Function score and decreased post-operative knee flexion. CONCLUSIONS Poorer functional results are significantly associated with an elevation in the JL compared to the contralateral healthy knee. In those patients with a suitable contralateral knee the JL level to restore can be assessed by the distance between the femoral condyle and the apex of the fibular head of the contralateral knee.
Collapse
Affiliation(s)
- Arnaud Clavé
- Orthopedic and Traumatologic Surgery Department, Brest University Hospital, Bd Tanguy Prigent, 29609, Brest, France.
| | - Goulven Le Henaff
- Orthopedic and Traumatologic Surgery Department, Brest University Hospital, Bd Tanguy Prigent, 29609, Brest, France
| | - Thomas Roger
- Orthopedic and Traumatologic Surgery Department, Limoges University Hospital, 2 Bd Martin Luther King, 87042, Limoges, France
| | - Paul Maisongrosse
- Orthopedic and Traumatologic Surgery Department, Toulouse Purpan University Hospital, Place du Docteur Baylac, 31059, Toulouse, France
| | - Christian Mabit
- Orthopedic and Traumatologic Surgery Department, Limoges University Hospital, 2 Bd Martin Luther King, 87042, Limoges, France
| | - Frédéric Dubrana
- Orthopedic and Traumatologic Surgery Department, Brest University Hospital, Bd Tanguy Prigent, 29609, Brest, France
| |
Collapse
|
|
18
|
Chung KS, Lee JK, Lee HJ, Choi CH. Double metal tibial blocks augmentation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:214-20. [PMID: 25300362 DOI: 10.1007/s00167-014-3368-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 09/26/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Severe uncontained tibial bone defects occurring during total knee arthroplasty are challenging, and which treatment method is the best remains unknown. In this study, clinical and radiographic outcomes of double metal blocks augmentation were examined. METHODS Between 2004 and 2012, double metal blocks augmentation was carried out in 17 patients with severe asymmetric uncontained tibial bone defects. The first block was attached to the tibial tray with screws, and then the second block was cemented to the first block. Out of 17 patients, 13 (8 primary, 5 revision) were available for final follow-up at a median of 69 months (range 24-99). For clinical assessment, range of motion and Knee Society score were evaluated preoperatively and annually thereafter. At the final follow-up, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford knee, Short Form-36, Lower extremity functional scale, and Lower extremity activity scale scores were evaluated. Radiographic assessment for radiolucent lines at the block-cement-bone interfaces and signs of failure was performed annually using fluoroscopy and standard radiographs. RESULTS Range of motion and Knee Society score were significantly improved post-operatively. Other clinical outcomes were favourable. Radiolucent lines were seen on fluoroscopy in three knees, but no sign of failure, such as loosening, collapse, or instability, was observed at the final follow-up. CONCLUSIONS Double metal blocks augmentation is a favourable and useful method, which does not cause mechanical failure or protrusion of the prosthetic because of its modularity, to manage severe asymmetric uncontained proximal tibial bone defects >15 mm in total knee arthroplasty. LEVEL OF EVIDENCE Case series, Level IV.
Collapse
Affiliation(s)
- Kyu Sung Chung
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea
| | - Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea
| | - Hee Jae Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea
| | - Choong Hyeok Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea.
| |
Collapse
|
|
19
|
Yilmaz S, Cankaya D, Deveci A, Firat A, Ozkurt B, Bozkurt M. The impact of joint line restoration on functional results after hinged knee prosthesis. Indian J Orthop 2016; 50:136-45. [PMID: 27053802 PMCID: PMC4800955 DOI: 10.4103/0019-5413.177580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hinged knee prosthesis is an effective treatment method as a salvage procedure in marked ligamentous insufficiency and severe bone defects. Joint line determination and restoration are difficult due to large bone defects and distorted anatomy. We evaluated the impact of joint line alteration on the outcome in rotating hinge knee arthroplasty (RHKA). MATERIALS AND METHODS 35 patients who had rotating hinged knee prosthesis applied between 2008 and 2013 were evaluated in this retrospective study. The patients were studied radiologically and clinically. Five patients were lost to followup and two patients died, leaving a total of 28 (7 male, 21 female) patients for final evaluation. The average age of the patients was 66.19 ± 8.35 years (range 52-83 years). The patients were evaluated clinically with Knee Society knee and functional score and patellar score. The joint line positions were evaluated radiographically with femoral epicondylar ratio method. The outcomes were also evaluated according to age, body weight and gender. Student's t-test, independent t-test, and the Wilcoxon signed rank test were used in the statistical analysis. RESULTS The mean Knee Society knee and functional score significantly improved from preoperative 19.52 ± 11.77 and 12.5 ± 15.66 respectively to 72.46 ± 14.01 and 70.36 ± 9.22 respectively postoperatively (P < 0.001). The mean range of motion of the knee improved from 55.95° ± 25.08° preoperatively to 92.14° ± 13.47° postoperatively (P < 0.001). Joint line position was restored in 20 patients (71.4%). Joint line alteration did not affect Knee Society Scores (KSSs) in contrast to patellar scores. Additionally, KSS was better in the patients with body mass index ≤30 at followup (P = 0.022 and P = 0.045). CONCLUSION RHKA is an effective salvage procedure for serious instability and large bone defects. Restoration of the joint line improves the patellar score although it had no effect on the clinical outcome.
Collapse
Affiliation(s)
- Serdar Yilmaz
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey,Address for correspondence: Dr. Serdar Yilmaz, Yeni Batı Mah. 2224. Sok. No: 12/18, Yenimahalle, Ankara, Turkey. E-mail:
| | - Deniz Cankaya
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Alper Deveci
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ahmet Firat
- Department of Orthopaedics and Traumatology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Bulent Ozkurt
- Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Murat Bozkurt
- Department of Orthopaedics and Traumatology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
|
20
|
Sadaka C, Kabalan Z, Hoyek F, Abi Fares G, Lahoud JC. Joint line restoration during revision total knee arthroplasty: an accurate and reliable method. SPRINGERPLUS 2015; 4:736. [PMID: 26640748 PMCID: PMC4661160 DOI: 10.1186/s40064-015-1543-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022]
Abstract
During revision total knee arthroplasty, the joint line is frequently malpositioned, due to the disappearance of the anatomical landmarks following previous interventions. This leads to decreased clinical outcome and increased risk of re-intervention. Many methods have been proposed to restore the joint line, but none of them has shown itself to be reliable. We describe an accurate and precise method to localize the exact position of the joint line which guarantees a better clinical knee score. The adductor tubercle (AT) is recognized to be the most reliable landmark used to localize the knee joint line (JL). The distance from the AT to the JL on antero-posterior radiographs (ATJL) and the femoral diameter (FD) on true lateral views were measured on 200 randomly selected normal knees. These measurements were tested for intra- and inter-observer differences. Then, the relationship between these two measurements was studied. A significant correlation and linear regression between FD and ATJL was found (p < 0.001), making the adductor tubercle a valid landmark to accurately position the prosthetic joint within 4 mm from the normal position. No significant difference was noted in the intra and inter-observer measurements (F test not significant). Sex was found to be an intervening variable (p ˂ 0.001). The correlation and regression between ATJL and FD had to be adjusted accordingly. Once the ATJL was determined preoperatively, the JL level is found during surgery by using a caliper that is held on the easily palpable AT. Knowing the femoral diameter, we can easily locate the joint line level surgically, using the adductor tubercle as a landmark. This method leads to better clinical outcomes and a reduced risk of re-intervention following revision total knee arthroplasty.
Collapse
Affiliation(s)
| | - Ziad Kabalan
- Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Fadi Hoyek
- Holy Spirit University of Kaslik, Jounieh, Lebanon
| | | | | |
Collapse
|
|
21
|
Bieger R, Huch K, Kocak S, Jung S, Reichel H, Kappe T. The influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods. Arch Orthop Trauma Surg 2014; 134:537-41. [PMID: 24509940 DOI: 10.1007/s00402-014-1953-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Restoring the joint line (JL) in primary as well as revision total knee arthroplasty (TKA) influences clinical results as well as long-term survival rates. Whereas studies agree about the negative effect of JL alteration, the reference system of choice is unclear. The purpose of the present study was to evaluate the effect of JL allocation comparing a ratio to a distance method on clinical outcome following revision TKA. MATERIALS After a miminum follow-up of 2 years JL reconstruction was evaluated in 69 consecutive patients after revision TKA. Clinical results were obtained using the Knee Society Score (KSS). We used the Figgie distance method in comparison to the epicondylar ratio method. RESULTS The mean postoperative KSS significantly improved in all 69 revision TKAs compared to the preoperative value. Patients with a positive JL reconstruction in reference to the epicondylar ratio showed significantly better KSS results compared to knees without restoration of the JL. The degree of JL reconstruction depending on the distance method showed no effect on postoperative KSS results. CONCLUSION We recommend the epicondylar ratio to calculate the physiological JL rather than JL allocation by a distance.
Collapse
Affiliation(s)
- Ralf Bieger
- Department of Orthopaedic Surgery, Centre of Musculoskeletal Research, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany,
| | | | | | | | | | | |
Collapse
|
|
22
|
Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW. Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc 2011; 19:2027-32. [PMID: 21431374 DOI: 10.1007/s00167-011-1468-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 03/01/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aimed to compare the clinical and radiological results of navigation-assisted TKAs performed using the measured gap resection or the gap balancing technique in thirty patients who underwent bilateral primary TKAs. METHODS Sixty cases of navigation-assisted TKAs [30 TKAs performed using the measured gap resection technique (Group A) and 30 TKAs performed using the gap balancing technique (Group B)] were analyzed prospectively with minimum follow-up of 2 years. The joint line positions were measured using preoperative and postoperative weight-bearing anteroposterior and lateral radiographs. Clinical results were evaluated using knee scores and functional scores. RESULTS No significant differences in knee scores or functional scores were observed. Polyethylene thickness and flexion/extension gaps were significantly larger in Group B (P < 0.05). The meaningful proximal shift of the joint line was shown in Group B (P < 0.05). CONCLUSION The navigation-assisted TKA with measured gap resection technique could be a useful technique with regard to restoration of the joint line.
Collapse
Affiliation(s)
- Han Jun Lee
- Department of Orthopedic Surgery, College of Medicine, Chung-Ang University, 221 Heuksuk dong, Dongjak-gu, Seoul, 156-755, South Korea
| | | | | | | | | | | |
Collapse
|
|
23
|
Tang Q, Zhou Y, Yang D, Tang J, Shao H. The knee joint line position measured from the tibial side in Chinese people. J Arthroplasty 2011; 26:989-93. [PMID: 21440408 DOI: 10.1016/j.arth.2011.02.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 02/14/2011] [Indexed: 02/01/2023] Open
Abstract
A magnetic resonance imaging study of 50 Chinese normal knees was conducted to determine the knee joint line position. The distances from the fibular head and the tibial tubercle to the joint line were measured, and each distance value was converted to a ratio relative to the anteroposterior tibial widths at the levels of the insertion of the patellar tendon and the apex of the fibular head. The distance to the joint line was 11.99 ± 1.20 mm from the fibular head and 20.48 ± 1.64 mm from the tibial tubercle. The fibular head and tibial tubercle are reliable landmarks. The distances and ratios can be used to determine the knee joint line position in revision surgery for the Chinese population.
Collapse
Affiliation(s)
- Qiheng Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | | | | | | | | |
Collapse
|
|
24
|
Lionberger DR, Correia N. Protection of repaired patellar tendons a surgical technique. J Arthroplasty 2011; 26:969-71. [PMID: 21856499 DOI: 10.1016/j.arth.2011.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 04/02/2011] [Indexed: 02/01/2023] Open
Abstract
Patellar tendon avulsion repairs are a frequent necessity in knee arthroplasty and revisions. These repairs are often accompanied by compromised healing from previous surgeries, resulting in devitalization of tissues and vascular support with scar tissue formation. This study describes the use of a dynamic and flexible leash to limit excursion of the patella while protecting the fragile repair.
Collapse
Affiliation(s)
- David R Lionberger
- Department of Orthopedic Surgery, Baylor College of Medicine,Houston, TX 77030, USA
| | | |
Collapse
|
|
25
|
König C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, Heller MO. Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 2010; 28:1-5. [PMID: 19637213 DOI: 10.1002/jor.20952] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
One difficulty in revision total knee arthroplasty (TKA) is the management of distal femoral bone defects in which a joint line elevation (JLE) is likely to occur. Although JLE has been associated with inferior clinical results, the effect that an elevated joint line has on knee contact forces has not been investigated. To understand the clinical observations and elaborate the potential risk associated with a JLE, we performed a virtual TKA on the musculoskeletal models of four subjects. Tibio- and patellofemoral joint contact forces (JCF) were calculated for walking and stair climbing, varying the location of the joint line. An elevation of the joint line primarily affected the patellofemoral joint with JCF increases of as much as 60% of the patient's body weight (BW) at 10-mm JLE and 90% BW at 15-mm JLE, while the largest increase in tibiofemoral JCF was only 14% BW. This data demonstrates the importance of restoring the joint line, as it plays a critical role for the magnitudes of the JCFs, particularly for the patellofemoral joint. JLE caused by managing distal femoral defects with downsizing and proximalizing the femoral component could increase the patellofemoral contact forces, and may be a contributing factor to postoperative complications such as pain, polyethylene wear, and limited function.
Collapse
Affiliation(s)
- Christian König
- Julius Wolff Institut and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
|
26
|
Abstract
The purpose of this study was to analyze the clinical results of patients who underwent navigation-assisted cruciate ligament retention-type mobile-bearing total knee arthroplasty (TKA) according to joint line changes. From September 2004 to January 2006, cruciate ligament retention-type mobile-bearing TKAs were performed using a navigation system (OrthoPilot; B. Braun Aesculap, Tuttlingen, Germany) on 50 knees in 45 patients (2 men, 43 women). The mean follow-up period was 46 (range, 39-55 months), and patient mean age was 65 years. There was 1 case of rheumatic arthritis; all others were of degenerative arthritis. Proximal tibia resection was performed at the sclerotic level of the medial tibial plateau. The distance from the lowest point of lateral tibial plateau (registered point) to the proximal resection plane was measured. Clinical outcomes (range of motion, Knee Society Score) were compared for joint line elevations of > or =3 mm (20 cases) and <3 mm (30 cases). Mean joint line elevation was 1.93 mm (range, -1-5 mm). Joint line change was not found to be associated with difference of clinical results (P>.05). The findings of this study suggest that joint line changes in the range of -1 to 5 mm after cruciate ligament retention-type mobile-bearing TKA do not affect clinical outcome.
Collapse
Affiliation(s)
- Jae-Hyuk Yang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | | | | | | |
Collapse
|
|
27
|
Aitchison GA, Hukins DWL, Parry JJ, Shepherd DET, Trotman SG. A review of the design process for implantable orthopedic medical devices. Open Biomed Eng J 2009; 3:21-7. [PMID: 19662153 PMCID: PMC2713416 DOI: 10.2174/1874120700903010021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 05/19/2009] [Accepted: 05/24/2009] [Indexed: 12/18/2022] Open
Abstract
The design process for medical devices is highly regulated to ensure the safety of patients. This paper will present a review of the design process for implantable orthopedic medical devices. It will cover the main stages of feasibility, design reviews, design, design verification, manufacture, design validation, design transfer and design changes.
Collapse
Affiliation(s)
- G A Aitchison
- School of Mechanical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | | | | | | |
Collapse
|