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Borukhov I, Ismailidis P, Esposito CI, LiArno S, Lyon J, McEwen PJ. Kinematic alignment recreates femoral trochlear geometry more closely than mechanical alignment in total knee arthroplasty : a CT analysis. Bone Joint J 2024; 106-B:817-825. [PMID: 39945008 DOI: 10.1302/0301-620x.106b8.bjj-2023-1209.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
Abstract
Aims This study aimed to evaluate if total knee arthroplasty (TKA) femoral components aligned in either mechanical alignment (MA) or kinematic alignment (KA) are more biomimetic concerning trochlear sulcus orientation and restoration of trochlear height. Methods Bone surfaces from 1,012 CT scans of non-arthritic femora were segmented using a modelling and analytics system. TKA femoral components (Triathlon; Stryker) were virtually implanted in both MA and KA. Trochlear sulcus orientation was assessed by measuring the distal trochlear sulcus angle (DTSA) in native femora and in KA and MA prosthetic femoral components. Trochlear anatomy restoration was evaluated by measuring the differences in medial, lateral, and sulcus trochlear height between native femora and KA and MA prosthetic femoral components. Results Femoral components in both MA and KA alignments exhibited a more valgus DTSA compared to native femora. However, DTSA deviation from native was significantly less in KA than in MA (4.8° (SD 2.2°) vs 8.8° (SD 1.8°); p < 0.001). DTSA deviation from native orientation correlated positively with the mechanical lateral distal femoral angle (mLDFA) in KA and negatively in MA (r = 0.53, p < 0.001; r = -0.18, p < 0.001). Medial trochlear height was not restored with either MA or KA, with MA resulting in lower medial trochlear height than KA in the proximal 20% of the trochlea. Lateral and sulcus trochlear height was not restored with either alignment in the proximal 80% of the trochlea. At the terminal arc point, KA replicated sulcus and lateral trochlear height, while MA led to over-restoration. Conclusion Femoral components aligned in KA demonstrated greater biomimetic qualities than those in MA regarding trochlear sulcus orientation and trochlear height restoration, particularly in valgus femora. Variability across knees was observed, warranting further research to evaluate the clinical implications of these findings.
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Affiliation(s)
| | - Petros Ismailidis
- The Orthopaedic Research Institute of Queensland, Townsville, Australia
- Division of Tropical Health and Medicine, College of Health Care Sciences, James Cook University, Brisbane, Australia
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
| | | | | | | | - Peter J McEwen
- The Orthopaedic Research Institute of Queensland, Townsville, Australia
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Aliyev O, Sarıkaş M, Uçan V, Uzer G, Tuncay İ, Yıldız F. Sagittal Patellar Offset Ratio Can Be a Predictor of Anterior Knee Pain after Primary Total Knee Arthroplasty without Patella Resurfacing. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:27-33. [PMID: 35654392 DOI: 10.1055/a-1823-1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Anterior knee pain (AKP) is an issue that persists even after successful total knee arthroplasty (TKA). In some patients, reasons for AKP occurrence are known, but it is unexplained in some others despite the patellofemoral joint being thought to be the main focus of pain. We investigated the relationship between unexplained AKP and the patellofemoral joint in the sagittal plane after primary TKA. METHODS We evaluated 372 knees of 317 patients retrospectively, who had completed a minimum 24-month follow-up. We divided them into two groups according to the presence of AKP. Sagittal patellar offset ratio (SPOR), anterior femoral offset ratio (AFOR), and Insall-Salvati ratio (ISR) were measured on lateral X-rays. Clinical outcomes were evaluated using the Oxford knee score (OKS) and WOMAC pre-and postoperatively, and AKP was evaluated using a visual analog scale (VAS) postoperatively. RESULTS Between non-AKP and AKP groups, SPOR (p < 0.001) and AFOR (p = 0.03) were significantly different but not ISR (p = 0.89). SPOR and AFOR were found to be two independent risk factors that may predict the likelihood of AKP. Receiver operating characteristic (ROC) analysis revealed that AFOR is a poor value, whereas SPOR is a reasonable predictive value. No correlation between SPOR and postoperative OKS (p = 0.92) and WOMAC (p = 0.25) and no correlation between AFOR and postoperative OKS (p = 0.44) and WOMAC (p = 0.58) were found. CONCLUSION We found that SPOR is a good predictive tool with a cutoff value of 46.4% and 91.5% sensitivity for AKP and its increased ratio increases the probability of AKP following TKA. Considering that the patellar offset will not change, especially in patients without patella resurfacing, care should be taken not to increase the anterior femoral offset.
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Affiliation(s)
- Orkhan Aliyev
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Murat Sarıkaş
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Vahdet Uçan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - İbrahim Tuncay
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
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Tammachote N, Kraisin T, Kanitnate S. Do we need to restore patellar thickness after total knee arthroplasty with patellar resurfacing? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3677-3682. [PMID: 37291460 DOI: 10.1007/s00590-023-03607-w] [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: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of this study was to investigate whether increased patellar thickness after resurfacing decreased knee flexion angle and had any effect on functional outcomes comparing with patellar thickness restoration (patelloplasty) in patients undergoing primary total knee arthroplasty (TKA) or not. METHODS We retrospectively reviewed 220 patients undergoing primary TKA: 110 patients undergoing patelloplasty and 110 patients received overstuffed patellar resurfacing using subchondral bone cut at lateral facet technique were recruited. The mean increase in patellar thickness after resurfacing equal to 2 ± 1.2 mm. The outcomes were postoperative knee flexion angle and modified Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score at minimum 2 year after surgery. RESULTS The mean postoperative knee flexion angles were similar between overstuffed resurfacing group and patelloplasty group (132 ± 7° vs. 134 ± 8°, 95% confidence interval [CI] - 6.9-1.8°, p = 0.1). The mean increase in postoperative knee flexion was 13° in both groups (p = 0.94). The mean change of overall modified WOMAC score was also similar between the two groups (42 ± 12 vs. 39 ± 9 points, 95% CI - 1.7-9.4 points, p = 0.17). CONCLUSION This study demonstrated that increased patellar thickness has no effect on postoperative knee flexion angle and functional outcomes in TKA. The finding clarified the misunderstanding principle of native patellar thickness restoration after resurfacing which had made many surgeons to refrain from resurfacing especially in patient who had thin patella.
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Affiliation(s)
- Nattapol Tammachote
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand.
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand.
| | - Teeramate Kraisin
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
| | - Supakit Kanitnate
- Investigation Performed at the Orthopedic Unit, Thammasat University Hospital, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Luang, 12120, Pathum Thani, Thailand
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Clinical outcomes after using patient specific instrumentation: is it worth the effort? A minimum 5-year retrospective review of 298 PSI knees. Arch Orthop Trauma Surg 2022; 143:3409-3422. [PMID: 36214876 PMCID: PMC9549813 DOI: 10.1007/s00402-022-04593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 08/10/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Use of patient specific instrumentation (PSI) for performing total knee arthroplasty (TKA) has been shown to improve component positioning but there is dearth of evidence regarding clinical outcomes. The aim of our study was to report patient satisfaction and functional outcome scores of patients who underwent PSI TKAs at minimum 5 year follow up. METHODS This is a retrospective study of a prospectively collected data of patients who underwent PSI TKAs between January 2012 and October 2015 under a single surgeon. Patient Reported Outcome Measures (PROMs), patient satisfaction questionnaires, surgeon directed 3D planning changes and intra-operative changes were collected and analysed. RESULTS The cohort included 298 consecutive PSI TKAs performed on 249 patients at a mean age of 71 years (range: 49-93 years). On an average 4 changes were made for each knee during 3D planning compared to preliminary plan. Intra-operative implant size change was required only in 3% (10 knees). The PROM scores were collected at a mean follow-up period of 6.8 years (range: 5.0-8.6 years) for 224 knees. Oxford Knee Score improved from median pre-operative score of 18 (IQR: 13-24) to median post-operative score of 44 (IQR: 40-47) with a median gain of 23 (IQR: 16-30). The median modified Forgotten Joint Score was 87.5 (IQR: 54.4-98.1). For the Beverland questionnaire, 75% (n = 166) reported being "Very Happy" and only 4% (n = 9/222) were 'Never Happy'. CONCLUSION Excellent patient satisfaction and functional scores at mid-term can be achieve d using PSI technique to perform TKA with careful surgeon directed pre-operative planning.
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Shin KH, Jang KM, Han SB. Component gap measurement reflects the planned gap balance during total knee arthroplasty more accurately and reliably than bone surface gap measurement. Knee Surg Sports Traumatol Arthrosc 2022; 30:584-592. [PMID: 33068127 DOI: 10.1007/s00167-020-06324-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/06/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to compare the reliability of two gap assessment methods (component and bone surface gap measurement vs. planned gap balance) and identify the contributors to component gaps other than planned gaps. METHODS The prospectively collected data for 122 consecutive primary total knee arthroplasties (TKAs; 114 patients). After femoral planning for gap balancing, the medial and lateral planned gaps were calculated (planned gap). The established medial extension and flexion gaps (MEG and MFG, respectively) and lateral extension and flexion gaps (LEG and LFG, respectively) were measured with and without the TKA components (bone surface and component gaps) at 0° and 90° flexion. The intraclass and Pearson correlation coefficients for each gap measurement method were assessed using planned gap values, and multiple linear regression analyses were performed to identify the contributors to component gaps. RESULTS Compared with the bone surface gap measurement, the component gap measurement showed higher reliability and stronger correlation with the planned gap balance for each gap. The changes in the medial posterior femoral offset contributed to the MEG and LEG, whereas those in the joint line height contributed to the LEG. The changes in the hip-knee-ankle angle and lateral posterior femoral offset contributed to the LFG. CONCLUSION Component gap measurements of the established gap more accurately and reliably reflect the planned gap balance than do bone surface gap measurements. The established gaps are affected by several factors other than femoral planning.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea.
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Itou J, Kuwashima U, Itoh M, Okazaki K. Anterior prominence of the femoral condyle varies among prosthesis designs and surgical techniques in total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:784. [PMID: 34511101 PMCID: PMC8436424 DOI: 10.1186/s12891-021-04670-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patellofemoral overstuffing after total knee arthroplasty (TKA) can cause limited range of motion and anterior knee pain. This study compared anterior prominence of femoral components among different prothesis designs in surgical simulation models utilizing the anterior reference (AR) and posterior reference (PR) techniques. METHODS Surgical simulations were performed using on a three-dimensional planning system preoperative computed tomography data of consecutive 30 patients with knee osteoarthritis scheduled to undergo TKA. Four implant models were used: Attune, Persona, Journey II, and Legion. Rotational alignment was set parallel to the transepicondylar axis and size was selected based on the absence of notch formation in the femoral anterior cortex and the best fit with the shape of the medial posterior femoral condyle. For each combination of surgical technique (AR or PR method) and implant model, measurements were taken of the maximum medial, central, and lateral prominence of the implant from the anterior femoral cortex. RESULTS Using either the AR or PR method, the medial and central prominences were significantly lower with Journey II than with the other models. The lateral prominence was the lowest with Attune in the AR method. The AR method was associated with significantly less prominence compared with the PR method, regardless of implant model. CONCLUSIONS The degree of anterior prominence of the femoral implant is affected by the implant design when the AR method is used. The PR method is associated with greater anterior prominence compared with the AR method, and the pitch size is an additional factor in the PR method. Surgeons should be familiar with implant designs, including the thickness of the anterior flange and the available size selections.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan.
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Parsons T, Al-Jabri T, Clement ND, Maffulli N, Kader DF. Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing. J Orthop Surg Res 2021; 16:185. [PMID: 33706779 PMCID: PMC7948323 DOI: 10.1186/s13018-021-02295-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively. AIMS To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty. METHOD A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae. RESULTS Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors. CONCLUSION Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.
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Affiliation(s)
- Thomas Parsons
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- Royal United Hospital Bath, Combe Park, Bath, Avon BA1 3NG UK
| | - Talal Al-Jabri
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ England
| | - Nick D. Clement
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG England
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, ST5 5BG UK
| | - Deiary F. Kader
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- University of Kurdistan Hewler, Erbil, Iraq
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Matz J, Lanting BA, Howard JL. Understanding the patellofemoral joint in total knee arthroplasty. Can J Surg 2019; 62:57-65. [PMID: 30693747 DOI: 10.1503/cjs.001617] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Total knee arthroplasty (TKA) is one of the most successful procedures in orthopedic surgery. Nevertheless, postoperative patellofemoral complications remain a challenging problem, affecting a substantial proportion of patients. Complications involving the patellofemoral joint (PFJ) can occur in both resurfaced and nonresurfaced patellae. Types of PFJ complications include anterior knee pain, maltracking, fracture, avascular necrosis and patellar clunk. The causes of patellofemoral complications can be categorized into patient-, surgeon- and implant-related factors. Patient characteristics such as female sex, young age, depression and increased body mass index have been linked with increased complications. Important technical considerations to avoid complications include achieving appropriate rotational alignment of the femoral and tibial components, maintaining joint line height, medializing the patellar button and avoiding “overstuffing” the PFJ. Component design features such as conformity, shape and depth of the femoral trochlea have also been shown to be important. Although the cause of patellofemoral complications after TKA may sometimes be unknown, it remains important to minimize errors that can lead to these complications.
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Affiliation(s)
- Jacob Matz
- From the Division of Orthopedic Surgery, London Health Sciences Centre, London, Ont. (Matz, Lanting, Howard)
| | - Brent A. Lanting
- From the Division of Orthopedic Surgery, London Health Sciences Centre, London, Ont. (Matz, Lanting, Howard)
| | - James L. Howard
- From the Division of Orthopedic Surgery, London Health Sciences Centre, London, Ont. (Matz, Lanting, Howard)
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Scott CE, Clement ND, Yapp LZ, MacDonald DJ, Patton JT, Burnett R. Association Between Femoral Component Sagittal Positioning and Anterior Knee Pain in Total Knee Arthroplasty: A 10-Year Case-Control Follow-up Study of a Cruciate-Retaining Single-Radius Design. J Bone Joint Surg Am 2019; 101:1575-1585. [PMID: 31483401 PMCID: PMC7406149 DOI: 10.2106/jbjs.18.01096] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior knee pain is the most common complication of total knee arthroplasty (TKA). The purpose of this study was to assess whether sagittal femoral component position is an independent predictor of anterior knee pain after cruciate-retaining single-radius TKA without routine patellar resurfacing. METHODS A prospective cohort study of 297 cruciate-retaining single-radius TKAs performed in 2006 and 2007 without routine patellar resurfacing identified 73 patients (25%) with anterior knee pain and 89 (30%) with no pain (controls) at 10 years. Patients were assessed preoperatively and at 1, 5, and 10 years postoperatively using patient-reported outcome measures (PROMs), including the Short Form-12 (SF-12), Oxford Knee Score (OKS), and satisfaction and expectation questionnaires. Variables that were assessed as predictors of anterior knee pain included demographic data, the indication for the TKA, early complications, stiffness requiring manipulation under anesthesia, and radiographic criteria (implant alignment, Insall-Salvati ratio, posterior condylar offset ratio, and anterior femoral offset ratio). RESULTS The 73 patients with anterior knee pain (mean age, 67.0 years [range, 38 to 82 years]; 48 [66%] female) had a mean visual analog scale (VAS) score of 34.3 (range, 5 to 100) compared with 0 for the 89 patients with no pain (mean age, 66.5 years [range, 41 to 82 years]; 60 [67%] female). The patients with anterior knee pain had mean femoral component flexion of -0.6° (95% confidence interval [CI] = -1.5° to 0.3°), which differed significantly from the value for the patients with no pain (1.42° [95% CI = 0.9° to 2.0°]; p < 0.001). The patients with and those without anterior knee pain also differed significantly with regard to the mean anterior femoral offset ratio (17.2% [95% CI = 15.6% to 18.8%] compared with 13.3% [95% CI = 11.1% to 15.5%]; p = 0.005) and the mean medial proximal tibial angle (89.7° [95% CI = 89.2° to 90.1°] compared with 88.9° [95% CI = 88.4° to 89.3°]; p = 0.009). All PROMs were worse in the anterior knee pain group at 10 years (p < 0.05), and the OKSs were worse at 1, 5, and 10 years (p < 0.05). Multivariate analysis confirmed femoral component flexion, the medial proximal tibial angle, and an Insall-Salvati ratio of <0.8 (patella baja) as independent predictors of anterior knee pain (R = 0.263). Femoral component extension of ≥0.5° predicted anterior knee pain with 87% sensitivity. CONCLUSIONS In our study, 25% of patients had anterior knee pain at 10 years following a single-radius cruciate-retaining TKA without routine patellar resurfacing. Sagittal plane positioning and alignment of the femoral component were associated with long-term anterior knee pain, with femoral component extension being a major risk factor. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chloe E.H. Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Nicholas D. Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Liam Z. Yapp
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | | | - James T. Patton
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Richard Burnett
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
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Song SJ, Kang SG, Lee YJ, Kim KI, Park CH. An intraoperative load sensor did not improve the early postoperative results of posterior-stabilized TKA for osteoarthritis with varus deformities. Knee Surg Sports Traumatol Arthrosc 2019; 27:1671-1679. [PMID: 30511096 DOI: 10.1007/s00167-018-5314-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/29/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE In the present study, the early results of sensor-assisted versus manually balanced posterior-stabilized total knee arthroplasty (TKA) for osteoarthritis with varus deformities were prospectively compared. METHODS Fifty patients undergoing sensor-assisted TKA (group S) and 50 patients receiving manually balanced TKA (group M) were prospectively compared. The groups did not differ in terms of demographics, preoperative clinical status, or severity of deformity. The knee and function scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM) were evaluated clinically. The mechanical axes and positions of components were assessed radiographically. In sensor-assisted TKA, the medial and lateral compartment loads were compared based on the patellar positions of inversion and eversion. RESULTS There was no between-group difference in the postoperative KS or FS (n.s., respectively). The average postoperative WOMAC score was 17.0 in group S and 18.0 in group M (n.s.). The ROM was 131.2° in group S and 130.8° in group M (n.s.). Neither the postoperative alignment of the mechanical axis nor the component positioning differed between the groups (n.s.). In sensor-assisted TKA, the difference between the medial and lateral compartment loads was less than 15 lbs (6.8 kg) in each knee. The lateral compartment load increased after patellar eversion (p < 0.001). CONCLUSION There are concerns about the cost-benefit ratio of the intraoperative load sensor, despite its advantage of more precisely assessing ligament balance without patellar eversion, which resulted in a smaller lateral gap. A long-term follow-up study with a large cohort is required. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Se Gu Kang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Yeon Je Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Kang Il Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-872, South Korea.
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Jhurani A, Agarwal P, Aswal M, Saxena P, Singh N. Safety and Efficacy of 6.2 mm Patellar Button in Resurfacing Less than 20 mm Thin Patella: A Matched Pair Analysis. Knee Surg Relat Res 2018; 30:153-160. [PMID: 29843200 PMCID: PMC5990234 DOI: 10.5792/ksrr.17.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose Restoring the native patellar thickness after patellar resurfacing provides optimal function of the knee after arthroplasty and minimises complications related to the patellofemoral articulation. The aim of this study was to assess the usefulness of a thin patellar button (6.2 mm) in patients with a patella thickness of less than 20 mm during total knee arthroplasty. Materials and Methods This is a retrospective case control study. A total of 54 female patients with an intraoperative patellar thickness of <20 mm, resurfaced with a patellar button of 6.2 mm in thickness were identified (group 1). They were matched with 54 patients with a patellar thickness of 20–23 mm, resurfaced with a patellar button of 8 mm (group 2), based on age, sex, body mass index, and deformity. A clinical and radiological evaluation was done at a minimum 2-year follow-up. Results The preoperative mean patellar thickness was 18.94±1.07 mm and was restored to 19.06±0.79 mm in group 1, as compared to 21.63±0.99 mm and 21.72±0.99 mm in group 2. The mean postoperative range of motion was 122.22°±9.25° in group 1 and 123.52°±8.72° in group 2 (p=0.13). No patellar bone or button related complications were observed in any patient in either group. Conclusions The 6.2 mm thin patella is useful to restore the native thickness in patients with a patellar thickness of less than 20 mm without risk of button fracture, loosening or overstuffing.
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Affiliation(s)
- Anoop Jhurani
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
| | - Piyush Agarwal
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
| | - Mukesh Aswal
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
| | - Purvi Saxena
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
| | - Nidhi Singh
- Department of Orthopedics, Joint Replacement Surgery Research Unit, Fortis Escorts Hospital, Jaipur, India
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Vandenneucker H, Labey L, Vander Sloten J, Desloovere K, Bellemans J. Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced. Knee Surg Sports Traumatol Arthrosc 2016; 24:3668-3677. [PMID: 25381467 DOI: 10.1007/s00167-014-3415-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 10/29/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The objectives of this in vitro project were to compare the dynamic three-dimensional patellofemoral kinematics, contact forces, contact areas and contact pressures of a contemporary patellofemoral prosthetic implant with those of the native knee and to measure the influence of patellar resurfacing and patellar thickness. The hypothesis was that these designs are capable to reproduce the natural kinematics but result in higher contact pressures. METHODS Six fresh-frozen specimens were tested on a custom-made mechanical knee rig before and after prosthetic trochlear resurfacing, without and with patellar resurfacing in three different patellar thicknesses. Full three-dimensional kinematics were analysed during three different motor tasks, using infrared motion capture cameras and retroflective markers. Patellar contact characteristics were registered using a pressure measuring device. RESULTS The patellofemoral kinematic behaviour of the patellofemoral arthroplasty was similar to that of the normal knee when the patella was resurfaced, showing only significant (p < 0.0001) changes in patellar flexion. Without patellar resurfacing, significant more patellar flexion, lateral tilt and lateral rotation was noticed. Compared to the normal knee, contact pressures were significantly elevated after isolated trochlear resurfacing. However, the values were more than doubled after patellar resurfacing. Changes in patellar thickness only influenced the antero-posterior patellar position. There was no other influence on the kinematics, and only a limited influence on the contact pressures in the low flexion angles. CONCLUSION The investigated design reproduced the normal patellofemoral kinematics acceptable well when the patella was resurfaced. From a kinematic point of view, patellar resurfacing may be advisable. However, the substantially elevated patellar contact pressures remain a point of concern in the decision whether or not to resurface the patella. This study therefore not only adds a new point in the discussion whether or not to resurface the patella, but also supports the claimed advantage that a patellofemoral arthroplasty is capable to reproduce the natural knee kinematics.
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Affiliation(s)
- Hilde Vandenneucker
- Department of Development and Regeneration - Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium.
| | - Luc Labey
- European Centre for Knee Research, Smith&Nephew, Technologielaan 11 bis, 3000, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, University of Leuven, Celestijnenlaan 300c, 3000, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium
| | - Johan Bellemans
- Department of Development and Regeneration - Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium
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13
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Berend ME, Meding JB, Malinzak RA, Faris PM, Jackson MD, Davis KE, Ritter MA. ACL Damage and Deficiency is Associated with More Severe Preoperative Deformity, Lower Range of Motion at the Time of TKA. HSS J 2016; 12:235-239. [PMID: 27703416 PMCID: PMC5026658 DOI: 10.1007/s11420-016-9504-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND ACL status varies in the arthritic knee during TKA. QUESTIONS/PURPOSES The purpose of this study was to examine clinical features and intraoperative findings associated with stages of ACL degeneration. METHODS Coronal deformity, ROM, intra-articular degenerative patterns, and ligament releases were assessed for 1656 knees during TKA. Common patterns of deformity and severity of degenerative change were assessed as a function of the severity of ACL deficiency. RESULTS Of the 1656 knees assessed, 27% had a normal ACL, 55% exhibited damage, and 18% exhibited complete absence of the ACL. Increased coronal deformity and lower preoperative ROM was associated with ACL deficiency. Increased chondral and meniscal damage and more extensive osteophyte formation were also found. More extensive ligament releases were required in ACL-deficient knees. CONCLUSIONS The status of the ACL is predictive of the need for increased surgical deformity correction. A better understanding of ACL status is an important consideration during in choosing TKA as opposed to unicompartmental arthroplasty. The status of the ACL should be considered in planning for implant choice in TKA.
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Affiliation(s)
- Michael E. Berend
- Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA
| | - John B. Meding
- Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA
| | - Robert A. Malinzak
- Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA
| | - Philip M. Faris
- Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA
| | - Michael D. Jackson
- Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA
| | - Kenneth E. Davis
- Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA
| | - Merrill A. Ritter
- Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA ,Joint Replacement Surgeons of Indiana Research Foundation, Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, Indiana 46158 USA
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Sakellariou VI, Poultsides LA, Ma Y, Bae J, Liu S, Sculco TP. Risk Assessment for Chronic Pain and Patient Satisfaction After Total Knee Arthroplasty. Orthopedics 2016; 39:55-62. [PMID: 26730683 DOI: 10.3928/01477447-20151228-06] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/26/2015] [Indexed: 02/07/2023]
Abstract
The estimated prevalence of patients who report minor or no improvement of their symptoms and pain after total knee arthroplasty (TKA) remains high, ranging from 5% to 40%. The authors sought to determine whether chronic pain and functional health are related to specific variations in demographic data, surgical techniques, or radiographic pre- and postoperative findings. They also sought to identify independent risk factors for persistent moderate-to-severe chronic pain after TKA. A total of 273 patients who underwent primary TKA from October 2007 to March 2010 with a minimum follow-up of 1 year were identified from electronic medical records. A questionnaire to identify persistent postoperative pain (36-item Short Form Health Survey [SF-36]) was mailed to these patients. Linear regression and logistic regression were used to identify predictors for SF-36 and chronic pain, respectively. Thirty-nine percent of patients reported persistent pain after TKA, with a median average pain score of 3 out of 10 and worst pain score of 5 out of 10. Independent risk factors for persistent pain are the length of the operative procedure (odds ratio [OR]=1.013), medical history of diabetes mellitus (OR=0.430), presence of preoperative flexion contracture (OR=1.089), and patellofemoral joint overstuffing (OR=0.915). Persistent postoperative pain is a common finding after TKA. Nonmodifiable risk factors could be used for risk stratification, whereas modifiable risk factors could be used as a clinical guidance for modification of some aspects of existing surgical techniques.
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15
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Shervin D, Pratt K, Healey T, Nguyen S, Mihalko WM, El-Othmani MM, Saleh KJ. Anterior knee pain following primary total knee arthroplasty. World J Orthop 2015; 6:795-803. [PMID: 26601061 PMCID: PMC4644867 DOI: 10.5312/wjo.v6.i10.795] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/09/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications.
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16
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External rotation of the femoral component decreases patellofemoral contact stress in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:3266-72. [PMID: 25026929 DOI: 10.1007/s00167-014-3103-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 05/27/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between patellofemoral (PF) contact stress in vivo and the alignment of the femoral component in patients after total knee arthroplasty (TKA). METHODS Thirty knees with medial compartment osteoarthritis that underwent mobile-bearing TKA with modified gap technique were evaluated. Surgery was performed using a subvastus approach to eliminate the effect of the approach to muscle balance, with a computed tomography-based navigation system (Vector Vision 1.61; Brain Lab, Heimstetten, Germany). PF contact stress was measured by a Flexiforce pressure sensor (Nitta Co., Ltd., Osaka, Japan) intraoperatively, and the results were compared with the alignment of the femoral component after TKA. RESULTS The PF contact stress was not correlated with sagittal and coronal alignment of the femoral component and patellar tracking, whereas rotational alignment of the femoral component was negatively correlated with PF contact stress (r = -0.718, p < 0.01). CONCLUSIONS Regarding the alignment of the femoral component, only the rotational alignment of the femoral component was correlated with PF contact stress. PF contact stress decreased more as the femoral component rotated more externally. LEVEL OF EVIDENCE Case control study, Level III.
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17
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Young SW, Clarke HD, Graves SE, Liu YL, de Steiger RN. Higher Rate of Revision in PFC Sigma Primary Total Knee Arthroplasty With Mismatch of Femoro-Tibial Component Sizes. J Arthroplasty 2015; 30:813-7. [PMID: 25534956 DOI: 10.1016/j.arth.2014.11.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty (TKA) systems permit a degree of femoro-tibial component size mismatch. The effect of mismatched components on revision rates has not been evaluated in a large study. We reviewed 21,906 fixed-bearing PFC Sigma primary TKAs using the Australian Orthopaedic Association National Joint Replacement Registry, dividing patients into three groups: no femoro-tibial size mismatch, tibial component size > femoral component size, and femoral component > tibial component. Revision rates were higher when the femoral size was greater than the tibia, compared to both equal size (HR = 1.20 (1.00, 1.45), P = 0.047) and to tibial size greater than femoral (HR = 1.60 (1.08, 2.37), P = 0.019). Potential mechanisms to explain these findings include edge loading of polyethylene and increased tibial component stresses.
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Affiliation(s)
| | | | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - Yen-Liang Liu
- Data Management and Analysis Centre, University of Adelaide, Adelaide, SA, Australia
| | - Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
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18
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Bracey DN, Brown ML, Beard HR, Mannava S, Nazir OF, Seyler TM, Lang JE. Effects of patellofemoral overstuffing on knee flexion and patellar kinematics following total knee arthroplasty: a cadaveric study. INTERNATIONAL ORTHOPAEDICS 2015; 39:1715-22. [PMID: 25776464 DOI: 10.1007/s00264-015-2715-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to test the hypothesis that overstuffing the patellofemoral joint during total knee arthroplasty (TKA) would decrease passive knee flexion and alter patellar kinematics during knee flexion. METHODS Ten cadaveric knees were implanted with cruciate-retaining TKAs, and the patellofemoral joint was overstuffed in 2-mm increments with custom-augmented patellar prostheses (+2 mm through +8 mm). Changes to knee flexion, patellar shift, tilt and rotation were measured with an imageless optical-tracking computer navigation system. RESULTS Knee flexion decreased an average 1.2° with each additional 2 mm of patellar thickness. Compared with control TKA (+0 mm), no significant decrease in knee flexion was detected until the patellofemoral joint was overstuffed with the +8-mm patellar prosthesis. Kinematic tracking data showed significantly greater lateral shift of patella with the +6- and +8-mm prostheses and significantly greater lateral tilt with the +8-mm prosthesis. Overstuffing had no appreciable effect on patellar rotation. CONCLUSIONS Passive knee flexion after TKA is significantly reduced when overstuffing the patellofemoral joint by +8 mm, and patellofemoral kinematics are altered when overstuffing the joint by +6 mm. These results demonstrate the relatively modest effects of patellofemoral overstuffing on knee flexion and patellar tracking kinematics after TKA.
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Affiliation(s)
- Daniel N Bracey
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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19
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Li T, Zhou L, Zhuang Q, Weng X, Bian Y. Patellar denervation in total knee arthroplasty without patellar resurfacing and postoperative anterior knee pain: a meta-analysis of randomized controlled trials. J Arthroplasty 2014; 29:2309-13. [PMID: 24582160 DOI: 10.1016/j.arth.2014.01.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/21/2013] [Accepted: 01/20/2014] [Indexed: 02/01/2023] Open
Abstract
The aim of this meta-analysis was to investigate whether patellar denervation with electrocautery (PD) after total knee arthroplasty (TKA) could reduce the postoperative anterior knee pain (AKP). Five randomized controlled trials (RCTs) with 572 patients and 657 knees were eligible for this meta-analysis. Our results showed that PD was associated with less AKP, lower visual analogue scale (VAS), higher patellar scores and better knee function compared with no patellar denervation (NPD). Complications did not differ significantly between the two groups. The existing evidence indicates that PD may be a better approach, as it improves both anterior knee pain and knee function after TKA. Future multi-center randomized controlled studies with large sample sizes are required to verify the current findings.
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Affiliation(s)
- Tao Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Lei Zhou
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Qianyu Zhuang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Yanyan Bian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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Effect of patellar thickness on early results of total knee replacement with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2014; 22:3093-9. [PMID: 25145946 DOI: 10.1007/s00167-014-3235-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/11/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE Patellar thickness is a concern in total knee replacement with patellar resurfacing because of the risk of patellar fracture or implant loosening. The aim of this study was to evaluate if patellar thickness is related to clinical outcome in the absence of patellar fracture or implant loosening. METHODS Early results of 169 patients who underwent total knee replacement with patellar resurfacing were reviewed to assess the effect of patellar thickness on clinical outcome. The mean follow-up was 13 months. The range of motion, Knee Society Score, Function Score and WOMAC Score were assessed preoperatively, at day 0, 6 months and 1 year. Radiographs were assessed for patellar fracture or implant loosening. RESULTS Thirty-one percent of all patients had preoperative thickness <21 mm. Seven percent had <12 mm residual thickness after patellar cut, all were female. Twenty-three percent had ≥1 mm increase of thickness after surgery. Radiographs did not show any patellar fracture or implant loosening. However, preoperative patellar thickness <21 mm had poorer gain in range of motion at 1 year. Preoperative range of motion had greater influence on postoperative range of motion than preoperative patellar thickness. Residual thickness <12 mm had lower gain in WOMAC score at 1 year and an increase in thickness ≥1 mm postoperatively was associated with lower gain in WOMAC score at 6 months. CONCLUSIONS Early results of patellar resurfacing with preoperative thickness <21 mm or residual thickness <12 mm were found to be inferior even in the absence of patellar fracture or implant loosening. Conservative cutting resulting in 1 mm increase in thickness was also found to have inferior clinical results. LEVEL OF EVIDENCE II.
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21
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Cheng T, Zhu C, Guo Y, Shi S, Chen D, Zhang X. Patellar denervation with electrocautery in total knee arthroplasty without patellar resurfacing: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2014; 22:2648-54. [PMID: 23743580 DOI: 10.1007/s00167-013-2533-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 05/13/2013] [Indexed: 02/09/2023]
Abstract
PURPOSE The impact of patellar denervation with electrocautery in total knee arthroplasty (TKA) on post-operative outcomes has been under debate. This study aims to conduct a meta-analysis and systematic review to compare the benefits and risks of circumpatellar electrocautery with those of non-electrocautery in primary TKAs. METHODS Comparative and randomized clinical studies were identified by conducting an electronic search of articles dated up to September 2012 in PubMed, EMBASE, Scopus, and the Cochrane databases. Six studies that focus on a total of 849 knees were analysed. A random-effects model was conducted using the inverse-variance method for continuous variables and the Mantel-Haenszel method for dichotomous variables. RESULTS There was no significant difference in the incidence of anterior knee pain between the electrocautery and non-electrocautery groups. In term of patellar score and Knee Society Score, circumpatellar electrocautery improved clinical outcomes compared with non-electrocautery in TKAs. The statistical differences were in favour of the electrocautery group but have minimal clinical significance. In addition, the overall complications indicate no statistical significance between the two groups. CONCLUSIONS This study shows no strong evidence either for or against electrocautery compared with non-electrocautery in TKAs. LEVEL OF EVIDENCE Therapeutic study (systematic review and meta-analysis), Level III.
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Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China,
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22
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Overstuffing in total knee replacement: no effect on clinical outcomes or anterior knee pain. INTERNATIONAL ORTHOPAEDICS 2014; 39:887-91. [DOI: 10.1007/s00264-014-2548-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
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Yang B, Yu JK, Zheng ZZ, Lu ZH, Zhang JY. Comparative study of sex differences in distal femur morphology in osteoarthritic knees in a Chinese population. PLoS One 2014; 9:e89394. [PMID: 24586746 PMCID: PMC3929686 DOI: 10.1371/journal.pone.0089394] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/20/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate sex differences in resected distal femoral morphology in Chinese osteoarthritic knees. METHODS The study included 130 osteoarthritic knees in 65 men and 65 women in China. None had anterior femoral osteophyte or serious patellar femoral joint degeneration. The following were measured using computed tomography and analyzed to identify morphological differences according to sex in the resected distal femurs: anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and mediolateral (ML) and anteroposterior (AP) dimensions. The ML/AP aspect ratio was calculated. RESULTS The average ALCH and AMCH were 8.2±1.8 mm, 3.1±1.5 mm for men and 7.4±1.7 mm, 3.6±1.5 mm for women. There were significant differences between men and women in ALCH values (P = 0.014) but not in AMCH values (P = 0.09). Women had smaller ML/AP aspect ratios than men for a given AP dimension. This indicated that the femoral ML dimension of a prosthesis with a given AP dimension may have overhang in women. CONCLUSIONS This study suggested that sex differences should be taken into account in the design of femoral prosthesis for Chinese men and women.
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Affiliation(s)
- Bo Yang
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jia-Kuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
- * E-mail:
| | - Zhuo-Zhao Zheng
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, China
| | - Zhi-Hua Lu
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
| | - Ji-Ying Zhang
- Institute of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, China
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Babazadeh S, Dowsey MM, Stoney JD, Choong PFM. The effect of tibio-femoral over-distraction in primary knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21:2810-6. [PMID: 23085821 DOI: 10.1007/s00167-012-2240-y] [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: 05/02/2012] [Accepted: 10/04/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE Overstuffing the patellofemoral joint has been associated with poor post-operative outcomes. No study has assessed the effect of over-distracting the tibio-femoral joint in the vertical plane and its effects on function and quality of life. The purpose of this study is to assess the effect of tibio-femoral joint distraction on function and quality of life after total knee arthroplasty. METHODS Measurements of knee joint distraction were devised using long-leg alignment radiographs. Seventy-three patients were prospectively recruited and their joint distraction measured post-operatively. A comparison was made between the level of joint distraction and functional outcomes as measured by the International Knee Society score and its components, such as pain and flexion, and the Knee injury and Osteoarthritis Outcome Score and quality of life as measured by the Short-Form 12 score. Twelve-month follow-up was achieved. RESULTS Knee joint over-distraction post-arthroplasty correlated significantly with Knee Society score (p = 0.041), flexion (p = 0.005) and pain (p = 0.002). Those knees that were over-distracted post-operatively suffered more pain, less flexion and a lower International Knee Society score compared with their counterparts. No correlation was found between over-distracting the knee joint and quality of life. CONCLUSION Over-distracting the tibio-femoral joint during arthroplasty is a significant predictor of reduction in function and increase in pain in the short to medium term. When between sizes of tibial inserts, the surgeon should consider using the thinner option.
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Affiliation(s)
- Sina Babazadeh
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia
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Mofidi A, Bajada S, Holt MD, Davies AP. Functional relevance of patellofemoral thickness before and after unicompartmental patellofemoral replacement. Knee 2012; 19:180-4. [PMID: 21489801 DOI: 10.1016/j.knee.2011.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 02/21/2011] [Accepted: 03/01/2011] [Indexed: 02/02/2023]
Abstract
The aim of this study was to assess the increase in the anterior height of the knee after unicompartmental patellofemoral replacement and the impact of this increase on the range of motion and function of the knee. Twenty-eight patients (34 knees) who underwent patellofemoral replacement with FPV(TM) prosthesis between 2005 and 2009 were identified and retrospectively analyzed using chart and radiological review. Trochlear height and patellar thickness were measured combined and compared pre and postoperatively. The range of movement and functional outcome scores after 6-12 months follow-up were noted. The effect of increased postoperative anterior-posterior height of the knee on the range of motion was studied. Postoperative mean range of flexion of the knee joint was 116°. The mean Oxford knee score was 21 points. The mean American Knee Society Knee Score was 80 points for pain and 61 points for function. The trochlear height and patellar thickness were increased by 3.5 and 2.5 mms respectively, resulting in average total increase of 6mm in the anterior-posterior height of the knee. We found no relationship between range of motion and function of the knee and the increase in the anterior-posterior height. We found a negative correlation between increase in the anterior-posterior height and preoperative anterior-posterior height. FPV patellofemoral replacement results in correct anatomical reconstruction of the trochlear height rather than 'overstuffing' of the patellofemoral joint. There is an increase in anterior-posterior height of the knee but this does not affect range of movement or clinical outcome.
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Affiliation(s)
- A Mofidi
- Morriston Hospital, Swansea SA6 6NL, UK.
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Song EK, Jung WB, Yoon TR, Park KS, Seo HY, Seon JK. Comparison of outcomes after bilateral simultaneous total knee arthroplasty using gender-specific and unisex knees. J Arthroplasty 2012; 27:226-31. [PMID: 21704482 DOI: 10.1016/j.arth.2011.03.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 03/31/2011] [Indexed: 02/01/2023] Open
Abstract
The clinical and radiologic results of a gender-specific total knee arthroplasty design were compared with those of a conventional unisex design in 50 female patients with bilateral osteoarthritis and a minimum follow-up of 2 years. Total knee arthroplasty was performed using a conventional unisex implant in one knee and a gender-specific implant in the other. Clinical outcomes, which included range of motion, Hospital for Special Surgery scores, and Western Ontario and McMaster Universities Osteoarthritis Index scores, were compared. In addition, patients' subjectively preferred sides were noted, and radiologic results based on implant positions, posterior offsets, anterior offsets, and patellofemoral alignments were evaluated. No significant differences were observed between range of motion, Hospital for Special Surgery score, or Western Ontario and McMaster Universities Osteoarthritis Index scores. Patient subjective preferences and radiologic results were also similar for both sides. In conclusion, gender-specific knees in female total knee patients showed no advantages over standard unisex knees in terms of clinical or radiologic outcomes.
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Affiliation(s)
- Eun Kyoo Song
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, South Korea
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Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow? Knee Surg Sports Traumatol Arthrosc 2011; 19:1453-9. [PMID: 21302046 DOI: 10.1007/s00167-011-1418-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA. METHODS In 50 patients (21 men, 29 women) undergoing TKA, we compared patellar blood flow at flexions 0° to 30°, 60°, 90°, and 110° before and after medial parapatellar arthrotomy to pre- and postoperative anterior knee pain scores by means of a laser Doppler flowmeter (LDF) probe. Anterior knee pain was assessed using the pain intensity numeric rating scale (NRS) of 0-10 (0-no, 10-worst pain). Based on the NRS pain values, patients were divided into two main groups: group A (n = 34) with no pain or discomfort (NRS range 0-4) and group B (n = 16) with anterior knee pain (NRS range 5-10). RESULTS Patients of group B demonstrated a significant decrease in blood flow before arthrotomy at flexions from 0° to 90°, and 110° and from 0° to 60°, 90°, and 110° after arthrotomy. For group A, a significant decrease in blood flow was detected at flexions from 0° to 90°, and 110° before and after arthrotomy. For both groups, medial arthrotomy did not have a statistically significant influence on patellar blood flow (margin of significance P < 0.05). Prior to TKA, 16 of the 50 patients of group B (32%) complained of anterior knee pain (mean NRS 7.1 ± 1.7). At 2-year follow-up, pain significantly decreased (NRS 3.1 ± 2.1) and only 4 of the 16 patients (25%) complained of moderate anterior pain (average NRS 5.7 ± 0.5), while 8 of 16 (50%) patients reported discomfort (mean NRS 3.5 ± 1.8) around the patella. Patients in group A also demonstrated a significant decrease in pain intensity (from NRS 1.5 ± 1.4 preoperatively to NRS 0.4 ± 1.5 at 2-year follow-up). Statistical analysis demonstrated no statistically significant correlation between pre-arthrotomy/post-arthrotomy patellar blood flow and the presence of preoperative and postoperative anterior knee pain. Only the degree of flexion had an influence on patellar blood flow. CONCLUSION Medial arthrotomy had no direct significant effect on patellar blood flow, and the diminished blood flow did not correlate with postoperative anterior knee pain. However, a significant correlation was revealed between patellar blood flow and the degree of flexion: in almost a quarter of patients, blood flow dropped to zero at flexions of 100° and above.
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The female knee: anatomic variations and the female-specific total knee design. Clin Orthop Relat Res 2008; 466:3059-65. [PMID: 18820981 PMCID: PMC2592531 DOI: 10.1007/s11999-008-0536-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 09/10/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED The concept and need for a gender-specific or female-specific total knee prosthesis have generated interest and discussion in the orthopaedic community and the general public. This concept relies on the assumption of a need for such a design and the opinion that there are major anatomic differences between male and female knees. Most of the information regarding this subject has been disseminated through print and Internet advertisements, and through direct-to-patient television and magazine promotions. These sources and a recent article in a peer-reviewed journal, which support the need for a female-specific implant design, have proposed three gender-based anatomic differences: (1) an increased Q angle, (2) less prominence of the anterior medial and anterior lateral femoral condyles, and (3) reduced medial-lateral to anterior-posterior femoral condylar aspect ratio. We examined the peer-reviewed literature to determine whether women have had worse results than men after traditional TKAs. We found women have equal or better results than men. In addition, we reviewed the evidence presented to support these three anatomic differences. We conclude the first two proposed differences do not exist, and the third is so small that it likely has no clinical effect. LEVEL OF EVIDENCE Level IV, systematic review. See the Guidelines for Authors for a complete description of levels of evidence.
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