Comparison of alternate references for femoral rotation in female patients undergoing total knee arthroplasty

Objective: Computer assisted total knee arthroplasty (CA TKA) platforms can provide detailed kinematic data that is presented in various forms including a coronal plane graphic that maps the flexion arc from full extension to deep flexion. Graphics obtained from normal tibiofemoral articulations reveal varied and complex kinematic patterns that have yet to be explained. An understanding of what drives curve variation would allow prediction of how a preoperative curve would be altered by total knee arthroplasty. Implant position could then be tailored to maintain a desirable curve or avoid an undesirable one. Methods: An articulated lower limb saw bone with a stable hip pivot was obtained. Adjustable osteotomies were created so that femoral torsion, femoral varus-valgus and tibial varus-valgus could be altered independently. The saw bone limb was registered with a CA TKA navigation system using the posterior condyles as a rotational axis. Axial and coronal plane morphology of the distal femur and coronal plane morphology of the proximal tibia were systematically altered and a kinematic curve obtained for each morphologic combination. Femoral rotational position was varied from 100 of internal torsion to 100 of external torsion in 20 increments. Similarly, femoral coronal position was varied from 20 of varus to 60 of valgus and tibial coronal position was varied from 5.50 of varus to 10 of valgus. Curves were obtained by manually flexing the joint through a full range of motion with the femoral condyles in contact with proximal tibia at all times. Results: Varying femoral rotation has no effect in full extension but drives the curve away from neutral as the knee flexes. Maximal deviation is seen at around 900 of flexion. Internal torsion drives the curve into valgus as the knee flexes and external torsion has a reciprocal effect. Varying femoral varus-valgus causes maximal deviation from neutral in full extension. Femoral varus drives the curve from varus in extension towards valgus as the knee flexes with the effect peaking in maximal flexion. Femoral valgus has a reciprocal effect. Varying tibial varus-valgus has no effect on curve shape but does move the curve either side of neutral. Complex (parabolic) curves are caused by large rotations or the opposing effects of femoral varus-valgus and femoral rotation. The modal human anatomy of slight femoral internal rotation, slight femoral valgus and slight tibial varus produces a straight neutral curve. Conclusion: Kinematic curve shape is driven by distal femoral anatomy. The typical changes made to distal femoral articular anatomy in TKA by externally rotating a neutrally orientated femoral component will bring many native curves towards neutral. Externally rotating when the preoperative curve begins neutral and drives into varus as the knee flexes will drive the curve harder into varus. Conversely, kinematic femoral placement will reconstitute the premorbid curve morphology. Which outcome is preferable has yet to be determined.

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Neuropathic Pain After Total Knee Arthroplasty: A Cross-sectional Study in Female Patients

Turkish Journal of Osteoporosis ◽

10.4274/tod.galenos.2020.62533 ◽

2021 ◽

Vol 27 (2) ◽

pp. 103-108

Author(s):

Cemile Sevgi Polat ◽

Didem Sezgin Özcan ◽

Elif Umay Altaş ◽

Şule Şahin Onat ◽

Belma Füsun Köseoğlu

Keyword(s):

Total Knee Arthroplasty ◽

Neuropathic Pain ◽

Knee Arthroplasty ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Female Patients ◽

Total Knee

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A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b3.bjj-2018-0852.r2 ◽

2019 ◽

Vol 101-B (3) ◽

pp. 340-347 ◽

Cited By ~ 16

Author(s):

N. M. Elkassabany ◽

L. F. Cai ◽

I. Badiola ◽

B. Kase ◽

J. Liu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Functional Outcomes ◽

Single Shot ◽

Block Group ◽

Adductor Canal Block ◽

Female Patients ◽

Adductor Canal ◽

Total Knee ◽

Male Patients

Aims Adductor canal block (ACB) has emerged as an alternative to femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA). The optimal duration of maintenance of the ACB is still questionable. The purpose of this study was to compare the analgesic benefits and physiotherapy (PT) outcomes of single-shot ACB to two different regimens of infusion of the continuous ACB, 24-hour and 48-hour infusion. Patients and Methods This was a prospective, randomized, unblinded study. A total of 159 American Society of Anesthesiologists (ASA) physical status I to III patients scheduled for primary TKA were randomized to one of three study groups. Three patients did not complete the study, leaving 156 patients for final analysis. Group A (n = 53) was the single-shot group (16 female patients and 37 male patients with a mean age of 63.9 years (sd 9.6)), group B (n = 51) was the 24-hour infusion group (22 female patients and 29 male patients with a mean age of 66.5 years (sd 8.5)), and group C (n = 52) was the 48-hour infusion group (18 female patients and 34 male patients with a mean age of 62.2 years (sd 8.7)). Pain scores, opioid requirements, PT test results, and patient-reported outcome instruments were compared between the three groups. Results The proportion of patients reporting severe pain, defined as a pain score of between 7 and 10, on postoperative day number 2 (POD 2) were 21% for the single-shot group, 14% for the 24-hour block group, and 12% for the 48-hour block group (p = 0.05). Cumulative opioid requirements after 48 hours were similar between the groups. Functional outcomes were similar in all three groups in POD 1 and POD 2. Conclusion There was no clear benefit of the 24-hour or 48-hour infusions over the single-shot ACB for the primary endpoint of the study. Otherwise, there were marginal benefits for keeping the indwelling catheter for 48 hours in terms of reducing the number of patients with moderate pain and improving the quality of pain management. However, all three groups had similar opioid usage, length of hospital stay, and functional outcomes. Further studies with larger sample sizes are needed to confirm these findings. Cite this article: Bone Joint J 2019;101-B:340–347.

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Preoperative hand-grip strength can be a predictor of stair ascent and descent ability after total knee arthroplasty in female patients

Journal of Orthopaedic Science ◽

10.1016/j.jos.2019.03.003 ◽

2020 ◽

Vol 25 (1) ◽

pp. 167-172 ◽

Cited By ~ 4

Author(s):

Shogo Hashimoto ◽

Kazuhisa Hatayama ◽

Masanori Terauchi ◽

Kenichi Saito ◽

Hiroshi Higuchi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Grip Strength ◽

Knee Arthroplasty ◽

Hand Grip Strength ◽

Female Patients ◽

Stair Ascent ◽

Hand Grip ◽

Total Knee

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Twenty-four-week hospital-based progressive resistance training on functional recovery in female patients post total knee arthroplasty

The Knee ◽

10.1016/j.knee.2019.02.008 ◽

2019 ◽

Vol 26 (3) ◽

pp. 729-736 ◽

Cited By ~ 2

Author(s):

Wei-Hsiu Hsu ◽

Wei-Bin Hsu ◽

Wun-Jer Shen ◽

Zin-Rong Lin ◽

Shr-Hsin Chang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Resistance Training ◽

Functional Recovery ◽

Knee Arthroplasty ◽

Progressive Resistance Training ◽

Female Patients ◽

Total Knee ◽

Progressive Resistance

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Total Knee Arthroplasty for Chronic Anterior Knee Dislocation

Clinical Medicine Insights Case Reports ◽

10.1177/1179547618782882 ◽

2018 ◽

Vol 11 ◽

pp. 117954761878288 ◽

Cited By ~ 1

Author(s):

Mahmoud Jabalameli ◽

Abolfazl Bagherifard ◽

Hosseinali Hadi ◽

Alireza Askari ◽

Salman Ghaffari

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Dislocation ◽

Female Patients ◽

Total Knee ◽

Anterior Knee

Background: The occurrence of chronic knee dislocation is rare. To the best of our knowledge, total knee arthroplasty for treatment of chronic anterior knee dislocation has not been reported. Method: This report describes 3 cases of chronic anterior knee dislocation treated by total knee arthroplasty. Results: Three female patients with chronic anterior knee dislocation were treated by hinged prosthesis total knee arthroplasty using the Insall rectus snip approach. At a mean of 17 months (range, 12-24 months) of follow-up, all patients showed a painless stable prosthesis and expressed satisfaction with the results. Conclusions: Total knee arthroplasty for chronic anterior knee dislocation is a challenging procedure. The Insall rectus snip approach with quadriceps release and constrained prosthesis is recommended.

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