scholarly journals The influence of postoperative coronal alignment on revision surgery in total knee arthroplasty

2007 ◽  
Vol 32 (5) ◽  
pp. 639-642 ◽  
Author(s):  
Samer S. Morgan ◽  
A. Bonshahi ◽  
N. Pradhan ◽  
A. Gregory ◽  
A. Gambhir ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Coronal Alignment ◽  
Total Knee

scholarly journals Influence of Gender on Occurrence of Aseptic Loosening and Recurrent PJI after Revision Total Knee Arthroplasty

Osteology ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 92-104
Author(s):  
Arne Kienzle ◽  
Sandy Walter ◽  
Yannick Palmowski ◽  
Stephanie Kirschbaum ◽  
Lara Biedermann ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Prosthesis Failure ◽  
Coronal Alignment ◽  
Total Knee ◽  
Revision Tka

Background: Periprosthetic joint infection (PJI) is a common yet severe complication after total knee arthroplasty (TKA). Surgical intervention and antibiotic therapy are obligatory to achieve successful, infection-free outcome. Compared to the outcomes after primary TKA, prosthesis failure rates are drastically increased after PJI-dependent revision surgery. Recurrent PJI and aseptic loosening are the most common reasons for prosthesis failure after revision TKA. An open question is the influence of the patients’ gender on long-term prosthesis survival after revision surgery. Additionally, it is unknown whether gender-related parameters and risk factors or differences in treatment are responsible for potential differences in outcome after revision arthroplasty. Patients and Methods: In this report, 109 patients that received TKA revision surgery due to PJI were retrospectively analyzed. We used clinical, paraclinical and radiological examinations to study the influence of gender on the long-term complications aseptic loosening and recurrent PJI after PJI-dependent revision arthroplasty. Results: While overall prosthesis failure rates and risk of recurrent PJI did not differ between genders, the long-term risk of aseptic loosening was significantly elevated in female patients. Postoperative coronal alignment was significantly more varus for women later diagnosed with aseptic loosening. Besides coronal alignment, no gender-dependent differences in clinical presentation or treatment were observed. Conclusions: Female patients displayed a significantly increased risk for aseptic loosening after PJI-dependent revision TKA. The observed gender-dependent differences in long-term outcome in our study support theories surrounding the role of bone metabolism in the development of aseptic loosening. Our data suggest that further research on a female design for PJI-dependent revision prostheses is warranted.

The Adjustment of the Rotational Alignment of the Distal End of the Extramedullary Guide to the Anteroposterior Axis of the Proximal Tibia in Total Knee Arthroplasty

2021 ◽  
Author(s):  
Hideki Mizu-uchi ◽  
Hidehiko Kido ◽  
Tomonao Chikama ◽  
Kenta Kamo ◽  
Satoshi Kido ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Proximal Tibia ◽  
Rotational Alignment ◽  
Coronal Alignment ◽  
Ideal Position ◽  
Total Knee ◽  
Alignment Guide ◽  
The Ideal

AbstractThe optimal placement within 3 degrees in coronal alignment was reportedly achieved in only 60 to 80% of patients when using an extramedullary alignment guide for the tibial side in total knee arthroplasty (TKA). This probably occurs because the extramedullary alignment guide is easily affected by the position of the ankle joint which is difficult to define by tibial torsion. Rotational direction of distal end of the extramedullary guide should be aligned to the anteroposterior (AP) axis of the proximal tibia to acquire optimal coronal alignment in the computer simulation studies; however, its efficacy has not been proven in a clinical setting. The distal end of the guide can be overly displaced from the ideal position when using a conventional guide system despite the alignment of the AP axis to the proximal tibia. This study investigated the effect of displacement of the distal end of extramedullary guide relative to the tibial coronal alignment while adjusting the rotational alignment of the distal end to the AP axis of the proximal tibia in TKA. A total of 50 TKAs performed in 50 varus osteoarthritic knees using an image-free navigation system were included in this study. The rotational alignment of the proximal side of the guide was adjusted to the AP axis of the proximal tibia. The position of the distal end of the guide was aligned to the center of the ankle joint as viewed from the proximal AP axis (ideal position) and as determined by the navigation system. The tibial intraoperative coronal alignments were recorded as the distal end was moved from the ideal position at 3-mm intervals. The intraoperative alignments were 0.5, 0.9, and 1.4 degrees in valgus alignment with 3-, 6-, and 9-mm medial displacements, respectively. The intraoperative alignments were 0.7, 1.2, and 1.7 degrees in varus alignment with 3-, 6-, and 9-mm lateral displacements, respectively. In conclusion, the acceptable tibial coronal alignment (within 2 degrees from the optimal alignment) can be achieved, although some displacement of the distal end from the ideal position can occur after the rotational alignment of the distal end of the guide is adjusted to the AP axis of the proximal tibia.

Costs of unicompartmental compared with total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 23-31
Author(s):  
Robert A. Burnett III ◽  
JaeWon Yang ◽  
P. Maxwell Courtney ◽  
E. Bailey Terhune ◽  
Charles P. Hannon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Healthcare Costs ◽  
Cost Savings ◽  
Vein Thrombosis ◽  
Total Knee ◽  
The Mean ◽  
One Year ◽  
Surgery Rates

Aims The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts. Results Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425). Conclusion Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23–31.

scholarly journals Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment

2020 ◽  
Author(s):  
Michel P. Bonnin ◽  
Lucas Beckers ◽  
Augustin Leon ◽  
Jules Chauveau ◽  
Jacobus H. Müller ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Coronal Alignment ◽  
Total Knee

scholarly journals Improving Tibial Component Coronal Alignment During Total Knee Arthroplasty with the Use of a Double‐Check Technique

2019 ◽  
Vol 11 (6) ◽  
pp. 1013-1019 ◽  
Author(s):  
De‐si Ma ◽  
Zhi‐wei Wang ◽  
Liang Wen ◽  
Shi‐xiang Ren ◽  
Yuan Lin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Coronal Alignment ◽  
Total Knee

Extramedullary Guide Alignment Is not Affected by Obesity in Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Jocelyn Compton ◽  
Jessell Owens ◽  
Jesse Otero ◽  
Nicolas Noiseux ◽  
Timothy Brown
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Primary Total Knee Arthroplasty ◽  
Coronal Plane ◽  
Coronal Alignment ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Valgus Alignment

AbstractCoronal alignment of the tibial implant correlates with survivorship of total knee arthroplasty (TKA), especially in obese patients. The purpose of this study was to determine if obesity affects coronal plane alignment of the tibial component when utilizing standard extramedullary tibial guide instrumentation during primary TKA. A retrospective review from June 2017 to February 2018 identified 142 patients (162 primary TKAs). There were 88 patients (100 knees) with body mass index (BMI) < 35 kg/m2 and 54 patients (62 knees) with BMI ≥ 35.0 kg/m2. The cohorts did not differ in age (p = 0.37), gender (p = 0.61), or Charlson's comorbidity index (p = 0.54). Four independent reviewers measured the angle between the base of the tibial component and the mechanical axis of the tibia on the anteroposterior view of long-leg film at first postoperative clinic visit. Outliers were defined as patients with greater than 5 degrees of varus or valgus alignment (n = 0). Reoperations and complications were recorded to 90 days postoperatively. There was no significant difference in mean tibial coronal alignment between the two groups (control alignment 90.8 ± 1.2 degree versus obese alignment 90.8 ± 1.2 degree, p = 0.91). There was no difference in varus versus valgus alignment (p = 0.19). There was no difference in the number of outliers (two in each group, p = 0.73). There was no difference in rate of reoperation (p = 1.0) or complication (p = 0.51). Obesity did not affect coronal plane alignment of the tibial component when using an extramedullary guide during primary TKA in our population.

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