scholarly journals Change of tibial tuberosity-trochlear groove (TT-TG) distance during total knee arthroplasty had no influence on clinical outcome and anterior knee pain

2021 ◽  
Author(s):  
Silvan Hess ◽  
Timo Fromm ◽  
Filippo Schiapparelli ◽  
Lukas B. Moser ◽  
Emma Robertson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
T Test ◽  
Tibial Tuberosity ◽  
Trochlear Groove ◽  
Femoral Mechanical Angle ◽  
Tibial Mechanical Angle ◽  
Total Knee

Abstract Purpose The main purpose of this study was to determine whether there is a correlation between the change of tibial tuberosity-trochlear groove (TT-TG) distance and clinical outcomes after total knee arthroplasty (TKA). Methods A total of 52 knees undergoing TKA due to primary osteoarthritis were included in this retrospective study. All patients had pre- and postoperative CT scans. TT-TG distance was measured by two independent observers and the following alignment parameters were measured: hip-knee ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA), and posterior condylar angle (PCA). Clinical outcome was assessed using Knee Society Score (KSS) pre- and post-operatively and at a minimum of 12-month follow-up. Evidence of AKP was noted from follow-up reports. Pre- and postoperative scores were compared using a paired Student t-test. Pearson correlations were calculated to assess the influence of TT-TG on clinical outcome and of alignment parameters on the change in TT-TG. TT-TG between patients with and without AKP was compared using unpaired Student’s t-test (p < 0.05). Results Neither the absolute postoperative TT-TG nor the amount of change in TT-TG correlated with the post-operative KSS or the change in KSS. Post-operative TT-TG and change in TT-TG did not differ significantly between patients with and patients without AKP. Only the change in FMA showed a correlation with the change in TT-TG (p = 0.01, r = 0.36). Conclusion Despite a missing correlation between outcomes and TT-TG distance in this study, excessive TT-TG distance should be avoided. Furthermore, surgeons need to be aware that changes in femoral joint line orientation might affect TT-TG distance.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

scholarly journals FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 807.3-807
Author(s):  
I. Moriyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Osteoarthritis Of The Knee ◽  
Patellar Resurfacing ◽  
Criterion A ◽  
Total Knee ◽  
The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

Infrapatellar Fat Pad Resection or Preservation during Total Knee Arthroplasty: A Systematic Review

2019 ◽  
Author(s):  
Benjamin Yao ◽  
Linsen T. Samuel ◽  
Alexander J. Acuña ◽  
Mhamad Faour ◽  
Alexander Roth ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Infrapatellar Fat Pad ◽  
Fat Pad ◽  
Total Knee

AbstractConsiderations of how to improve postoperative outcomes for total knee arthroplasty (TKA) have included preservation of the infrapatellar fat pad (IPFP). Although the IPFP is commonly resected during TKA procedures, there is controversy regarding whether resection or preservation should be implemented, and how this influences outcomes. Therefore, the purpose of this systematic review was to evaluate how IPFP resection and preservation impacts postoperative flexion, pain, Insall-Salvati Ratio (ISR), Knee Society Score (KSS), patellar tendon length (PTL), and satisfaction in primary TKA. PubMed, EBSCO host, and SCOPUS were queried to retrieve all reports evaluating IPFP resection or preservation during TKA, which resulted into 488 studies. Two reviewers independently reviewed these articles for eligibility based on pre-established inclusion and exclusion criteria. Eleven studies were identified for final analysis, which reported on 11,996 cases. Patient demographics, type of surgical intervention, follow-up duration, and clinical outcome measures were collected and analyzed. Complete resection was implemented in 3,723 cases (31%), partial resection in 5,458 cases (45.5%), and preservation of the IPFP in 2,815 cases (23.5%). Clinical outcome measures included PTL (5 studies), knee flexion (4 studies), pain (6 studies), KSS (3 studies), ISR (3 studies), and patient satisfaction (1 study). No differences were found following IPFP resection for patient satisfaction (p = 0.98), ISR (p > 0.05), and KSS (p > 0.05). There was mixed evidence for PTL, pain, and knee flexion following IPFP resection versus preservation. Studies of shorter follow-up intervals suggested improved pain following resection, while reports of longer follow-up times indicated that resection resulted in increased pain. Given the mixed data available from the current literature, we were unable to conclude that one surgical technique can definitively be considered superior over the other. More extensive research, including randomized controlled trials, is required to better elucidate potential differences between the surgical handling choices. Future studies should focus on patient conditions in which one technique would be best indicated to establish guidelines for best surgical outcomes in those patients.

Spacer-Based Gap Balancing in Total Knee Arthroplasty: Clinical Success with a Reproducible Technique

2017 ◽  
Vol 30 (08) ◽  
pp. 798-806 ◽  
Author(s):  
Frédéric Lavoie
Keyword(s):  
Total Knee Arthroplasty ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Clinical Success ◽  
Postoperative Outcome ◽  
Trochlear Groove ◽  
Ligament Balancing ◽  
Gap Balancing ◽  
Total Knee

AbstractProper coronal and transverse ligament balancing is an important aspect of total knee arthroplasty (TKA) and has an impact on postoperative outcome. Many variations of the gap balancing technique were described to address this challenge, most of them using various tensioning devices, but none for which the use is widespread. The aim of this paper is to describe a gap technique variant for TKA using spacer blocks and report the clinical results for a cohort of patients on which it was used. A total of 114 TKAs were performed in 101 patients using a standardized surgical technique that integrates ligament balancing with sizing and positioning of the femoral component. Clinical variables were assessed preoperatively and after a mean follow-up of 43 months using the Knee Society score, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the International Knee Documentation Committee (IKDC) score. A significant improvement in every clinical function score was noted at the latest follow-up compared with preoperative values. All the knees except four (96%) were well-balanced at the last follow-up examination; a firm but delayed end-point was noted in the remaining four knees but did not seem to affect patient outcome. The patellar button was centered in the prosthetic trochlear groove for all knees on the postoperative radiographs. Similar improvements in the scores and in range of motion were noted for knees with a preoperative coronal misalignment of 10 degrees or more (n = 26) compared with knees with less than 10 degrees of varus or valgus (n = 77). The described surgical technique appears to be reliable to obtain well-balanced knees and good patellar tracking when performing a primary TKA, even in knees with important coronal misalignment.

scholarly journals Are Metaphyseal Sleeves a Viable Option to Treat Bone Defect during Revision Total Knee Arthroplasty? A Systematic Review

Joints ◽  
2019 ◽  
Vol 07 (01) ◽  
pp. 019-024 ◽  
Author(s):  
Tommaso Bonanzinga ◽  
Ibrahim Akkawi ◽  
Akos Zahar ◽  
Thorsten Gehrke ◽  
Carl Haasper ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Bone Defect ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Septic Loosening ◽  
Total Knee ◽  
Revision Tka

Abstract Purpose Bone loss is a challenging problem during revision total knee arthroplasty (TKA). Several studies have been published on the use of metaphyseal sleeves during revision TKA. Therefore, the aim of this systematic review was to summarize the clinical and radiographic outcomes of the use of metaphyseal sleeves in the setting of revision TKA. Methods A comprehensive search of PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar was performed, covering the period between January 1, 2000, and August 12, 2017. Various combinations of the following key words were used: “metaphyseal,” “sleeves,” “knee,” and “revision.” A total of 10 studies were included in the present systematic review. Results A total of 904 patients with 928 implants were recorded with a mean age of 69 years. They were evaluated at a mean follow-up of 45 months. Overall 1,413 sleeves, 888 in the tibia and 525 in the femur, were implanted. There were 36 septic re-revisions of the prosthetic components (4%). Five sleeves were found loose during septic re-revision; therefore, the rate of septic loosening of the sleeves was 0.35%. An aseptic re-revision of the prosthetic components was performed 27 times (3%). Ten sleeves were found loose during aseptic re-revision; therefore, the rate of aseptic loosening of the sleeves was 0.7%. Intraoperative fractures occurred 44 times (3.1%). Finally, clinical outcome was improved at final follow-up. Conclusion Metaphyseal sleeves demonstrate high radiographic signs of osteointegration, low septic loosening rate, low intraoperative fractures rate, and a good-to-excellent clinical outcome. Hence, they are a valid option to treat large metaphyseal bone defect during revision TKA. Level of Evidence This is a systematic review of level IV studies.

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