scholarly journals Significant differences in rates of aseptic loosening between two variations of a popular total knee arthroplasty design

2021 ◽  
Author(s):  
Michael Brown ◽  
Rohan Ramasubbu ◽  
Mark Jenkinson ◽  
James Doonan ◽  
Mark Blyth ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Revision Rate ◽  
Primary Total Knee Arthroplasty ◽  
Cement Mantle ◽  
Kaplan Meier ◽  
Early Revision ◽  
Total Knee

Abstract Purpose The NexGen Legacy Posterior Stabilised (LPS) prosthesis (Zimmer Biomet, Warsaw, IN, USA) has augmentable and non-augmentable tibial baseplate options. We have noted an anecdotal increase in the number of cases requiring early revision for aseptic loosening since adopting the non-augmentable option. The purpose of this study was to ascertain our rates of aseptic tibial loosening for the two implant types within five years of implantation and to investigate the causes for any difference observed. Methods A database search was performed for all patients who underwent primary total knee arthroplasty (TKA) using the NexGen LPS between 2009 and 2015. Kaplan–Meier curves were plotted to assess for differences in revision rates between cohorts. We collected and compared data on gender, age, body mass index, component alignment and cement mantle quality as these were factors thought to affect the likelihood of aseptic loosening. Results Two thousand one hundred seventy-two TKAs were included with five year follow-up. There were 759 augmentable knees of which 14 were revised and 1413 non-augmentable knees of which 48 were revised. The overall revision rate at five years was 1.84% in the augmentable cohort and 3.4% in the non-augmentable cohort. The revision rate for aseptic loosening was 0.26% in the augmentable group and 1.42% in the non-augmentable group (p = 0.0241). Conclusions We have identified increased rates of aseptic loosening in non-augmentable components. This highlights the effect that minor implant changes can have on outcomes. We recommend that clinicians remain alert to implant changes and publish their own results when important trends are observed.

scholarly journals The effect of postoperative mechanical axis alignment on the revision rate of primary total knee arthroplasty after a follow up of 10 years

10.29007/3c7w ◽  
2018 ◽  
Author(s):  
Eun-Kyoo Song ◽  
Jongkeun Seon ◽  
Dong-Hyun Lee ◽  
Je-Hyoung Yeo
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Revision Rate ◽  
Primary Total Knee Arthroplasty ◽  
Outlier Group ◽  
Primary Tkas ◽  
Total Knee

The purpose of this study is to evaluate the effect of postoperative mechanical alignment on clinical outcomes and revision rate by comparing acceptable mechanical axis group from neutral and an outlier mechanical axis.Between 2000 and 2006, clinical and radiographic data of 334 primary TKAs were retrospectively reviewed. Post-operative mechanical axis was investigated within 1 month after TKA. The first group was an acceptable group of 286 knees (85.6%, with mechanical axis of 0°±3°). The second group was an outlier group of 48 knees (14.4%, with mechanical axis of beyond 0°±3°). Clinical outcomes before surgery and at the final follow up were analyzed using scoring method such as Hospital for Special Surgery, Knee Society Score, and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) score. Radiologic outcomes including changes of mechanical axis between immediate postop and last follow-up were evaluated. Postoperative complications and revision rates were also evaluated.The mean degrees in change of mechanical axis between immediate postop and last follow-up were greater in the outlier group (1.6°±2.7) than acceptable group (0.8°±2.4). No significance difference in clinical outcome was found between the two groups. The incidence of aseptic loosening, instability, polyethylene wear, polyethylene breakage, and periprosthetic fracture was 2/4/2/2/2 each in the acceptable group and 1/1/2/0/0 each in the outlier group. Six (2.1%) of 286 in the acceptable group and 4 (8.3%) of 48 in the outlier group were revised (p=0.04). The Kaplan-Meier survival analysis showed a tendency towards improved survival with restoration of neutral mechanical axis. However, such improvement was not statistically significant (p=0.25).Restoration of neutral limb alignment is a factor of total knee arthroplasty that can result in less revision rate and higher longevity. However, there are no significant differences in clinical outcomes between the two groups.

Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee

2019 ◽  
Vol 101-B (11) ◽  
pp. 1356-1361 ◽  
Author(s):  
Brian P. Chalmers ◽  
Kapil G. Mehrotra ◽  
Rafael J. Sierra ◽  
Mark W. Pagnano ◽  
Michael J. Taunton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Cox Regression Analysis ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean

Aims Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361.

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

2020 ◽  
Vol 34 (01) ◽  
pp. 115-120
Author(s):  
Ali Utkan ◽  
Emrah Caliskan ◽  
Batuhan Gencer ◽  
Bulent Ozkurt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Histopathological Analysis ◽  
Knee Score ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractAlthough there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

scholarly journals Complications of Patella in Total Knee Arthroplasty (TKA)

2021 ◽  
Vol 6 (5) ◽  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patellar Instability ◽  
Revision Rate ◽  
Functional Limitation ◽  
Patellofemoral Instability ◽  
Mobile Bearing ◽  
Extensor Mechanism ◽  
Total Knee

Background and Methods: Postoperative complications may impair the outcome of total knee arthroplasty (TKA). Patellar instability is a major cause of postoperative pain and functional limitation for which revision surgery may be necessary [1]. It may occur after TKA with or without patellar resurfacing. RESULTS AND CONCLUSIONS: Subluxation is more common than dislocation; the incidence of symptomatic instability leading to revision is low (0.5 to 0.8%) [2, 3]. In a multicentre study of low contact stress mobile bearing TKAs, only 6 of 259 revisions were associated with patellar instability, which accounted for a revision rate of 0.1% after a mean follow-up duration of 5.7 years [4]. A revision rate of 12% was reported secondary to complications of the extensor mechanism [5]. The aetiology of patellofemoral instability can be related to (1) the surgical technique and component positioning, (2) extensor mechanism imbalance, and (3) other causes.

scholarly journals Early outcomes of posterior cruciate retaining primary total knee arthroplasty in patients of osteoarthritis in Indian population

2018 ◽  
Vol 4 (3) ◽  
pp. 463
Author(s):  
Sunil Kumar Dash ◽  
Sanket Mishra ◽  
Sumanyu Tripathy ◽  
Manish Sharma ◽  
Aurobinda Das
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Indian Population ◽  
Primary Total Knee Arthroplasty ◽  
Walking Distance ◽  
Cruciate Retaining ◽  
Functional Parameters ◽  
Total Knee ◽  
Primary Total Knee

<p class="abstract"><strong>Background:</strong> Total knee replacement arthroplasty today has become the final treatment option for patients with unsalvageable, severely arthritic, painful and deformed knees. In India the numbers of such surgeries are steadily on the rise with bulk of the patients being relatively younger group. Amongst several factors affecting the kinematics of knee, variations in surface geometry and the retention or sacrificing the posterior cruciate ligament is considered especially important. The role of the retaining a PCL on the demographic, clinical and functional parameters of a patient undergoing TKA remains controversial. The aim of the study was to evaluate the outcomes of cruciate retaining primary total knee arthroplasty in patients of osteoarthritis in relation to demographic, clinical and functional parameters.</p><p class="abstract"><strong>Methods:</strong> 20 knees from 12 patients of osteoarthritis including 8 females and 4 males in age group 45-80 years were operated with cruciate retaining implants. The pre and postoperative evaluations were done radiologicaly and clinically using new knee society score. Patients were followed up for minimum 1 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> evaluations of patients revealed good postoperative improvements at subsequent follow up in comparison to preoperative scores. The average range of movement improved by 43.3 degree. The objective, patients satisfaction and functional score improved with scores of 89, 34 and 89.7 at 1 year follow up. The walking distance and staircase climbing, squatting scores also did well. Age did not seem to affect overall outcomes with males having slightly better postoperative scoring overall.</p><p class="abstract"><strong>Conclusions:</strong> In Indian population when the patient is young, high demanding, the retention of cruciate ligaments gives excellent postoperative functionality and objectivity and should be always considered as first choice surgery.</p>

Early Clinical and Radiological Outcomes of the Metaphyseally Fixed Totally Stabilized Knee Prosthesis in Primary Total Knee Arthroplasty

2019 ◽  
Vol 33 (07) ◽  
pp. 678-684 ◽  
Author(s):  
Fahad Hossain ◽  
Sujith Konan ◽  
Babar Kayani ◽  
Christina Kontoghiorghe ◽  
Toby Barrack ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractThe use of valgus–varus constrained (VVC) implant designs in primary total knee arthroplasty (TKA) is considered in situations of severe deformities, bone loss, and inadequate soft tissue balance. It is not known whether the use of such prosthesis designs may predispose to reduced function owing to its constraining design. The components are usually implanted with diaphyseal stem extensions to dissipate the increased forces. The totally stabilized (TS) implant is a contemporary VVC design with metaphyseal fixation only. It has a conforming articulation with increased rotational freedom compared with conventional VVC designs. The aim of this study was to assess whether the use of the contemporary TS implant with its metaphyseally fixed components would be associated with inferior outcomes compared with conventional standard primary posterior stabilized (PS) implants. We reviewed 38 consecutive complex primary TKAs performed using the metaphyseally fixed TS implant and 76 matched patients receiving primary PS TKA, at a minimum follow-up of 24 months. The mean follow-up was 61.1 months (24–102). Only patients with osteoarthritis were included. Clinical outcome was assessed using range of motion (ROM) and Oxford knee score (OKS). Radiographic assessment was performed using the femorotibial angle (FTA) at 6 weeks followed by assessment of bone–implant interface lucencies at final follow-up. There were no major early postoperative complications. The mean postoperative ROM in the TS and PS groups were 114.1 and 112.0, respectively. There was no difference in the mean ROM and OKS between the two groups. The mean FTA for patients in both groups was within 3° of the expected. There was no evidence of progressive lucencies or implant migration at final follow-up. The metaphyseally fixed TS knee design achieves comparable short-term functional outcomes when compared with conventional PS designs in primary knee arthroplasty. Long-term follow-up studies are required to assess survivorship.

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