scholarly journals Contemporary knee arthroplasty: one fits all or time for diversity?

2021 ◽  
Author(s):  
Johannes Beckmann ◽  
Malin Kristin Meier ◽  
Christian Benignus ◽  
Andreas Hecker ◽  
Emmanuel Thienpont
Keyword(s):  
Personalized Medicine ◽  
Knee Osteoarthritis ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Treatment Options ◽  
Patient Specific ◽  
Partial Knee Arthroplasty ◽  
Limited Series ◽  
Total Knee ◽  
The Individual

Abstract Introduction Total knee arthroplasty (TKA) has historically been the preferred solution for any type of knee osteoarthritis, independently of the number of compartments involved. In these days of patient-specific medicine, mono-compartmental disease could also be approached with a more individualized treatment, such as partial knee arthroplasty (PKA). Off-the-shelf (OTS) implants are often the compromise of averages and means of a limited series of anatomical parameters retrieved from patients and the pressure of cost control by limited inventory. Personalized medicine requires respect and interest for the individual shape and alignment of each patient. Materials and methods A Pubmed and Google Scholar search were performed with the following terms: “patient-specific knee” and “arthroplasty” and “custom implant” and “total knee replacement” and “partial knee replacement” and “patellofemoral knee replacement” and “bicompartmental knee replacement”. The full text of 90 articles was used to write this narrative review. Results Unicondylar, patellofemoral and bicompartmental knee arthroplasty are successful treatment options, which can be considered over TKA for their bone and ligament sparing character and the superior functional outcome that can be obtained with resurfacing procedures. For TKA, where compromises dominate our choices, especially in patients with individual variations of their personal anatomy outside of the standard, a customized implant could be a preferable solution. Conclusion TKA might not be the only solution for every patient with knee osteoarthritis, if personalized medicine wants to be offered. Patient-specific mono-compartmental resurfacing solutions, such as partial knee arthroplasty, can be part of the treatment options proposed by the expert surgeon. Customized implants and personalized alignment options have the potential to further improve clinical outcome by identifying the individual morphotype and respecting the diversity of the surgical population.

Treatment Options in Knee Osteoarthritis: Total Knee Arthroplasty Versus Platelet-Rich Plasma

PM&R ◽  
2011 ◽  
Vol 3 (4) ◽  
pp. 377-386 ◽  
Author(s):  
Brian A. Klatt ◽  
Hector H. Lopez ◽  
Neil A. Segal ◽  
Gary P. Chimes
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Total Knee

Femoral Component Malrotation Produces Quadriceps Weakness and Impaired Ambulatory Function following Total Knee Arthroplasty: Results of a Forward-Dynamic Computer Model

2019 ◽  
Vol 33 (11) ◽  
pp. 1121-1127
Author(s):  
John F. Nettrour ◽  
Swithin S. Razu ◽  
James A. Keeney ◽  
Trent M. Guess
Keyword(s):  
Total Knee Arthroplasty ◽  
Internal Rotation ◽  
Femoral Component ◽  
Computer Model ◽  
Knee Arthroplasty ◽  
Vastus Lateralis ◽  
Patient Specific ◽  
Patient Reported ◽  
Total Knee ◽  
The Individual

AbstractProper placement of the prosthetic components is believed to be an important factor in successful total knee arthroplasty (TKA). Implant positioning errors have been associated with postoperative pain, suboptimal function, and inferior patient-reported outcome measures. The purpose of this study was to investigate the biomechanical effects of femoral component malrotation on quadriceps function and normal ambulation. For the investigation, publicly available data were used to create a validated forward-dynamic, patient-specific computer model. The incorporated data included medical imaging, gait laboratory measurements, knee loading information, electromyographic data, strength testing, and information from the surgical procedure. The ideal femoral component rotation was set to the surgical transepicondylar axis and walking simulations were subsequently performed with increasing degrees of internal and external rotation of the femoral component. The muscle force outputs were then recorded for the quadriceps musculature as a whole, as well as for the individual constituent muscles. The quadriceps work requirements during walking were then calculated for the different rotational simulations. The highest forces generated by the quadriceps were seen during single-limb stance phase as increasing degrees of femoral internal rotation produced proportional increases in quadriceps force requirements. The individual muscles of the quadriceps displayed different sensitivities to the rotational variations introduced into the simulations with the vastus lateralis showing the greatest changes with rotational positioning. Increasing degrees of internal rotation of femoral component were also seen to demand increasing quadriceps work to support normal ambulation. In conclusion, internal malrotation of the femoral component during TKA produces a mechanically disadvantaged state which is characterized by greater required quadriceps forces (especially the vastus lateralis) and greater quadriceps work to support normal ambulation.

scholarly journals Alternative Management Of Bone Defect In Primary Total Knee Replacement

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0010
Author(s):  
M.A Abdullah ◽  
N Selvanathan ◽  
S Kassim ◽  
A.F Kassim ◽  
S Chopra
Keyword(s):  
Bone Loss ◽  
Total Knee Replacement ◽  
Bone Defect ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Proximal Tibia ◽  
Treatment Options ◽  
Bone Defects ◽  
Total Knee ◽  
Primary Total Knee

Introduction: Bone defects are not common in primary total knee arthroplasty (TKA) contrary to a revision setting. The surgeon must assess the degree of complexity preoperatively and intraoperatively and have a broad armamentarium available during surgery. Multiple surgical options are available to repair or reconstruct the loss of bone, these include: bone cement, bone grafts, metal augments and custom-made implants. Principles to consider in bone loss management are knee and patient-related. Bone defects in primary TKA are usually associated malalignment of the limb combined with severe destruction of the articular cartilage. The treatment options for bone defects in primary TKA should be focus on preserving of the host bone, joint line restoration, balancing the flexion /extension stability and stabilizing the prosthesis. Materials/Methods: We are presenting a 65 years old lady with severe osteoarthritis bilateral varus deformity with severe bone loss over the posterior tibia condyle. Pre operatively multiple radiographs AP, lateral, patella skyline and oblique view are taken. For this patien we taken CT scan for assessment of the bone defect particularly on the tabia side. The pre operative templating of the radiographs is fundamental important in this patient in planning for primary complex TKA . This patient underwent bilateral total knee replacement with semiconstraint implant with mesh and impaction bone grafting over the posterior apesct of proximal tibia. Result: This patient was susseccfully operated with no immediate and post operative complication. Patient which unable to walk because of severe deformity able to gain confidence level to walk and back to her daily living activity Discussion: Primary and revision TKA will continue to increase, proper management of femoral and tibia bone loss represents a common situation that have to be faced by the orthopaedic surgeon. Whatever technique is used in management of bone loss during knee arthroplasty, certain fundamentals must be applied and the remaining bone structure will guide treatment. For this case the bone defect was severe uncontained less than 50% of the posterior proximal was lost. Impaction grafting with mesh was performed to create back the proximal tibia. It’s give a new solid platform for the tibia tray to be inserted and this may allow the patient to weight bear immediately post operatively. This will avoid from using fully constrain implant which put more stress on the joint. Periarticular defect requiring more than a minimal prosthetic augment, it is imperative to use stemmed components to transfer stress away from join. Reestablishment of well-aligned and stable implants is necessary, but this can’t be accomplished without a sufficient restoration of an eventual bone loss Conclusion: There are several treatment options to deal with a specific bone defect in the primary TKA and these options will be dictated by the patient’s factors, the defect factors and surgeon experience. Careful preoperative planning is essential to ensure successful reconstruction with all the appropriate armamentarium prepared. References: Pagano MW, Trousdale RT Tibial Wedge augmentation for Bone deficiency in TKA. Clin Orthop Relats Res. 1995;321:151-5

scholarly journals Osteoarthritis of the knee in the elderly: is knee replacement always justified?

2019 ◽  
pp. 70-75
Author(s):  
A. V. Lychagin ◽  
A. V. Garkavi ◽  
V. A. Meshcheryakov ◽  
V. S. Kaykov
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Knee Replacement ◽  
Elderly Population ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
The Elderly ◽  
Osteoarthritis Of The Knee ◽  
Total Knee ◽  
Grading Scale

Osteoarthritis is a condition that mostly affects the elderly population and tends to be localized to the knee joint. At old age, active treatment options are limited by co-morbidities and a higher risk for surgical complications. Therefore, the search for strategies that could become a temporary alternative to knee replacement is a pressing concern. The aim of this study was to analyze how justifiable is total knee replacement in elderly patients with knee osteoarthritis and to propose a less aggressive therapeutic alternative to this surgery. The study included 178 patients over 60 years of age with clinically established knee osteoarthritis who had been previously recommended knee replacement but chosen not to undergo it. The choice of a treatment strategy tested in the study was based on the original grading scale for the evaluation of the knee joint dislocation syndrome. The treatment consisted of therapeutic arthroscopy and intraarticular injections of hyaluronic acid and platelet-rich plasma (PRP). The data were processed in Statistica 12. Data analysis revealed that 39.3% of the participants did not have compelling indications for knee replacement. The proposed combination therapy with intraarticular PRP injections and arthroscopy allowed all the patients to delay knee replacement for at least a year; unaided by arthroscopy, intraarticular injections worked well for only 40%.

Hip Fusion Takedown with Subsequent Hip and Knee Arthroplasty. Case Study

2020 ◽  
Vol 22 (6) ◽  
pp. 477-486
Author(s):  
Tomasz Poboży ◽  
Wojciech Konarski ◽  
Martyna Hordowicz
Keyword(s):  
Knee Replacement ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Treatment Options ◽  
Left Knee ◽  
Increased Risk ◽  
Hip And Knee Arthroplasty ◽  
Total Knee ◽  
End Stage ◽  
Hip Fusion

There is no uniform standard of treatment for patients with hip fusion and accompanying symptomatic osteoarthritis of the ipsilateral knee. Fusion takedown is associated with an increased risk of complications, and often the results are not satisfactory for patients. Therefore, each case should be considered individually. We present a case report regarding a 70-year-old patient with hip fusion as a result of tuberculosis at a young age who underwent hip fusion takedown with total hip arthroplasty followed by total knee arthroplasty as a second step. The 70-year-old patient with end-stage renal failure and hip fusion as a complication of tuberculosis in adolescence complained of increasing pain in the left knee. After taking into account his comorbidities and discussing with the patient possible treatment options and their limitations, he was qualified for 2-step surgery involving hip replacement and total knee replacement spaced 5 months apart. At the last follow-up visit the patient did not report any pain, with a hip joint mobility of 110° flexion and -10° extension and internal and external rotation of 35° each. The range of knee flexion was 110°. On a VAS scale, the patient’s quality of life was rated 85/100 vs. 30/100 preoperatively. In patients with hip fusion, satisfactory results can be achieved with 2-stage hip and knee replacement, even despite significant co-morbidities. However, this requires careful intraoperative planning and management of patient expectations.

Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

2020 ◽  
Author(s):  
Stephen Thomas ◽  
Ankur Patel ◽  
Corey Patrick ◽  
Gary Delhougne
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Hospital Cost ◽  
Readmission Rate ◽  
Hospital Costs ◽  
Patient Specific ◽  
P Value ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Total Knee

AbstractDespite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

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