Use of Osteochondral and Meniscal Allografts from Bone Cuts of Total Knee Arthroplasty for the Treatment of Tibial Plateau Malunions: A Case Series of Four Patients Showing Early Results

A bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design was introduced to improve knee kinematics by more closely approximating those of a normal knee. Previous studies have shown a high incidence of complications with this implant type, which led to recent modifications of the design by the manufacturer. The current study was undertaken to assess whether the use of a guided-motion knee system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. The secondary aim was to assess if there were any differences between the original and modified implant designs. This retrospective study enrolled 204 consecutive patients (204 knees) undergoing TKA for osteoarthritis of the knee, with the first 154 receiving cemented Journey BCS I implants and the remaining 51 receiving cemented Journey BCS II implants when these became available. At follow-up, patients were tested for the presence of iliotibial friction syndrome (ITB-F) and midflexion instability. Knee score and function score were taken preoperatively, at one year, and at final follow-up. Outcome data between the two implant types were compared using the Mann-Whitney test. No patients were lost to follow-up. Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness (flexion < 90°). Incidence of ITB-F syndrome was considered low: three (2.0%) knees in the BCS I group and two (3.9%) in the BCS II group (p = 0.367). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (3.9%) in the BCS II group (p = 0.367). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no significant differences in range of motion, knee score, or function score. When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant. Long-term follow-up studies are needed to confirm our findings.

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Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

The Open Orthopaedics Journal ◽

10.2174/1874325001711010051 ◽

2017 ◽

Vol 11 (1) ◽

pp. 51-56 ◽

Cited By ~ 6

Author(s):

Hagen Hommel ◽

Kai Wilke

Keyword(s):

Total Knee Arthroplasty ◽

Surgical Technique ◽

Knee Arthroplasty ◽

Case Series ◽

Functional Results ◽

Similar Rate ◽

Osteoarthritis Of The Knee ◽

Early Results ◽

Total Knee

Background: Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer. Objective: The current study was undertaken to assess whether the use of this TKA system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. Material and Methods: This retrospective study enrolled 257 consecutive patients (257 knees) undergoing TKA for osteoarthritis of the knee, with the first 153 receiving cemented Journey BCS I implants and the remaining 104 receiving cemented Journey BCS II implants when these became available. Results: Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness. Incidence of iliotibial friction syndrome was considered low: three (2.0%) knees in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no clinically relevant differences in any of the clinical outcomes. Conclusion: When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant.

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Low-Degree Tibial Slope Angle Prevents Component Overhang by Enlarging the Lateral Plateau Surface Area in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1718598 ◽

2020 ◽

Author(s):

Mehmet Emin Simsek ◽

Mustafa Akkaya ◽

Safa Gursoy ◽

Özgür Kaya ◽

Murat Bozkurt

Keyword(s):

Total Knee Arthroplasty ◽

Surface Area ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Slope Angle ◽

Three Dimensional ◽

Tibial Slope ◽

Total Knee ◽

Lateral Plateau ◽

Gender Groups

AbstractThis study aimed to investigate whether overhang or underhang around the tibial component that occurs during the placement of tibial baseplates was affected by different slope angles of the tibial plateau and determine the changes in the lateral and medial plateau diameters while changing the slope angle in total knee arthroplasty. Three-dimensional tibia models were reconstructed using the computed tomography scans of 120 tibial dry bones. Tibial plateau slope cuts were performed with 9, 7, 5, 3, and 0 degrees of slope angles 2-mm below the subchondral bone in the deepest point of the medial plateau. Total, lateral, and medial tibial plateau areas and overhang/underhang rates were measured at each cut level. Digital implantations of the asymmetric and symmetric tibial baseplates were made on the tibial plateau with each slope angles. Following the implantations, the slope angle that prevents overhang or underhang at the bone border and the slope angle that has more surface area was identified. A significant increase was noted in the total tibial surface area, lateral plateau surface area, and lateral anteroposterior distance, whereas the slope cut angles were changed from 9 to 0 degrees in both gender groups. It was found that the amount of posteromedial underhang and posterolateral overhang increased in both the asymmetric and symmetric tibial baseplates when the slope angle was changed from 0 to 9 degrees. Although the mediolateral diameter did not change after the proximal tibia cuts at different slope angles, the surface area and anteroposterior diameter of the lateral plateau could change, leading to increased lateral plateau area. Although prosthesis designs are highly compatible with the tibial surface area, it should be noted that the component overhangs, especially beyond the posterolateral edge, it can be prevented by changing the slope cut angle in males and females.

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An imaging measurement study of normal knee parameters in southeast China

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210827131228 ◽

2021 ◽

Vol 17 ◽

Author(s):

Huitong Liu ◽

Bingqiang Xu ◽

Eryou Feng ◽

Shizhang Liu ◽

Wei Zhang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Femoral Condyle ◽

Age Groups ◽

Young Group ◽

Normal Female ◽

Valgus Angle ◽

Significant Difference ◽

Total Knee

Background: Imaging measurement of distal femur and proximal tibia has been the hot point in the research of total knee arthroplasty and prosthesis development, which is an important treatment for patients with advanced knee joint disease. This study retrospectively investigated the digital imaging measurement of normal knee parameters in southeast China and evaluated their clinical value. Methods: From February 2010 to May 2014, and in accordance with the inclusion criteria, a total of 677 knees (334 female knees and 343 male knees) were categorized into 3 age groups. Clinical and digital imaging data, including the distal femoral condyle diameter (FCD), tibial plateau diameter (TPD), the distance between the medial tibial plateau and fibular head (DPF), tibiofemoral valgus angle, distal femoral valgus angle, proximal tibia (PT) varus angle and the angle from femoral condyle to tibial perpendicular (FT), were measured by using AutoCAD 10.0 software. All measured variables were statistically analyzed by SPSS statistical software (version 18.0). Results: Data are presented as the mean ± standard deviation. The normal female and male femoral condyle diameter was (7.69 ± 0.46) cm and (8.68 ± 0.55) cm, while the normal female and male tibial plateau diameter was (7.66 ± 0.46) cm and (8.60 ± 0.55) cm, respectively. The normal female and male DPF was (0.76 ± 0.36) cm and (0.79 ± 0.36) cm. For females and males, the tibiofemoral valgus angle and distal femoral valgus angle were (3.89 ± 2.20) ° and (3.29 ± 2.12) °, (9.03 ± 2.18) ° and (8.25 ± 2.20) °. As the two methods to measure tibial plateau varus angle, PT angle of normal female and male was (4.29 ± 1.86) ° and (4.84 ± 2.23) °, while the normal female and male FT angle was (5.34 ± 1.95) ° and (5.52 ± 2.07) °. Based on the data obtained, we found significant differences between the two genders in terms of the femoral condyle diameter and tibial plateau diameter in all age groups (P < 0.01). The DPF parameter showed an obvious difference between the young group and the middle-aged group (P < 0.05), and no significant difference was observed between the sides and genders (P > 0.05). The distal femoral valgus angle showed statistical differences between genders in the left side of the young group and middle-aged group (P < 0.05), while angle PT and FT showed no significant difference (P > 0.05). Conclusion: A large number of knee measurements was obtained, and a local knee database was developed in this study. Imaging measurement prior to total knee arthroplasty is clinically important for increasing the accuracy and long-term efficacy of total knee arthroplasty. These data can also provide useful information for knee surgery and sports medicine as well as prosthesis development.

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Outcomes of Kinematically Aligned Total Knee Arthroplasty in Indian Population—Case Series with Three Year Clinical Results

Indian Journal of Orthopaedics ◽

10.1007/s43465-021-00521-3 ◽

2021 ◽

Author(s):

Narayanasamy Ragunandhan ◽

Palanisamy Jeya Venkatesh

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Indian Population ◽

Case Series ◽

Clinical Results ◽

Total Knee

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Corrigendum to “The early results of gender-specific total knee arthroplasty in Thai patients” [The Knee 18 (2011) 483–487]

The Knee ◽

10.1016/j.knee.2011.10.005 ◽

2012 ◽

Vol 19 (3) ◽

pp. 227

Author(s):

Aree Tanavalee ◽

Thana Rojpornpradit ◽

Sukree Khumrak ◽

Srihatach Ngarmukos

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Early Results ◽

Total Knee ◽

Gender Specific

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Difficult Cases in Robotic Arm-Assisted Total Knee Arthroplasty: A Case Series

The Journal of Knee Surgery ◽

10.1055/s-0037-1608839 ◽

2017 ◽

Vol 31 (01) ◽

pp. 027-037 ◽

Cited By ~ 7

Author(s):

Robert Marchand ◽

Anton Khlopas ◽

Nipun Sodhi ◽

Caitlin Condrey ◽

Nicolas Piuzzi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Case Series ◽

Valgus Deformity ◽

Robotic Assisted ◽

Surgical Technology ◽

Flexion Contractures ◽

Total Knee ◽

Robotic Devices ◽

Sagittal Deformity

AbstractSagittal deformity of the knee is commonly corrected to neutral biomechanical axis (±3 degrees) during total knee arthroplasty (TKA), which is a widely accepted goal. Recent advances in surgical technology have made it possible to accurately plan and fulfill these goals. One of these is robotic-assisted TKA, which has been noted to help increase accuracy and precision of restoring a neutral mechanical axis. While there are data confirming the ability of robotic devices to better correct knee alignment than the manual technique, there is a lack of data concerning the use of the robotic devices in more complex cases, such as those in patients with severe varus or valgus deformity, as well as in flexion contractures. Therefore, the purpose of this case study is to present three cases in which the robotic-assisted TKA device was used to correct a severe varus and severe valgus deformities. Based on this case series, it should be noted that the robotic device can also help correct severe varus/valgus deformities and flexion contractures.

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Finite-element analysis of the proximal tibial sclerotic bone and different alignment in total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3008-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Ye-Ran Li ◽

Yu-Hang Gao ◽

Chen Yang ◽

Lu Ding ◽

Xuebo Zhang ◽

...

Keyword(s):

Finite Element ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Three Dimensional ◽

Genu Varum ◽

Sclerotic Bone ◽

Dimensional Measurements ◽

Tibial Cut ◽

Total Knee

Abstract Background Despite potential for improving patient outcomes, studies using three-dimensional measurements to quantify proximal tibial sclerotic bone and its effects on prosthesis stability after total knee arthroplasty (TKA) are lacking. Therefore, this study aimed to determine: (1) the distribution range of tibial sclerotic bone in patients with severe genu varum using three-dimensional measurements, (2) the effect of the proximal tibial sclerotic bone thickness on prosthesis stability according to finite-element modelling of TKA with kinematic alignment (KA), mechanical alignment (MA), and 3° valgus alignment, and (3) the effect of short extension stem augment utilization on prosthesis stability. Methods The sclerotic bone in the medial tibial plateau of 116 patients with severe genu varum was measured and classified according to its position and thickness. Based on these cases, finite-element models were established to simulate 3 different tibial cut alignments with 4 different thicknesses of the sclerotic bone to measure the stress distribution of the tibia and tibial prosthesis, the relative micromotion beneath the stem, and the influence of the short extension stem on stability. Results The distribution range of proximal tibial sclerotic bone was at the anteromedial tibial plateau. The models were divided into four types according to the thickness of the sclerotic bone: 15 mm, 10 mm, 5 mm, and 0 mm. The relative micromotion under maximum stress was smallest after MA with no sclerotic bone (3241 μm) and largest after KA with 15 mm sclerotic bone (4467 μm). Relative micromotion was largest with KA and smallest with MA in sclerotic models with the same thickness. Relative micromotion increased as thickness of the sclerotic bone increased with KA and MA (R = 0.937, P = 0.03 and R = 0.756, P = 0.07, respectively). Relative micromotion decreased with short extension stem augment in the KA model when there was proximal tibial sclerotic bone. Conclusions The influence of proximal tibial sclerotic bone on prosthesis’s stability is significant, especially with KA tibial cut. Tibial component’s short extension stem augment can improve stability.

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Total knee arthroplasty after distal femoral osteotomy: a systematic review and current concepts

SICOT-J ◽

10.1051/sicotj/2020033 ◽

2020 ◽

Vol 6 ◽

pp. 35 ◽

Cited By ~ 1

Author(s):

Francesco Luceri ◽

Jacopo Tamini ◽

Paolo Ferrua ◽

Damiano Ricci ◽

Cécile Batailler ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Randomized Clinical Trials ◽

Case Series ◽

Femoral Osteotomy ◽

Long Term Results ◽

Radiographic Evaluation ◽

Distal Femoral Osteotomy ◽

Total Knee

Introduction: Distal Femoral Osteotomy (DFO) is a common procedure for correcting lower limb valgus deformity and lateral compartment overload. Low 20-year survivorship rate was reported with a consequent need for total knee arthroplasty (TKA). This study aims to review literature and to analyse the influence of a previous distal femoral osteotomy on outcomes of patients undergoing TKA. Methods: A systematic literature review was performed in PubMed/Medline and Embase in May 2020. Papers were selected based on the following criteria: patient with a previous distal femoral osteotomy; total knee replacement; Pre- and Postoperative outcomes; surgical outcomes: clinical scores, range of motion, radiographic evaluation and revisions for any cause; case series, retrospective studies, observational studies, open-label studies, randomized clinical trials; systematic reviews and meta-analyses were included to extract primitive studies. Results: 306 articles were found, of which five papers were considered eligible for this review. In every study included, postoperative clinical outcomes (Knee Society Score or Hospital for Special Surgery score) statistically improved from the preoperative. Complications were not uncommon; implant survivorship at the available follow-up seems to be similar to primary TKA, although being too short to draw any conclusions. Conclusions: Limited and highly heterogeneous evidence is currently available on the influence of DFO on outcomes after TKA. Knee replacement improves clinical middle-term outcomes in patients with previous distal femoral osteotomy. In this complex surgery, the use of technical tips and tricks could help surgeons to obtain an accurate knee balancing and better long-term results.

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