Evaluation of Postoperative Changes in Patellar and Quadriceps Tendons after Total Knee Arthroplasty–A Comprehensive Analysis by Shear Wave Elastography, Power Doppler and B-mode Ultrasound

2020 ◽  
Vol 27 (6) ◽  
pp. e148-e157 ◽  
Author(s):  
Valentin Quack ◽  
Marcel Betsch ◽  
Julian Hellmann ◽  
Jörg Eschweiler ◽  
Simone Schrading ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Shear Wave ◽  
Knee Arthroplasty ◽  
Power Doppler ◽  
Shear Wave Elastography ◽  
Comprehensive Analysis ◽  
Postoperative Changes ◽  
Total Knee

scholarly journals Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty: a prospective randomized controlled trial

2020 ◽  
Vol 102-B (11) ◽  
pp. 1511-1518
Author(s):  
Matthew S. Banger ◽  
William D. Johnston ◽  
Nima Razii ◽  
James Doonan ◽  
Philip J. Rowe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Controlled Trial ◽  
Robotic Arm ◽  
Randomized Controlled ◽  
Unicompartmental Knee ◽  
Postoperative Changes ◽  
Total Knee

Aims The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. Methods An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. Results The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). Conclusion Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001). Cite this article: Bone Joint J 2020;102-B(11):1511–1518.

scholarly journals Postoperative Changes in Knee Joint Function of Total Knee Arthroplasty Patients

2011 ◽  
Vol 23 (5) ◽  
pp. 719-724 ◽  
Author(s):  
Takaki Maruyama ◽  
Yutaka Sawada ◽  
Seiji Kubo ◽  
Keisuke Kinoshita ◽  
Masahiro Kurosaka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Joint Function ◽  
Postoperative Changes ◽  
Total Knee

scholarly journals Bony Resection Outliers: Insights from 10,144 Clinical Cases using A Contemporary Computer-Assisted Total Knee Arthroplasty System

10.29007/bwjk ◽  
2019 ◽  
Author(s):  
Yifei Dai ◽  
Charlotte Bolch ◽  
Siyuan Gao ◽  
Amaury Jung ◽  
Cyril Hamad
Keyword(s):  
Total Knee Arthroplasty ◽  
Surgical Resection ◽  
Knee Arthroplasty ◽  
Accurate Solution ◽  
Comprehensive Analysis ◽  
Computer Assisted ◽  
Application Software ◽  
Technology Learning ◽  
Total Knee ◽  
Geographic Regions

This study accessed the alignment outliers of intraoperatively measured bony resection during total knee arthroplasty on 10,144 cases performed using a modern CAOS system. The impacts from geographic regions, surgeon’s adoption of the technology (learning or proficient phases), and historical progression of the CAOS application (software versions) were evaluated. The comprehensive analysis demonstrated that the CAOS system is a robust and accurate solution to assist the surgeons to achieve his/her surgical resection goals across its application history.

Posterior Condyle Offset and Maximum Knee Flexion Following a Cruciate Retaining Total Knee Arthroplasty

2018 ◽  
Vol 32 (02) ◽  
pp. 146-152 ◽  
Author(s):  
Wei Wang ◽  
Bin Yue ◽  
JianHua Wang ◽  
Hany Bedair ◽  
Harry Rubash ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Weight Bearing ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Cruciate Retaining ◽  
Posterior Condyle ◽  
Postoperative Changes ◽  
Total Knee

Inconsistent data has been reported on the effect of the femoral posterior condyle offset (PCO) on the maximal knee flexion after total knee arthroplasty (TKA). This study investigated the relationship between the postoperative changes of the PCO and the changes of maximal knee flexion after a cruciate retaining (CR) TKA. Nine patients with medial osteoarthritis (OA) in one knee were investigated. Before operation, each index knee was magnetic resonance imaging (MRI) scanned for construction of a three-dimensional (3D) knee model. The patient then performed a maximal weight-bearing (WB) flexion and the index knee flexion was measured using a dual fluoroscopy technique. At an average of 8 months after a CR TKA, all patients performed the same WB knee flexion. The postoperative changes of the PCO, the posterior cruciate ligament (PCL) elongation, and the posterior tibial slope (PTS) were determined. The postoperative changes of maximal knee flexion were determined by comparing with the preoperative maximal flexion angles of the knee. The correlations of the postoperative changes of PCO and PTS with the postoperative changes of the maximal flexion angle and PCL elongation of the knee were analyzed. The preoperative PCO (28.5 ± 4.5 mm) was significantly smaller than the postoperative PCO (31.1 ± 5.1 mm) (p < 0.05). The increasing of PCO after surgery is correlated with the decreasing of maximal knee flexion angle (r = 0.74) and the increasing of PCL elongation (r = 0.64) after the TKA. The PTS was not found to change significantly after the TKA and was not significantly correlated to the maximal knee flexion angle and PCL elongation. The postoperative increases of the PCO were shown to cause overstretching of the PCL and poor flexion angle of the knee after the CR TKA. Restoration of PCO could help optimize the maximal flexion of the knee after the TKA with consideration about PCL tension.

scholarly journals Predictors of Successful Outcomes Following Revision Total Knee Arthroplasty for Flexion Instability

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Payton K. Arnold ◽  
Joseph A. Madden ◽  
Mary Ziemba-Davis ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Univariate Analysis ◽  
Presenting Symptoms ◽  
Postoperative Changes ◽  
Early Revision ◽  
Radiographic Measurements ◽  
Patient Reported ◽  
Total Knee

Background and Hypothesis: Flexion instability is a poorly understood cause of total knee arthroplasty (TKA) failure, often referred to as a “wastebasket” diagnosis for unexplained persistent pain. It remains a challenging diagnosis, with unpredictable outcomes following revision surgery. This study identified predictors of successful patient reported outcome measures (PROMS) following revision for flexion instability. Methods: 121 consecutive revision TKAs for flexion instability from 2011-2018 at a single center were retrospectively reviewed. PROMS were prospectively obtained preoperatively and at minimum one-year follow-up. 33 potential predictors of PROMS encompassed: presenting symptoms, demographics/medical covariates, intraoperative observations, and pre/postoperative radiographic measurements. Variables related to outcomes with p≤0.20 in univariate analysis were entered in regression models. Nonsignificant predictors were pruned until only predictors with p<0.05 and the best model statistics were achieved. Results: The sample was 63% female with mean age of 65±11 and BMI of 34±7 kg/m2. Pre- to postoperative changes in three radiographic measurements vital to the stability and function of TKA were related to function (p<0.001), pain (p=0.019), and satisfaction (p=0.030) after surgery. Pain with walking (p≤0.059) and stair climbing (p≤0.048) were almost exclusively related to demographic/medical covariates. Only one of the presenting symptoms commonly associated with flexion instability influenced early revision outcomes (p=0.021). Conclusion and Potential Impact: Instability is one of the most common reasons for TKA failure leading to costly revision surgery. To our knowledge, this is the largest flexion instability cohort studied to date, including substantially more predictors in an attempt to elucidate factors indicative of successful treatment outcomes. With the exception of radiographic parameters reflecting surgical decisions, findings suggest that many factors related to outcomes may be beyond the control of arthroplasty surgeons.

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

2020 ◽  
Author(s):  
Robert Brochin ◽  
Jashvant Poeran ◽  
Khushdeep S. Vig ◽  
Aakash Keswani ◽  
Nicole Zubizarreta ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Trend Test ◽  
Strong Impact ◽  
Hospitalization Costs ◽  
Teaching Status ◽  
Increasing Trend ◽  
Total Knee ◽  
Increasing Trends

AbstractGiven increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

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