Effects of Femoral Component Size on Proximal Tibial Strain With Anatomic Graduated Components Total Knee Arthroplasty

Abstract Background: Total knee arthroplasty (TKA) is an established surgical treatment for advanced knee osteoarthritis by which patients can expect improvement of knee pain and function. Although many surgeons have investigated limb alignment after TKA, changes in coronal positional relation between the femur and tibia are not known well.Methods: Radiographs of 105 knees of young patients without osteoarthritic changes who received arthroscopic surgeries at our hospital were used in this study. Using 2D-templates of the medial pivot design (the FINE total knee), we simulated TKA on the knee radiographs. First, the femoral component was placed in normal knee alignment and then was merged to the medial concave of the insert where the tibial component was placed in neutral alignment. The length of the mediolateral shift of the femoral component was measured as an estimate of lateral shift of the femoral condyle, of which association with radiographic parameters for the knee was analyzed. Subjects were classified into three groups according to the femoral component size that was chosen in simulation of TKA.Results: The estimated mean lateral shift of the femoral condyle was 5.99 ± 1.98 mm and was greater in males than females (p < 0.05). Also, it was most highly correlated with the medial proximal tibial angle (MPTA) (r = -0.553, p < 0.01). A group receiving larger component sizes significantly shifted more laterally compared with a group receiving smaller component sizes (p < 0.01). Conclusions: These results suggest that the coronal positional relation between the femur and tibia is altered and subsequent ligament imbalance may occur after mechanically aligned TKA using the medial pivot design.

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Variation of Femoral Component Size by Reference Points and Target Alignments in Total Knee Arthroplasty

10.21203/rs.3.rs-404360/v1 ◽

2021 ◽

Author(s):

Shojiro Ishibashi ◽

Hideki Mizu-uchi ◽

Shinya Kawahara ◽

Hidetoshi Tsushima ◽

Yukio Akasaki ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Three Dimensional ◽

Reference Points ◽

Component Size ◽

Reference Guide ◽

Standard Position ◽

Total Knee ◽

Cutting Direction

Abstract Selecting appropriately sized components is important in total knee arthroplasty because they can affect postoperative knee function and pain. This study investigated size differences of 19 different femoral component placements from the standard position by three-dimensional virtual surgery using three-dimensional bone models of 101 varus osteoarthritic knees. Distal femoral bone was cut perpendicular to the femoral mechanical axis (MA) in the coronal plane. Twenty different component placements consisting of five cutting directions (perpendicular to MA, 3° and 5° extension/flexion relative to MA in the sagittal plane), two rotational alignments (clinical and surgical epicondylar axes), and two rotational types of anterior reference guide (central and medial) were simulated. The mean anteroposterior dimension of the standard position was 55.5 mm which means that the difference compared to 19 different methods ranged from -1.2 ± 0.2 mm to 7.1 ± 1.3 mm. Multiple regression analysis revealed that flexion cutting direction, surgical epicondylar axis, and central were associated with smaller component size. In conclusion, the femoral component size can be affected easily by not only cutting direction but also the reference guide type and the target alignment. Our findings could provide surgeons with clinically useful information to fine-tune for unintended loose or tight joint gaps by adjusting the component size.

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Effect of Surgeon Experience on Femoral Component Size Selection During Total Knee Arthroplasty

Journal of Surgical Orthopaedic Advances ◽

10.3113/jsoa.2013.0118 ◽

2013 ◽

Vol 22 (02) ◽

pp. 118-122 ◽

Cited By ~ 1

Author(s):

Sumon Nandi ◽

James V. Bono ◽

Mark Froimson ◽

Morgan Jones ◽

Boris Bershadsky

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Component Size ◽

Size Selection ◽

Surgeon Experience ◽

Total Knee

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Risk factors and outcomes in asymmetrical femoral component size for posterior referencing bilateral total knee arthroplasty: a matched pair analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-018-2220-6 ◽

2018 ◽

Vol 19 (1) ◽

Author(s):

Piya Pinsornsak ◽

Adisai Chaiwuttisak ◽

Krit Boontanapibul

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Matched Pair ◽

Bilateral Total Knee Arthroplasty ◽

Component Size ◽

Matched Pair Analysis ◽

Total Knee ◽

Pair Analysis

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Femoral Component Size in Total Knee Arthroplasty.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.50.316 ◽

2001 ◽

Vol 50 (2) ◽

pp. 316-319

Author(s):

Hiroo Sato ◽

Kazutoshi Nomura ◽

Mako Hirano ◽

Noburou Hashimoto ◽

Tetsuya Fukumoto ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Component Size ◽

Total Knee

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Restoration of Femoral Condylar Anatomy for Achieving Optimum Functional Expectations: Component Design and Early Results

Reconstructive Review ◽

10.15438/rr.6.3.156 ◽

2016 ◽

Vol 6 (3) ◽

Author(s):

Sridhar Durbhakula ◽

Laura F. Rego

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Component Size ◽

Component Sizing ◽

Early Results ◽

Component Design ◽

Total Knee

BACKGROUND: Many total knee arthroplasty (TKA) systems are used across a variety of markets in which outcome will be influenced by patient morphology and normal activities of daily living, for that patient population. Femoral component sizing in primary total knee arthroplasty is of paramount importance for optimizing complication free post-operative function across all patients. The purpose of this study was to report the early results of a primary TKA system in support of the component design characteristics for achievement of increased functional expectations.METHODS: A prospective, continuous series of 176 primary posterior stabilized (PS) TKAs were performed in 172 patients by a single surgeon. Femoral component size distribution was assessed and all patients were followed for a minimum of two-years post-operatively. Total Hospital for Special Surgery (HSS) scores and range of motion (ROM) was assessed for the entire cohort and by gender.RESULTS: There were no patients lost to follow-up. Two patients required incision and drainage for superficial wound infection of the indicated knees. There was no radiographic evidence of component failure. As expected, femoral component size frequency use was skewed by gender with the larger sizes in males. There were no pre- or post-operative clinical or functional differences by gender and at the recent follow-up (avg. 3.8 years). In addition, there was an average significant increase in change of HSS score (p<0.01) and ROM (P<0.01) when compared to pre-operative baseline.CONCLUSIONS: The design characteristic for component sizing and functional expectations were confirmed in the reported Western population cohort series. Further continued use and study of this primary TKA system is warranted across all ethnic cultures.

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Isolated Liner Revision for Total Knee Arthroplasty Instability: A Road That Should Remain Less Taken

The Journal of Knee Surgery ◽

10.1055/s-0040-1721091 ◽

2020 ◽

Author(s):

Jason D. Tegethoff ◽

Rafael Walker-Santiago ◽

William M. Ralston ◽

James A. Keeney

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

P Value ◽

Surgical Morbidity ◽

Exact Test ◽

Total Knee ◽

Component Revision

AbstractIsolated polyethylene liner exchange (IPLE) is infrequently selected as a treatment approach for patients with primary total knee arthroplasty (TKA) prosthetic joint instability. Potential advantages of less immediate surgical morbidity, faster recovery, and lower procedural cost need to be measured against reoperation and re-revision risk. Few published studies have directly compared IPLE with combined tibial and femoral component revision to treat patients with primary TKA instability. After obtaining institutional review board (IRB) approval, we performed a retrospective comparison of 20 patients treated with IPLE and 126 patients treated with tibial and femoral component revisions at a single institution between 2011 and 2018. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and reoperation (90 days, <2 years, and >2 years) were assessed using paired Student's t-test or Fisher's exact test with a p-value <0.01 used to determine significance. Patients undergoing IPLE were more likely to undergo reoperation (60.0 vs. 17.5%, p = 0.001), component revision surgery (45.0 vs. 8.7%, p = 0.002), and component revision within 2 years (30.0 vs. 1.6%, p < 0.0001). Differences in 90-day reoperation (p = 0.14) and revision >2 years (p = 0.19) were not significant. Reoperation for instability (30.0 vs. 4.0%, p < 0.001) and infection (20.0 vs. 1.6%, p < 0.01) were both higher in the IPLE group. IPLE does not provide consistent benefits for patients undergoing TKA revision for instability. Considerations for lower immediate postoperative morbidity and cost need to be carefully measured against long-term consequences of reoperation, delayed component revision, and increased long-term costs of multiple surgical procedures. This is a level III, case–control study.

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