Development of a Modern Knee Society Radiographic Evaluation System and Methodology for Total Knee Arthroplasty

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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Intra and Inter-Rater Reliability of brief balance Evaluation system test in Patients with total Knee Arthroplasty

Indian Journal of Physiotherapy and Occupational Therapy - An International Journal ◽

10.5958/0973-5674.2018.00026.6 ◽

2018 ◽

Vol 12 (1) ◽

pp. 144

Author(s):

B Mital Shah ◽

A Thangamani Ramalingam ◽

D Bid Dibyendunarayan ◽

Patel KeniK ◽

S Patel Krishna ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Evaluation System ◽

Rater Reliability ◽

Total Knee

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Preoperative Radiological Assessment of The Total Knee Arthroplasty

Forbes Journal of Medicine ◽

10.5222/forbes.2021.35119 ◽

2021 ◽

Author(s):

Atilla Hikmet Cilengir ◽

Suat Dursun ◽

Kazım Ayberk Sinci ◽

Özgür Tosun

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Clinical Results ◽

Preoperative Imaging ◽

Radiographic Evaluation ◽

Prosthetic Material ◽

Total Knee ◽

Severity Of The Disease ◽

Implant Alignment

Total knee arthroplasty (TKA) is a surgery method that can reduce symptoms and restore joint functions. Long-term success of this operation depends on the correct anatomical and mechanical planning before the prosthetic material implantation. Accurate implant alignment together with anatomical balance provides more successful clinical outcomes and longer duration of the prosthetic material. Improper preoperative planning may cause implant loosening and increased load on the knee joint. Conventional radiographs are the most frequently used imaging methods for this purpose. Computed tomography and magnetic resonance imaging may be used in required cases. In addition, computer-aided systems have come into use and successful results have been reported. Early radiographic evaluation is unnecessary after an uncomplicated TKA. Preoperative imaging has several aims such as to assess the severity of the disease, to analyze the reserve bone tissue, to review the relevant anatomy, and to decide which implant and surgical approach will be applied. In this article, we aimed to present the necessary and also auxiliary radiological evaluations made before TKA in order to achieve better clinical results.

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Sonographic and radiographic evaluation of the extensor tendons in early postoperative period after total knee arthroplasty

Skeletal Radiology ◽

10.1007/s00256-020-03574-x ◽

2020 ◽

Author(s):

Viviane Creteur ◽

Riccardo De Angelis ◽

Julie Absil ◽

Theofylaktos Kyriakidis ◽

Afarine MADANI

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Postoperative Period ◽

Early Postoperative Period ◽

Radiographic Evaluation ◽

Extensor Tendons ◽

Total Knee

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The Effect of Cement Viscosity in Total Knee Arthroplasty

Volume 2: Biomedical and Biotechnology ◽

10.1115/imece2012-89094 ◽

2012 ◽

Author(s):

Kevin Abbruzzese ◽

Richard O’Laughlin ◽

Daniel Lee ◽

D. Gordon Allan ◽

Manish Paliwal

Keyword(s):

Total Knee Arthroplasty ◽

Aseptic Loosening ◽

Knee Arthroplasty ◽

Evaluation System ◽

Sagittal Plane ◽

Mechanical Tests ◽

Lateral View ◽

Superior Performance ◽

Posterior View ◽

Total Knee

Aseptic loosening of the tibial implant remains one of the major reasons of failure in Total Knee Arthroplasty (TKA). Currently, there is no consensus on the role that cement viscosity at the time of application to the bone plays in ensuring the long-term success of the arthroplasty. The purpose of this study was to investigate the relationship between cement viscosity and aseptic loosening of tibial implants. Three cements (Depuy 2, Palacos R (high viscosity cements) and Simplex-P, a medium viscosity cement) were compared during TKA through radiographic analysis and mechanical loading tests using surrogate tibia. Cement penetration was measured from radiographs of the constructs and analyzed according to the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation System. Simplex-P had the maximum cumulative penetration in seven zones in the mediolateral view, and three zones in antero-posterior view. Simplex exhibited maximum penetration in zone 7 in the antero-posterior view, and in zone 3 in the lateral view. For the mechanical tests the TKA constructs were subjected to cyclic compressive loading in the sagittal plane. Simplex-P had the smallest micro-motion in sagittal plane, the results were significant when compared to Palacos R. The consistently superior performance of Simplex-P suggests that cement viscosity does indeed play a role in arthroplasty success. These results have direct clinical relevance for TKA patients suffering from aseptic loosening.

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Postoperative TKA alignment in sagittal and axial plane, a systematic review

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2018-0011 ◽

2018 ◽

Vol 1 (1) ◽

pp. 50-57

Author(s):

Bogdan Ştefan Creţu ◽

Călin Dragosloveanu ◽

Dragoş Cotor ◽

Şerban Dragosloveanu ◽

Cristian Ioan Stoica

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Ct Scan ◽

Knee Arthroplasty ◽

Computer Tomography ◽

Axial Plane ◽

Radiographic Evaluation ◽

Total Knee

AbstractThe aim of this paper was to review the existing described methods for measuring postoperative TKA alignment in sagittal and axial plane and to review the existing literature regarding the axial plane evaluation with the use of the computer tomography. The most frequent mistakes when positioning the total knee arthroplasty (TKA) components are done in the axial plane, so it is necessary to know what the limits of the radiographic evaluation are and, for this evaluation, the CT scan is the most valuable in assessing the rotation of the components.

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Radiographic evaluation of tibial component alignment in total knee arthroplasty following extramedullary and intramedullary tibial referencing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174714 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1199

Author(s):

B. Harikrishnan ◽

Anjan Prabhakara ◽

Gururaj R. Joshi

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Radiographic Evaluation ◽

Component Alignment ◽

Tibial Component Alignment ◽

Knee Deformity ◽

Total Knee ◽

The Difference

Background: Long term survivorship of total knee arthroplasty (TKA) is significantly dependant on prostheses alignment. The debate on optimal referencing for femoral component is largely resolved with Intra-medullary jigs reproducing superior alignment. However there is still a contention about whether intramedullary or extramedullary jigs are better for tibial referencing. This study aims to compare the accuracy of tibial component alignment in TKA using intramedullary and extramedullary tibial referencing jigs.Methods: Between December 2012 and September 2014, 66 primary conventional cemented TKAs were performed using Nexgen-LPS Flex (Zimmer) implants in 55 patients, 50-80 y old (mean 65.54 y) with osteoarthritis/rheumatoid arthritis. Intramedullary and extramedullary tibial referencing was used in alternate patients undergoing TKA after excluding patients with BMI >35 kg/m2, knee deformity >150,excessive tibial bowing, previous fractures/surgeries/retained metalwork around knee. Postoperatively, tibial component alignment (TCA) in coronal plane was assessed using AP radiograph of leg. A 3º cutoff from neutral mechanical axis (i.e., 90o±3o) was considered acceptable.Results: The intramedullary group (n=33) had 4 outliers (TCA >93º or <87º) whereas the extramedullary group (n=33) had 7 outliers (p=0.511). The difference in mean TCA between intramedullary and extramedullary groups was not statistically significant [90.70±2.43 and 90.55±2.17 (p=0.790)]. There were no significant per-operative/post-operative complications in either group.Conclusions: We conclude that both intramedullary and extramedullary tibial referencing guides can be used to achieve desired tibial component alignment (90±3º) in TKA. However the surgeon should appreciate the benefits and deficiencies of either types of tibial referencing and use whichever is suited in a particular case.

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