An Overview and Predictors of Achieving the Postoperative Ceiling Effect of the WOMAC Score Following Total Knee Arthroplasty

2019 ◽  
Vol 34 (2) ◽  
pp. 273-280 ◽  
Author(s):  
Nicholas D. Clement ◽  
David Weir ◽  
James P. Holland ◽  
Craig H. Gerrand ◽  
David J. Deehan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Womac Score ◽  
Ceiling Effect ◽  
Score Following ◽  
Total Knee

scholarly journals Double-high insert presents with worse mid-term outcomes in cruciate-retaining medial-pivotal total knee arthroplasty – a propensity score matched analysis with averaged 8-year follow-up

2021 ◽  
Author(s):  
Shuai Xiang ◽  
Yingzhen Wang ◽  
Chengyu Lv ◽  
Changyao Wang ◽  
Haining Zhang
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Womac Score ◽  
Cruciate Retaining ◽  
Radiographic Outcomes ◽  
Clinical Scores ◽  
Total Knee ◽  
Knee Society Function Score

Abstract Background The aim of this study was to compare the mid-term clinical and radiographic outcomes between medial-pivotal (MP) insert and double-high (DH) insert used under cruciate-retaining condition in ADVANCE® total knee arthroplasty (TKA). Methods The follow-up was conducted for 158 consecutive patients underwent unilateral ADVANCE® TKA from January 2011 to April 2014. 84 MP inserts and 74 DH inserts were used under cruciate-retaining condition. A 1:1 propensity score matching (PSM) analysis was performed between MP insert and DH insert to compare the clinical and radiographic outcomes. Results After a 1:1 PSM, 120 patients (60 pairs) were matched between MP insert and DH insert. The baseline demographic parameters and clinical scores were comparable between the two groups. The postoperative clinical outcomes at an averaged 8-year follow-up of both groups were significantly improved. The range of motion (ROM) of DH group was better than that of MP group and equivalent Knee Society Function Score (KSFS) between the two groups was found. However, the Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Forgotten Joint Score (FJS) of MP group were found to be significantly superior than those of DH group. Comparable complication rate and revision rate were observed between the two groups. The radiographic results were also equally good between MP and DH group. Conclusions Although the mid-term clinical and radiographic outcomes of DH insert are fairly good, the clinical scores of DH group were worse than those of MP group.

scholarly journals Revision Total Knee Arthroplasty with Metaphyseal Sleeves without Stem: Short-Term Results

Joints ◽  
2017 ◽  
Vol 05 (04) ◽  
pp. 207-211 ◽  
Author(s):  
Giacomo Stefani ◽  
Valerio Mattiuzzo ◽  
Greta Prestini
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Knee Arthroplasty ◽  
Bone Ingrowth ◽  
Womac Score ◽  
Revision Total Knee Arthroplasty ◽  
X Rays ◽  
Short Term ◽  
Total Knee ◽  
Baseline Values

Purpose The aim of this study was to evaluate the efficacy of revision total knee arthroplasty (TKA) with cementless metaphyseal sleeves without stems either in the femoral or tibial side or in both. Methods In this retrospective study, 51 patients (51 knees) operated in the period 2010 to 2015 met the above-mentioned criteria and were invited to a medical examination including X-rays. Forty-six were available for the study. Mean follow-up was 37 months. Knee Society score (KSS) (objective knee score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and range of motion (ROM) were used as outcome scores and compared with baseline values. X-rays were also examined and compared with postoperative exams to evaluate the presence of loosening, radiolucent lines, and bone ingrowth. Satisfaction of the patients was also investigated using a linear scale from 1 to 10. Results KSS improved from 39 to 77 (p < 0.01); WOMAC score improved from 76 to 41 (p < 0.01). Twenty-four (52%) patients were satisfied, 15 (32%) were partially satisfied, and 7 (16%) were unsatisfied. ROM improved from 93 to 96 degrees (nonsignificant difference). X-rays showed no loosening of the implants, radiolucent lines in 4 patients (3 of them were asymptomatic) and bone ingrowth in 43 out of 46 patients. Conclusion In this short-term retrospective study, the use of sleeves without stem was a safe and effective procedure in revision TKA. We found a significant improvement in clinical results compared with baseline values and no signs of implant loosening. Level of Evidence Level IV, therapeutic case series.

A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee

2018 ◽  
Vol 32 (10) ◽  
pp. 1008-1014 ◽  
Author(s):  
Trevor J. Shelton ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Womac Score ◽  
Lateral Compartment ◽  
Maximum Extension ◽  
Anterior Translation ◽  
Total Knee ◽  
Posterior Position ◽  
Anterior Posterior

AbstractWe hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior–posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured. Measurements were repeated after exchanging to a 2 mm thicker insert. The sum of the average of the medial and lateral compartment forces at 0, 45, and 90 degrees of flexion represented the tibial force through a 90-degree motion arc. For the implanted insert, the tibial force averaged 28 ± 17 lb, which is comparable to the 20 ± 7 lb reported for the native knee. At 6 months, patients reported an average 40 point Oxford Knee and 15 point Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. For the 2 mm thicker insert, the tibial force averaged 50 ± 28 lb. A 30 lb tibial force greater than native generated a 3-degree loss of extension, a 3-degree loss of flexion, and 3-mm anterior translation of the tibia. Because a TKA with a tibial force greater than native has signs of stiffness, a strategy for lowering this risk is to match the tibial force of the native knee when balancing a TKA as this restored high function.

scholarly journals Anatomic Versus Mechanically Aligned Total Knee Arthroplasty for Unicompartmental Knee Arthroplasty Revision

2016 ◽  
Vol 10 (1) ◽  
pp. 357-363 ◽  
Author(s):  
Panagiota Toliopoulos ◽  
Marc-Andre LeBlanc ◽  
Jonathan Hutt ◽  
Martin Lavigne ◽  
Francois Desmeules ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Womac Score ◽  
Kinematic Alignment ◽  
Mechanical Alignment ◽  
Medial Proximal Tibial Angle ◽  
Alignment Technique ◽  
Total Knee ◽  
Small Patient

Objectives:The purpose of this study was to compare the intra-operative benefits and the clinical outcomes from kinematic or mechanical alignment for total knee arthroplasty (TKA) in patients undergoing revision of failed unicompartmental kneel arthroplasty (UKA) to TKA.Methods:Ten revisions were performed with a kinematic alignment technique and 11 with a mechanical alignment. Measurements of the hip-knee-ankle angle (HKA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) were performed using long-leg radiographs. The need for augments, stems, and constrained inserts was compared between groups. Clinical outcomes were compared using the WOMAC score along with maximum distance walked as well as knee range of motion obtained prior to discharge. All data was obtained by a retrospective review of patient files.Results:The kinematic group required less augments, stems, and constrained inserts than the mechanical group and thinner polyethylene bearings. There were significant differences in the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) between the two groups (p<0.05). The mean WOMAC score obtained at discharge was better in the kinematic group as was mean knee flexion. At last follow up of 34 months for the kinematic group and 58 months for the mechanical group, no orthopedic complications or reoperations were recorded.Conclusion:Although this study has a small patient cohort, our results suggest that kinematic alignment for TKA after UKA revision is an attractive method. Further studies are warranted.

scholarly journals Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results

2021 ◽  
Vol 8 ◽  
Author(s):  
Lazaros Kostretzis ◽  
Gabriel Bouchard Roby ◽  
Sagi Martinov ◽  
Marc-Olivier Kiss ◽  
Janie Barry ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Womac Score ◽  
Kinematic Alignment ◽  
Posterior Stabilized ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) protocol and to report (1) rerevision rate and adverse events, (2) patient-reported outcome measures (PROMs), and (3) radiological signs of implant dysfunction related to this technique.Methods: The rKA protocol was used in 43 selected TKA revisions cases suitable for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and radiographic evaluation to identify signs of implant dysfunction were documented at last follow-up.Results: After a mean follow-up of 4.0 years (0.9–7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the femur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior stabilized tibial insert was used, while 12 (28%) cases required a semi-constrained insert. The mean WOMAC score was 34.4 (0–80, ±21.7). Mean postoperative arithmetic hip-knee-ankle angle (HKA) was 0.8° varus (from 5° varus to 4° valgus), mean mechanical distal femoral angle was 1.7° valgus (from 2° varus to 5° valgus), and mean mechanical tibia proximal angle was 2.2° varus (from 5° varus to 1° valgus). No radiological evidence of aseptic loosening or periprosthetic radiolucencies were identified.Conclusion: Although current revision TKA implants are not ideal for revision TKA performed with rKA, they are an appealing alternative to MA, especially in cases of early, non-wear-related, unsuccessful MA TKAs. rKA TKA revision using short-cemented stems in conjunction with meticulous preoperative planning is safe in the mid-term.Level of evidence: IV

scholarly journals Intra-operative peri-articular cocktail injection in inflammatory arthritis patients undergoing total knee arthroplasty

2021 ◽  
Vol 7 (6) ◽  
pp. 1215
Author(s):  
Rohit R. ◽  
U. Thyagarajan ◽  
Raghavendran B. ◽  
Karhik Seetharaman
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Inflammatory Arthritis ◽  
Case Series ◽  
Clinical Score ◽  
Functional Score ◽  
Score Following ◽  
Post Operative Pain ◽  
Total Knee ◽  
The Mean

<p class="abstract"><span lang="EN-US">Pain following TKA is often severe in most patients. The purpose of this case series was to assess the efficiency of intra-operative peri-articular cocktail injection in management of pain following total knee arthroplasty. This case series involves 16 patients with inflammatory arthritis of knee undergoing total knee arthroplasty (TKA). All patients had received peri-articular cocktail of drugs before the implantation of prosthesis with cement. In our study, there was significant improvement of Knee Clinical Score and Knee Functional Score following TKA. The mean KSS score was 37.5 (range: 31-44) improved to 92.5 (range, 86-99) and the functional score improved from 25.5 (range, 18-33) to 76 (range, 72- 80) at 6 months and 93 (range: 90-96) at 12 months. Intraoperative peri-articular injection with 20 ml of 0.5% ropivacaine, 1 ml of ketorolac, 1ml of clonidine and 0.5ml noradrenaline diluted in 20 ml of saline is effective in reducing immediate post-operative pain and thereby improving the overall functional outcome.</span></p>

scholarly journals REPLACEMENT VERSUS NON-REPLACEMENT OF THE PATELLAR JOINT SURFACE IN TOTAL KNEE ARTHROPLASTY

2018 ◽  
Vol 26 (3) ◽  
pp. 175-178
Author(s):  
RAFAEL ALUISIO FENERICH HONORIO FERREIRA ◽  
LEONARDO BARROS MASCARENHAS ◽  
RODRIGO SALIM ◽  
ALINE MIRANDA FERREIRA ◽  
FABRÍCIO FOGAGNOLO ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Womac Score ◽  
Reoperation Rate ◽  
Joint Surface ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Total Knee

ABSTRACT Objective This study addresses functional data, pain, and the reoperation rate in patients undergoing primary total knee arthroplasty (TKA) during which the patella was or was not replaced. Methods Fifty-three knees were included, 18 with the patella replaced and 35 with the patella not replaced. WOMAC and SF-12 scores and knee pain were analyzed preoperatively and 3, 6, and 12 months after TKA. The reoperation rate was also evaluated. Results Both groups presented significant improvement in WOMAC score and pain at all postoperative follow-up appointments. There was no significant difference between the groups in all evaluated variables. Two subjects in the group did not undergo patellar replacement due to complaints of anterior knee pain after arthroplasty. There was no difference between the groups in relation to the reoperation rate. Conclusion Patients receiving patellar replacement during TKA did exhibit significant differences in the rate of reoperation, function, or pain when compared to patients in which the patella was replaced. Level of Evidence III; Cohort study.

Predicting the Outcome of Total Knee Arthroplasty Using the WOMAC Score: A Review of the Literature

2018 ◽  
Vol 32 (08) ◽  
pp. 736-741 ◽  
Author(s):  
Lucy Camilla Walker ◽  
Nick D. Clement ◽  
David J. Deehan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Outcome Measure ◽  
Postoperative Outcome ◽  
Womac Score ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Factors ◽  
Patient Reported ◽  
Total Knee

AbstractIt is estimated that up to a third of recipients of total knee arthroplasty (TKA) experience chronic pain postoperatively. However, there are no clear indications within the literature that predict which patients are at higher risk of being dissatisfied with their TKA. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) is one of the most commonly used, patient-reported outcome measures in patients with lower limb osteoarthritis. This review discusses the available evidence surrounding the predictability of the outcome of TKA using the WOMAC score as well as considering further patient factors that have been implicated in the level of improvement post TKA. It may be concluded from the available literature that a combination of knee scores and patient factors would be the most accurate way of predicting those patients most likely to have a good outcome from their TKA. There is some disparity within the literature about which patient factors and reported outcome measure scores lead to a positive postoperative outcome. Patient expectations following the procedure also need to be evaluated, as objective measures on a scoring system do not necessarily equate with the subjective patient experience.

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