Results of Cemented Posterior-Stabilized Total Knee Arthroplasty in Obese Patients With an Average 10-Year Follow-Up

2020 ◽  
Vol 35 (8) ◽  
pp. 2097-2100
Author(s):  
Dallas S. Hagman ◽  
C. Michael Granade ◽  
Langan S. Smith ◽  
Madhusudhan R. Yakkanti ◽  
Arthur L. Malkani
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Obese Patients ◽  
Posterior Stabilized ◽  
Total Knee

Prospective randomized trial of standard versus highly crosslinked tibial polyethylene in primary posterior-stabilized total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 33-39 ◽  
Author(s):  
P. F. Lachiewicz ◽  
J. A. O’Dell
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Randomized Study ◽  
Posterior Stabilized ◽  
Function Score ◽  
Score Change ◽  
Osteolytic Lesions ◽  
Significant Difference ◽  
Total Knee

Aims There is insufficient evidence to recommend the use of alternative polyethylene bearings in modular, fixed-bearing total knee arthroplasty (TKA). The purpose of this study was to compare standard polyethylene (SP) and highly crosslinked polyethylene (XLP) tibial liners in posterior-stabilized TKA, with osteolysis as the primary outcome and clinical results and the rate of re-operation as the secondary outcomes. Patients and Methods This is a single-surgeon, prospective randomized study involving one design of modular posterior-stabilized TKA. An analysis of 122 TKAs with an SP compression moulded liner and 123 with an XLP liner was performed, with a mean follow-up of six years (2 to 11). Patients were evaluated clinically using the Knee Society score, Lower Extremity Activity Score (LEAS), and the presence of an effusion, and standard radiographs were assessed for radiolucent lines and osteolytic lesions. Results Osteolysis was present in four TKAs (3.3%) in the SP group, and no knees in the XLP group (p = 0.06). There were no significant differences between the Knee Society total score, change in total score, knee function score, change in function score, LEAS, and change in LEAS in the two groups. There was a significant difference in the presence of an effusion (10/122 with SP liners, 1/123 with XLP liners; p = 0.02). There was no significant difference in the rate of re-operation between the two groups (p = 0.36). There were no complications related to the XLP liner. Conclusion At this length of follow-up, there were no advantages and no complications related to the use of this XLP tibial liner. The presence of effusion and small osteolytic lesions was more frequent with SP than XLP liners, but of unknown clinical significance. Cite this article: Bone Joint J 2019;101-B(7 Supple C):33–39

scholarly journals Cruciate retaining versus posterior stabilized total knee arthroplasty for the treatment of valgus osteoarthritis?

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Max Ettinger ◽  
Peter Savov ◽  
Henning Windhagen ◽  
Evelyn Mielke ◽  
Tilman Calliess
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Valgus Knee ◽  
Posterior Stabilized ◽  
Cruciate Retaining ◽  
Early Revision ◽  
Koos Score ◽  
Total Knee

Aims and Objectives: The debate of cruciate retaining (CR) versus posterior stabilized (PS) designs in total knee arthroplasty (TKA) is ongoing. With the posterior cruciate ligament retained, the TKA is supposed to function better in terms of proprioception, balance and kinematics. In contrast to that, PS designs are supposed to lead to higher degrees of flexion and a better femoral rollback. It is known, that the preoperative deformity negatively correlates with inferior results following TKA. When balancing a valgus knee, Ranawat et al. suggest to address the PCL in the first place. It is known that in 60% of valgus knees 1-2 soft tissue releases are necessary in order to achieve neutral alignment. Up to date no study exists, reporting the outcome of CR versus PS TKA in valgus knees. Thus, it was purpose of this study to evaluate the mid term outcome of CR versus PS TKA for the treatment of valgus OA in groups between 3°-6° of valgus, 7-10° of valgus and >10° of valgus. Materials and Methods: With the KOOS score as the primary endpoint, a sample size of 117 cases (78 CR and 39 PS) was needed in order to get a statistical power of 80%.Between 01-2011 and 03-2014 a total of 248 patients with a preoperative valgus >3° were treated with a CR TKA (167 cases) or a PS TKA (81 cases) of the same manufacturer (Stryker Triathlon, Stryker, Kalamazoo USA). CR patients were divided into the following groups: Preoperative valgus >3°-6°, 7°-10° and >10°. PS patients were divided into the following groups: Preoperative valgus >3°-6°, 7°-10° and >10°. The KOOS Score and the Oxford Knee score was collected at the time of follow up. For the CR and PS group failure rates and failure etiologies were analyzed. Patients demographics and were collected as well. Results: 141 patients were included into this study (97 CR and 44 PS cases). The CR group had a mean follow up of 57 weeks, the PS group had a follow up of 52weeks. In the CR group, 11/97 (11%) patients were revised due to a.p. instability, whereas 2/44 (5%) patients were revised in the PS group due to infection or aseptic loosening. There was no difference regarding OKS and the KOOS score between the two groups. Further, there was no difference regarding patients demographics and no correlation between the BMI and the clinical outcome. Conclusion: The most important findings of this study are that the CR group showed a significant higher early revision rate, whereas the clinical mid term follow up results are equal. The CR version of the used system showed significantly higher early failure due to a.p. instability.

Highly Cross-Linked Versus Conventional Polyethylene in Posterior-Stabilized Total Knee Arthroplasty at a Mean 5-Year Follow-up

2015 ◽  
Vol 30 (10) ◽  
pp. 1736-1739 ◽  
Author(s):  
R. Michael Meneghini ◽  
Luke R. Lovro ◽  
Shelly A. Smits ◽  
Philip H. Ireland
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Posterior Stabilized ◽  
Total Knee

scholarly journals Mid-Term Follow Up Results of Mini-Subvastus Approach for Total Knee Arthroplasty in Obese Patients

2017 ◽  
Vol 7 (3) ◽  
Author(s):  
Aditya laxmikant Kekatpure ◽  
Nilen A Shah ◽  
Prithviraj Prabhakar Nistane ◽  
Pritam K Agrawal
Keyword(s):  
Total Knee Arthroplasty ◽  
Obese Patient ◽  
Knee Arthroplasty ◽  
Patient Population ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Subvastus Approach ◽  
Functional Scores ◽  
Total Knee

Background: Use of mini-subvastus   approach for  total  knee  arthroplasty  (TKA )  in  obese  patients  is  still  debated . We had hypothesized in our  study published  in  July 2010 , that  obesity  should  not  be  considered  as  a  problem for  patients  undergoing  a  TKA  with  the  mini-subvastus  approach  as  the anatomy  of  the  quadriceps in  the  obese and  the  non-obese  patient population is  the  same. We present  a  mid-term  follow-up  study  of  the  same  set  of patients  with  an  average  follow  up  of  96 months.Materials and Methods: 97 obese patients (109 knees) 81 females + 16 males with mean age 64 years underwent TKA by mini-subvastus approach between January 2006 to July 2007. 16 patients (18 knees) were morbidly obese. Out of the total number of patients, 08 were lost in follow up and 01 died because of unrelated causes. Out of these 09 patients, two were operated for bilateral TKR. Thus, we have a midterm follow up results of 98 knees in 88 patients. Knee society and functional scores were used for patient evaluation and compared to their pre-operative and earlier follow up scores.Results: At our latest follow-up of 96 months the Knee Society Score and functional scores were 84(range 64-90) and 58(range 45-75) respectively. One morbidly obese lady had aseptic loosening of tibial component at 42 months which needed a revision.Conclusion: Our mid-term results show that the mini-subvastus approach can be  considered  for TKA in obese and morbidly obese patient population with outcomes comparable to standard surgical approach.Keywords:  Mini-subvastus approach, Total knee arthroplasty ,Obesity

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

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