Influence of stem length on component flexion and posterior condylar offset in revision total knee arthroplasty

The aim of this systematic review was to evaluate the evidence on reservation of Posterior Femoral Condylar Offset (PFCO) and Joint Line (JL) after Revision Total Knee Arthroplasty (RTKA) for im- proved functional outcomes. A comprehensive search of PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted, with papers published from the inception of the database to October 2020 included. All relevant articles were retrieved, and their bibliographies were hand searched for further references on Posterior condylar offset and revision total knee arthroplasty. The search strategy yielded 28 articles. After duplicate titles were excluded, abstracts and full text were reviewed. Nine studies were assessed for eligibility, four studies were excluded because they did not fully comply with the inclusion criteria. Six articles were finally included in this systematic review. Based on this systematic review restoration of the JL and PFCO in RTKR is associated with a significant improvement in the post-operative range of motion, KSS, OKS, patellar function, and SF-36. Reservation of JL should be a major consideration when undertaking RTKA. Of note, increasing PFCO to balance the flexion gap while maintaining joint line should be well assessed intra-operatively. The upper limit of the PFCO that widely accepted is up to 40 % greater than that of the native knee. 4 mm is the upper limit for JL restoration. Level of evidence III.

Download Full-text

Changes in Femoral Posterior Condylar Offset, Tibial Posterior Slope Angle, and Joint Line Height after Cruciate-Retaining Total Knee Arthroplasty

Knee Surgery and Related Research ◽

10.5792/ksrr.2016.28.1.27 ◽

2016 ◽

Vol 28 (1) ◽

pp. 27-33 ◽

Cited By ~ 6

Author(s):

Sang Jun Song ◽

Dae Kyung Bae ◽

Kang Il Kim ◽

Ho Yeon Jeong

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Slope Angle ◽

Joint Line ◽

Cruciate Retaining ◽

Posterior Slope ◽

Posterior Condylar Offset ◽

Posterior Condylar ◽

Total Knee ◽

Posterior Slope Angle

Download Full-text

Pain associated with cemented and uncemented long-stemmed tibial components in revision total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b6.bjj-2020-2439.r2 ◽

2021 ◽

Vol 103-B (6 Supple A) ◽

pp. 165-170

Author(s):

Darin J. Larson ◽

John H. Rosenberg ◽

Maxwell A. Lawlor ◽

Kevin L. Garvin ◽

Curtis W. Hartman ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Stem Length ◽

Exact Test ◽

Patient Dissatisfaction ◽

Total Knee ◽

Revision Tka

Aims Stemmed tibial components are frequently used in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate patient satisfaction, overall pain, and diaphyseal tibial pain in patients who underwent revision TKA with cemented or uncemented stemmed tibial components. Methods This is a retrospective cohort study involving 110 patients with revision TKA with cemented versus uncemented stemmed tibial components. Patients who underwent revision TKA with stemmed tibial components over a 15-year period at a single institution with at least two-year follow-up were assessed. Pain was evaluated through postal surveys. There were 63 patients with cemented tibial stems and 47 with uncemented stems. Radiographs and Knee Society Scores were used to evaluate for objective findings associated with pain or patient dissatisfaction. Postal surveys were analyzed using Fisher’s exact test and the independent-samples t-test. Logistic regression was used to adjust for age, sex, and preoperative bone loss. Results No statistically significant differences in stem length, operative side, or indications for revision were found between the two cohorts. Tibial pain at the end of the stem was present in 25.3% (16/63) of cemented stems and 25.5% (12/47) of uncemented stems (p = 1.000); 74.6% (47/63) of cemented patients and 78.7% (37/47) of uncemented patients were satisfied following revision TKA (p = 0.657). Conclusion There were no differences in patient satisfaction, overall pain, and diaphyseal tibial pain in cemented and uncemented stemmed tibial components in revision TKA. Patient factors, rather than implant selection and surgical technique, likely play a large role in the presence of postoperative pain. Stemmed tibial components have been shown to be a possible source of pain in revision TKA. There is no difference in patient satisfaction or postoperative pain with cemented or uncemented stemmed tibial components in revision TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):165–170.

Download Full-text

Stem length in revision total knee arthroplasty

Current Reviews in Musculoskeletal Medicine ◽

10.1007/s12178-015-9297-4 ◽

2015 ◽

Vol 8 (4) ◽

pp. 407-412 ◽

Cited By ~ 15

Author(s):

Anay Rajendra Patel ◽

Brian Barlow ◽

Amar S. Ranawat

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Stem Length ◽

Total Knee

Download Full-text

Does Posterior Condylar Offset Affect Clinical Results following Total Knee Arthroplasty?

The Journal of Knee Surgery ◽

10.1055/s-0037-1608819 ◽

2017 ◽

Vol 31 (08) ◽

pp. 754-760 ◽

Cited By ~ 1

Author(s):

Ryan Degen ◽

Jacob Matz ◽

Matthew Teeter ◽

Brent Lanting ◽

James Howard ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Outcome Measures ◽

Knee Arthroplasty ◽

Short Form ◽

Clinical Results ◽

Patient Reported Outcome Measures ◽

Posterior Condylar Offset ◽

Patient Reported ◽

Posterior Condylar ◽

Total Knee

AbstractTotal knee arthroplasty (TKA) is an effective, durable treatment for knee osteoarthritis. However, a subset of patients experiences incomplete pain relief and ongoing dysfunction. Posterior condylar offset (PCO) has previously been shown to be associated with postoperative range of motion (ROM) following TKA; however, an association with patient-reported outcome measures (PROMs) has not been established. The purpose of this study was to evaluate the association between PCO and postoperative ROM and PROMs. A retrospective review of 970 posterior-stabilized single design TKAs was performed. Preoperative and postoperative radiographs were analyzed to measure the change in PCO and anteroposterior (AP) femoral dimension. Clinical outcome measures, including Short Form-12 physical and mental component summaries, Western Ontario and McMaster Universities Arthritis Index, and Knee Society Score were reviewed to determine if these were influenced by changes in PCO and AP dimension. PCO was increased by more than 3 mm in 15.1%, maintained (within 3 mm) in 59.6%, and decreased by more than 3 mm in 25.3% of patients. Comparing between these groups, there were no significant differences in postoperative ROM or PROM. AP dimension increased in 24.4%, maintained in 47.8%, and decreased in 27.8%. Similarly, there were no significant differences in ROM or PROM between these groups. Spearman's correlation analyses failed to identify an association between PCO and ROM or PROMs. In conclusion, increasing or decreasing PCO or AP femoral dimension with this PS TKA design did not significantly affect postoperative ROM or PROM. Similarly, maintenance of PCO within one implant size with this system compared with optimal sizing had no deleterious effect on TKA outcomes.

Download Full-text