Postoperative Stiffening after Bicruciate-Retaining Total Knee Arthroplasty

2017 ◽  
Vol 31 (05) ◽  
pp. 453-458 ◽  
Author(s):  
Fidaa Al-Shakfa ◽  
James Moore ◽  
Lydia Mychaltchouk ◽  
Khaled Iguer ◽  
Frédéric Lavoie
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Knee Kinematics ◽  
Flexion Contracture ◽  
Early Postoperative Period ◽  
Active Population ◽  
Total Knee ◽  
Comparative Cohort Study ◽  
Bcr Tka

AbstractBicruciate-retaining (BCR) total knee arthroplasty (TKA) has recently experienced a resurgence of popularity. It may be a good option among a younger, more active population because it restores knee kinematics better than other prosthetic designs. Results obtained in the first 100 BCR TKAs implanted with a simplified gap-balancing technique are reported, with special attention paid to knee flexion, through comparison with a cohort of 100 posterior-stabilized (PS) TKAs. We conducted a retrospective comparative cohort study of 100 BCR TKAs (90 patients) and 100 PS TKAs (88 patients). Knees with a BCR TKA lost significantly more flexion PS TKA in the early postoperative period when their preoperative flexion was less than 130 degrees (loss of 40 degrees vs. loss of 24 degrees). Postoperative range of motion was similar between BCR TKA and PS TKA when preoperative knee flexion was 130 degrees or more, and when there was no preoperative flexion contracture. Postoperative stiffening seems to be more frequent and of greater magnitude after BCR TKA, compared with PS TKA, in patients suffering from preoperative flexion stiffness. Further investigation on the causes of this phenomenon is warranted.

Tibiofemoral Contact After Conventional and High-Flexion Posterior Cruciate-Retaining Total Knee Arthroplasty

2003 ◽  
Author(s):  
Ephrat Most ◽  
Guoan Li ◽  
Harry E. Rubash
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Contact Point ◽  
Knee Kinematics ◽  
Testing System ◽  
High Flexion ◽  
Human Knee ◽  
Contact Points ◽  
Total Knee

The human knee is capable of flexing up to 160°, yet most patients do not achieve more than 120° after total knee arthroplasty (TKA). The translation of the tibiofemoral contact points with flexion is important in the overall understanding of knee kinematics and knee stability, particularly in high flexion. In this study, cadaveric knees were used in conjunction with a robotic testing system and TekScan® film to quantify the tibiofemoral contact between 0°–150° for two TKA designs. We found that, for both TKAs, with increasing knee flexion, the peak contact point moved posteriorly and that the contact area decreased with increasing knee flexion.

scholarly journals Bicruciate retaining total knee arthroplasty : results throughout history

2021 ◽  
Vol 87 (1) ◽  
pp. 73-83
Author(s):  
Jef De Mulder ◽  
Pieter Berger ◽  
Hilde Vandenneucker
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Kinematics ◽  
Functional Results ◽  
Clinical Results ◽  
High Rate ◽  
Total Knee ◽  
High Level ◽  
Bcr Tka

Approximately 20% amongst patients are dissatisfied after total knee arthroplasty (TKA). Bicruciate retaining (BCR) TKA offers superior knee kinematics and proprioception, but many surgeons abandoned its use because of complications and technical difficulties. Recently, two new BCR implant designs were introduced : Vanguard XP (Zimmer Biomet) and Journey XR (Smith&Nephew). We searched Pubmed, Limo, Embase and Cochrane, screened reference lists of eligible studies and included studies that met the inclusion criteria. We included 35 articles reporting on ten different BCR implants, including three articles presenting results of the Vanguard XP prosthesis. Unfortunately, no articles reporting on the results of the Journey XR prosthesis had been published. The BCR implants of the early 1970s showed good functional results, but a high rate of complications, mainly loosening and infections. The Townley Anatomic TKA was the first BCR implant with good clinical results, a low incidence of loosening and a high survivorship. One article of the three reporting on the Vanguard XP yielded high patient satisfaction (94%) with two revisions (1.4%). The two other articles reported three revisions (5%) after one year of follow-up and 19 revisions (13.4%) after three years of follow-up. Throughout history, the functional results of BCR TKA improved, with lessening of the complications. The short-term results of the Vanguard XP implant showed good functional results, but two out of three articles reported a high rate of loosening. Based on the results reported in this review, the use of BCR TKA is still debatable. Further high-level evidence research is necessary to assess the clinical benefit of BCR TKA.

Gender Influences Gait Asymmetry following Bicruciate-Retaining Total Knee Arthroplasty

2019 ◽  
Vol 33 (06) ◽  
pp. 582-588 ◽  
Author(s):  
David Hennessy ◽  
Paul Arauz ◽  
Christian Klemt ◽  
Shuai An ◽  
Young-Min Kwon
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Imaging System ◽  
Knee Kinematics ◽  
Male And Female ◽  
Female Patients ◽  
Total Knee ◽  
Bcr Tka ◽  
Anterior Posterior

AbstractThis is an experimental study. Gender has been reported to influence outcomes in patients with total knee arthroplasty (TKA) for knee osteoarthritis (OA). However, the influence of gender on three-dimensional (3D) in vivo kinematics during gait remains unclear. This study aimed to determine if 3D gait kinematics, including 3D knee translations and rotations, differed in men and women following bicruciate-retaining (BCR) TKA. Twenty-nine well-functioning unilateral BCR TKA patients (14 males and 15 females) underwent evaluation of both knees during level walking on a treadmill at a self-selected speed using a dual fluoroscopic imaging system. Interlimb comparisons of in vivo 6 degree-of-freedom kinematics were compared between male and female patients. Differences of pre- and postoperative Knee Society scores (KSSs) were compared between the groups. Both groups were matched regarding age and body mass index. Both male and female patients demonstrated improvement in their postoperative KSSs. Statistically significant differences were observed with respect to spatiotemporal anterior–posterior interlimb translations (p < 0.05). Although females presented more femoral posterior translation in the operative knee than the nonoperative knee during most of the stance phases (2.8 vs. −1.6 mm), males exhibited less femoral translation in the operative knee than the nonoperative knee (2.3 vs. −1.8 mm), when interlimb differences were detected during stance phase. Results demonstrated that there are 3D motion asymmetries of the knee in both male and female unilateral BCR TKA patients during gait with anterior–posterior interlimb asymmetries significantly greater in female than male participants. This suggests that gender may influence the in vivo knee kinematics in BCR TKA patients during gait.

scholarly journals In vivo kinematics and cruciate ligament forces in bicruciate-retaining total knee arthroplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenichi Kono ◽  
Hiroshi Inui ◽  
Tetsuya Tomita ◽  
Takaharu Yamazaki ◽  
Shoji Konda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Knee Kinematics ◽  
Anteroposterior Translation ◽  
Total Knee ◽  
Bcr Tka ◽  
Femoral Condyles

AbstractWe analyzed the effects of bicruciate-retaining total knee arthroplasty (BCR-TKA) on knee kinematics and cruciate ligament forces. Patients (N = 15) with osteoarthritis (OA) and an intact anterior cruciate ligament (ACL) underwent magnetic resonance imaging and single-plane fluoroscopy to measure tibiofemoral kinematics during two deep knee bend activities before and after BCR-TKA: (1) weight-bearing squat; (2) non-weight-bearing cross-legged sitting. Forces in ligament bundles were calculated using VivoSim. The dynamic range of varus-valgus angulation decreased from 3.9 ± 4.4° preoperatively to 2.2 ± 2.7° postoperatively. Preoperatively, the medial femoral condyle translated anteriorly from 10° to 50° of flexion, and posteriorly beyond 50° of flexion. Postoperatively, the medial and lateral femoral condyles translated posteriorly throughout flexion in a medial pivot pattern. ACL forces were high in extension and decreased with flexion pre- and postoperatively. PCL forces increased with flexion preoperatively and did not change significantly postoperatively. Preoperatively, ACL forces correlated with anteroposterior translation of the femoral condyles. Postoperatively, PCL forces correlated with anteroposterior translation of the lateral femoral condyle. BCR-TKA altered knee kinematics during high flexion activity which correlated significantly with changes in cruciate ligament forces.

scholarly journals Exposure in Difficult Total Knee Arthroplasty Using Coronal Tibial Tubercle Osteotomy

2000 ◽  
Vol 8 (1) ◽  
pp. 61-65 ◽  
Author(s):  
WJ Bruce ◽  
J Rooney ◽  
SR Hutabarat ◽  
MC Atkinson ◽  
JA Goldberg ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Special Surgery ◽  
Total Knee ◽  
Tibial Cortex ◽  
Fixed Flexion Deformity

Exposure in a total knee arthroplasty can be challenging regardless of whether it is a difficult primary or a revision. Various techniques both proximal and distal to the patella have been described and implemented to gain exposure and improve knee flexion.3,6,12 When patella eversion is not possible due to previous surgery or severe preoperative knee flexion contracture, a coronal tibial tubercle osteotomy may be utilized.15,16 We present successful results utilizing the coronal tibial tubercle osteotomy procedure. The technique involved in this series is based on that described by Whiteside.15,16 It involves the development of a long lateral musculoperiosteal flap incorporating the tibial tubercle and anterior tibia, and leaving the proximal tibial cortex intact. This is extended along the tibia distally for 10 cm. It finishes by gradually osteotomising the anterior surface of the tibial crest. The tubercle is reattached with wires at the end of the procedure. This technique minimizes complications that have been associated with the tibial tubercle osteotomy.10,11,17 The 10 knees in 9 patients, who had total knee arthroplasty with a coronal tibial tubercle osteotomy, were reviewed pre and postoperatively. All knees were assessed using the Hospital for Special Surgery knee score (HSS). The scores averaged 43.6 preoperatively (range, 29–57) and 79.2 postoperatively (range, 67–90), and the mean range of motion was 59.5° preoperatively and 78.0° postoperatively. There were no cases of extension lag. Fixed flexion deformity was present in 3 cases postoperatively. Average time to union at the proximal and distal ends of the osteotomy was 8 and 24 weeks respectively. There was no evidence of nonunion and no other significant complications occurred.

The Effect of Knee Flexion Contracture Following Total Knee Arthroplasty on the Energy Cost of Walking

2014 ◽  
Vol 29 (1) ◽  
pp. 85-89 ◽  
Author(s):  
Michael T. Murphy ◽  
Tina L. Skinner ◽  
Andrew G. Cresswell ◽  
Ross W. Crawford ◽  
Simon F. Journeaux ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Energy Cost ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Knee Flexion Contracture ◽  
Total Knee ◽  
Energy Cost Of Walking

scholarly journals Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up

2012 ◽  
Vol 36 (9) ◽  
pp. 1835-1839 ◽  
Author(s):  
Sebastien Lustig ◽  
Corey J. Scholes ◽  
Tim J. Stegeman ◽  
Sam Oussedik ◽  
Myles R. J. Coolican ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Flexion Contracture ◽  
Knee Flexion Contracture ◽  
Total Knee ◽  
One Year

scholarly journals Early Spatiotemporal Patterns and Knee Kinematics during Level Walking in Individuals following Total Knee Arthroplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Xubo Wu ◽  
Lixi Chu ◽  
Lianbo Xiao ◽  
Yong He ◽  
Shuyun Jiang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Gait Analysis ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Knee Kinematics ◽  
Gait Pattern ◽  
Swing Phase ◽  
Knee Flexion Angle ◽  
Total Knee ◽  
Support Time

Purpose. With the aim of investigating the spatiotemporal features of early gait pattern and knee kinematics after total knee arthroplasty and analyzing the association between outcomes of gait analyses and knee kinematic parameters, the relationship between walking and dynamic knee deformity at the early period after total knee arthroplasty was assessed in this study. Methods. Eighteen patients including 14 women and 4 men who underwent total knee arthroplasty were analyzed using three-dimensional gait analysis system to observe gait parameters and values of maximum knee flexion angle (MKFA) during swing phase and knee flexion angle (KFA) and knee valgus angle (KVA) at midstance phase. Results. 3D gait analysis showed that operated side exhibited significantly less total support time and single support time as well as significantly longer swing phase compared with the other side. During walking, the operated side had significantly smaller MKFA and greater KFA and KVA than the nonoperated side. There was moderate to significant correlation between gait pattern and the dynamic knee kinematics. Conclusion. The gait abnormality of patients after TKA was associated with inadequate flexion of knees at swing phase and insufficient extension at stance phase as well as increased range of valgus.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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