Is There a Difference between Cemented and Uncemented Femoral Stem Extensions in Revision Knee Arthroplasty?

2018 ◽  
Vol 33 (01) ◽  
pp. 084-088 ◽  
Author(s):  
Paul F. Lachiewicz ◽  
Jane Ann O'Dell
Keyword(s):  
Pain Score ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
Femoral Stem ◽  
Function Score ◽  
Optimal Method ◽  
Radiographic Loosening ◽  
Significant Difference ◽  
Revision Tka

AbstractA stem is usually recommended for the femoral component in revision total knee arthroplasty (TKA) for reasons of alignment, fixation, and bone loss. However, the optimal method of fixation for the femoral component stem remains controversial. We queried the prospective revision TKA database of one surgeon and performed a clinical and radiographic evaluation of 84 knee revisions in which a femoral component stem extension was implanted. There was no established protocol for fixation of the femoral stem during this time. There were 34 knees with cemented (C) fixation and 50 with uncemented (UC) fixation. There were no significant differences in age, gender, body mass index (BMI), or Anderson's Orthopaedic Research Institute (AORI) defect between the two groups. Patients were evaluated using the classic Knee Society clinical and radiographic scores and followed for a mean of 6 years (range: 2–17 years). There was no statistically significant difference in prevalence of reoperation for loosening between cemented and uncemented stems (cemented 3.3% vs. uncemented 10%; p = 0.4). Post hoc power analysis showed that 203 knees in each group would be needed for statistical significance. With the numbers available, there was no difference in aseptic component loosening and radiographic loosening combined (one revision and two radiographic loosening, 9%, in the C group vs. five revisions and three radiographic loosening, 16%, in the UC group; p = 0.51). There was no difference between the groups in the overall rate of any reoperation. There were no differences in postoperative Knee Society pain score, change in pain score, Knee Society function score, or change in function score. Due to the numbers required, a large multicenter study will be needed to determine the optimal method of fixation of the femoral stem in revision TKA.

scholarly journals Revision total knee arthroplasty versus primary total knee arthroplasty

2020 ◽  
Vol 1 (3) ◽  
pp. 29-34
Author(s):  
Paul Stirling ◽  
Scott D. Middleton ◽  
Ivan J. Brenkel ◽  
Phil J. Walmsley
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Lateral Release ◽  
Matched Cohort ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Revision Tka

Introduction The primary aim of this study was to describe a baseline comparison of early knee-specific functional outcomes following revision total knee arthroplasty (TKA) using metaphyseal sleeves with a matched cohort of patients undergoing primary TKA. The secondary aim was to compare incidence of complications and length of stay (LOS) between the two groups. Methods Patients undergoing revision TKA for all diagnoses between 2009 and 2016 had patient-reported outcome measures (PROMs) collected prospectively. PROMs consisted of the American Knee Society Score (AKSS) and Short-Form 12 (SF-12). The study cohort was identified retrospectively and demographics were collected. The cohort was matched to a control group of patients undergoing primary TKA. Results Overall, 72 patients underwent revision TKA and were matched with 72 primary TKAs with a mean follow-up of 57 months (standard deviation (SD) 20 months). The only significant difference in postoperative PROMs was a worse AKSS pain score in the revision group (36 vs 44, p = 0.002); however, these patients still produced an improvement in the pain score. There was no significant difference in improvement of AKSS or SF-12 between the two groups. LOS (9.3 days vs 4.6 days) and operation time (1 hour 56 minutes vs 1 hour 7 minutes) were significantly higher in the revision group (p < 0.001). Patients undergoing revision were significantly more likely to require intraoperative lateral release and postoperative urinary catheterisation (p < 0.001). Conclusion This matched-cohort study provides results of revision TKA using modern techniques and implants and outlines what results patients can expect to achieve using primary TKA as a control. This should be useful to clinicians counselling patients for revision TKA.

scholarly journals Revision total knee arthroplasty versus primary total knee arthroplasty

2020 ◽  
Vol 1 (3) ◽  
pp. 29-34
Author(s):  
Paul Stirling ◽  
Scott D. Middleton ◽  
Ivan J. Brenkel ◽  
Phil J. Walmsley
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Lateral Release ◽  
Matched Cohort ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Revision Tka

Introduction The primary aim of this study was to describe a baseline comparison of early knee-specific functional outcomes following revision total knee arthroplasty (TKA) using metaphyseal sleeves with a matched cohort of patients undergoing primary TKA. The secondary aim was to compare incidence of complications and length of stay (LOS) between the two groups. Methods Patients undergoing revision TKA for all diagnoses between 2009 and 2016 had patient-reported outcome measures (PROMs) collected prospectively. PROMs consisted of the American Knee Society Score (AKSS) and Short-Form 12 (SF-12). The study cohort was identified retrospectively and demographics were collected. The cohort was matched to a control group of patients undergoing primary TKA. Results Overall, 72 patients underwent revision TKA and were matched with 72 primary TKAs with a mean follow-up of 57 months (standard deviation (SD) 20 months). The only significant difference in postoperative PROMs was a worse AKSS pain score in the revision group (36 vs 44, p = 0.002); however, these patients still produced an improvement in the pain score. There was no significant difference in improvement of AKSS or SF-12 between the two groups. LOS (9.3 days vs 4.6 days) and operation time (1 hour 56 minutes vs 1 hour 7 minutes) were significantly higher in the revision group (p < 0.001). Patients undergoing revision were significantly more likely to require intraoperative lateral release and postoperative urinary catheterisation (p < 0.001). Conclusion This matched-cohort study provides results of revision TKA using modern techniques and implants and outlines what results patients can expect to achieve using primary TKA as a control. This should be useful to clinicians counselling patients for revision TKA.

scholarly journals COMPARISON OF HEMOSTASIS WITH TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY

2021 ◽  
Vol 29 (4) ◽  
pp. 184-188
Author(s):  
OTÁVIO MONTOVANELLI MONTEIRO ◽  
RODRIGO TURRA PERRONE ◽  
FABRÍCIO NASCIMENTO ALMEIDA ◽  
CID PEREIRA DE MOURA JUNIOR ◽  
SAULO GOMES DE OLIVEIRA ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
Primary Total Knee Arthroplasty ◽  
Joint Surface ◽  
Thromboembolic Events ◽  
Significant Difference ◽  
Total Knee ◽  
Group 3

ABSTRACT Objective: To compare the use of intravenous and topical tranexamic acid (TXA) in unilateral primary total knee arthroplasty (TKA) in relation to blood loss and complications inherent to the medication. Method: Three groups with 14 patients each were constituted, and all of them were operated using the same surgical technique. In Group 1, usual measures for bleeding control were performed. Group 2 patients received TXA topically on the joint surface. In Group 3, intravenous TXA was used. Hemoglobin (HB), hematocrit (HTC), platelets (PLAT), prothrombin time, activated partial thromboplastin time and volume of blood drained observed 24 hours after arthroplasty were compared to the values of tests found before surgery. Results: There was a decrease in the concentration of HB, HTC and PLAT in all groups in relation to the preoperative, however without significant difference. Group 3 had a lower mean volume of drained blood than the other groups, with statistical significance. No adverse effects or thromboembolic events were observed in the groups that received TXA. Conclusion: This study showed superiority in the use of intravenous TXA in decreasing the volume of bleeding, without increasing the risk of thromboembolic events. Level of Evidence I, High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals.

Does the femoral offset affect replacements? The results from a National Joint Registry

2018 ◽  
Vol 29 (3) ◽  
pp. 289-298 ◽  
Author(s):  
Michael C Wyatt ◽  
David C Kieser ◽  
Mark A Kemp ◽  
Gavin McHugh ◽  
Chris M A Frampton ◽  
...  
Keyword(s):  
Femoral Component ◽  
Revision Rate ◽  
Femoral Stem ◽  
Joint Registry ◽  
Total Hip Replacements ◽  
Significant Difference ◽  
Hip Replacements ◽  
Cemented Stem ◽  
And Gender ◽  
Low Offset

Background: Femoral component offset influences the torque forces exerted on a femoral stem and may therefore adversely affect femoral component survival. This study investigated the influence of femoral component offset on revision rates for primary total hip replacements (THR) registered on the New Zealand Joint Registry (NZJR). Methods: There were 106,139 primary THRs registered, resulting in 4960 revisions for any cause. There were 46,242 THRs performed using the five commonest femoral components listed on the NZJR. A total of 41,100 were done for primary osteoarthritis of which 40,548 had all the offset information available for analysis. We defined low offset as < 42 mm, standard as 42–48 mm and high offset as > 48 mm offset and examined revision rates according to the reasons for revision. We performed survival analyses for both cemented and uncemented femoral components grouped by the different offsets. Results: The all-cause revision rate was 0.54/100 component years (cys). Stems with < 42 mm offset had a revision rate of 0.58/100 cys (mean 0.58; 95% confidence interval (CI) 0.53–0.63), 42–48 mm offset 0.47 (95% CI 0.43–0.52) and > 48 mm offset 0.67 (95% CI 0.57–0.79). There was no significant difference in all-cause revision rates between varying stem offsets in uncemented stems adjusting for age and gender. In cemented stems both high and low offset stems were more likely to be revised. Uncemented stems of all offsets were more likely to undergo revision for femoral fracture. Conclusions: Femoral component offset affects the overall all-cause revision rate of the most commonly used cemented stem, but not uncemented stem designs. In cemented stems offset influences the rate of revision for loosening and periprosthetic fractures.

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 Correlation Between Asymmetric Resection of Posterior Femoral Condyles and Femoral Component Rotation in Total Knee Arthroplasty

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0014
Author(s):  
Harun Reşit Güngör ◽  
Nusret Ök ◽  
Kadir Ağladıoğlu ◽  
Semih Akkaya ◽  
Esat Kıter
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Trochlear Groove ◽  
Femoral Component Rotation ◽  
Component Rotation ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean ◽  
The Asymmetry

Objectives: Pertaining to peculiar designs of current knee prostheses, more bone is removed from posteromedial femoral condyle than posterolateral condyle to obtain desired femoral component rotation. The aim of our study was to evaluate whether there is a correlation between the asymmetry of the cuts and the femoral component rotation in total knee arthroplasty. Methods: We built a model to simulate anterior chamfer cut (ACC) performed during total knee arthroplasty for measuring posterior condylar offset (PCO). Right knee axial MRI slices of a total 290 consecutive patients (142 male, 138 female, and mean age 31.39 ± 6.6) were examined. A parallel line to surgical transepiphyseal axis was drawn, and placed at the deepest part of trochlear groove. Posteromedial and posterolateral condylar offsets were measured by drawing perpendicular lines to ACC beginning from the intersection points of both anteromedial and anterolateral cortices to posterior joint line (PJL), respectively. Differences between posteromedial and posterolateral PCO were calculated, and femoral rotation angles (FRA) relative to PJL were measured. Results: The mean surgical FRA was 4.76 ± 1.16 degrees and the mean PCO differencesss- was 4.35 ± 1.04 mm for the whole group and there was no statistically significant difference between genders. There was a strong correlation between surgical FRA and PCO difference (p<0.0001, r=0.803). Linear regression analyses revealed that 0.8 mm of difference between the anteroposterior dimensions of medial and lateral PCO corresponds to 1 degree of surgical FRA (p<0.0001, R2=0.645). Conclusion: Correlation between the asymmetry of posterior chamfer cuts and achieved femoral component rotation can verify the accuracy of desired rotation, intraoperatively. However, further clinical investigations should be planned to test the results of our morphometric study.

scholarly journals The comparison of femoral component rotation in the total knee arthroplasty

2017 ◽  
Vol 17 (3) ◽  
pp. 24-31
Author(s):  
M Chmurny ◽  
S Krivanek ◽  
M Melisik ◽  
M Rovnak ◽  
L. Necas
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Significance Level ◽  
Femoral Component Rotation ◽  
Gap Technique ◽  
Component Rotation ◽  
Significant Difference ◽  
Total Knee ◽  
Balanced Gap Technique

Abstract Introduction Background: Optimal femoral component rotation in total knee arthroplasty (TKA) is crucial to establish a balanced knee reconstruction. Unbalanced knees can lead to instability, patellofemoral problems, persistent pain, stiffness, and generally poorer outcomes including early failure. There are several methods to achieve the femoral component rotation such as balanced gap technique, measured resection technique, and bone landmarks such as transepicondylar line (TEA) and Whiteside line. The purpose of this study was to compare the balan ced gap technique with the TEA technique. Materials and Methods: This randomised prospective study compares the femoral component rotation obtained with the use of balanced gap technique and the TEA, as well as compares the differences due to preoperative knee desaxations. The study includes 50 knees, 19 with neutral alignment, 22 with varus, and 9 with valgus desaxation. The femoral component rotation was measured postoperatively on photodocumentation taken after determining the TEA and balanced gap technique line peroperatively. These lines were compared to the posterior femoral condyles obtaining the degree of rotation. In case of transepicondylar line it is condylar twist angle (CTA) and in case of ligament balancer rotation axis it is ligament balancer angle (LBA). Results: The statistically significant differences in femoral component rotation using the techniques mentioned above as well as differences in individual knee desaxations were observed. The average LBA was 3.42 degrees and average CTA 3.58 in neutral knees group, but in the varus knees the average CTA value was 2.27 degrees and LBA value was 1.05 degrees. The average CTA value in patients with valgus desaxation is 4.78 degrees and LBA value is 5.22 degrees. According to Tukey Post Hoc test a statistically significant difference in LBA value is between neutral and varus knees with a significance level of p = 0.000022 and the most significant difference between varus and valgus knees with a significance level of p = 0.000011. Conclusion: The statistically significant differences in femoral component rotation using the techniques mentioned above as well as differences in individual knee desaxations were observed.

scholarly journals Effect of Enhanced Exercise Program on Pain and Physical Activity for Patients after Total Knee Arthroplasty

2021 ◽  
Vol 3 (3) ◽  
pp. 14
Author(s):  
Safaa M. Hamed ◽  
Rasha F. M. Gaballah
Keyword(s):  
Physical Activity ◽  
Total Knee Arthroplasty ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Rating Scale ◽  
Treatment Plan ◽  
Exercise Program ◽  
Orthopedic Procedure ◽  
Significant Difference ◽  
Total Knee

Context: Total knee arthroplasty (TKA) is considered the most effective orthopedic procedure for treating knee osteoarthritis. The need for knee replacement is predicted to increase six-fold between 2005 and 2030 to reflect an increasingly yet functionally demanding population. Aim: This study aimed to evaluate the effect of an enhanced exercise program on pain and physical activity after total knee arthroplasty. Methods: Quasi-experimental (pre/posttest) design was utilized in this study. The study was carried out in the orthopedic department, Benha University Hospital, and followed the patients through the orthopedic outpatient clinic from the beginning of May 2020 till the beginning of May 2021. A purposive sample of 64 patients was recruited to achieve the aim of this study. Four tools were used to collect the study data. These are the structured interview questionnaire to assess patients' knowledge regarding total knee arthroplasty, Barthel ADL index scale, Lysholm knee scoring scale, and Numeric Pain Rating Scale to assess the effect of the enhanced exercise program. Results: Showed that nearly two-thirds of the study sample was ≤60 years old, females, and married. The study also showed a statistically significant difference between pre-and post- enhanced exercise program in terms of total knowledge mean score among the study sample, as well as an increase in the total mean score in Barthel ADL index, decrease Lysholm knee scoring, and pain score after one month and after three months of enhanced program exercise implementation. Conclusion: Implementing an enhanced exercise program for patients with total knee arthroplasty effectively improved knowledge, increased physical activity (Barthel ADL index), decreased Lysholm knee scoring, and pain score. The present study recommended including an enhanced exercise program in the treatment plan for patients with total knee arthroplasty to improve patient's knowledge and practices. Also, repeating the study on a larger probability sample to achieve generalization of the findings.            

Robot-Assisted Unicompartmental Knee Arthroplasty: Increasing Surgical Accuracy? A Cadaveric Study

2019 ◽  
Author(s):  
Magaly Iñiguez ◽  
Roberto Negrín ◽  
Jaime Duboy ◽  
Nicolás O. Reyes ◽  
Rodrigo Díaz
Keyword(s):  
Femoral Component ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Functional Results ◽  
Tibial Slope ◽  
Clinical Results ◽  
Robot Assisted ◽  
Post Surgery ◽  
Unicompartmental Knee ◽  
Significant Difference

AbstractUnicompartmental knee arthroplasty (UKA) represents 10% of knee arthroplasties. Advantages are better functional results, quicker recovery, shorter hospitalization time, and lower blood loss, among others. However, revision rates are larger than total knee arthroplasty. Among the most important factors that explain this are the implant position and alignment, and the correct surgical indication. Greater accuracy in the implant placement may improve clinical results and increase the rate of implant survival. The objective of this study is to evaluate the precision of the Navio robot-assisted system in the position and alignment of medial UKA compared with the conventional technique. This is an experimental pilot study. Twenty-six cadaveric models were randomized into 2 groups: Robot-Assisted surgery (R) and Conventional Surgery (C). Radiological study was performed pre- and post-surgery, evaluating the medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), tibial slope, tibiofemoral angle (TFA), sagittal femoral angle (SFA), and size of the femoral and tibial components. The main result measurement was the change in postoperative angulation. The results of this study are MDFA median of 1.07° (0.19–4.5) for group R and 0.12° (0.03–10.4) with a significant difference in variances; a Welch t-test of p = 0.013; and an MPTA of 1.28° (0.05–5.87) for R and 1.3°(0.08–14.1) for C with significantly different variances (p = 0.0064). Size of the femoral component has a difference of p < 0.05 between groups. No differences for dispersion of TFA nor for the size of the tibial component were observed. In conclusion, using robot-assisted UKA allows for greater accuracy in the positioning of the implants and in the prediction of the size of the femoral component.

scholarly journals Short uncemented femoral component for hip revision: prognosis and risk factors associated with failure

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zeming Liu ◽  
Bo Liu ◽  
Bingshi Zhang ◽  
Wenhui Ma ◽  
Tao Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
Femoral Component ◽  
Revision Surgery ◽  
Femoral Fracture ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Categorical Variables ◽  
Periprosthetic Femoral Fracture ◽  
Significant Difference

Abstract Background The application of short femoral stems is partially restricted in revision surgery. This study will demonstrate the therapeutic effect and unsuitable situation for short stem revision. Methods Demographic characteristics of all patients were recorded in detail (Table 1). Anteroposterior view radiographic examinations of proximal femur are necessary before and after the operation for patients. The primary outcome of interest was the survival rate of the femoral stem at the final follow-up. Risk factors for failure were also investigated. The secondary outcomes of interest included the Harris hip score, excellent to good rate and incidence of complications. The Mann–Whitney U test was performed for comparisons between continuous variables. The chi-square test was performed for comparisons between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and the failure of revision surgery. Results A total of 381 patients with short stems were retrospectively reviewed. There were 188 males and 193 females. The average age and body mass index before revision surgery were 58.85 ± 13.46 years and 23.72 ± 3.40 kg/m2, respectively. The mid-term survival rate of the short femoral component was 94.23%. The prognosis and complications of patients between the two groups were compared. There was no significant difference between the two groups in the Harris score, complication incidence or survival rate of the femoral component. The strongest risk factor in this study was intraoperative periprosthetic femoral fracture during revision surgery (HR = 5.477, 95% CI = 2.156–13.913). Conclusion Three risk factors for failure were identified: ageing, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, a short femoral stem should be implanted in patients with these risk factors with additional caution.

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