Early Clinical and Radiological Outcomes of the Metaphyseally Fixed Totally Stabilized Knee Prosthesis in Primary Total Knee Arthroplasty

AbstractThe use of valgus–varus constrained (VVC) implant designs in primary total knee arthroplasty (TKA) is considered in situations of severe deformities, bone loss, and inadequate soft tissue balance. It is not known whether the use of such prosthesis designs may predispose to reduced function owing to its constraining design. The components are usually implanted with diaphyseal stem extensions to dissipate the increased forces. The totally stabilized (TS) implant is a contemporary VVC design with metaphyseal fixation only. It has a conforming articulation with increased rotational freedom compared with conventional VVC designs. The aim of this study was to assess whether the use of the contemporary TS implant with its metaphyseally fixed components would be associated with inferior outcomes compared with conventional standard primary posterior stabilized (PS) implants. We reviewed 38 consecutive complex primary TKAs performed using the metaphyseally fixed TS implant and 76 matched patients receiving primary PS TKA, at a minimum follow-up of 24 months. The mean follow-up was 61.1 months (24–102). Only patients with osteoarthritis were included. Clinical outcome was assessed using range of motion (ROM) and Oxford knee score (OKS). Radiographic assessment was performed using the femorotibial angle (FTA) at 6 weeks followed by assessment of bone–implant interface lucencies at final follow-up. There were no major early postoperative complications. The mean postoperative ROM in the TS and PS groups were 114.1 and 112.0, respectively. There was no difference in the mean ROM and OKS between the two groups. The mean FTA for patients in both groups was within 3° of the expected. There was no evidence of progressive lucencies or implant migration at final follow-up. The metaphyseally fixed TS knee design achieves comparable short-term functional outcomes when compared with conventional PS designs in primary knee arthroplasty. Long-term follow-up studies are required to assess survivorship.

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Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1709181 ◽

2020 ◽

Vol 34 (01) ◽

pp. 115-120

Author(s):

Ali Utkan ◽

Emrah Caliskan ◽

Batuhan Gencer ◽

Bulent Ozkurt

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Oxford Knee Score ◽

Primary Total Knee Arthroplasty ◽

Histopathological Analysis ◽

Knee Score ◽

Total Knee ◽

The Mean ◽

Primary Total Knee

AbstractAlthough there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

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Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-020-00561-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Fabio Mancino ◽

Ivan De Martino ◽

Aaron Burrofato ◽

Carmine De Ieso ◽

Maristella F. Saccomanno ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Consecutive Series ◽

Radiographic Outcomes ◽

First Choice ◽

Total Knee ◽

The Mean ◽

Primary Total Knee

Abstract Background The purpose of this study was to evaluate (1) the reoperation rates and survivorship for septic and aseptic causes, (2) radiographic outcomes, and (3) clinical outcomes of condylar-constrained knee (CCK) implants used in primary total knee arthroplasty (TKA) with severe coronal deformity and/or intraoperative instability. Materials and methods A consecutive series of CCK implants in primary TKA was retrospectively evaluated in patients with severe coronal deformities. Forty-nine patients (54 knees) were included with a mean follow-up of 9 years (range 6–12). All patients were treated with a single-design, second-generation CCK implant. The primary diagnosis was osteoarthritis in 36 knees, post-traumatic arthritis in 7 knees, and rheumatoid arthritis in 4 knees. Preoperatively, standing femorotibial alignment was varus in 22 knees and valgus in 20 knees. Results At a mean follow-up of 9 years, overall survivorship was 93.6%. Two knees (4.3%) required revision for periprosthetic joint infection. One knee (2.1%) required subsequent arthroscopy due to patellar clunk syndrome. At final follow-up, no evidence of loosening or migration of any implant was reported, and the mean Knee Society knee scores improved from 43 to 86 points (p < 0.001). The mean Knee Society function scores improved to 59 points (p < 0.001). The average flexion contracture improved from 7° preoperatively to 2° postoperatively and the average flexion from 98° to 110°. No knees reported varus–valgus instability in flexion or extension. Conclusion CCK implants in primary TKA with major coronal deformities and/or intraoperative instability provide good midterm survivorship, comparable with less constrained implants. In specific cases, CCK implants can be considered a viable option with good clinical and radiographic outcomes. However, a higher degree of constraint should be used cautiously, leaving the first choice to less constrained implants. Level of evidence Therapeutic study, level IV.

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A STUDY OF PRIMARY TOTAL KNEE ARTHROPLASTY (TOTAL KNEE REPLACEMENT) IN SEVERE DEGENERATIVE OSTEO ARTHRITIS OF KNEE

10.36106/ijar/2404944 ◽

2021 ◽

pp. 56-58

Author(s):

Voligi Shekhar ◽

Sateesh Chandra P ◽

Gunda Veera Redd

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Computer Assisted ◽

Assisted Navigation ◽

Total Knee ◽

The Mean ◽

Lost To Follow Up ◽

Primary Total Knee

AIM: To assess the clinical outcome, to study radiological variable inuencing the outcome of total knee arthroplasty and to identity patient variable which signicantly inuence the outcome. Out MATERIALS&METHODS: of the 30 Arthroplasties performed in 28 patients with in the study period. 5 patients (5 knees) were lost to follow-up for various reasons and thus 23 patients (25 knees) were available for clinical review. The mean age of the patient RESULTS: at the time of surgery was 61.04 years. 76% of Knee had primary osteoarthritis and 25% had secondary OA. The average post-operative alignment as 4.3º valgus (range, 3º varus-10º valgus), the mean posterior slope of tibia (s) was 3.5º (range, 0-8º)c and the average femoral exion angle (?) 7.6º. In the assessment of post CONCLUSION: operative outcome of total knee arthroplasty, Knee Society Score is a very useful tool. Restoration of normal alignment of valgus (6 + 2º) is possible with conventional (without computer assisted navigation) surgical technique.

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Primary total knee arthroplasty using the Genesis I total knee prosthesis: A 5- to 10-year follow-up study

The Knee ◽

10.1016/j.knee.2004.12.004 ◽

2005 ◽

Vol 12 (5) ◽

pp. 341-345 ◽

Cited By ~ 10

Author(s):

Yoshinori Ishii ◽

Yoshikazu Matsuda ◽

Shigeo Sakata ◽

Naoaki Onda ◽

Go Omori

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Prosthesis ◽

Primary Total Knee Arthroplasty ◽

Total Knee Prosthesis ◽

Follow Up Study ◽

Total Knee ◽

Primary Total Knee

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PRIMARY TOTAL KNEE ARTHROPLASTY FOR SEVERE VALGUS DEFORMITY: A 2YEAR FOLLOW-UP STUDY AT HASAN SADIKIN HOSPITAL

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00060 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0006

Author(s):

K. A. M. Luthfi ◽

D. Mulyadi ◽

F.A. Tanjung

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Oxford Knee Score ◽

Primary Total Knee Arthroplasty ◽

Valgus Deformity ◽

X Rays ◽

Femorotibial Angle ◽

Total Knee ◽

Primary Total Knee

Valgus deformity (VD) accounts for only 10% of total knee arthroplasties (TKAs), but is frequently considered the most challenging to manage. The aim of this study was to review outcome of primary total knee arthroplasty for severe valgus deformity at Hasan Sadikin Hospital, Bandung. Methods: From January 2015 and December 2017 consecutive patients undergoing unconstrained primary total knee arthroplasty with severe VD, grade II and III were enrolled in a prospective observational cohort study. Preoperatively, at 6 weeks, and 2 years after surgery, patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Knee Society Score (KSS, 2011, modified version). Femorotibial angle were measured on the frontal standing X-rays. Results and Discussions: There were twenty-four patients (18 women, 6 men) with mean age of 66 years (55 - 80). The knee range of motion improved from a mean of 71 degrees preoperatively to a mean of 95 degrees. KOOS Quality of life had increased significantly 6 weeks – 2 years after surgery. KOOS pain mean score was 40.3 points before surgery and increased significantly to 86.6 at two year follow up. OKS mean score increased from 22.1 to 41.8 two years after surgery. KSS 2011 mean objective score increased from 22 to 96 and mean function score increased from 32 to 81 two years after surgery. The mean femorotibial angle were improved from valgus 32.72º±9.68º pre-operation to 4.89º±0.90º post-operation (P <0.001). Conclusion: Primary total knee arthroplasty can be effective and safe for severe valgus deformity and the clinical results up to two years after surgery are promising. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components.

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A facile extramedullary method to perform primary total knee arthroplasty in patients without hardware removal: a case series

10.21203/rs.2.24699/v1 ◽

2020 ◽

Author(s):

Yu-Kai Tseng ◽

Yen-Nien Chen ◽

Chih-Han Chang ◽

Kuo-An Lai ◽

Chyun-Yu Yang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Hardware Removal ◽

Knee Arthritis ◽

Primary Tkas ◽

Total Knee ◽

Post Traumatic ◽

The Mean ◽

Primary Total Knee

Abstract Background It is technical demanding to execute primary total knee arthroplasty (TKA) for post-traumatic knee arthritis with periarticular implants. Our purpose is to present a simple extramedullary guide technique and report the clinical results of our series of primary TKAs in patients with post-traumatic arthritis without hardware removal. Methods Between April 2014 and March 2019, a series of seven patients with post-traumatic knee arthritis and retained hardware were included. All the surgeries were performed by the same surgeon. The mean age of the patients was 67 years. All the index procedures were performed with primary TKAs by the same surgeon according to simple extramedullary technique. The parallelism between the distal femoral and proximal tibial cuts as well as the required limb alignments were verified intra-operatively. Radiographic measurements and clinical outcomes were reviewed retrospectively. Results Overall, there was a good restoration of postoperative mechanical alignment in all cases. The mean post-operative Hip-Knee-Ankle (HKA) angle was 179.4°. No patient required allogenic blood transfusion or prolonged hospital stays. No surgical site-specific complications were noted by chart review. In the last follow-up, no implant failure was found. Clinical assessments according to knee society score showed good knee scores (89.1), functional scores (87.9) and motion arc (112.9). Conclusions Our results show that post-traumatic knee arthritis can be safely managed with this extramedullary method without hardware removal.

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Factors determining the range of motion in primary total knee arthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195793 ◽

2019 ◽

Vol 6 (1) ◽

pp. 12

Author(s):

Mallesh Rathod ◽

Sandeep Kumar Kanugula ◽

Venugopal S. M. ◽

Jagadeesh Gudaru

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Tibial Slope ◽

Implant Design ◽

Total Knee ◽

The Mean ◽

Primary Total Knee

Background: Total knee arthroplasty (TKA) is one of the most successful surgical procedure with over 90% survival rate at 10 to 15 years. It provides a stable, pain free range of motion (ROM) for day to day activities. The aim of this study is to evaluate various factors determining ROM after TKA.Methods: 348 patients with 390 knees treated with TKA using cruciate retaining (CR) and posterior stabilized (PS) prosthesis were included and analysed. Mean follow up period was 18 months. Patients were analysed for factors like age, sex, diagnosis, body mass index (BMI), pre-operative exercises, ROM, deformity, posterior femoral condylar offset (PFCO), posterior tibial slope (PTS), post-operative rehabilitation and implant design (CR vs PS). Statistical analysis of above factors on knee ROM was done. Patients were assessed pre-operatively, at 6 weeks, 3, 6, 12 and 18 months post-operatively.Results: Age and sex did not affect the final ROM. The mean knee ROM improved from 86.87° to 96.95°. Factors like BMI, deformity had negative correlation and Pre-operative diagnosis, exercises, knee scores, good preoperative ROM, PFCO, PTS had positive correlation on ROM.Conclusions: Pre-operative exercises, diagnosis, ROM, deformity, BMI, PFCO and PTS were important factors which influence ROM in TKA. Patient selection and preoperative counselling are important for good clinical outcome.

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