Femoral Component Malrotation Produces Quadriceps Weakness and Impaired Ambulatory Function following Total Knee Arthroplasty: Results of a Forward-Dynamic Computer Model

2019 ◽  
Vol 33 (11) ◽  
pp. 1121-1127
Author(s):  
John F. Nettrour ◽  
Swithin S. Razu ◽  
James A. Keeney ◽  
Trent M. Guess
Keyword(s):  
Total Knee Arthroplasty ◽  
Internal Rotation ◽  
Femoral Component ◽  
Computer Model ◽  
Knee Arthroplasty ◽  
Vastus Lateralis ◽  
Patient Specific ◽  
Patient Reported ◽  
Total Knee ◽  
The Individual

AbstractProper placement of the prosthetic components is believed to be an important factor in successful total knee arthroplasty (TKA). Implant positioning errors have been associated with postoperative pain, suboptimal function, and inferior patient-reported outcome measures. The purpose of this study was to investigate the biomechanical effects of femoral component malrotation on quadriceps function and normal ambulation. For the investigation, publicly available data were used to create a validated forward-dynamic, patient-specific computer model. The incorporated data included medical imaging, gait laboratory measurements, knee loading information, electromyographic data, strength testing, and information from the surgical procedure. The ideal femoral component rotation was set to the surgical transepicondylar axis and walking simulations were subsequently performed with increasing degrees of internal and external rotation of the femoral component. The muscle force outputs were then recorded for the quadriceps musculature as a whole, as well as for the individual constituent muscles. The quadriceps work requirements during walking were then calculated for the different rotational simulations. The highest forces generated by the quadriceps were seen during single-limb stance phase as increasing degrees of femoral internal rotation produced proportional increases in quadriceps force requirements. The individual muscles of the quadriceps displayed different sensitivities to the rotational variations introduced into the simulations with the vastus lateralis showing the greatest changes with rotational positioning. Increasing degrees of internal rotation of femoral component were also seen to demand increasing quadriceps work to support normal ambulation. In conclusion, internal malrotation of the femoral component during TKA produces a mechanically disadvantaged state which is characterized by greater required quadriceps forces (especially the vastus lateralis) and greater quadriceps work to support normal ambulation.

Patient-Specific Simulated Dynamics After Total Knee Arthroplasty Correlate With Patient-Reported Outcomes

2018 ◽  
Vol 33 (9) ◽  
pp. 2843-2850 ◽  
Author(s):  
Joshua G. Twiggs ◽  
Edgar A. Wakelin ◽  
Justin P. Roe ◽  
David M. Dickison ◽  
Brett A. Fritsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Patient Specific ◽  
Patient Reported ◽  
Total Knee

scholarly journals Accuracy of a Novel 3D‐Printed Patient‐Specific Intramedullary Guide to Control Femoral Component Rotation in Total Knee Arthroplasty

2020 ◽  
Vol 12 (2) ◽  
pp. 429-441
Author(s):  
Mao‐lin Sun ◽  
Ying Zhang ◽  
Yang Peng ◽  
De‐jie Fu ◽  
Hua‐quan Fan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Femoral Component Rotation ◽  
Component Rotation ◽  
3D Printed ◽  
Total Knee

scholarly journals Patellar Tilt in Two Modern Total Knee Arthroplasty Systems: A Matched-Cohort Analysis

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Braeden W. Estes, BS ◽  
Lauren Pitz, BS ◽  
Evan R. Deckard, BSE ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Activity Level ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Premature Failure ◽  
Patient Reported ◽  
Total Knee

Background and Hypothesis: Excessive patellar tilt is undesirable in total knee arthroplasty (TKA) and can result in patellofemoral complications and premature failure/wear. Few studies have investigated patellar tilt between TKA systems with different femoral component geometries and bearing articulations. The purpose of this study was to (1) compare patellar tilt between TKA systems with differing femoral component geometries and (2) evaluate related differences in patient-reported outcome measures (PROMS). The study hypothesis was neutral patellar tilt would correlate with improved postoperative PROMS. Experimental Design or Project Methods: 380 symmetric trochlear groove TKAs were matched to 380 asymmetric lateralized trochlear groove TKAs on age, sex, body mass index, and preoperative patellar tilt. All cases were performed by one surgeon between 12/2010 and 10/2018. Patellar tilt (in degrees) was measured by two independent blinded raters on preoperative and 4-week postoperative merchant view radiographs per the modern Knee Society Radiographic Evaluation System. Prospectively collected and validated PROMS including UCLA Activity Level, components of the Knee Society Score, and Likert satisfaction were evaluated at minimum one-year. Results: There were no differences between study cohorts for demographics, covariates, or preoperative patellar tilt (p≥0.479). Asymmetric lateralized trochlear groove TKAs had significantly less postoperative patellar tilt compared with symmetric trochlear groove TKAs (p<0.001). Patellar tilt and femoral implant type had no correlation to pain scores (Knee Society), UCLA Activity Level, or satisfaction (p≥0.138); however, postoperative patellar tilt was significantly less for patients who stated their knee “always” felt normal compared to patients who stated their knee “sometimes” felt normal but not “never” felt normal (p=0.033). Conclusion and Potential Impact: Findings suggest implant type and patellar tilt have minimal effect on overall PROMS. However, minimizing patella maltracking may provide patients with a more normal feeling TKA and could potentially provide long-term benefits of preventing polyethylene wear or other complications leading to premature implant failure.

scholarly journals Core Outcome Measurement Instruments for Clinical Trials of Total Knee Arthroplasty: A Systematic Review

2020 ◽  
Vol 9 (8) ◽  
pp. 2439
Author(s):  
Vivien Reynaud ◽  
Anargyros Verdilos ◽  
Bruno Pereira ◽  
Stéphane Boisgard ◽  
Frédéric Costes ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Short Form ◽  
Oxford Knee Score ◽  
Measurement Properties ◽  
Patient Specific ◽  
Minimal Important Change ◽  
Patient Reported ◽  
Physical Tests ◽  
Total Knee

(1) Background: We have updated knowledge of the psychometric qualities of patient-reported outcome measures and, for the first time, systematically reviewed and compared the psychometric qualities of physical tests for patients with knee osteoarthritis who are undergoing total knee arthroplasty. This work was conducted to facilitate the choice of the most appropriate instruments to use in studies and clinical practice. (2) Methods: A search of medical databases up to December 2019 identified the studies and thus the instruments used. The quality of the measurement properties was assessed by the Bot et al. criteria. (3) Results: We identified 20 studies involving 25 instruments. Half of the instruments were questionnaires (n = 13). Among the condition-specific instruments, the Oxford knee score, Knee injury and Osteoarthritis Outcomes Score, and the Western Ontario and McMaster Universities Osteoarthritis index had the highest overall scores. Concerning generic tools, the Medical Outcomes Study Short-Form 36 (SF-36) or SF-12 obtained the highest overall score. For patient-specific tools, the Hospital Anxiety and Depression Scale ranked the highest. Some physical tests seemed robust in psychometric properties: 6-min Walk Test, five times Sit-To-Stand test, Timed Up and Go test strength testing of knee flexor/extensor by isometric or isokinetic dynamometer and Pressure Pain Threshold. (4) Conclusion: To make stronger recommendations, key areas such as reproducibility, responsiveness to clinical change, and minimal important change still need more rigorous evaluations. Some promising physical tests (e.g., actimetry) lack validation and require rigorous studies to be used as a core set of outcomes in future studies.

scholarly journals Patient-Specific Computer Model of Dynamic Squatting After Total Knee Arthroplasty

2015 ◽  
Vol 30 (5) ◽  
pp. 870-874 ◽  
Author(s):  
Hideki Mizu-uchi ◽  
Clifford W. Colwell ◽  
Cesar Flores-Hernandez ◽  
Benjamin J. Fregly ◽  
Shuichi Matsuda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Computer Model ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Total Knee

The Accuracy and Clinical Success of Robotic-Assisted Total Knee Arthroplasty

2021 ◽  
pp. 155633162110263
Author(s):  
Brian T. Nickel ◽  
Kaitlin M. Carroll ◽  
Andrew D. Pearle ◽  
Laura J. Kleeblad ◽  
Joost Burger ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Rating Scale ◽  
High Reliability ◽  
Patient Specific ◽  
Component Alignment ◽  
Robotic Assisted ◽  
Patient Reported ◽  
Total Knee

Background: Robotic-assisted total knee arthroplasty (rTKA) has emerged as a patient-specific customizable tool that enables 3-dimensional preoperative planning, intraoperative adjustment, robotic-assisted bone preparation, and soft-tissue protection. Haptic rTKA may enhance component positioning, but only a few small studies have examined patient satisfaction and clinical outcomes after haptic rTKA. Purpose: In patients who underwent haptic rTKA, we sought to evaluate (1) the discrepancy in alignment between the executed surgical plan and implanted alignment in the coronal and sagittal planes 1 year postoperatively and (2) patient-reported outcomes 2 years postoperatively. Methods: From a prospectively collected database, we reviewed 105 patients who underwent haptic rTKA from August 2016 to May 2017. Two fellowship-trained arthroplasty surgeons independently reviewed hip-to-ankle standing biplanar radiographs to measure overall limb alignment and individual tibial and femoral component alignment relative to the mechanical axis and compared this to the executed surgical plan. Patient-reported outcomes were collected preoperatively and at 2 years postoperatively using the Lower Activity Extremity Score (LEAS), Knee Injury and Osteoarthritis Outcome Score Junior (KOOS Jr.), and Numeric Pain Rating Scale (NPRS). Results: Mean patient age was 62.4 years, and mean body mass index was 30.6 kg/m2. Interobserver reliability was significant with a κ of 0.89. Absolute mean deviations in postoperative coronal alignment compared to intraoperative alignment were 0.625° ± 0.70° and 0.45° ± 0.50° for the tibia and femur, respectively. Absolute mean deviations in postoperative tibial sagittal alignment were 0.47° ± 0.76°. Overall mechanical alignment was 0.97° ± 1.79°. Outcomes in LEAS, KOOS Jr., and NPRS changed from 8 to 10, 78 to 88.3, and 8 to 1, respectively. Conclusions: Haptic rTKA demonstrated high reliability and accuracy (less than 1°) of tibial coronal, femoral coronal, and tibial sagittal component alignment postoperatively compared to the surgical plan. Patient-reported outcomes improved, as well. A more rigorous study on long-term outcomes is warranted.

scholarly journals Two-dimensional planning can result in internal rotation of the femoral component in total knee arthroplasty

2014 ◽  
Vol 24 (1) ◽  
pp. 229-235 ◽  
Author(s):  
Shigetoshi Okamoto ◽  
Hideki Mizu-uchi ◽  
Ken Okazaki ◽  
Satoshi Hamai ◽  
Yasutaka Tashiro ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Internal Rotation ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Two Dimensional ◽  
Total Knee
Sign in / Sign up

Export Citation Format

Share Document