scholarly journals Is Robotic TKA Having Added Advantage over Conventional TKA? A Comparative Study of Functional and Radiological Outcome of Robotic versus Conventional Total Knee Arthroplasty

2021 ◽  
Author(s):  
Himanshu Panchal ◽  
Ashwini S. Patel
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Mechanical Axis ◽  
Statistical Significance ◽  
Radiological Outcome ◽  
Soft Tissue Management ◽  
Significant Difference ◽  
Total Knee

Abstract Objective Total knee arthroplasty (TKA) is most commonly performed procedure in patients who are not showing improvement in pain, activities of daily living, and quality of life by conservative modalities. Precise component implantation and soft tissue management is required to achieve desired outcome following TKA. 1.3% patients remain disappointed due to persistent pain, 24% due to instability, and 2.5% due to malalignment following TKA. Robotic TKA is associated with the use of customized implants and bone cuts leading to precise component implantation and reduced deviation from mechanical axis in coronal, transverse, and sagittal plane and proper soft tissue management. This study compares conventional against robotic TKA in terms of clinical, functional, and radiological outcome. Materials and Methods  This is a prospective randomized control trial carried over period of 3 years where patients were selected on the basis of inclusion and exclusion criteria and were randomly divided into both groups and compared using their pre- and postoperative radiological and functional outcomes as well as intraoperative and postoperative complications and statistical significance of difference was calculated. Results There was no significant difference in terms of ROM, KOOS (Knee Injury and Osteoarthritis Outcome Score), (Knee Society Score) KSS, Eq. 5D, (Western Ontario and McMaster Universities Osteoarthritis Index) WOMAC, and (visual analog scale) VAS scores while we found significant difference in mechanical axis deviation, femoral and tibial implant alignment in both planes. Discussion Advantages of using robotic TKA are customized preoperative planning, implants, cuts, accuracy of the intraoperative procedure, and radiological superiority with no significant differences in clinical and functional outcomes. In fact, robotic TKA is associated with steep learning curve, increased cost, and operative time. Still there are no added complications caused by it.

Does Kinematic Alignment Improve Short-Term Functional Outcomes after Total Knee Arthroplasty Compared with Mechanical Alignment? A Systematic Review and Meta-analysis

2017 ◽  
Vol 31 (01) ◽  
pp. 078-086 ◽  
Author(s):  
Yanhong Li ◽  
Yuliang Wang ◽  
Mingxuan Yang ◽  
Shuanke Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Mechanical Axis ◽  
Meta Analysis ◽  
Mechanical Alignment ◽  
Short Term ◽  
Significant Difference ◽  
Total Knee

AbstractThis meta-analysis was conducted to study whether kinematically aligned total knee arthroplasty (TKA) improves short-term functional outcomes compared with mechanical alignment without changing the hip–knee–ankle angle. Prospective cohort studies were searched from electronic literature databases, including PubMed, Web of Science, Embase (Ovid interface), and Cochrane Library (Ovid interface). Total 1,159 records were identified. Six trials involving 561 patients were eligible for data extraction and meta-analysis. The included studies recorded outcomes in the follow-up range from 6 to 34 months. Primary outcomes were to assess the functional outcomes in follow-up, and KA group achieved better performance on WOMAC score (mean difference [MD] = −18.82, 95% CI: −16.06 to −5.58), knee function score (MD = 7.23, 95% CI: 0.52–13.94), Oxford knee score (MD = 4.76, 95% CI: 0.40–9.12), and knee range of flexion (MD = 4.48, 95% CI: 2.09–6.86), whereas other parameters including Knee Society score, knee range of extension, VAS pain score, and the occurrence of the complications were without significant difference (p > 0.05). Second outcomes evaluated the perioperative clinic indexes. Our meta-analysis showed that KA group had a shorter time of operation (MD = −15.44, 95% CI: −27.47 to −3.71) and a longer walk distance before discharge (MD = 53.24, 95% CI: 21.32–85.15) when compared with the MA group, whereas the change in hemoglobin, incision length, knee range of flexion before discharge, and length of stays were without significant difference (p > 0.05). Third outcomes were used to analyze the alignment data. Our study showed that KA had larger angles of femoral component and mechanical axis of the femur (MD = −1.95,95% CI: −2.77 to −1.13), tibial component and mechanical axis of tibia (MD = 2.06, 95% CI: 1.43–2.70), anatomic knee angle (MD = −0.72, 95% CI: −1.33 to −0.11), and operative limb alignment (MD = −1.97, 95% CI: −2.50 to −1.45,) compared with the MA group, but the hip–knee–ankle angles between the two groups were similar. KA provided better functional outcomes and better flexion following short-term follow-up of TKA. However, longer-term follow-up and larger sample studies are needed to put into research in the future.

scholarly journals Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Takashi Kobayashi ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Varus Deformity ◽  
Varus Knee ◽  
Before And After ◽  
Knee Deformity ◽  
Varus Stress ◽  
Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

scholarly journals Bone Cement Solidifiliation Influence the Limb Alignment and Gap Balance during TKA

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Dongquan Shi ◽  
Xingquan Xu ◽  
Anyun Guo ◽  
Jin Dai ◽  
Zhihong Xu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Statistical Significance ◽  
Mechanical Alignment ◽  
Early Loosening ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee

Introduction. Mechanical alignment deviation after total knee arthroplasty is a major reason for early loosening of the prosthesis. Achieving optimum cement penetration during fixation of the femoral and tibial component is an essential step in performing a successful total knee arthroplasty. Bone cement is used to solidify the bone and prosthesis. Thickness imbalance of bone cement leads to the deviation of mechanical alignment. To estimate the influence of bone cement, a retrospective study was conducted.Materials and Methods. A total of 36 subjects were studied. All the TKA were performed following the standard surgical protocol for navigated surgery by medial approach with general anaesthesia. Prostheses were fixed by bone cement.Results. We compared the mechanical axis, flexion/extension, and gap balance before and after cementation. All the factors were different compared with those before and after cementation. Internal rotation was reached with statistical significance (P=0.03).Conclusion. Bone cement can influence the mechanical axis, flexion/extension, and gap balance. It also can prompt us to make a change when poor knee kinematics were detected before cementation.

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

2021 ◽  
Author(s):  
Mohammadreza Minator Sajjadi ◽  
Mohammad Ali Okhovatpour ◽  
Yaser Safaei ◽  
Behrooz Faramarzi ◽  
Reza Zandi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Soft Tissue Release ◽  
Varus Knee ◽  
Significant Difference ◽  
Leg Alignment ◽  
Total Knee ◽  
Group 2

AbstractThe aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal–Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.

A Prospective Randomised Control Trial Comparing Functional with Mechanical Axis Alignment in Total Knee Arthroplasty: study protocol for an investigator initiated trial

2021 ◽  
Author(s):  
Richard Steer ◽  
Beth Tippett ◽  
R Nazim Khan ◽  
Dermot Collopy ◽  
Gavin Clark
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Medical Information ◽  
Randomised Control Trial ◽  
Computer Assisted ◽  
Patient Reported ◽  
Total Knee ◽  
Alternative Alignment

Abstract Background: A drive to improve functional outcomes for patients undergoing total knee arthroplasty (TKA) has led to alternative alignment being used. Functional alignment (FA) uses intraoperative soft tissue tension to determine the optimal position of the prosthesis within the patients soft tissue envelope. Angular limits for bone resections are followed to prevent long term prosthesis failure. This study will use the aid of robotic assistance to plan and implement the final prosthesis position. This method has yet to be compared to the traditional mechanically aligned (MA) knee in a randomised trial. Methods: A blinded randomised control trial with 100 patients will be undertaken via Perth Hip and Knee clinic. Fifty patients will undergo a MA TKA and fifty will undergo a FA TKA. Both alignment techniques will be balanced via computer assisted navigation to assess prosthetic gaps, being achieved via the initial bony resection and further soft tissue releases as required to achieve satisfactory balance. The primary outcome will be the forgotten joint score (FJS) two years after surgery, with secondary outcomes being other patient reported outcome measures, clinical functional assessment, radiographic position and complications. Other data that will be collected will be patient demography (Sex, Age, level of activity) and medical information (grade of knee injury, any other relevant medical information). The linear statistical model will be fitted to the response (FJS), including all the other variables as covariates. Discussion: Many surgeons are utilising alternative alignment techniques with a goal of achieving better functional outcomes for their patients. Currently MA TKA remains the gold standard with good outcomes and excellent longevity. There is no published RCTs comparing FA to MA yet and only two registered studies are planned or currently in progress. This study utilizes a FA technique which differs from the two studies. This study will help determine if FA TKA has superior functional results for patients.Trial registration: This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) http://www.anzctr.org.au: U1111-1257-2291, registered 25th Jan 2021. It is also listed on www.clinicaltrials.gov: NCT04748510

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.

scholarly journals Coronal Knee Laxity Measured During Computer-Assisted Total Knee Arthroplasty

10.29007/mdm5 ◽  
2018 ◽  
Author(s):  
Yifei Dai ◽  
Guillaume Bras ◽  
David Liu
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Knee Laxity ◽  
Computer Assisted ◽  
Clinical Implications ◽  
Valgus Knee ◽  
Soft Tissue Management ◽  
Soft Tissue Laxity ◽  
Total Knee

This observational study on fifty-six patients presents the coronal knee angular laxity measured during computer-assisted total knee arthroplasty. Varus/valgus knee laxity was assessed at extension, mid-flexion, and high flexion, and compared between arthritic knees and knees following trial TKA implantation. The data represented soft tissue laxity under surgical reality and may be used to further understand the clinical implications of intraoperative soft-tissue management. The findings highlight the potential for CAOS to accurately manage soft tissue balance in addition to bony cuts and overall alignment.

scholarly journals Personalized alignment in total knee arthroplasty: current concepts

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 19
Author(s):  
Sébastien Lustig ◽  
Elliot Sappey-Marinier ◽  
Camdon Fary ◽  
Elvire Servien ◽  
Sébastien Parratte ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Inverse Kinematic ◽  
Joint Line ◽  
Kinematic Alignment ◽  
Joint Line Obliquity ◽  
Total Knee ◽  
Neutral Alignment

Traditionally in total knee arthroplasty (TKA), a post-operative neutral alignment was the gold standard. This principle has been contested as functional outcomes were found to be inconsistent. Analysis of limb alignment in the non-osteoarthritic population reveals variations from neutral alignment and consideration of a personalized or patient-specific alignment in TKA is challenging previous concepts. The aim of this review was to clarify the variations of current personalized alignments and to report their results. Current personalized approaches of alignment reported are: kinematic, inverse kinematic, restricted kinematic, and functional. The principle of “kinematic alignment” is knee resurfacing with restitution of pre-arthritic anatomy. The aim is to resurface the femur maintaining the native femoral joint line obliquity. The flexion and extension gaps are balanced with the tibial resection. The principle of the “inverse kinematic alignment” is to resurface the tibia with similar medial and lateral bone resections in order to keep the native tibial joint line obliquity. Gap balancing is performed by adjusting the femoral resections. To avoid reproducing extreme anatomical alignments there is “restricted kinematic alignment” which is a compromise between mechanical alignment and true kinematic alignment with a defined safe zone of alignment. Finally, there is the concept of “functional alignment” which is an evolution of kinematic alignment as enabling technology has progressed. This is obtained by manipulating alignment, bone resections, soft tissue releases, and/or implant positioning with a robotic-assisted system to optimize TKA function for a patient’s specific alignment, bone morphology, and soft tissue envelope. The aim of personalizing alignment is to restore native knee kinematics and improve functional outcomes after TKA. A long-term follow-up remains crucial to assess both outcomes and implant survivorship of these current concepts.

scholarly journals The Effect of Intra- vs. Extramedullary Tibial Guides on the Alignment of Lower Extremity and Functional Outcomes following Total Knee Arthroplasty: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Mohammadreza Razzaghof ◽  
SM Javad Mortazavi ◽  
Alireza Moharrami ◽  
Pouya Tabatabaei Irani ◽  
Abbas Noori
Keyword(s):  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Definitive Treatment ◽  
Normal Ranges ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Abstract Background: Total knee arthroplasty (TKA) has been known as a definitive treatment of advanced knee osteoarthritis. Both intra- (IM) and extramedullary (EM) tibial guides have been used to restore the desired extremity alignment. However, controversy exists regarding the superiority of either technique. We aimed to compare their functional outcomes and accuracy in providing neutral alignment after TKA. Methods: In a randomized, double-blinded clinical trial, we studied 98 patients undergoing primary TKA in two groups of IM and EM. We measured the medial proximal tibial angle (MPTA), varus angle (VA), and joint-line convergence angle with normal ranges of 90°±3°, 0-2°, and 0±3°, respectively, on a three-joint alignment view after three months. We also assessed functional outcomes at the last follow-up. Finally, we compared these outcomes between groups. Results: Eighty-four patients (IM=42, EM=42) were included in the final analysis (16 males, 68 females; mean age: 63.9±8.6 years; mean follow-up: 27±2.9 months). The mean postoperative alignment angles showed no significant difference, although MPTA outliers were significantly more frequent in the EM group (26.2% vs. 9.5% in IM, P=0.04). None of the functional outcomes showed a significant difference between groups. However, the mean ROM increase was significantly higher in VAs within ±3° of normal than those outside it (30.8 vs. 27.4, respectively; P=0.039). Conclusions: We conclude that both techniques were not different in terms of the mean alignment angles and functional outcomes. However, fewer MPTA outliers can be seen with IM. A postoperative mechanical axis within ±3° of neutral can result in a more ROM increase after one year. Trial registration: IRCT, IRCT20160809029286N5. Registered 21 April 2020, https://www.irct.ir/trial/46976

Tourniquet Use Does Not Affect Pain and Function after Total Knee Arthroplasty: Patient Evaluation According to Pain Threshold

2021 ◽  
Author(s):  
Savaş Çamur ◽  
Serkan Bayram ◽  
Adnan Kara ◽  
Mustafa Faik Seçkin ◽  
Necdet Sağlam ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Pain Threshold ◽  
Early Stage ◽  
Significant Difference ◽  
Total Knee ◽  
Group 2 ◽  
Without Tourniquet ◽  
Group 1

AbstractWe evaluated the effect of using a tourniquet on early-stage pain and 1-year postoperative functional outcomes when patients were divided into two groups according to the pain threshold (PT). Overall, 120 patients who were assessed preoperatively with an algometer were recruited for this prospective, double-blinded, randomized controlled trial. Patients were randomized to undergo total knee arthroplasty (TKA) with a tourniquet (group 1, 60 patients) and without tourniquet (group 2, 60 patients). Primary outcome measures were visual analog scale (VAS) pain scores at 24, 36, and 48 hours postoperatively and functional assessment with Knee Society Score (KSS) test at 1 year postoperatively. No significant differences were observed between groups in terms of gender (49 females and 8 males in group 1 vs. 53 females and 6 males in group 2; p = 0.201) and age (68.9 years in group 1 vs. 68.7 years in group 2; p = 0.811). There was no significant difference between groups in all the VAS and KSS 1 and KSS 2 scores. PT measurements ranged from 2.5 to 11.5 with a mean of 7.69 ± 1.70 and a median of 8. Total 54 patients with a median value of < 8 were defined as the low-PT group, and 62 patients with a median value of ≥ 8 were defined as the high-PT group. When the groups were evaluated according to using the tourniquet, 21 patients were operated on with a tourniquet and 33 patients without it in the low-PT group, while 36 patients were operated on with a tourniquet and 26 patients without it in the high-PT group. There was no significant difference in pain or functional scores between patients when comparing with-tourniquet and without-tourniquet or when comparing the low- and high-PT groups. This showed that the use of a tourniquet during TKA was not associated with either early-stage pain or 1-year postoperative functional outcomes according to algometer evaluation.Level of evidence: Level 1 prospective randomized study.

Sign in / Sign up

Export Citation Format

Share Document