scholarly journals Distal Femoral Pin Tracker Placement Prevents Pin Tract-induced Fracture in Robotic-Assisted Total Knee Arthroplasty

2021 ◽  
Author(s):  
Ji-Hoon Baek ◽  
Su Chan Lee ◽  
Jin-Hong Kim ◽  
Hye Sun Ahn ◽  
Chang Hyun Nam
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Sagittal Plane ◽  
Knee Prosthesis ◽  
Consecutive Series ◽  
Posterior Stabilized ◽  
Robotic Assisted ◽  
Total Knee

AbstractThe purpose of this study was to determine the effectiveness of the placement of pin trackers in the medial sagittal plane of the distal femur in robotic-assisted total knee arthroplasty (TKA) over a minimum follow-up period of 3 months. From August 2020 to October 2020, a consecutive series of 81 TKAs were performed in 59 patients using the Triathlon posterior-stabilized total knee prosthesis with a robotic-assisted system (Mako) at our hospital. Patient charts were reviewed for complications associated with the pin sites, including fracture, infection, thigh pain, and the need for reoperation. No patients had any minor or major complications associated with distal femoral pins. This technique, which used pin trackers in the medial sagittal plane of the distal femur, could be a useful option for surgeons performing robotic-assisted TKA. This is a Level IV study.

The Outcome of Posterior-Stabilized, Rotating Platform Total Knee Arthroplasty at a Minimum Ten-Year Follow-up, a Middle East Institution Experience

2020 ◽  
Author(s):  
Ahmed A. Khalifa ◽  
Mostafa Fayez ◽  
Hesham Elkady ◽  
Ahmed M. Abdelaal ◽  
Maher A. Elassal
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Middle East ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Posterior Stabilized ◽  
Rotating Platform ◽  
Total Knee

AbstractPosterior-stabilized, rotating platform knee prosthesis design was aimed to decrease polyethylene wear for the sake of improving implant survivorship. The purpose of the present prospective study was to evaluate the long-term clinical and radiographic results as well as the survival rate after using a rotating platform, posterior-stabilized knee prosthesis at a minimum of 10 years at a Middle East institution. We compared the results with reports in the literature on western populations. From January 2002 to June 2008, 96 patients (106 knees) underwent total knee arthroplasty (TKA) using a cemented rotating platform posterior-stabilized knee prosthesis. At a mean of 11.5 ± 1.3 years, 85 patients (95 TKAs) were available for clinical, radiographic, and implant survival analysis. At the final follow-up, 78.9% of the patients had excellent Knee Society Scoring system score, the average knee flexion was 110 ± 17 degrees, the average anatomical knee coronal alignment was 186 ± 2 degrees and 187 ± 3 degrees for varus and valgus knees, respectively. Five (5.2%) knees were revised of these: two for bearing dislocation, two for aseptic loosening, and one for infection. The Kaplan-Meier survival rate was 94.7% for all revisions and 97.8% when only revision for aseptic loosening considered as the end point. At a long-term follow-up, reasonable clinical and radiographic outcomes had been achieved after using a rotating platform, posterior-stabilized knee prosthesis in our population with acceptable survival rate reaching up to 95%, which is comparable to reports from the western population.

scholarly journals Mid-term Outcome of Total Knee Arthroplasty with Low-restricted Posterior-stabilized Prosthesis in Patients with Severe Fixed Valgus Deformity: A Case-Control Study

2020 ◽  
Author(s):  
Jiani Gou ◽  
Xiaojun Shi ◽  
Senhao Liu ◽  
Jing Yang ◽  
Pengde Kang
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Complication Rate ◽  
Knee Prosthesis ◽  
Valgus Deformity ◽  
Posterior Stabilized ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background: The intraoperative soft tissue balance in primary total knee arthroplasty (TKA) is particularly difficult to perform in patients with severe fixed valgus deformity above 20°, which may have an adverse effect on clinical outcomes. The purpose of our study was to determine whether the TKA with low-restricted posterior-stabilized prosthesis in patients with severe fixed valgus deformity could be as successful as in those with no preoperative deformities by comparing perioperative evaluations and mid-term outcomes.Methods: 45 patients (group A) with severe valgus deformity were treated by TKA with low-restricted posterior- stabilized knee prosthesis; 90 patients (group B) without severe valgus deformity were treated with same surgery and were classified to match the cases in group A. The perioperative evaluations, clinical and radiographic outcomes were compared between the two groups. The postoperative stability was measured by the Kneelax 3 Arthrometer.Results: The mean follow-up time was 7.64 years. There was no significant difference in age, gender, BMI between the two groups. There was no revision for any reason in either group. The mean operation time and blood transfusion rate were 114 minutes and 46.7% in group A, while 81 minutes and 11.1% in group B, respectively. There were significant differences in both parameters between the two groups (p<0.001). The incidence of residual valgus in group A was 20% and the complication rate was 22.2%, while 3.3% and 4.4% in group B, respectively. The incidence of residual valgus and the complication rate was significantly higher in group A than in group B (p=0.004). However, there was no statistical difference in Hospital for Special Surgery (HSS) score, range of motion, component fixation, or knee stability at the most recent follow-up. Conclusion: Although total knee arthroplasty for severe fixed valgus deformity increases the difficulty of operation and the complication rate in perioperative period, low-restricted posterior-stabilized knee prosthesis with proper alignment and soft tissue balance can have satisfactory mid-term outcomes. Level of evidence: Case-control study, Level III.

Results of Robotic-Assisted Versus Manual Total Knee Arthroplasty at 2-Year Follow-up

2021 ◽  
Author(s):  
Kevin B. Marchand ◽  
Rachel Moody ◽  
Laura Y. Scholl ◽  
Manoshi Bhowmik-Stoker ◽  
Kelly B. Taylor ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Postoperative Outcomes ◽  
Medical Complications ◽  
Womac Pain ◽  
Robotic Assisted ◽  
Surgical Data ◽  
Total Knee

AbstractRobotic-assisted technology has been developed to optimize the consistency and accuracy of bony cuts, implant placements, and knee alignments for total knee arthroplasty (TKA). With recently developed designs, there is a need for the reporting longer than initial patient outcomes. Therefore, the purpose of this study was to compare manual and robotic-assisted TKA at 2-year minimum for: (1) aseptic survivorship; (2) reduced Western Ontario and McMaster Universities Osteoarthritis Index (r-WOMAC) pain, physical function, and total scores; (3) surgical and medical complications; and (4) radiographic assessments for progressive radiolucencies. We compared 80 consecutive cementless robotic-assisted to 80 consecutive cementless manual TKAs. Patient preoperative r-WOMAC and demographics (e.g., age, sex, and body mass index) were not found to be statistically different. Surgical data and medical records were reviewed for aseptic survivorship, medical, and surgical complications. Patients were administered an r-WOMAC survey preoperatively and at 2-year postoperatively. Mean r-WOMAC pain, physical function, and total scores were tabulated and compared using Student's t-tests. Radiographs were reviewed serially throughout patient's postoperative follow-up. A p < 0.05 was considered significant. The aseptic failure rates were 1.25 and 5.0% for the robotic-assisted and manual cohorts, respectively. Patients in the robotic-assisted cohort had significantly improved 2-year postoperative r-WOMAC mean pain (1 ± 2 vs. 2 ± 3 points, p = 0.02), mean physical function (2 ± 3 vs. 4 ± 5 points, p = 0.009), and mean total scores (4 ± 5 vs, 6 ± 7 points, p = 0.009) compared with the manual TKA. Surgical and medical complications were similar in the two cohorts. Only one patient in the manual cohort had progressive radiolucencies on radiographic assessment. Robotic-assisted TKA patients demonstrated improved 2-year postoperative outcomes when compared with manual patients. Further studies could include multiple surgeons and centers to increase the generalizability of these results. The results of this study indicate that patients who undergo robotic-assisted TKA may have improved 2-year postoperative outcomes.

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

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

2019 ◽  
Vol 33 (07) ◽  
pp. 678-684 ◽  
Author(s):  
Fahad Hossain ◽  
Sujith Konan ◽  
Babar Kayani ◽  
Christina Kontoghiorghe ◽  
Toby Barrack ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

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.

scholarly journals Cruciate retaining versus posterior stabilized total knee arthroplasty for the treatment of valgus osteoarthritis?

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Max Ettinger ◽  
Peter Savov ◽  
Henning Windhagen ◽  
Evelyn Mielke ◽  
Tilman Calliess
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Valgus Knee ◽  
Posterior Stabilized ◽  
Cruciate Retaining ◽  
Early Revision ◽  
Koos Score ◽  
Total Knee

Aims and Objectives: The debate of cruciate retaining (CR) versus posterior stabilized (PS) designs in total knee arthroplasty (TKA) is ongoing. With the posterior cruciate ligament retained, the TKA is supposed to function better in terms of proprioception, balance and kinematics. In contrast to that, PS designs are supposed to lead to higher degrees of flexion and a better femoral rollback. It is known, that the preoperative deformity negatively correlates with inferior results following TKA. When balancing a valgus knee, Ranawat et al. suggest to address the PCL in the first place. It is known that in 60% of valgus knees 1-2 soft tissue releases are necessary in order to achieve neutral alignment. Up to date no study exists, reporting the outcome of CR versus PS TKA in valgus knees. Thus, it was purpose of this study to evaluate the mid term outcome of CR versus PS TKA for the treatment of valgus OA in groups between 3°-6° of valgus, 7-10° of valgus and >10° of valgus. Materials and Methods: With the KOOS score as the primary endpoint, a sample size of 117 cases (78 CR and 39 PS) was needed in order to get a statistical power of 80%.Between 01-2011 and 03-2014 a total of 248 patients with a preoperative valgus >3° were treated with a CR TKA (167 cases) or a PS TKA (81 cases) of the same manufacturer (Stryker Triathlon, Stryker, Kalamazoo USA). CR patients were divided into the following groups: Preoperative valgus >3°-6°, 7°-10° and >10°. PS patients were divided into the following groups: Preoperative valgus >3°-6°, 7°-10° and >10°. The KOOS Score and the Oxford Knee score was collected at the time of follow up. For the CR and PS group failure rates and failure etiologies were analyzed. Patients demographics and were collected as well. Results: 141 patients were included into this study (97 CR and 44 PS cases). The CR group had a mean follow up of 57&#61617; weeks, the PS group had a follow up of 52&#61617;weeks. In the CR group, 11/97 (11%) patients were revised due to a.p. instability, whereas 2/44 (5%) patients were revised in the PS group due to infection or aseptic loosening. There was no difference regarding OKS and the KOOS score between the two groups. Further, there was no difference regarding patients demographics and no correlation between the BMI and the clinical outcome. Conclusion: The most important findings of this study are that the CR group showed a significant higher early revision rate, whereas the clinical mid term follow up results are equal. The CR version of the used system showed significantly higher early failure due to a.p. instability.

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