Early resumption of driving within 3 weeks following patient-specific instrumented total knee arthroplasty: an evaluation of 160 cases

ObjectivesMost patients want to resume normal activities as soon as possible after total knee arthroplasty (TKA), with driving an integral aspect to re-establish social and recreational independence. This study aimed to determine when patients resumed driving after TKA.MethodsAll patients undergoing patient-specific instrumented (PSI) medial pivot TKA between January 2017 and April 2018 were included. Patients who did not drive were excluded. A detailed questionnaire was sent to patients 2 weeks after surgery to record their driving status. 50 patients were randomly selected to assess flexion at the hip, knee and ankle joints while seated in the driver’s seat of their own vehicle.Results160 patients (female=94 and male=66) with a mean age of 68 years (45–90 years) underwent a PSI TKA (left side [L]=75, right side [R]=85). 73% patients returned to driving within the first 3 weeks after surgery, of which 15 (10%) resumed driving within the first postoperative week, 52 (35%) in the second week and 41 (28%) in the third week. The median time to resume driving following surgery was 3 weeks for both operative sides, with IQR of 2.0 (L) and 1.0 (R).ConclusionA majority of patients resume driving within 3 weeks after undergoing a PSI TKA, regardless of operative side or transmission of vehicle.Level of evidenceIV

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Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06398-3 ◽

2021 ◽

Author(s):

Nicola Pizza ◽

Stefano Di Paolo ◽

Raffaele Zinno ◽

Giulio Maria Marcheggiani Muccioli ◽

Piero Agostinone ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Motor Task ◽

Medial Compartment ◽

Level Of Evidence ◽

Contact Points ◽

Sit To Stand ◽

Medial Pivot ◽

Total Knee

Abstract Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. Methods 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: “KSS > 70 group”, patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); “KSS < 70 group”, patients with a fair-to-poor score (53.3 ± 18.3 points, n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student’s t test (p < 0.05). Results Low point AP translation of the medial compartment was significantly lower (p < 0.05) than the lateral one in both the KSS > 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS < 70 groups (2.7 mm ± 3.5 mm vs 11.0 mm ± 5.6 mm). Furthermore, the AP translation of the lateral femoral compartment was not significantly different (p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). Conclusion In the group of patients with a postoperative KSS < 70, the medial compartment translation was almost one-fourth of the lateral one. Surgeons should be aware that an over-constrained kinematic of the medial compartment might lead to lower clinical outcomes. Level of evidence II.

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Accuracy of bone resection in total knee arthroplasty using CT assisted-3D printed patient specific cutting guides

SICOT-J ◽

10.1051/sicotj/2018032 ◽

2018 ◽

Vol 4 ◽

pp. 29 ◽

Cited By ~ 3

Author(s):

Ikram Nizam ◽

Ashish V. Batra

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Specific ◽

Surgical Patient ◽

Bone Resection ◽

Patient Specific Instrumentation ◽

Medial Pivot ◽

Cutting Guides ◽

3D Printed ◽

Total Knee

Introduction: We conducted this study to determine if the pre-surgical patient specific instrumented planning based on Computed Tomography (CT) scans can accurately predict each of the femoral and tibial resections performed through 3D printed cutting guides. The technique helps in optimization of component positioning determined by accurate bone resection and hence overall alignment thereby reducing errors. Methods: Prophecy evolution medial pivot patient specific instrumented knee replacement systems were used for end stage arthrosis in all consecutive cases over a period of 20 months by a single surgeon. All resections (4 femoral and 2 tibial) were measured using a vernier callipers intraoperatively. These respective measurements were then compared with the preoperative CT predicted bone resection surgical plan to determine margins of errors that were categorized into 7 groups (0 mm to ≥2.6 mm). Results: A total of 3618 measurements (averaged to 1206) were performed in 201 knees (105 right and 96 left) in 188 patients (112 females and 76 males) with an average age of 67.72 years (44 to 90 years) and average BMI of 32.3 (25.1 to 42.3). 94% of all collected resection readings were below the error margin of ≤1.5 mm of which 90% showed resection error of ≤1 mm. Mean error of different resections were ≤0.60 mm (P ≤ 0.0001). In 24% of measurements there were no errors or deviations from the templated resection (0.0 mm). Conclusion: The 3D printed cutting blocks with slots for jigs accurately predict bone resections in patient specific instrumentation total knee arthroplasty which would directly affect component positioning.

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Evolving indications and reported complications suggest total knee arthroplasty after acute and complex periarticular fractures remains a high-risk operation: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000297 ◽

2019 ◽

Vol 4 (5) ◽

pp. 242-247

Author(s):

Simon Lau ◽

Catherine Guest ◽

Lucas Annabell

Keyword(s):

Total Knee Arthroplasty ◽

Patient Selection ◽

Knee Arthroplasty ◽

Fracture Pattern ◽

Patient Specific ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Total Knee

ImportanceComplex periarticular fractures of the knee can be difficult to reconstruct with osteosynthesis, can result in poor function and can lead to increased morbidity and mortality—particularly in the elderly. Primary acute total knee arthroplasty (TKA) is a surgical option which is rarely performed, but thought to have high rates of complication postoperatively.ObjectiveTo investigate the literature regarding optimal patient selection for TKA after acute fracture with particular emphasis on postoperative outcomes and complications.Evidence reviewA literature search of the MEDLINE, EMBASE and Cochrane Databases using established methodology for conducting systematic reviews investigating acute TKA after trauma. Two reviewers screened citations using the methodological index for non-randomi zed studies score to determine inclusion, methodological quality assessment and data extraction.FindingsEighteen papers met the inclusion criteria; totalling 284 acute arthroplasty procedures. The majority of cases were performed in elderly females and the most common fracture pattern was the Arbeitsgemeinschaft für Osteosynthesefragen type C. Inclusion criteria for acute arthroplasty—whether fracture or patient specific—was poorly defined. Modular, stemmed and highly constrained (condylar or hinged) prostheses were used. Complications were often seen including 44 deaths within 5 years of surgery and three instances of above knee amputation.Conclusion and relevanceAcute knee arthroplasty can be considered as primary management for an acute periarticular fracture in some cases, although patient selection is vital. These patients should also be viewed similar to fractured neck of femur patients and cared for appropriately.Level of evidence4.

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Demographic data is more predictive of component size than digital radiographic templating in total knee arthroplasty

Knee Surgery and Related Research ◽

10.1186/s43019-020-00075-y ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Stephen J. Wallace ◽

Michael P. Murphy ◽

Corey J. Schiffman ◽

William J. Hopkinson ◽

Nicholas M. Brown

Keyword(s):

Total Knee Arthroplasty ◽

Regression Model ◽

Knee Arthroplasty ◽

Tibial Component ◽

Demographic Data ◽

Patient Specific ◽

Consecutive Series ◽

Level Of Evidence ◽

Component Size ◽

Total Knee

Abstract Background Preoperative radiographic templating for total knee arthroplasty (TKA) has been shown to be inaccurate. Patient demographic data, such as gender, height, weight, age, and race, may be more predictive of implanted component size in TKA. Materials and methods A multivariate linear regression model was designed to predict implanted femoral and tibial component size using demographic data along a consecutive series of 201 patients undergoing index TKA. Traditional, two-dimensional, radiographic templating was compared to demographic-based regression predictions on a prospective 181 consecutive patients undergoing index TKA in their ability to accurately predict intraoperative implanted sizes. Surgeons were blinded of any predictions. Results Patient gender, height, weight, age, and ethnicity/race were predictive of implanted TKA component size. The regression model more accurately predicted implanted component size compared to radiographically templated sizes for both the femoral (P = 0.04) and tibial (P < 0.01) components. The regression model exactly predicted femoral and tibial component sizes in 43.7 and 43.7% of cases, was within one size 90.1 and 95.6% of the time, and was within two sizes in every case. Radiographic templating exactly predicted 35.4 and 36.5% of cases, was within one size 86.2 and 85.1% of the time, and varied up to four sizes for both the femoral and tibial components. The regression model averaged within 0.66 and 0.61 sizes, versus 0.81 and 0.81 sizes for radiographic templating for femoral and tibial components. Conclusions A demographic-based regression model was created based on patient-specific demographic data to predict femoral and tibial TKA component sizes. In a prospective patient series, the regression model more accurately and precisely predicted implanted component sizes compared to radiographic templating. Level of evidence Prospective cohort, level II.

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Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1713353 ◽

2020 ◽

Author(s):

Stephen Thomas ◽

Ankur Patel ◽

Corey Patrick ◽

Gary Delhougne

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Hospital Cost ◽

Readmission Rate ◽

Hospital Costs ◽

Patient Specific ◽

P Value ◽

Total Hospital Cost ◽

Total Hospital ◽

Total Knee

AbstractDespite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

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