scholarly journals Computed tomography is not necessary to assess rotation of the femoral component in navigation-assisted total knee replacement

2016 ◽  
Vol 44 (6) ◽  
pp. 1314-1322 ◽  
Author(s):  
Daniel Hernández-Vaquero ◽  
Alfonso Noriega-Fernandez ◽  
Ivan Perez-Coto ◽  
Manuel A. Sandoval García ◽  
Andres A. Sierra-Pereira ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Total Knee Replacement ◽  
Femoral Component ◽  
Knee Replacement ◽  
Transepicondylar Axis ◽  
Component Rotation ◽  
Preoperative Ct ◽  
Total Knee ◽  
The Mean ◽  
Ct Data

Objective To demonstrate that postoperative computed tomography (CT) is not needed if navigation is used to determine the rotational position of the femoral component during total knee replacement (TKR). Methods Preoperative CT, navigational, and postoperative CT data of 70 TKR procedures were analysed. The correlation between the rotational angulation of the femur measured by CT and that measured by perioperative navigation was examined. The correlation between the femoral component rotation determined by navigation and that determined by CT was also assessed. Results The mean femoral rotation determined by navigation was 2.64° ± 4.34°, while that shown by CT was 6.43° ± 1.65°. Postoperative rotation of the femoral component shown by CT was 3.09° ± 2.71°, which was closely correlated with the angle obtained through the intraoperative transepicondylar axis by navigation (Pearson’s R = 0.930). Conclusions Navigation can be used to collect the preoperative, intraoperative, and postoperative data and final position of the TKR. The rotation of the femoral component can be determined using navigation without the need for CT.

scholarly journals Enhanced conventional method is as precise as navigation for distal femur resection during total knee replacement: a randomized controlled trial

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 360
Author(s):  
Rohan Bhimani ◽  
Fardeen Bhimani ◽  
Rohan Bir Singh ◽  
Preeti Singh
Keyword(s):  
Total Knee Replacement ◽  
Femoral Component ◽  
Knee Replacement ◽  
Computer Navigation ◽  
Varus Deformity ◽  
Conventional Technique ◽  
Coronal Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Introduction: The purpose of this prospective study was to determine the accuracy of distal femoral cut and femoral component placement in the coronal plane with the enhanced conventional technique when compared to computer navigation during total knee replacement (TKR). Methods: In total, 475 total knee arthroplasties (TKA) were analyzed (200 optimized conventional TKAs and 275 navigated TKAs) for postoperative mechanical alignment or hip-knee-ankle angle and femoral component coronal alignment and compared between the two groups Results: Mean femoral component coronal alignment was not significantly different (p=0.35) when navigation and enhanced conventional groups were compared. There was no significant difference in the mean femoral component coronal alignment between knees with a valgus correction angle (VCA) <5° (p=0.28), knees with VCA 5°-7° (p=0.48) and knees with >7° (p=0.09). No significant difference was noted in the mean femoral component coronal alignment between knees with varus deformity <10° (p=0.19), varus deformity 10°-20° (p=0.72) and valgus deformity (p=0.35). Conclusions: Using the enhanced conventional technique in each patient to perform distal femoral cut during total knee arthroplasty can help achieve the coronal alignment of the femoral component comparable to navigation technique. Registration: UMIN-CTR ID UMIN000036204.

scholarly journals Migration of the femoral component and clinical outcomes after total knee replacement: a narrative review

2020 ◽  
Author(s):  
R. Zinno ◽  
S. Di Paolo ◽  
G. Ambrosino ◽  
D. Alesi ◽  
S. Zaffagnini ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Clinical Outcomes ◽  
Femoral Component ◽  
Knee Replacement ◽  
Narrative Review ◽  
Alternative Solution ◽  
Total Knee ◽  
Long Term Performance ◽  
Term Performance ◽  
Cobalt Chrome

AbstractLoosening is considered as a main cause of implant failure in total knee replacement (TKR). Among the predictive signs of loosening, migration is the most investigated quantitative parameter. Several studies focused on the migration of the tibial component in TKR, while no reviews have been focused on the migration of the femoral component and its influence on patients’ clinical outcomes. The aim of this narrative review was (1) to provide information about of the influence of migration in femoral component of TKR prostheses, (2) to assess how migration may affect patient clinical outcomes and (3) to present alternative solution to the standard cobalt-chrome prostheses. A database search was performed on PubMed Central® according to the PRISMA guidelines for studies about Cobalt-Chrome femoral component migration in people that underwent primary TKR published until May 2020. Overall, 18 articles matched the selection criteria and were included in the study. Few studies investigated the femoral component through the migration, and no clear migration causes emerged. The Roentgen Stereophotogrammetric Analysis has been mostly used to assess the migration for prognostic predictions. An annual migration of 0.10 mm seems compatible with good long-term performance and good clinical and functional outcomes. An alternative solution to cobalt-chrome prostheses is represented by femoral component in PEEK material, although no clinical evaluations have been carried out on humans yet. Further studies are needed to investigate the migration of the femoral component in relation to clinical outcomes and material used.

Neutrophil–Lymphocyte Ratio as a Predictor of Venous Thromboembolism after Total Knee Replacement

2019 ◽  
Author(s):  
Won-Woo Seo ◽  
Myung-Soo Park ◽  
Sung Eun Kim ◽  
Jun-Hee Lee ◽  
Dae-Gyun Park ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Venous Thromboembolism ◽  
Total Knee Replacement ◽  
Ct Scan ◽  
Knee Replacement ◽  
Independent Predictor ◽  
Characteristic Curve ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Total Knee

AbstractVenous thromboembolism (VTE) is a potentially serious complication after total knee replacement (TKR), and recent guideline recommends thromboprophylaxis for VTE after TKR. The neutrophil–lymphocyte ratio (NLR) has emerged as a simple and new prognostic biomarker for several cardiovascular diseases. This study was performed to investigate the precise incidence of postoperative VTE and the role of NLR for predicting VTE in patients receiving thromboprophylaxis after TKR. We retrospectively enrolled 264 patients undergoing TKR who underwent routine screening enhanced pulmonary artery and lower extremity venography computed tomography (CT) scan within 7 postoperative days. Biochemical tests were performed within 2 weeks prior to surgery, and the NLR was defined as the absolute neutrophil count in peripheral blood divided by lymphocyte count. All patients received thromboprophylaxis with enoxaparin postoperatively. Of 264 patients, 102 (38.6%) were diagnosed with deep vein thrombosis (DVT) or pulmonary embolism on CT scan. Preoperative NLR was significantly higher in patients with postoperative VTE compared with that in patients without VTE (2.57 ± 1.59 vs. 2.11 ± 1.10, p = 0.011). Receiver operating characteristic curve analysis showed that a preoperative NLR of 1.90 was the best cutoff value for the prediction of postoperative VTE (sensitivity 57.8%, specificity 55.6%, and area under curve 0.589). In the multivariate analysis, a preoperative NLR ≥1.90 was a sole independent predictor of postoperative VTE (odds ratio: 1.95, 95% computed tomography: 1.16–3.31, p = 0.013). The present study shows a higher incidence of VTE (38.6%) after TKR in patients receiving thromboprophylaxis than that reported in previous studies. Furthermore, preoperative NLR was significantly higher in patients with postoperative VTE, and a high preoperative NLR (≥1.90) was an independent predictor of VTE after TKR. NLR measurement may be a simple and useful method for the prediction of VTE in patients undergoing TKR.

Kniegelenksendoprothetik bei hämophiler Arthropathie

2010 ◽  
Vol 30 (S 01) ◽  
pp. S104-S106
Author(s):  
W. Miesbach ◽  
L. M. Sahner ◽  
A. Kurth ◽  
B. Habermann
Keyword(s):  
Quality Of Life ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Society Score ◽  
Normal Population ◽  
Knee Function ◽  
Total Knee ◽  
The Mean

Summary Purpose Purpose of this retrospective study was to evaluate our own results after total knee replacement in patients with haemophilia. Patients, material, method: 30 patients with haemophilia who underwent total knee replacement between 1987 and 2005 were included. We used the clinical and radiological Knee Society Score. Furthermore, the Petterson and the Arnold and Hilgartner score were applied. Results: The mean age at the time of surgery was 43.2 (27–66). At the time of follow- up examination the mean age was 51.6 (30–82) years. The mean follow-up was 7.1 (2–20) years. Preoperative, he mean Arnold and Hilgartner score was 4.17 (± 0.59) and the mean Petterson-Score was 9 ± 2.29. Compared to the preoperative deficiency in knee function (KSS-Score 88.17 ± 33.58) an improvement with 166.67 (± 22.73) points was seen. 1 patient showed an aseptic loosening after 11 years. Discussion: Total knee replacement in patients with haemophilia improves knee function and quality of life. The results of our study represent results in earlier published studies. Compared to a non-haemo-philic normal population the rate of perioper-ative complications was not increased.

The Effects of Resection Technique on Implant Migration in Single Radius Posterior-Stabilized Total Knee Replacement

2018 ◽  
Vol 33 (01) ◽  
pp. 078-083
Author(s):  
Matthew G. Teeter ◽  
Kevin Perry ◽  
Xunhua Yuan ◽  
James L. Howard ◽  
Brent A. Lanting
Keyword(s):  
Total Knee Replacement ◽  
Femoral Component ◽  
Knee Replacement ◽  
Tibial Component ◽  
Posterior Stabilized ◽  
Gap Balancing ◽  
Measured Resection ◽  
Total Knee ◽  
Single Radius ◽  
Component Migration

AbstractThe purpose of the present study was to measure the effects of gap balancing and resection techniques on migration of a single total knee replacement implant design. A total of 23 patients (24 knees) were recruited on referral to either a surgeon performing gap balancing or a surgeon performing measured resection and followed prospectively. All patients received a fixed bearing, posterior stabilized total knee replacement implant of a single radius femoral component design with cement fixation, and all aspects of care outside of resection technique were identical. Patients underwent radiostereometric analysis (RSA) at 2 weeks (baseline), 6 weeks, 3 months, 6 months, 1 year, and 2 years. Migration of the tibial and femoral components was compared between groups. Tibial component migration was greater at 2 years in the gap balancing group (mean difference = 0.336 mm, p = 0.036), but there was no difference at 1 year. One measured resection and three gap balancing tibial components demonstrated continuous migration > 0.2 mm between years 1 and 2. There was no difference in femoral component migration. Small differences in tibial component migration were found between the gap balancing and measured resection techniques. However, comparing the migration to established predictive thresholds for long-term loosening risk, implants performed with both techniques were found to have equally low revision risk.

scholarly journals Prospective, observational study to evaluate the relation between patient-reported outcomes and component rotation in total knee replacement: protocol for the CRACK study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031166
Author(s):  
Hans-Peter van Jonbergen ◽  
Ellie Landman ◽  
Maarten Horst ◽  
Robin Westerbeek ◽  
Ydo Kleinlugtenbelt
Keyword(s):  
Total Knee Replacement ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Knee Replacement ◽  
Tibial Component ◽  
Patient Reported Outcomes ◽  
Persistent Pain ◽  
Component Rotation ◽  
Patient Reported ◽  
Total Knee

IntroductionTotal knee replacement (TKR) for osteoarthritis results in a satisfactory outcome in the majority of patients, although up to one in five patients may be dissatisfied with the outcome. Persistent pain is a main contributor to patient dissatisfaction, and femoral and tibial component malrotation have been identified as a potential cause for both persistent pain and patellofemoral problems. Based on the assumption that component malrotation is the causative factor for persistent pain, early revision for patients with symptomatic malrotated components has been advocated in the literature. However, convincing evidence that component malrotation indeed results in less than optimal outcomes is lacking. This study aims to assess the relation between knee prosthesis component rotation and patient-reported outcomes in a large group of patients and to determine the range of femoral, tibial and combined rotation that results in the best clinical outcomes.Methods and analysisIn this single-centre, prospective observational cohort study, a total of 500 patients will undergo TKR. All patients will have a 3D-CT assessment of femoral and tibial component rotation within 8 weeks after surgery. Outcome measures will include the Oxford Knee Score, the Knee Injury and Osteoarthritis Outcome Score, EQ-5D, visual analogue scale for pain, the American Knee Society Score and the knee joint range of motion. We will assess the relation between femoral, tibial and combined component rotation and patient-reported outcome measures at 8 weeks and 1 year of follow-up, and we will determine the range of femoral, tibial and combined rotation that results in the best clinical outcomes.Ethics and disseminationEthical approval for this study has been granted by the Isala Hospital ethics committee. The results will be published in a peer-reviewed journal and presented at relevant meetings.Trial registration numberNL7635.

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