scholarly journals Rotation-hinged knee prosthesis for the treatment of Charcot arthropathy: a case report and literature review

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110588
Author(s):  
Weibin Du ◽  
Rongdan Dai ◽  
Rongliang Chen ◽  
Fuxiang Shen
Keyword(s):  
Clinical Symptoms ◽  
Knee Prosthesis ◽  
Surgical Techniques ◽  
Charcot Arthropathy ◽  
Prosthesis Loosening ◽  
Sensory Disorders ◽  
Insidious Onset ◽  
Residual Cavity ◽  
Total Knee ◽  
Joint Prostheses

Charcot arthropathy is a type of destructive osteoarthropathy characterized by neurotrophic and sensory disorders. The condition is relatively rare, with an insidious onset, and it is easily misdiagnosed. Total knee arthroplasty (TKA) can cause excessive joint wear, continuous inflammatory stimulation of the prosthesis, postoperative residual cavity, prosthesis loosening and subsidence, peripheral fracture, infection, and other complications. Furthermore, these complications are more likely to occur in patients with Charcot arthropathy because of disease-specific pathological characteristics, when TKA is performed. Therefore, Charcot arthropathy was once a contraindication to TKA. Recently, with the optimization of joint prostheses and the maturity of surgical techniques, more studies have reported successful cases of TKA in patients with Charcot arthropathy. We report a case of Charcot arthropathy in our hospital, and describe the patient’s medical history, clinical symptoms, signs, imaging findings, diagnosis, and the entire TKA process, to explore the TKA strategy and prosthesis selection in a patient with Charcot arthropathy.

scholarly journals Three-year clinical and radiological results of a cruciate-retaining type of the knee prosthesis with anatomical geometry developed in Japan

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Arata Nakajima ◽  
Manabu Yamada ◽  
Masato Sonobe ◽  
Yorikazu Akatsu ◽  
Masahiko Saito ◽  
...  
Keyword(s):  
Knee Prosthesis ◽  
Cruciate Retaining ◽  
Radiolucent Lines ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Clinical And Radiological Results ◽  
Anatomical Geometry

Abstract Background The FINE total knee was developed in Japan and clinical use began in 2001. It has unique design features, including an oblique 3o femorotibial joint line that reproduces anatomical geometry. Although 20 years have passed since the FINE knee was clinically used for the first time in Japan, a formal clinical evaluation including patient-reported and radiographic outcomes has not been undertaken. Methods A total of 175 consecutive primary cruciate-retaining (CR)-FINE total knee arthroplasties (TKAs) at our hospital between February 2015 and March 2017 were included in this study. Three years postoperatively, range of motion (ROM), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score (FJS) were recorded and compared with preoperative scores. Radiographic analyses including mechanical alignment, component alignment, and incidence of radiolucent lines also were undertaken based on the radiographs 3 years postoperatively. Results One-hundred twenty-two knees (70%) were available for 3-year follow-up data using KOOS, except for the sports subscale. Postoperative KOOS-symptom, −pain and -ADL were > 85 points, but KOOS-sports, −QOL and FJS were less satisfactory. ROM, KSS and all the subscales of KOOS were significantly improved compared with preoperative scores. Postoperative mean FJS was 66 and was significantly correlated with all the subscales of KOOS, but not with postoperative ROM. Radiolucent lines ≧1 mm wide were detected in five knees (4.1%). There were no major complications needing revision surgeries. Conclusions Patient-reported outcomes (PROs) for symptoms, pain and ADL after the CR-FINE TKA were generally improved, but those for sports, QOL and FJS were improved less. The incidence of radiolucent lines was rare but detected around the femoral components. With the mid- to long-term follow-up, improvements of surgical technique will be necessary to achieve better PROs from patients receiving the FINE knee.

scholarly journals Analysis of Friction in Total Knee Prosthesis during a Standard Gait Cycle

Lubricants ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 36
Author(s):  
Matúš Ranuša ◽  
Markus A. Wimmer ◽  
Spencer Fullam ◽  
Martin Vrbka ◽  
Ivan Křupka
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Computational Models ◽  
Gait Cycle ◽  
Knee Prosthesis ◽  
Shear Stresses ◽  
Cobalt Chromium ◽  
Joint Friction ◽  
The Coefficient Of Friction ◽  
Total Knee

Total knee arthroplasty is on the rise worldwide. Despite its success, revision surgeries are also increasing. According to the American Joint Replacement Registry 2020, 3.3% of revision surgeries are due to wear, and 24.2% are due to mechanical loosening. The combination of shear stresses and wear particles occurring at the bone/implant interface can lead to local osteolysis. Although the shear stresses are partially driven by joint friction, relatively little is known about the evolution of the coefficient of friction (CoF) during a gait cycle in total knee replacement. Here we describe the CoF during a gait cycle and investigate its association with kinematics (slide–roll-ratio), applied load, and relative velocity. The artificial knee was simulated by cobalt–chromium condyle on a flat ultra-high-molecular-weight polyethylene (UHMWPE) tibial plateau, lubricated by either water or proteinaceous solution. We found that the CoF is not a constant but fluctuates between the values close to 0 and 0.15. Cross-correlation suggested that this is primarily an effect of the slide–roll ratio and the contact pressure. There was no difference in the CoF between water and proteinaceous solution. Knowledge about the CoF behavior during a gait cycle will help to increase the accuracy of future computational models of total knee replacement.

scholarly journals Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shaw-Ruey Lyu ◽  
Chia-Chen Hsu ◽  
Jung-Pin Hung
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Varus Deformity ◽  
Outcome Study ◽  
Primary Arthroplasty ◽  
Post Operative Pain ◽  
Plateau Fracture ◽  
Advanced Stages ◽  
Total Knee ◽  
Medial Release

Abstract Introduction Persistent post-operative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty. The surgical techniques and outcomes of incorporating this concept into the management of both primary arthroplasty cases and patients suffering from unknown causes of PPOP after arthroplasties were presented. Materials and methods In a 1-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated medial abrasion phenomenon (MAP) on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasties were referred to the author for the arthroscopic medial release procedure (the AMR group) after being diagnosed as MAS. Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study. Results All 166 patients were followed for more than 3 years (mean 3.7 years, 3.1–4.2) for the outcome study. All knees receiving arthroplasty showed medial plicae with MAP at the time of surgery. Only 2 of them suffered from PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA, and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society Scores and all subscales of KOOS were statistically improved in all groups. Conclusions MAS is a cause of pain in patients who have received knee arthroplasties, and MAP should be eliminated to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR.

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