scholarly journals Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986700
Author(s):  
Dhanasekararaja Palanisami ◽  
Melvin J George ◽  
Arif Mohammed Hussain ◽  
Chunchesh MD ◽  
Rajkumar Natesan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Strong Positive Correlation ◽  
Component Placement ◽  
Positive Correlation ◽  
Total Knee ◽  
The Mean

Purpose: Tibial bowing in valgus knees with arthritis can lead to component malplacement during total knee arthroplasty (TKA). Incidence of valgus knees with medial tibial bowing, its effect on tibial component placement during primary TKA and methods to improve accuracy of the component placement were studied. Methods: Full-length weight-bearing alignment radiograph was taken in 117 patients (149 knees) with valgus deformity undergoing TKA. In these cases, the proximal tibial reference for extramedullary jig placement was planned preoperatively with reference to the tibial spines and classified as four zones. Results: The mean preoperative hip–knee–ankle (HKA) angle was 192.9° (180.3–234.5°). Bowing >3° was considered significant ( p < 0.001) and at this level of bowing, the proximal tibial reference was shifted from centre to medial. Tibial bowing <3° was considered straight and >3° as tibia valga. Tibia was bowed in 70 knees (46.97%). Severity of valgus deformity had strong positive correlation with the tibia valga ( p < 0.001). The post-operative medial proximal tibial angle (MPTA) and HKA angle were 91.63° (87.9–95.7°) and 182.6° (178.1–189.7°), respectively. The mean MPTA and post-operative HKA angle in bowed and straight tibiae were 90.35° versus 89.78° ( p = 0.547) and 181.5° versus 180.7° ( p = 0.5716), respectively, and the difference was not statistically significant. Conclusion: Medial tibial bowing is very common in valgus knees. Tibia valga has a strong positive correlation with the severity of valgus deformity. Accurate tibial component placement can be achieved with a medialized reference point for extramedullary tibial cutting jig in knees with significant tibia valga. The study has been registered in clinical trials registry – India (CTRI/2018/03/012283).

scholarly journals Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Kazumi Goto ◽  
Yozo Katsuragawa ◽  
Yoshinari Miyamoto
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Operative Time ◽  
Case Series ◽  
Level Of Evidence ◽  
Ankle Angle ◽  
Total Knee ◽  
The Mean ◽  
Hip Knee Ankle Angle

Abstract Purpose There are concerns that malalignment in total knee arthroplasty (TKA) occurs with less experienced surgeons. This study investigates the influence of surgical experience on TKA outcomes. Materials and methods Nineteen patients (38 knees) who underwent bilateral TKA between 2011 and 2015 were included. A supervisor performed knee replacements associated with lower Knee Society Scores (KSS); trainee surgeons operated on the other knee. Knees were categorized into two groups: operations by the supervisor (group S) versus operations by trainee surgeons (group T). Range of motion (ROM), KSS, operative time, hip–knee–ankle angle, and femoral and tibial component angle were evaluated. Results The mean operative time was 92.5 min in group S and 124.2 min in group T (p < 0.01). The mean postoperative maximal flexion was 113.2° in group S and 114.2° in group T (not significant). The mean postoperative KSS was 92.9 in group S and 93.9 in group T (not significant). No significant differences between groups in terms of proportion of inliers for the hip–knee–ankle angle, femoral component angle, or tibial component angle were observed. Conclusions Although operative time was significantly longer for trainee surgeons versus the supervisor, no significant differences in ROM, KSS, or component positioning between supervisor and trainee surgeons were observed. Level of evidence IV (retrospective case series design).

scholarly journals A prospective analytical study on the effect of posterior femoral condylar offset on range of knee flexion in patients undergoing cruciate retaining total knee arthroplasty

2021 ◽  
Author(s):  
Ranjit Kumar G. ◽  
Murukan Babu ◽  
Tom Jose
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Analytical Study ◽  
Strong Positive Correlation ◽  
Range Of Movement ◽  
Cruciate Retaining ◽  
Positive Correlation ◽  
Before And After ◽  
Total Knee

<p><strong>Background:</strong> Osteoarthritis (OA) of knee joint is a common problem in our society causing pain, deformity, oedema, malalignment and limitation of activity. Total knee arthroplasty (TKA) is the surgery done for treatment of this problem. The range of movement obtained after TKA is an important factor influencing success of surgery. Posterior femoral condylar offset (PCO) is one of the parameters influencing range of movement after surgery. The dearth of studies in Indian population and contradicting results in already conducted studies has been observed in assessing the effect of PCO on range of knee flexion in patients undergoing TKA. Hence this study is done to explore this correlation.</p><p><strong>Methods:</strong> A prospective analytical study on 36 patients (50 knees) who underwent cruciate retaining TKA at Department of Orthopaedics, Rajagiri Hospital, Aluva. PCO and posterior femoral condylar offset ratio (PCOR) were calculated radiologically before and after TKA. Range of flexion (ROF) and knee society scores (for functional outcome assessment) were recorded preoperatively and postoperatively (at 6 weeks and 3 months).</p><p><strong>Results:</strong> The study found a strong positive correlation between PCO difference and ROF difference (r=0.735). Strong positive correlation was also found between PCOR difference and ROF difference (r=0.777). Both these correlations were statistically significant (p&lt;0.05).</p><p><strong>Conclusions:</strong> The study enlightened us about the point that PCO is an important factor in attaining a good ROF after cruciate retaining TKA.</p>

Rotational alignment of the tibial component affects the kinematic rotation of a weight-bearing knee after total knee arthroplasty

The Knee ◽  
2015 ◽  
Vol 22 (3) ◽  
pp. 201-205 ◽  
Author(s):  
Hiroyuki Nakahara ◽  
Ken Okazaki ◽  
Satoshi Hamai ◽  
Shinya Kawahara ◽  
Hidehiko Higaki ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Weight Bearing ◽  
Rotational Alignment ◽  
Total Knee

scholarly journals SMOC Approach for Total Knee Arthroplasty in Valgus Knees

2020 ◽  
Author(s):  
Tao Li ◽  
Yingzhen Wang ◽  
Haiyan Li ◽  
Pengcheng Guo ◽  
Haining Zhang
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Primary Total Knee Arthroplasty ◽  
Valgus Deformity ◽  
Early Recovery ◽  
Subvastus Approach ◽  
Total Knee ◽  
The Mean

Abstract Purpose The subvastus approach sometimes can not provide adequate exposure and lateral approach has disadvantages of closure of the soft tissues and patellar tracking. The hypothesis of this study was that SMOC approach could be used in valgus knees and would offer good function.Methods We retrospectively reviewed 25 patients (25 knees) with valgus deoformity undergoing primary total knee arthroplasty (TKA) with SMOC approach. Necessary soft tissue releases, Visual Analog Scale (VAS), straight leg raising (SLR), International Knee Society score (KSS), radiological alignment were assessed with average follow-up of 16 months.Results KSS improved significantly from 38.5 to 90.3. The mean range of motion increased from 89.5°to 121.8°.The mean tibiofemoral valgus was corrected from preoperative 17.1° to 6.3°. No instability, recurrent valgus deformity, or radiographic loosening was found during follow-up.Conclusions SMOC approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.

scholarly journals Unusually High Rate of Early Failure of Tibial Component in ATTUNE Total Knee Arthroplasty System at Implant–Cement Interface

2017 ◽  
Vol 30 (05) ◽  
pp. 435-439 ◽  
Author(s):  
Anton Khlopas ◽  
Morad Chughtai ◽  
Connor Cole ◽  
Chukwuweike Gwam ◽  
Steven Harwin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Rare Complication ◽  
Weight Bearing ◽  
High Rate ◽  
Radiographic Evaluation ◽  
Rotating Platform ◽  
Cement Interface ◽  
Total Knee

AbstractA novel design total knee arthroplasty (TKA) system has been introduced to improve patient outcomes and increase longevity. However, we have encountered a high rate of debonding of tibial implant–cement interface. In addition, multiple reports have been filed in Manufacturer and User Facility Device Experience database (MAUDE) with the same mechanism of failure. Therefore, we evaluated: clinical, radiographic, and intraoperative findings of patients who received this system and required a revision surgery, and findings from MAUDE database compiled to this date. We reviewed three hospital databases for patients who had revision TKA for tibial loosening at the implant–cement interface. This yielded 15 cases with a mean age of 61 years (range, 47–84). All patients received a novel knee system at another institution. Radiographic analysis was performed by treating orthopaedist. The MAUDE database was reviewed for reports of aseptic failure. Patients presented with pain on weight bearing, effusion, and decreased range of motion (ROM) within 2 years after surgery. Radiographic evaluation demonstrated loosening of the tibial components in 2 of 15 knees. This included cruciate retaining, posterior stabilized, fixed bearing, and rotating platform bearing designs. Intraoperative findings demonstrated gross loosening of the tibial component at the implant–cement interface. Femoral and patellar components were well fixed. There were 21 reports of tibial loosening at the implant–cement interface in MAUDE database in the past 2 months alone. Numerous other tibial failures were reported; however, the mechanisms of failures were not specified. Tibial component loosening is a rare complication of cemented TKA at short-term follow-up. Several possible reasons include increased constraint, reduced cement pockets, and reduced keel rotational stabilizers. The tibial component, which has greater torsional loads, has lower surface roughness than femoral component. We believe that this complication is underreported due to failure of radiographs to assess loosening. In addition, MAUDE database reporting is not consistent and competing companies cannot provide data on the revised components. In patients who have negative workup for a painful joint, one must consider the diagnosis of debonding.

scholarly journals Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Nicholas A. Antao ◽  
Sanjay Londhe ◽  
Rajan Toor ◽  
Rajesh Shirishkar ◽  
Siddharth Aiyer
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Locking Plate ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Womac Score ◽  
Full Weight Bearing ◽  
Osteoarthritis Of The Knee ◽  
Total Knee ◽  
The Mean

Abstract Purpose Presence of supracondylar and periarticular femoral fracture with associated arthritis of knee poses a challenging situation to the orthopaedic surgeon. The results of fixation of fracture in osteoporosis are not very satisfactory and have complications. With fixation alone, they still cannot bear weight on affected leg due to severe disability of osteoarthritis. To make patient walk, conventionally three surgeries in the form of fracture fixation, removal of implant and total knee arthroplasty (TKA) needs to be done in staged manner. We propose a novel management in form of bifold fixation and simultaneous TKA. Methods Eight cases (6 females, 2 males) of supracondylar femoral fractures with severe osteoarthritis of the knee and osteoporosis were primarily fixed with bifold fixation using SIGN nail (www.signfracturecare.org) and locking plate together with simultaneous total knee arthroplasty. There were five cases (2 males and 3 females) of grade 4 (Kellgren-Lawrence grading) osteoarthritis (OA) and three cases (all females) of severe rheumatoid arthritis (RA). Results The mean age was 68 years and average time for full weight bearing was 6 days. Radiographic evidence of fracture union was achieved in 16.25 weeks. The mean Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 months was 83.13 and 22.13 respectively. Conclusions Single stage combined bifold osteosynthesis with interlocking nail and locking plate together with total knee arthroplasty helps in one time management of these difficult injuries. It is a cost-effective and economically sound option and gives excellent results with good patient satisfaction.

scholarly journals New option of tibial plateau plasty in total knee arthroplasty

2021 ◽  
Vol 27 (5) ◽  
pp. 592-596
Author(s):  
I.F. Akhtyamov ◽  
◽  
I.Sh. Gilmutdinov ◽  
E.R. Khasanov ◽  
◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Tibial Plateau ◽  
Proximal Tibia ◽  
Weight Bearing ◽  
Cement Augmentation ◽  
Early Weight Bearing ◽  
Regular Triangle ◽  
Total Knee

Abstract. Introduction There are several options of fixation and plasty for tibial defects. Screw and cement augmentation of the tibia is an alternative to conventional bone autograft and allograft. Although use of metal and cement augments provides reliable support for the tibial plateau and facilitates early weight-bearing on the operated limb the technique fails to maintain enough bone stock for future revisions. The purpose was to present an option of cement and metal augmentation of the tibial component in total knee arthroplasty (TKA). Material and methods The technique consists of cement and screw augmentation using three screws placed vertically as a regular triangle and being perpendicular to the tibial plateau. We describe the technique and a clinical instance of type 2A defect of the proximal tibia using the author's method. Outcome measures were goniometry and radiography. Results Goniometry examination showed positive dynamics in the first week after surgery with flexion of 110.0 degrees, extension 175.0 degrees; at 12 months with flexion of 90.0 degrees and extension of 180.0 degrees. Radiographic examination demonstrated no instability and micromobility of the cement mantle. Discussion The author's technique of screw and cement augmentation of the tibial component was practical for type 2A defects of the proximal tibia with a shortage of materials of bone autografts. This is a pilot study that requires further investigations.

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