scholarly journals The application of Patient specific Instrument （PSI ）in total knee arthroplasty with valgus knee

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Wang Yuehui ◽  
Zou Shiping ◽  
Cao Liangliang ◽  
Chen Wenzhong
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Valgus Knee ◽  
Specific Instrument ◽  
Guide Plate ◽  
Before And After ◽  
Total Knee ◽  
Surgery Department

Introduction: To invest the auxiliary role of Patient specific Instrument(PSI) used as osteotomy guide plate in total knee arthroplasty(TKA) with valgus knee. Hypotheses: PSI osteotomy guide plate is applicable for total knee arthroplasty with valgus knee. Methods: A retrospective analysis was performed on 21 patients with valgus knee, including 5 males and 16 females, who underwent TKA in joint surgery department I of ZhengZhou Orthopaedic Hospital from March 2016 to February 2018. All the operations were performed with the assistance of PSI, and the radiographic and clinical evaluations including femoral tibial joint ectropion angle(FTA) before and after operation, range of motion(ROM) and the Hospital for Special Surgery (HSS) knee score were reviewed, and surgical complications were recorded. Results: All the 21 patients werefollowed up for 10 ˜ 26 months (mean 16 months).All the incisions healed by first intention. The FTA was reduced significantly to 6.3 °±1.2° after operation from 17.6 ° + 5.7 °(P < 0.05), the ROM was improved significantly from preoperative 71.3° ±5.8° to postoperative 102.4°±7.5° (P < 0.05), the HSS score at the last follow-up was improved from 38.2±5.7 to 87.5-3.5(P < 0.05). During the follow-up, no complications such as infection, loosening, sinking and valgus were observed. Conclusion: Providing accurate osteotomy, effective correction of the force line, simple operation and satisfactory clinical effect, the PSI osteotomy guide plate is applicable for total knee arthroplasty with valgus knee.

CLINICAL AND RADIOLOGICAL RESULTS OF TOTAL KNEE REPLACEMENT USING PATIENT-SPECIFIC POSITIONING GUIDES WITH AT LEAST 5 YEARS OF FOLLOW-UP

2020 ◽  
pp. 2050020
Author(s):  
Xabier Foruria ◽  
Jesús Moreta ◽  
Carlos Jaramillo ◽  
Ane Anton ◽  
Isidoro Calvo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Knee Score ◽  
Conventional Instrumentation ◽  
Total Knee ◽  
The Mean ◽  
Clinical And Radiological Results ◽  
Coronal Malalignment

Objective: Patient-specific positioning guides have been designed to improve precision in total knee arthroplasty. The aim of this study is to evaluate the medium-term clinical and radiological outcomes with magnetic resonance imaging-based patient-specific positioning guides. Material and methods: We retrospectively reviewed patients from two centers treated with total knee arthroplasty performed with patient-specific positioning guides. We enrolled patients operated on between January 2011 and December 2013, with a minimum follow-up of 5 years. Preoperative and postoperative hip knee angle (HKA) and position of each component in the coronal plane were assessed. Overall malalignment was defined as an outlier of more than [Formula: see text] from the neutral mechanical axis and specific malalignment as when any component showed more than [Formula: see text] of deviation. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee Score. Results: This study included 68 patients with a mean age of 72 years. The mean postoperative alignment (HKA) was [Formula: see text] and 26.5% of patients showed coronal malalignment [Formula: see text]. Regarding femoral components, 19.1% showed specific malalignment [Formula: see text], while 11.7% of tibial components were classified as outliers. The mean HSS Knee Score at final follow up was 89.2. Patients whose implants were mechanically aligned did not obtain better functional outcomes ([Formula: see text]). Conclusion: In our series, the use of patient-specific positioning guides resulted in a range of mechanical malalignment, similar to conventional instrumentation results reported in the literature.

scholarly journals Total knee arthroplasty with the least-constrained implant possible for type II valgus knee > 20°: a 3–14 years’ follow-up

Arthroplasty ◽  
2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Jiangdong Ren ◽  
Xiaogang Zhang ◽  
Wuhuzi Wulamu ◽  
Nuerailijiang Yushan ◽  
Abudousaimi Aaimaiti ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Valgus Knee ◽  
Type Ii ◽  
Total Knee

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.

scholarly journals Application of 3D printed osteotomy guide plate-assisted total knee arthroplasty in treatment of valgus knee deformity

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Zhimin Shen ◽  
Hong Wang ◽  
Yiqiang Duan ◽  
Jian Wang ◽  
Fengyan Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Treatment Group ◽  
Knee Arthroplasty ◽  
Combined Treatment ◽  
Operation Time ◽  
Valgus Knee ◽  
Guide Plate ◽  
Knee Deformity ◽  
3D Printed ◽  
Total Knee

Abstract Introduction To analyze the application of 3D printed osteotomy guide plate-assisted total knee arthroplasty (TKA) for valgus knee deformity. Methods The clinical data of 20 patients with valgus knee deformity admitted to our hospital from April 2012 to April 2017 were collected and analyzed. According to the treatment method, these patients were divided into two groups: 3D printed osteotomy guide plate-assisted TKA (combined treatment group, n = 10) and TKA (treatment group, n = 10). The operation time, intraoperative bleeding volume, postoperative mean femorotibial angle (MFTA), and Knee Society Score (KSS) of the two groups were statistically analyzed. Results Compared with the treatment group, the operation time was significantly shorter (P < 0.05), the intraoperative blood loss and postoperative MFTA were significantly decreased (P < 0.05), and the clinical and functional scores were significantly increased (P < 0.05) in the combined treatment group. Conclusion 3D printed osteotomy guide plate-assisted TKA for valgus knee deformity is more effective than TKA alone.

scholarly journals Assessing the Patient-Specific Functional Scale's Ability to Detect Early Recovery Following Total Knee Arthroplasty

2014 ◽  
Vol 94 (6) ◽  
pp. 838-844 ◽  
Author(s):  
Paul W. Stratford ◽  
Deborah M. Kennedy ◽  
Amy V. Wainwright
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Early Recovery ◽  
Functional Scale ◽  
Change Scores ◽  
Strength Change ◽  
Total Knee ◽  
Exercise Class

Background The Patient-Specific Functional Scale (PSFS) has received considerable attention over the last 2 decades; however, validation studies have not examined its performance in patients after total knee arthroplasty (TKA). Objective The purpose of this study was to investigate the ability of the PSFS to detect change in patients post-TKA by comparing PSFS change scores with Lower Extremity Functional Scale (LEFS) and pooled impairment change scores. Methods One hundred thirty-three patients participating in a post-TKA exercise class were assessed at their initial and discharge visits. Initial assessments occurred within 28 days of arthroplasty; follow-up assessments occurred within 80 days of surgery. At both assessments, participants completed the PSFS, LEFS, and the P4 pain measure, and their knee range of motion (ROM) and extensor strength were measured. The ability to detect change was expressed as the standardized response mean (SRM) and as a correlation between the PSFS change scores and 2 reference standards: (1) LEFS change scores and (2) pooled impairment change scores. The pooled impairment measure consisted of pain, ROM, and strength change scores. Results The SRMs were PSFS 4.60 (95% confidence interval [CI]=4.00, 5.36) for the PSFS and 2.28 (95% CI=2.04, 2.60) for the LEFS. The correlation between the PSFS and pooled impairment change scores was 0.12 (95% CI=−0.04, 0.25), and the correlation between the PSFS and LEFS changes scores was 0.18 (0.02, 0.34). Limitations The order of measure administration was not standardized, and fixed activity set does not reflect clinical application in many instances. Conclusions The results suggest that the PSFS is adept at detecting improvement in patients post-TKA but that the PSFS, like other patient-specific measures, is likely to be of limited value in distinguishing different levels of change among patients.

scholarly journals A patient-specific 3D model of the knee to compare the femoral rollback before and after total knee arthroplasty (TKA)

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Alexandra Mercader ◽  
Timon Röttinger ◽  
Amir Bigdeli ◽  
Tim C. Lüth ◽  
Heinz Röttinger
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
3D Model ◽  
Standard Procedure ◽  
Patient Specific ◽  
Number Of Patients ◽  
Before And After ◽  
Total Knee ◽  
The Impact

Abstract Purpose Total knee arthroplasty (TKA) is nowadays performed as a standard procedure on a large number of patients suffering from arthrosis. Replacing the knee joint causes changes in the geometry and kinematics of the knee, which are unique to each individual. This research focuses on the method to detect these changes after TKA and on the impact on the knee movement. This approach could reduce complications in patients with post-operative pain and reduce the number of revisions. Methods A 3D model of a patient’s knee was made by measuring the movement with a medically certified infrared stereo camera. This measurement was combined with the 3D model of the patient’s bones, previously segmented from the CT scan. This model is printed in 3D, one part being the mechanism that follows the movement of the patient, and the other part being the 3D copy of the femur and tibia bones. The knee replacement operation is performed directly on the model and the resulting rollback is being measured before and after TKA. Results We observe a difference in the rollback before and after TKA on the 3D printed model. The variation in size and shape of the femoral implant compared to the natural femur condyles is one of the reasons for the changes in the rollback effect. The rollback is half as large after the prosthesis insertion, which confirms the fact that the femoral prosthesis geometry influences the knee kinematics. Conclusions In this study, a first 3D model combining the patient-specific kinematic and the geometry of his bones has been constructed. This model allows the surgeon to validate the plan of the operation, but also to understand the problems and consequences generated by the prosthesis insertion. The rollback is one of the most important motion of the knee joint and this behavior could be quantified, providing comparative analysis of the knee joint before and after the operation. As a future study, the model could be used to analyse more parameters of the TKA such as the impact of different implantation methods.

Manipulation under anaesthesia after primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 126-130
Author(s):  
Brian P. Chalmers ◽  
Enrique Goytizolo ◽  
Mithun D. Mishu ◽  
Geoffrey H. Westrich
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Pain Scores ◽  
Neuraxial Anaesthesia ◽  
Manipulation Under Anaesthesia ◽  
Total Knee ◽  
The Mean ◽  
Sedation Group

Aims Manipulation under anaesthesia (MUA) remains an effective intervention to address restricted range of motion (ROM) after total knee arthroplasty (TKA) and occurs in 2% to 3% of primary TKAs at our institution. Since there are few data on the outcomes of MUA with different anaesthetic methods, we sought to compare the outcomes of patients undergoing MUA with intravenous (IV) sedation and neuraxial anaesthesia. Methods We identified 548 MUAs after primary TKA (136 IV sedation, 412 neuraxial anaesthesia plus IV sedation) from March 2016 to July 2019. The mean age of this cohort was 62 years (35 to 88) with a mean body mass index of 31 kg/m2 (18 to 49). The mean time from primary TKA to MUA was 10.2 weeks (6.2 to 24.3). Pre-MUA ROM was similar between groups; overall mean pre-MUA extension was 4.2° (p = 0.452) and mean pre-MUA flexion was 77° (p = 0.372). We compared orthopaedic complications, visual analogue scale (VAS) pain scores, length of stay (LOS), and immediate and three-month follow-up knee ROM between these groups. Results Following MUA, patients with IV sedation had higher mean VAS pain scores of 5.2 (SD 1.8) compared to 4.1 (SD = 1.5) in the neuraxial group (p < 0.001). The mean LOS was shorter in patients that received IV sedation (9.5 hours (4 to 31)) compared to neuraxial anaesthesia (11.9 hours (4 to 51)) (p = 0.009), but an unexpected overnight stay was similar in each group (8.6%). Immediate-post MUA ROM was 1° to 121° in the IV sedation group and 0.9° to 123° in the neuraxial group (p = 0.313). Three-month follow-up ROM was 2° to 108° in the IV sedation group and 1.9° to 110° in the neuraxial anaesthesia group (p = 0.325) with a mean loss of 13° (ranging from 5° gain to 60° loss), in both groups by three months. No patients in either group sustained a complication. Conclusion IV sedation alone and neuraxial anaesthesia are both effective anaesthetic methods for MUA after primary TKA. Surgeons and anaesthetists should offer these anaesthetic techniques to match patient-specific needs as the orthopaedic outcomes are similar. Also, patients should be counselled that ROM following MUA may decrease over time. Cite this article: Bone Joint J 2021;103-B(6 Supple A):126–130.

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