scholarly journals Severity and location of lumbar spine stenosis affects the outcome of total knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
William L. Sheppard ◽  
Kevin M. McKay ◽  
Alexander Upfill-Brown ◽  
Gideon Blumstein ◽  
Howard Y. Park ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lumbar Spine ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Flexion Contracture ◽  
Lumbar Spine Surgery ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Targeted Analysis ◽  
Total Knee

Abstract Background Recent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility before and after TKA. Methods This retrospective case series assessed all TKAs performed at our institution for primary osteoarthritis from 2017–2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery was necessary for inclusion. Stenosis severity was demonstrated by (1) anterior–posterior (AP) diameter of the thecal sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. Results Patients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1–2, L2–3, L3–4, and L4–5, there was a significant reduction in preoperative-AOM (p < 0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p < 0.001). The same was noted with respect to increased morphological grade (p < 0.001), with a 5 degree decrease for patients’ most stenotic level (p < 0.001). Conclusion Severe LSS, which is readily demonstrated by a reduction in the AP diameter of the thecal sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of evidence: Level 4

scholarly journals Severity and Location of Lumbar Spine Stenosis Affects the Outcome of Total Knee Arthroplasty

2021 ◽  
Author(s):  
William Sheppard ◽  
Kevin M McKay ◽  
Alexander Upfill-Brown ◽  
Gideon Blumstein ◽  
Howard Park ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lumbar Spine ◽  
Knee Arthroplasty ◽  
Flexion Contracture ◽  
Lumbar Spine Surgery ◽  
Level Of Evidence ◽  
Dural Sac ◽  
Targeted Analysis ◽  
Postoperative Flexion ◽  
Total Knee

Abstract BackgroundRecent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility following TKA. MethodsThis retrospective study assessed all TKAs performed at our institution for primary osteoarthritis from 2017-2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery were necessary for inclusion. Stenosis severity was demonstrated by (1) anterior-posterior (AP) diameter of the dural sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. ResultsPatients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1-2, L2-3, L3-4, and L4-5, there was a significant reduction in preoperative-AOM (p<0.001 for each), with a 16 degree decrease when using patients’ most stenotic level (p<0.001). The same was noted with respect to increased morphological grade (p<0.001), with a 5 degree decrease for patients’ most stenotic level (p<0.001). ConclusionSevere LSS, which is readily demonstrated by a reduction in the AP diameter of the dural sac or increased morphological grade on MRI, correlated with a significant reduction in preoperative-AOM that was not improved after TKA. Persistent postoperative reductions in AOM may contribute to reduced patient satisfaction and recovery. Level of Evidence: Level 4

Decreasing Posterior Femoral Condyle Offset Improves Intraoperative Correction of Flexion Contracture in Total Knee Arthroplasty

2020 ◽  
Author(s):  
Murilo Anderson Leie ◽  
Antonio Klasan ◽  
Wei Wang Yeo ◽  
Dylan Misso ◽  
Myles Coolican
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Level Of Evidence ◽  
Full Extension ◽  
Time Of Surgery ◽  
Posterior Femoral Condyle ◽  
Total Knee

AbstractMultiple intraoperative strategies are described to achieve full extension in total knee arthroplasty, but only a few studies have assessed the effect of the flexion gap on intraoperative improvement in flexion contracture. The aim of this study was to determine whether posterior condylar offset, in isolation, independently affects extension at the time of total knee arthroplasty.Two hundred and seventy-eight patients who underwent total knee arthroplasty for knee osteoarthritis and flexion contracture ≥ 5 degrees between January 2008 and July 2018 were included in this study. Patients with other factors that could affect knee extension at the time of surgery were excluded. We recorded the thickness of posterior femoral condyle bone resected as well as the thickness of the posterior femoral component chosen for each patient. Patients' knee extension was recorded under anesthetic, prior to resection and intraoperatively after total knee replacement.Average thickness of bone resection for the posteromedial femur was 12.64  ± 1.65 mm and for the posterolateral femur was 10.38  ± 1.52 mm. Using a linear regression model, we found that changes in posterior offset and implant downsizing influenced correction of fixed flexion deformity at the time of surgery. When patients had a combined posteromedial and posterolateral offset 2 mm thinner than the thickness of bone resected, there was an average correction of 3.5 degrees of flexion contracture.Our study demonstrated that posterior femoral condyle offset is an independent variable affecting correction of flexion contracture at the time of surgery in a gap balanced cruciate-retaining total knee arthroplasty. Level of evidence Level IV evidence

Evaluation of quality of life and walking ability among amputated patients and those who refused to undergo amputation following infection of total knee arthroplasty: Small case series

2014 ◽  
Vol 39 (6) ◽  
pp. 463-469 ◽  
Author(s):  
Camilo Partezani Helito ◽  
Andre Thiago Scandiuzzi de Brito ◽  
Riccardo Gomes Gobbi ◽  
Marco Kawamura Demange ◽  
Luis Eduardo P Tirico ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Short Form ◽  
Case Series ◽  
Medical Community ◽  
Walking Ability ◽  
Retrospective Case ◽  
Total Knee

Background:Patients who undergo transfemoral amputation after infection of a total knee arthroplasty do not have good functional outcomes and have major difficulty walking.Objectives:To evaluate the quality of life and walking ability among patients who underwent amputation and among those who refused to undergo amputation following infection of a total knee arthroplasty.Study design:Retrospective case series.Methods:Patients who received an indication for amputation following an infection of a total knee arthroplasty were evaluated retrospectively. The patients were divided between those who accepted the amputation procedure and those who refused amputation (four amputee vs four non-amputees). Walking ability and quality of life were evaluated using the Short Form–36 questionnaire.Results:The average physical health was 27.4 for the amputees and 31.3 for the non-amputees. The average mental health was 49.9 for the amputees and 47.1 for the non-amputees. In relation to walking ability, only one (25%) of the amputees was able to walk, as opposed to 100% in the non-amputee groups.Conclusion:Twenty-five percent of the amputee patients continued to be able to walk. The functional outcome of non-amputee patients was better, with 100% being able to walk, though with limitations.Clinical relevanceThis is the first study evaluating patients who refused the amputation procedure and remained with the spacer. Despite the fact that this option is not recommended by the medical community, we believe that these data are useful when discussing, with a patient, quality of life after amputation.

scholarly journals NAVIGATED TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS WITH EXTRA-ARTICULAR DEFORMITY

2018 ◽  
Vol 26 (3) ◽  
pp. 170-174 ◽  
Author(s):  
IZUMI TANI ◽  
NAOKI NAKANO ◽  
KOJI TAKAYAMA ◽  
KAZUNARI ISHIDA ◽  
RYOSUKE KURODA ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Radiographic Outcomes ◽  
Navigation Group ◽  
Significant Difference ◽  
Total Knee

ABSTRACT Objective It is difficult to achieve proper alignment after total knee arthroplasty (TKA) in patients with extra-articular deformity (EAD) because of altered anatomical axis and distorted landmarks. As of this writing, only case series have been reported with regard to the usefulness of computer-assisted navigation systems for TKA with EAD. This study therefore compared outcomes in TKA with EAD, with and without navigation. Methods Fourteen osteoarthritis patients with EAD due to previous fracture malunion or operations were assessed. Seven TKAs were performed with navigation (navigation group) and another 7 were performed without navigation (manual group). Clinical and radiographic outcomes were compared before and two years after surgery. Results The mean postoperative Knee Society function score was significantly higher in the navigation group. No significant difference was found in postoperative range of motion and Knee Society knee score. The rate of outliers in radiographic outcomes tended to be lower in the navigation group. Conclusion Better clinical outcomes were achieved in cases in which navigation was used. Computer-assisted navigation is useful in TKA for patients with EAD. Level of Evidence III; Case control study.

scholarly journals Cement Arthrodesis of the Knee with a Custom Long Recon Nail After Failed Total Knee Arthroplasty: Surgical Technique and Results

2018 ◽  
Vol 12 (1) ◽  
pp. 554-566
Author(s):  
Malcolm R. DeBaun ◽  
Stuart B. Goodman ◽  
David W. Lowenberg
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Treatment Algorithm ◽  
Case Series ◽  
Cement Spacer ◽  
Knee Arthrodesis ◽  
Retrospective Case ◽  
Total Knee

Background and Objective: Persistent periprosthetic joint infection (PJI) is a devastating complication after Total Knee Arthroplasty (TKA). We hypothesize that our novel treatment algorithm utilizing a customized knee spanning recon nail combined with an antibiotic eluting cement spacer improves ambulation status and prevents recurrent PJI in patients with failed TKA and severe bone loss. Methods: In a retrospective case series, 15 consecutive patients who underwent knee arthrodesis after failed ipsilateral TKA secondary to infection from 2004-2017 with at least 1 year of follow-up were enrolled. The average age of patients at the time surgery was 68 (range 50-81) years with an average follow-up of 3.2 (range 1-6) years. Post-surgical ambulation status and eradication of index infection were analyzed as primary outcomes using McNemar’s test for before-and-after study design with p<0.05 for significance. Results: Cement arthrodesis significantly improved ambulation with 67% (10/15) of patients unable to ambulate before arthrodesis and 93% (14/15) of patients able to ambulate at final follow-up (p=0.004). The complication rate was 20% (3/15). There were no periprosthetic fractures. Amongst patients who presented with active PJI, 91% (10/11) had eradication of their index infection final follow-up (p=0.002). Overall prevention of recurrent index infection was 93% (14/15) (p=0.0001). Conclusion: Cement arthrodesis utilizing a custom knee spanning recon nail combined with an antibiotic eluting spacer improves ambulation status and prevents or treats recurrent infection in the majority of patients who have failed total knee arthroplasty.

scholarly journals Peri-prosthetic trans-patellar fractures after Total knee Arthroplasty: a case series and review of literature

Arthroplasty ◽  
2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Gaurav Govil ◽  
Lavindra Tomar ◽  
Pawan Dhawan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Society Score ◽  
Case Series ◽  
Good Choice ◽  
Knee Score ◽  
Level Of Evidence ◽  
Patella Fractures ◽  
Total Knee ◽  
The Mean

Abstract Peri-prosthetic patella fracture is the second most common peri-prosthetic fracture after total knee arthroplasty. This report presented the treatment results in 6 patients with peri-prosthetic patella fractures. From January 2015 to February 2019, six patients with peri-prosthetic patella fractures were treated. The mean age at surgery was 64 years (range, 48–72 years). Four patients with displaced fractures were treated surgically, and two patients with non-displaced fractures were treated non-surgically. Outcomes were assessed in terms of motion, functional knee score, and Knee Society score. The mean follow-up period lasted 16 months (range: 12–20 months). The average arc of motion was 110° (range: 80°–130°). The mean functional knee score was 77 (range: 70–87). The mean Knee Society score was 84 (range: 75–89). The non-surgical treatment may be a good choice for non-displaced peri-prosthetic patella fractures. For displaced fractures, surgical treatments yielded good functional outcomes. Level of evidence IVa

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 Tibial Tubercle Osteotomy in Total Knee Arthroplasty: Midterm Results Experience of a Monocentric Study

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 095-099 ◽  
Author(s):  
Stefano Biggi ◽  
Stefano Divano ◽  
Riccardo Tedino ◽  
Andrea Capuzzo ◽  
Stefano Tornago ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Primary Total Knee Arthroplasty ◽  
Implant Design ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Level Of Evidence ◽  
Total Knee ◽  
Revision Tka

Purpose Difficult primary total knee arthroplasty (TKA) and revision TKA may be high demanding, especially during joint exposure. Aim of this article is to evaluate the clinical and radiological outcomes of a series of patients, who underwent TKA and revision TKA, where tibial tubercle osteotomy (TTO) was performed. Methods We retrospectively reviewed a cohort of 79 consecutives TKAs where TTO was performed. Patients were assessed clinically and radiographically at their last follow-up (mean, 7.4 ± 3.7 years). Clinical evaluation included the Knee Society Score (KSS), the pain visual analogue scale (VAS), and range of motion. Radiological assessment included the evaluation of radiolucent lines, osteolysis, cortical bone hypertrophy, time of bone healing of the TTO fragment, and the hardware complication. Results KSS raised from 40.7 ± 3.1 to 75 ± 4.3 (p < 0.0001). Knee flexion increased from 78.7 ± 9.9° to 95.0 ± 9.5° (p < 0.0001), and VAS improved from 7.9 ± 0.9 to 3.8 ± 1 (p < 0.0001). No signs of loosening or evolutive radiolucency lines were found. Osteolytic areas around the stem were detected. No significant association was found between the implant design and the outcomes, while aseptic loosening showed significantly better results. Complications were: 4 painful hardware, 3 late periprosthetic infections, 1 extension lag of 5°, and 3 flexion lag. Conclusion Our experience suggests the use of TTO to improve the surgical approach in difficult primary TKA or revision TKA. A precise surgical technique leads to good results with low risk of complications. Level of Evidence Level IV, therapeutic case series.

scholarly journals Component gap control during posterior-stabilised total knee arthroplasty using the posterior condylar pre-cut technique

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Makoto Kawasaki ◽  
Ryutaku Kaneyama ◽  
Hitoshi Suzuki ◽  
Teruaki Fujitani ◽  
Manabu Tsukamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Femoral Condyle ◽  
Posterior Part ◽  
Case Series ◽  
Knee Extension ◽  
Level Of Evidence ◽  
Gap Control ◽  
Total Knee

Abstract Purpose Adjusting the gap lengths to ensure equal lengths in both extension and flexion during total knee arthroplasty (TKA) is important for achieving successful outcomes. We designed a new pre-cut trial component (PCT) for posterior-stabilised (PS) TKA and aimed to determine whether the pre-cut technique is useful for component gap (CG) control in PS TKA. Methods A total of 70 knees were included. The PS PCT for PS TKA is composed of a 9-mm-thick distal part and 5-mm-thick posterior part with a cam structure. First, the distal femur and proximal tibia were cut to create an extension gap. Next, a 4-mm pre-cut was made from the posterior femoral condylar line; then, the PS PCT was attached, and the CGs were checked and compared at 0° and 90° knee flexion. Final CGs with the trial femoral components were compared with gaps in PS PCT at 0° and 90° knee flexion. Results CGs using PS PCTs were 10.2 mm at 0° and 13.6 mm at 90° knee flexion. According to the release of the posterior capsule at intercondylar notch and the adjustment of the cutting level of posterior femoral condyle, the final CG on knee extension was 11.3 mm; it did not significantly differ from CGs with PS PCT. The final CG at 90° knee flexion was 12.7 mm; it did not significantly differ from the estimated gap (12.4 mm) in PS PCT after flexion gap control. Conclusion CG control using PS PCT is a useful technique during PS TKA. Level of evidence Level IV: Case series.

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