scholarly journals Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Tomofumi Kinoshita ◽  
Kazunori Hino ◽  
Tatsuhiko Kutsuna ◽  
Kunihiko Watamori ◽  
Takashi Tsuda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Specific Difference ◽  
Full Extension ◽  
Before And After ◽  
Total Knee ◽  
The Mean ◽  
Postoperative Knee ◽  
Gender Specific

Abstract Background Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC. Methods One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated. Results The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed > 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p<0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p<0.01). Conclusion Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles. Level of evidence III.

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

scholarly journals Result of posteromedial capsule and superficial medial collateral ligament release on gap and alignment in total knee arthroplasty in varusknee deformity by computer assisted surgery measurement: a retrospective stud

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0006
Author(s):  
Pruk Chaiyakit ◽  
Ittiwat Onklin ◽  
Weeranate Ampunpong
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Computer Assisted Surgery ◽  
Varus Deformity ◽  
Flexion Contracture ◽  
Computer Assisted ◽  
Total Knee ◽  
The Mean ◽  
Lateral Gaps

Soft tissue release and gap balancing in total knee arthroplasty (TKA) are important issue and lack of conclusive result. We performed posteromedial capsule (PMC) and superficial medial collateral ligament (sMCL) release by preservation of anterior attachment of pes anserine. Gaps and alignment were recorded by computer assisted surgery measurement. Results: T: The mean correction of varus deformity after PMC release and sMCL release were 4.88 ± 2.82° and 3.39 ± 1.7 respectively with the mean FC after PMC and sMCL release correction of 5.57 ± 3.5 and 1.34 ± 2.9° respectively. The mean medial gap changes on full extension after PMC and sMCL release was 1.83 ± 1.39 and 1.67 ± 1.04 mm. respectively with the mean medial gaps at 90 degree flexion after PMC and sMCL release changes of 0.73 ± 0.9 and 5.14 ± 2.11 mm. respectively. The mean lateral gap changes on extension after PMC and sMCL release were -1.3 ± 1.83 and -1.1 ± 1.6 mm. respectively with the mean lateral gaps at 90 degree flexion after PMC and sMCL release changes of -0.19 ± 1.03 and 0.06 ± 1.75 mm. here were 21 patients (16 female and 5 male) with mean age of 68 (48-78) years. The mean body mass index was 28.49 (20.70 – 39.95) kg/m2. The mean preoperative hip-knee-ankle angle was varus 8.12 (3.5-16.0) degrees with mean flexion contracture of 11.3 (3.5-16.0) degrees. Sixteen knees were implanted with Fixed bearing knee prosthesis and five knees were implanted with Mobile bearing knee prosthesis (Table.1). We performed PMC release in all patients, and combined PMC and sMCL release in fourteen patients. The mean correction of varus deformity after PM release and sMCL release were 4.88 ± 2.82 and 3.39 ± 1.7 degrees respectively. While the mean correction of flexion contracture after PMC release and sMCL release were 5.57 ± 3.5 and 1.34 ± 2.9 degrees respectively (Fig.8). The mean medial gaps change on extension after PMC and sMCL release were 1.83 ± 1.39 and 1.67 ± 1.04 mm. respectively. The mean medial gaps change at 90 degree flexion after PMC and sMCL release were 0.73 ± 0.9 and 5.14 ± 2.11 mm. respectively (Fig.9). The mean lateral gaps change on extension after PMC and sMCL release were 1.3 ± 1.83 and -1.1 ± 1.6 mm. respectively. The mean lateral gaps change at 90 degree flexion after PMC and sMCL release were -0.19 ± 1.03 and 0.06 ± 1.75 mm. (Fig.9). There is no instability of knee after PMC and sMCL release. Materials and Methods: Twenty one patient had been operated on. TKA with computer assisted surgery was performed using PMC and sMCL release by preservation of anterior attachment of pes anserine. Alignment, medial and lateral gaps were measured by computer assisted surgery. The mean age was 68 (48-78) years with the mean preoperative hip-kneeankle angle of 8.12 (3.5-16.0) degrees and the mean flexion contracture (FC) of 11.3 (3.516.0) degrees. Conclusion: We believe that sMCL release with preservation of anterior attachment of pes anserinus in total knee arthroplasty has additional effect on varus knee correction after PMC release without creation of knee instability.

A dynamic knee extension device improves flexion contracture before total knee arthroplasty: a randomized controlled trial

2020 ◽  
Vol 31 (4) ◽  
pp. 347-351 ◽  
Author(s):  
Andrea H. Stone ◽  
Justin J. Turcotte ◽  
M. Brook Fowler ◽  
James H. MacDonald ◽  
Marc F. Brassard ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Knee Extension ◽  
Flexion Contracture ◽  
Randomized Controlled ◽  
Total Knee

scholarly journals Relationship between Postoperative Knee Extension Lag and Preoperative Limitation of Knee Extension in Patients with Total Knee Arthroplasty

2017 ◽  
Vol 32 (1) ◽  
pp. 11-15
Author(s):  
Yutaro SANADA ◽  
Takahiro SAKAI ◽  
Maki KOYANAGI ◽  
Takayuki SHIIKI ◽  
Suguru OHSAWA ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Extension ◽  
Total Knee ◽  
Postoperative Knee

scholarly journals Comparison of Knowledge, Skills of Exercise and Ambulation, Outcome of Care and Quality of Life Before and After Implementing the Hospital to Homecare Pathway for Patients With Total Knee Arthroplasty

2021 ◽  
Vol 44 (1) ◽  
pp. 29-39
Author(s):  
Parichart Pronsawatchai ◽  
Suchitra Auefuea ◽  
Yothaga Phanyateaim ◽  
Wannapa Yensirikul ◽  
Anong Dittasung
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Home Health Care ◽  
Knee Arthroplasty ◽  
Knee Extension ◽  
Assessment Tools ◽  
Before And After ◽  
Post Operation ◽  
Total Knee

Background: The hospital to homecare pathway for patients with total knee arthroplasty was developed and needed to be evaluated for effectiveness and improvement. Objective: To compare knowledge, skills of exercise and ambulation, outcomes of nursing care and quality of life before and after implementing the hospital to homecare pathway for patients with total knee arthroplasty (HHPTKA). Methods: This quasi-experimental study was purposively selected 50 cases referred to the home health care unit, ambulatory care nursing service, Ramathibodi Hospital. The HHPTKA included providing and evaluating the knowledge, exercise and ambulation skill, and other outcomes at day 0 (before operation), day 3 (post operation), day 10 (home visit), and day 14 (outpatient follow-up). Data were collected by questionnaire and assessment tools which analyzed by descriptive statistics, paired t test, and analysis of variance (ANOVA). Results: There were statistically significant differences before and after the implementation of HHPTKA (P < .001). Mean scores of knowledge, skills of exercise and ambulation, quality of life, and degree of range of motion of knee were higher than before, pain score was decreased, and knee extension was increased. Only 1 case faced with wound bleeding at day 14 post operation. Conclusions: HHPTKA could direct standard practice for home care nurses.

scholarly journals Subluxation of knees in TKA - a neglected fact? An in vitro study.

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0014
Author(s):  
Günther Maderbacher ◽  
Hans-Robert Springorum ◽  
Joachim Grifka ◽  
Clemens Baier ◽  
Armin Keshmiri
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
In Vitro Study ◽  
Functional Results ◽  
Whole Body ◽  
P Value ◽  
Full Extension ◽  
Before And After ◽  
Total Knee

Aims and Objectives: Correct implant alignment is a well known factor for good functional results and increased implant survival after total knee arthroplasty (TKA). However, in present studies only coronal, sagittal and rotational alignment parameters have been considered, while translational parameters, the relative position between the femur and the tibia in medio-lateral, ventro-dorsal and proximo-distal direction are widely neglected. Due to variable mediolateral, proximodistal and ventrodorsal component placement in TKA, we hypothesised changed relative positions between the femoral and tibial bone resulting in a subluxation of knees after TKA. Materials and Methods: In nine Thiel embalmed whole body cadavers without any history of orthopaedic surgeries, fracutres and osteoarthritis, the relative positions between the femoral and tibial bones were measured between 0 and 90° of flexion before and after TKA (DePuy PFC Sigma, CR, fixed bearing) by means of a navigation system (Brainlab 2.6, Feldkirchen). To compare femoral positions before and after TKA, a paired t-test was used. A two-sided p-value of <0.05 was considered statistically significant. Results: In full extension, the femoral bones shifted 5.7 mm laterally(SD 4.0, p=0.003), and 2.7 proximally (SD 3.1, p=0.030), which decreased up to 90° of flexion to a lateral shift of 3.7 mm (SD 3.5, p=0.006) and proximal shift of 0.9 mm (SD 1.6, p=0.144). The femoral bones were located more dorsal in extension (2.8 mm dorsally (SD 4.8, p=0.113) which changed to a more ventral position in flexion (2.8 mm, SD 4.2, p=0.077). Conclusion: In the present setting, total knee arthroplasty resulted in significant changes of translational positions between the femoral and tibial bones, thus subluxation of knees. Major reasons for that might be a non centered placement of tibial or femoral implants, symmetric implants which do not respect individual anatomy, operative techniques, and large steps between two component sizes. Subluxation might cause an altered tension of the ligaments and consequently change tibiofemoral or patellar kinematics or tensioning of the periarticular soft tissue resulting in pain. However, clinical trials are necessary to evaluate clinical impact of the presented results.

scholarly journals Range of Motion Comparison Following Total Knee Arthroplasty with and without Patella Resurfacing

2021 ◽  
Vol 11 ◽  
Author(s):  
Melissa Jackels ◽  
Samantha Andrews ◽  
Maya Matsumoto ◽  
Kristin Mathews ◽  
Cass Nakasone
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Knee Extension ◽  
Implant Design ◽  
Tourniquet Time ◽  
Full Extension ◽  
Total Knee ◽  
Low Incidence

Background: Despite significant evaluation, no consensus has been reach for best clinical practice for resurfacing the patella during total knee arthroplasty. Further complicating the ability to reach a conclusion is the inclusion of several different implant types used in previous research. Questions/Purpose: The purpose of this study was to compare post-TKA outcomes between two cruciate retaining implants with or without patella resurfacing. Methods: This retrospective review included 289 patients (380 knees) with a minimum six-month follow-up. All patients received a CR implant, with either a symmetric or an asymmetric tibial baseplate. Post-TKA knee flexion was categorized as <120° and ≥120° and knee extension classified as 0° or >0° and required knee manipulations were noted. Descriptive, nonparametric statistics were performed and a multivariate logistic regression was performed to determine risk of poor range of motion and manipulations. Results: Age was significantly lower in the resurfaced group (p=0.001) and the resurfaced group had longer tourniquet time (p=0.003). The symmetric-resurfaced group had ≥120° of flexion and full extension in 72% and 98.7% of patients, respectively. Compared to symmetric-resurfaced, all other groups had a significantly greater risk of not reaching 120° of knee flexion (p<0.05). There were no significant differences in the risk of requiring a MUA between groups (p>0.06). Conclusions: The effect of resurfacing the patella on post-TKA outcomes may be influenced by tibial implant design. Compared to all other combinations, a symmetric tibial baseplate and resurfaced patella resulted in the highest percentage of patients reaching ≥120°, with a low incidence of manipulations.

scholarly journals FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 807.3-807
Author(s):  
I. Moriyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Osteoarthritis Of The Knee ◽  
Patellar Resurfacing ◽  
Criterion A ◽  
Total Knee ◽  
The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

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