scholarly journals Slight femoral under-correction versus neutral alignment in total knee arthroplasty with preoperative varus knees: a comparative study

Arthroplasty ◽  
2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Kai Lei ◽  
Li-Ming Liu ◽  
Peng-Fei Yang ◽  
Ran Xiong ◽  
De-Jie Fu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Clinical Results ◽  
Patient Reported Outcome Measures ◽  
Tourniquet Time ◽  
Patient Reported ◽  
Total Knee ◽  
Neutral Alignment

Abstract Background This study aimed to compare the short-term clinical results of slight femoral under-correction with neutral alignment in patients with preoperative varus knees who underwent total knee arthroplasty. Methods The medical records and imaging data were retrospectively collected from patients who had undergone total knee arthroplasty in our hospital from January 2016 to June 2019. All patients had varus knees preoperatively. Upon 1:1 propensity score matching, 256 patients (256 knees) were chosen and divided into a neutral alignment group (n=128) and an under-correction group (n=128). The patients in the neutral group were treated with the neutral alignment. In the under-correction group, the femoral mechanical axis had a 2° under-correction. The operative time, tourniquet time and the length of hospital stay in the two groups were recorded. The postoperative hip-knee-ankle angle, frontal femoral component angle and frontal tibial component angle were measured. Patient-reported outcome measures were also compared. Results The operative time, tourniquet time and the length of hospital stay in the under-correction group were significantly shorter than the neutral alignment group (P<0.05). At the 2-year follow-up, the under-correction group had a larger varus alignment (P<0.05) and a larger frontal femoral component angle (P<0.05), and the frontal tibial component angles of the two groups were comparable. Compared with the neutral alignment group, the slight femoral under-correction group had significantly better patient-reported outcome measures scores (P<0.05). Conclusion For varus knees treated with total knee arthroplasty, alignment with a slight femoral under-correction has advantages over the neutral alignment in terms of the shorter operative time and better short-term clinical results. Level of evidence III

Does Posterior Condylar Offset Affect Clinical Results following Total Knee Arthroplasty?

2017 ◽  
Vol 31 (08) ◽  
pp. 754-760 ◽  
Author(s):  
Ryan Degen ◽  
Jacob Matz ◽  
Matthew Teeter ◽  
Brent Lanting ◽  
James Howard ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Outcome Measures ◽  
Knee Arthroplasty ◽  
Short Form ◽  
Clinical Results ◽  
Patient Reported Outcome Measures ◽  
Posterior Condylar Offset ◽  
Patient Reported ◽  
Posterior Condylar ◽  
Total Knee

AbstractTotal knee arthroplasty (TKA) is an effective, durable treatment for knee osteoarthritis. However, a subset of patients experiences incomplete pain relief and ongoing dysfunction. Posterior condylar offset (PCO) has previously been shown to be associated with postoperative range of motion (ROM) following TKA; however, an association with patient-reported outcome measures (PROMs) has not been established. The purpose of this study was to evaluate the association between PCO and postoperative ROM and PROMs. A retrospective review of 970 posterior-stabilized single design TKAs was performed. Preoperative and postoperative radiographs were analyzed to measure the change in PCO and anteroposterior (AP) femoral dimension. Clinical outcome measures, including Short Form-12 physical and mental component summaries, Western Ontario and McMaster Universities Arthritis Index, and Knee Society Score were reviewed to determine if these were influenced by changes in PCO and AP dimension. PCO was increased by more than 3 mm in 15.1%, maintained (within 3 mm) in 59.6%, and decreased by more than 3 mm in 25.3% of patients. Comparing between these groups, there were no significant differences in postoperative ROM or PROM. AP dimension increased in 24.4%, maintained in 47.8%, and decreased in 27.8%. Similarly, there were no significant differences in ROM or PROM between these groups. Spearman's correlation analyses failed to identify an association between PCO and ROM or PROMs. In conclusion, increasing or decreasing PCO or AP femoral dimension with this PS TKA design did not significantly affect postoperative ROM or PROM. Similarly, maintenance of PCO within one implant size with this system compared with optimal sizing had no deleterious effect on TKA outcomes.

Kinematically Aligned Total Knee Arthroplasty Did Not Show Superior Patient-Reported Outcome Measures: An Updated Meta-analysis of Randomized Controlled Trials with at Least 2-Year Follow-up

2020 ◽  
Author(s):  
Shuhei Hiyama ◽  
Tsuneari Takahashi ◽  
Katsushi Takeshita
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Clinical Results ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Significant Difference ◽  
Patient Reported ◽  
Total Knee

AbstractKinematically aligned total knee arthroplasty (KATKA) was developed to improve the anatomical alignment of knee prostheses, assisting in restoring the native alignment of the knee and promoting physiological kinematics. Early clinical results were encouraging, showing better functional outcomes than with mechanically aligned total knee arthroplasty (MATKA). However, there have been concerns about implant survival, and follow-up at 10 years or more has not been reported. In addition, randomized controlled trials (RCTs) comparing KATKA with MATKA have reported inconsistent results. The current meta-analysis of RCTs with a minimum of 2 years of follow-up investigated the clinical and radiological differences between KATKA and MATKA. A systematic review of the English language literature resulted in the inclusion of four RCTs. The meta-analysis found no significant difference in any of the following parameters: postoperative range of motion for flexion (mean difference for KATKA − MATKA [MD], 1.7 degrees; 95% confidence interval [CI], −1.4 to 4.8 degrees; p = 0.29) and extension (MD, 0.10 degrees; 95% CI, −0.99 to 1.2 degrees; p = 0.86); Oxford Knee Score (MD, 0.10 points; 95% CI, −1.5 to 1.7 points; p = 0.90); Knee Society Score (MD, 1.6 points; 95% CI, −2.8 to 6.0 points; p = 0.49); and Knee Function Score (MD, 1.4 points; 95% CI, −4.9 to 7.8 points; p = 0.66). In addition, there was no significant difference between KATKA and MATKA in the rate of complications requiring reoperation or revision surgery (odds ratio, 1.01; 95% CI, 0.25–4.09; p = 0.99) or in the length of hospital stay (MD, 1.0 days; 95% CI, −0.2 to 2.2 days; p = 0.092). KATKA did not increase the number of patients with poor clinical results due to implant position, particularly for varus placement of the tibial component. In this meta-analysis based on four RCTs with a minimum of 2 years of follow-up, KATKA were only relevant to cruciate retaining TKA and could not be extrapolated to posterior stabilized TKA. Patient-reported outcome measures with KATKA were not superior to those with MATKA.

scholarly journals Bicompartmental Knee Arthroplasty (BKA) in comparison to unicompartmental (UKA), Patellofemoral (PFA) ans total knee arthroplasty (TKA) – Early Clinical Results

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Johannes Holz ◽  
Stefan Schneider ◽  
Ansgar Ilg ◽  
Rene Kaiser
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Clinical Results ◽  
Single Center ◽  
Patient Reported ◽  
Total Knee ◽  
Bicompartmental Arthroplasty

Aims and Objectives: The purpose was to evaluate the clinical outcomes of patients with knee osteoarthritis treated with bicompartmental arthroplasty (BKA) in comparison to unicompartmental (UKA), patellofemoral (PFA) and total knee arthroplasty (TKA) in a single center. Materials and Methods: This is a prospective study analyzing a consecutive series of 396 patients from two surgeons in a single center. In 191 men and 205 women either partial or total knee replacement were performed. Their mean age at surgery was 63±6,85 years and mean BMI 29,55±5,00 kg/m2. In 238 patients UKA, in 125 TKA, in 21 PFA and in 11 patients BKA was performed. Implants were cemented and made of cobalt chrome in partial knee and zirconium oxide in total knee replacement. Demographics and patient reported outcomes (VAS, KOOS, Oxford Knee Score (OKS)) were collected preoperatively and 3,6 and 12 months postoperatively. A total of 202 patients have thus far completed the 12 months follow-up time point. Results: All mean KOOS and OKS scores improved significantly 1 year after surgery (p<0.05). Mean preoperative aggregated KOOS improved from 49,0±14,1 to 74,3±17,8 in UKA, from 44,1±12,9 to 67,5±9,4 in PFA, from 46,1±15,1 to 71,0±14,8 in TKA and from 45,7±13,8 to 72,6±9,7 in BKA (p<0.05). Mean preoperative aggregated OKS improved from 25,1±7,6) to 38,5±9,7 in UKA, from 23,0±7,6 to 36,8±3,8 in PFA, from 23,4±8,2 to 37,3±8,1 in TKA and from 22,9±9,6 to 37,0±1,5 in BKA (p<0.05). The mean pain level (VAS)decreased from pre-treatment to 12 months after surgery in UKA from 5,5 to 1,6, in PFA from 6,1 to 2,5, in TKA from 6,0 to 1,9 and in BKA from 6,6 to 2,6. One patient (0.4%) underwent revision (at 3 month for inlay dislocation). Conclusion: This study shows excellent early clinical results of patients treated with unicompartmental, bicompartmental and total knee arthroplasty. Adherence to strict indications lead to a significant improvement of patient reported outcomes and a low revision rate one year postoperatively. The reported results for BKA are comparable to those of patients treated with unicompartmental arthroplasty. We conclude that bicompartmental arthroplasty is a safe and reliable surgery for patients with bicompartmental osteoarthritis.

scholarly journals Efficiency and Blood Loss of Various Spacer and Intramedullary Dowel Constructs in Two-Stage Treatment of Total Knee Arthroplasty

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Hanna House, BS ◽  
Mary Ziemba-Davis, BA ◽  
Michael Meneghini, MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Operating Time ◽  
Treatment Protocol ◽  
Two Stage ◽  
Tourniquet Time ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee

Background and Hypothesis: Treatment for infected total knee arthroplasty (TKA) employs antibiotic-eluding articulating or static spacers, with or without intramedullary (IM) dowels between implant resection and reimplantation. While it is unknown which spacer type is more efficient intra-operatively, IM dowels require additional time for fabrication. Surgical efficiency is critical to minimizing anesthesia time and blood loss, especially in complex surgeries with compromised hosts. We quantified operative time and postoperative intra-articular blood loss based on spacer type and the use of IM dowels. Project Methods: 103 consecutive infected TKAs treated from 2010-2019 were retrospectively reviewed. Outcome variables included operative time and intraarticular drain rate. Covariates included sex; age, BMI; ASA-PS classification; surgeon; McPherson infection classification; tourniquet time; tranexamic acid (TXA) use; intrathecal anesthesia, length of stay, and blood transfusion. Multivariate analyses were used. Results: The sample was 52% female with average age of 66±9 years and average BMI of 36±9 kg/m2. Articulating spacers without dowels (ASwoD), articulating spacers with dowels (ASwD), and static spacers with dowels were used in 57.3%, 21.4%, and 21.4% of knees, respectively. Longer mean operating time was observed when static spacers with dowels were used at resection (162 vs.130 ASwoD/140 ASwD minutes; p=0.001) and reimplantation (187 vs. 149 ASwoD/148 ASwD minutes; p=0.017). At reimplantation, drain rate was highest when articulating spacers with dowels were used (37 vs. 20/26 mL/hr), but not when TXA was used (p=0.002). Conclusion and Potential Impact: Articulating and static spacers provide equivalent infection eradication, and the necessity of IM dowels has not been thoroughly studied. In light of this equivalency, it is important to understand other costs associated with spacer types and IM dowels. Our observations that spacer/dowel constructs affect time under anesthesia and blood loss may contribute to the efficiency and safety of the two-stage treatment protocol.

Spinopelvic mismatch is associated with patient-reported outcome measures after total knee arthroplasty at a mean follow-up of 15 years

The Knee ◽  
2022 ◽  
Vol 34 ◽  
pp. 156-166
Author(s):  
Yoshinori Okamoto ◽  
Hitoshi Wakama ◽  
Tomohiro Okayoshi ◽  
Junya Matsuyama ◽  
Shuhei Otsuki ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Outcome Measures ◽  
Knee Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Total Knee
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