scholarly journals Appropriate determination of the surgical transepicondylar axis can be achieved following distal femur resection in navigation-assisted total knee arthroplasty

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Sang Jun Song ◽  
Hyun Woo Lee ◽  
Kang Il Kim ◽  
Cheol Hee Park
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Ct Images ◽  
Level Of Evidence ◽  
Transepicondylar Axis ◽  
Imageless Navigation ◽  
Before And After ◽  
Total Knee

Abstract Background Many surgeons have determined the surgical transepicondylar axis (sTEA) after distal femur resection in total knee arthroplasty (TKA). However, in most navigation systems, the registration of the sTEA precedes the distal femur resection. This sequential difference can influence the accuracy of intraoperative determination for sTEA when considering the proximal location of the anatomical references for sTEA and the arthritic environment. We compared the accuracy and precision in determinations of the sTEA between before and after distal femur resection during navigation-assisted TKA. Methods Ninety TKAs with Attune posterior-stabilized prostheses were performed under imageless navigation. The sTEA was registered before distal femur resection, then reassessed and adjusted after distal resection. The femoral component was implanted finally according to the sTEA determined after distal femur resection. Computed tomography (CT) was performed postoperatively to analyze the true sTEA (the line connecting the tip of the lateral femoral epicondyle to the lowest point of the medial femoral epicondylar sulcus on axial CT images) and femoral component rotation (FCR) axis. The FCR angle after distal femur resection (FCRA-aR) was defined as the angle between the FCR axis and true sTEA on CT images. The FCR angle before distal resection (FCRA-bR) could be presumed to be the value of FCRA-aR minus the difference between the intraoperatively determined sTEAs before and after distal resection as indicated by the navigation system. It was considered that the FCRA-bR or FCRA-aR represented the differences between the sTEA determined before or after distal femur resection and the true sTEA, respectively. Results The FCRA-bR was −1.3 ± 2.4° and FCRA-aR was 0.3 ± 1.7° (p < 0.001). The range of FCRA-bR was from −6.6° to 4.1° and that of FCRA-aR was from −2.7° to 3.3°. The proportion of appropriate FCRA (≤ ±3°) was significantly higher after distal femur resection than that before resection (91.1% versus 70%; p < 0.001). Conclusions The FCR was more appropriate when the sTEA was determined after distal femur resection than before resection in navigation-assisted TKA. The reassessment and adjusted registration of sTEA after distal femur resection could improve the rotational alignment of the femoral component in navigation-assisted TKA. Level of evidence IV.

Distal Femur Locking Plates Fit Poorly Before and After Total Knee Arthroplasty

2019 ◽  
Vol 33 (5) ◽  
pp. 239-243 ◽  
Author(s):  
Sean T. Campbell ◽  
Liam C. Bosch ◽  
Steven Swinford ◽  
Derek F. Amanatullah ◽  
Julius A. Bishop ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Locking Plates ◽  
Before And After ◽  
Total Knee

Is bone density in the distal femur affected by use of cement and by femoral component design in total knee arthroplasty?

1999 ◽  
Vol 4 (3) ◽  
pp. 180-186 ◽  
Author(s):  
Takahiro Seki ◽  
Go Omori ◽  
Yoshio Koga ◽  
Yoshihiro Suzuki ◽  
Yoshinori Ishii ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Density ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Component Design ◽  
Total Knee

Return to Play and Performance in Golfers After Total Knee Arthroplasty: Does Component Type Matter?

2021 ◽  
pp. 194173812110193
Author(s):  
Joseph S. Tramer ◽  
Lindsay M. Maier ◽  
Elizabeth A. Klag ◽  
Ayooluwa S. Ayoola ◽  
Michael A. Charters ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Golf Swing ◽  
Return To Play ◽  
Multiple Time ◽  
Level Of Evidence ◽  
Component Type ◽  
Before And After ◽  
Total Knee

Background: Golf is a popular sport among patients undergoing total knee arthroplasty (TKA). The golf swing requires significant knee rotation, which may lead to changes in golfing ability postoperatively. The type of implant used may alter the swing mechanics or place different stresses on the knee. The purpose of this study was to evaluate golf performance and subjective stability after TKA and compare outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) implants. Hypothesis: Patients with CR implants will experience better stability during the golf swing compared to patients with PS implants. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients who underwent primary TKA were identified from the medical record and sent an electronic questionnaire focusing on return to play (RTP), performance, pain, and stability during the golf swing. Knee injury and Osteoarthritis Outcome Scores (KOOS) were collected before and at multiple time points after surgery. Patients were surveyed postoperatively and asked to evaluate overall performance, pain, and stability before and after surgery. Outcomes were compared based on implant type. Results: Most patients (81.5%) were able to return to golf at an average of 5.3 ± 3.1 months from surgery. The average postoperative KOOS was 74.6 ± 12.5 in patients able to RTP compared with 64.4 ± 9.5 in those who were not ( P < 0.05). Knee pain during golf significantly improved from 6.4 ± 2.1 to 1.8 ± 2.2 ( P < 0.01). There were no significant differences in pain, performance, or stability between the CR and PS patients. Conclusion: Most patients can successfully return to golfing after TKA. Knee replacement offers patients reliable pain relief during the golf swing and fewer physical limitations during golf, with no detriment to performance. There is no difference in performance or subjective knee stability based on component type. Clinical Relevance: Understanding associated outcomes of different TKA knee systems allows for unbiased and confident recommendations of either component to golfers receiving total knee replacement.

scholarly journals Correlations of typical pain patterns with SPECT/CT findings in unhappy patients after total knee arthroplasty

2021 ◽  
Author(s):  
Dominic T. Mathis ◽  
Samuel Tschudi ◽  
Felix Amsler ◽  
Antonia Hauser ◽  
Helmut Rasch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Tracer Uptake ◽  
Diagnostic Process ◽  
Level Of Evidence ◽  
Ct Findings ◽  
Localization Scheme ◽  
Constant Pain ◽  
Total Knee

Abstract Purpose The diagnostic process in patients after painful total knee arthroplasty (TKA) is challenging. The more clinical and radiological information about a patient with pain after TKA is included in the assessment, the more reliable and sustainable the advice regarding TKA revision can be. The primary aim was to investigate the position of TKA components and evaluate bone tracer uptake (BTU) using pre-revision SPECT/CT and correlate these findings with previously published pain patterns in painful patients after TKA. Methods A prospectively collected cohort of 83 painful primary TKA patients was retrospectively evaluated. All patients followed a standardized diagnostic algorithm including 99m-Tc-HDP-SPECT/CT, which led to a diagnosis indicating revision surgery. Pain character, location, dynamics and radiation were systematically assessed as well as TKA component position in 3D-CT. BTU was anatomically localized and quantified using a validated localization scheme. Component positioning and BTU were correlated with pain characteristics using non-parametric Spearman correlations (p < 0.05). Results Based on Spearman’s rho, significant correlations were found between pain and patients characteristics and SPECT/CT findings resulting in nine specific patterns. The most outstanding ones include: Pattern 1: More flexion in the femoral component correlated with tender/splitting pain and patella-related pathologies. Pattern 3: More varus in the femoral component correlated with dull/heavy and tingling/stinging pain during descending stairs, unloading and long sitting in patients with high BMI and unresurfaced patella. Pattern 6: More posterior slope in the tibial component correlated with constant pain. Conclusion The results of this study help to place component positioning in the overall context of the "painful knee arthroplasty" including specific pain patterns. The findings further differentiate the clinical picture of a painful TKA. Knowing these patterns enables a prediction of the cause of the pain to be made as early as possible in the diagnostic process before the state of pain becomes chronic. Level of evidence Level III

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