Excessive flexed position of the femoral component was associated with poor new Knee Society Score after total knee arthroplasty with the Bi-Surface knee prosthesis

Aims This study aimed to evaluate the association between the sagittal alignment of the femoral component in total knee arthroplasty (TKA) and new Knee Society Score (2011KSS), under the hypothesis that outliers such as the excessive extended or flexed femoral component were related to worse clinical outcomes. Methods A group of 156 knees (134 F:22 M) in 133 patients with a mean age 75.8 years (SD 6.4) who underwent TKA with the cruciate-substituting Bi-Surface Knee prosthesis were retrospectively enrolled. On lateral radiographs, γ angle (the angle between the distal femoral axis and the line perpendicular to the distal rear surface of the femoral component) was measured, and the patients were divided into four groups according to the γ angle. The 2011KSSs among groups were compared using the Kruskal-Wallis test. A secondary regression analysis was used to investigate the association between the 2011KSS and γ angle. Results According to the mean and SD of γ angle (γ, 4.0 SD 3.0°), four groups (Extended or minor flexed group, −0.5° ≤ γ < 2.5° (n = 54)), Mild flexed group (2.5° ≤ γ < 5.5° (n = 63)), Moderate flexed group (5.5° ≤ γ < 8.5° (n = 26)), and Excessive flexed group (8.5° ≤ γ (n = 13)) were defined. The Excessive flexed group showed worse 2011KSSs in all subdomains (Symptoms, Satisfaction, Expectations, and Functional activities) than the Mild flexed group. Secondary regression showed a convex upward function, and the scores were highest at γ = 3.0°, 4.0°, and 3.0° in Satisfaction, Expectations, and Functional activities, respectively. Conclusion The groups with a sagittal alignment of the femoral component > 8.5° showed inferior clinical outcomes in 2011KSSs. Secondary regression analyses showed that mild flexion of the femoral component was associated with the highest score. When implanting the Bi-Surface Knee prosthesis surgeons should pay careful attention to avoiding flexing the femoral component extensively during TKA. Our findings may be applicable to other implant designs. Cite this article: Bone Joint J 2020;102-B(6 Supple A):36–42.

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A Flexible Intramedullary Guide Can Reduce the Anteroposterior Oversizing of Femoral Components Used in Total Knee Arthroplasty in Patients with Osteoarthritis and Severe Distal Femoral Sagittal Bowing

The Journal of Knee Surgery ◽

10.1055/s-0040-1722325 ◽

2021 ◽

Author(s):

Do Weon Lee ◽

Joonhee Lee ◽

Junpyo Lee ◽

Du Hyun Ro ◽

Myung Chul Lee ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Femoral Component ◽

Knee Arthroplasty ◽

Sagittal Alignment ◽

Primary Tkas ◽

Functional Scores ◽

Total Knee ◽

Intramedullary Rod ◽

Rigid Rod

AbstractTraditionally, a rigid intramedullary rod has been used as the reference guide for femoral cutting in total knee arthroplasty (TKA). However, correct positioning of this rigid rod is difficult, especially in the knees with severe distal femoral sagittal bowing. A flexible intramedullary rod has been developed to address this problem. This study was performed to compare the sagittal alignment and clinical outcomes of TKAs performed with flexible and rigid femoral intramedullary guides. Thirty-eight knees that underwent primary TKAs with flexible intramedullary rods as femoral cutting guides were matched according to patient height and sex with 38 knees that underwent TKAs using conventional rigid rods. Clinical outcomes, including the range of motion and functional scores, and radiological variables, including the distal femoral bowing angle (DFBA), femoral component flexion angle (FFA), and mediolateral overhang and anteroposterior (AP) oversizing of femoral components, were evaluated. Clinical and radiological outcomes did not differ significantly between the flexible rod and conventional rigid rod groups. A subgroup analysis of knees with severe distal femoral sagittal bowing (DFBA >4 degrees) showed that the FFA was significantly larger in the flexible rod group than in the rigid rod group, with an average difference of 3 degrees (5.2 ± 2.4 vs. 2.2 ± 1.6 degrees, respectively, p = 0.022). In addition, the incidence of AP oversizing of femoral components was lower in the flexible rod group than in the rigid rod group (11.1 vs. 60.0%, respectively, p = 0.027). Relative to TKA with a rigid rod, TKA performed with a flexible femoral intramedullary guide resulted in more flexed sagittal alignment of femoral components in patients with severe distal femoral sagittal bowing. This greater flexion of the femoral component resulted in less AP oversizing. However, the use of a flexible rod had no impact on short-term clinical outcomes.

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A Wireless Visualized Sensing System with Prosthesis Pose Reconstruction for Total Knee Arthroplasty

Sensors ◽

10.3390/s19132909 ◽

2019 ◽

Vol 19 (13) ◽

pp. 2909 ◽

Cited By ~ 1

Author(s):

Hanjun Jiang ◽

Shaolin Xiang ◽

Yanshu Guo ◽

Zhihua Wang

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Knee Prosthesis ◽

Image Data ◽

Force Balance ◽

Prototype System ◽

Sensing System ◽

Flexion Extension ◽

Total Knee

The surgery quality of the total knee arthroplasty (TKA) depends on how accurate the knee prosthesis is implanted. The knee prosthesis is composed of the femoral component, the plastic spacer and the tibia component. The instant and kinetic relative pose of the knee prosthesis is one key aspect for the surgery quality evaluation. In this work, a wireless visualized sensing system with the instant and kinetic prosthesis pose reconstruction has been proposed and implemented. The system consists of a multimodal sensing device, a wireless data receiver and a data processing workstation. The sensing device has the identical shape and size as the spacer. During the surgery, the sensing device temporarily replaces the spacer and captures the images and the contact force distribution inside the knee joint prosthesis. It is connected to the external data receiver wirelessly through a 432 MHz data link, and the data is then sent to the workstation for processing. The signal processing method to analyze the instant and kinetic prosthesis pose from the image data has been investigated. Experiments on the prototype system show that the absolute reconstruction errors of the flexion-extension rotation angle (the pitch rotation of the femoral component around the horizontal long axis of the spacer), the internal–external rotation (the yaw rotation of the femoral component around the spacer vertical axis) and the mediolateral translation displacement between the centers of the femoral component and the spacer based on the image data are less than 1.73°, 1.08° and 1.55 mm, respectively. It provides a force balance measurement with error less than ±5 N. The experiments also show that kinetic pose reconstruction can be used to detect the surgery defection that cannot be detected by the force measurement or instant pose reconstruction.

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Long-Term Clinical Outcomes and Survivorship of Revision Total Knee Arthroplasty with Use of a Constrained Condylar Knee Prosthesis

The Journal of Arthroplasty ◽

10.1016/j.arth.2015.04.019 ◽

2015 ◽

Vol 30 (10) ◽

pp. 1804-1809 ◽

Cited By ~ 13

Author(s):

Young-Hoo Kim ◽

Jang-Won Park ◽

Jun-Shik Kim ◽

Hyun-Keun Oh

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Prosthesis ◽

Revision Total Knee Arthroplasty ◽

Total Knee

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Clinical evaluation of low cost Indian knee prosthesis in government medical colleges

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210965 ◽

2021 ◽

Author(s):

Ansari Muqtadeer Abdul Aziz ◽

Pratik Rathod ◽

Altamash Akil Patel

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Knee Society Score ◽

Knee Prosthesis ◽

Low Cost ◽

Primary Total Knee Arthroplasty ◽

Deformity Correction ◽

X Rays ◽

Total Knee

Background: The clinical and functional outcome of total knee arthroplasty was studied using low cost Indian knee prosthesis called Destiknee by Maxx Company in government medical hospital. The objectives was to do assessment of pain relief, joint mobility and deformity correction post-operatively, pre-operative and post-operative Knee society score comparison.Methods: Patients included were those who underwent primary total knee arthroplasty in Department of Orthopaedics, GMCH Aurangabad from January 2020 to January 2021. Clinical and functional assessment was done using the Knee society score and x-rays at 3, 6 and 12 months intervals.Results: At 1 year follow up of 28 knees, there was an improvement in the average pre-op Knee society score of 53.92 to average post-op score of 86.25 and in the range of motion from 80.42 degree to 127.32 degrees and knee flexion deformity improved from 15.25 degrees to 2.17 degrees, all of which had a p value<0.05 are significant statistically. One diabetic patient with poor glycemic control had superficial infection and one developed minor pulmonary embolism which recovered with medical management. Patients had good satisfaction both in unilateral and bilateral TKA.Conclusions: TKA resulted in significant reduction in knee pain and improvement in the functional ability of patients. The results of this low cost Indian prosthesis in a government rural setup with no laminar airflow with good efficacy and minimal complications are excellent. It was a boon for the rural population suffering from knee pain.

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Femoral component malrotation is not correlated with poor clinical outcomes after total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-05880-2 ◽

2020 ◽

Vol 28 (12) ◽

pp. 3879-3887 ◽

Cited By ~ 1

Author(s):

Katia Corona ◽

Simone Cerciello ◽

Michele Vasso ◽

Giuseppe Toro ◽

Adriano Braile ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Femoral Component ◽

Knee Arthroplasty ◽

Total Knee

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Superior Mid- to Long-Term Clinical Outcomes of Mobile-Bearing Total Knee Arthroplasty Compared to Fixed-Bearing: A Meta-analysis Based on a Minimum of 5 Years of Study

The Journal of Knee Surgery ◽

10.1055/s-0040-1709490 ◽

2020 ◽

Author(s):

Kaiyang Wang ◽

Fang Fang Zhang ◽

Xu Yan ◽

Yifan Shen ◽

Weijie Cai ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Society Score ◽

Meta Analysis ◽

Mobile Bearing ◽

Fixed Bearing ◽

Total Knee ◽

Standardized Mean Difference

AbstractAs more patients undergo total knee arthroplasty (TKA) each year, and the average age of patients gets younger, the patients are generally more active requiring a greater physiological demand and increasing range of motion on the prosthesis than the previous patients. However, there is no consensus on the optimal TKA tibial bearing design. We performed this systematic review to compare the clinical differences between mobile and fixed bearing constructs used in contemporary TKA. We searched PubMed, EMBASE, and Cochrane Library databases, identifying 515 total publications, including 17 randomized controlled trials (RCTs). A meta-analysis was performed, while the quality and bias of the evidence were rated according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) guidelines and the Cochrane Database questionnaire. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seventeen studies were included, with a total of 1505 knees receiving a mobile bearing TKA and 1550 knees receiving a fixed bearing TKA. The meta-analysis compared clinical outcomes between mobile bearing (MB)-TKA and fixed bearing (FB)-TKA using postoperative Knee Society Score, postoperative ROM, and survivorship and showed that there was a distinct difference in Knee Society Score between the mobile-bearing and fixed-bearing groups (overall standardized mean difference = 1.38; 95% confidence interval (CI): 0.50–2.25; p = 0.002; I2 = 60%). Patients treated with mobile-bearing prostheses were more likely to report good or excellent range of motion results (overall standardized mean difference = 2.06; 95% CI: 0.65–3.47; p = 0.004). No difference in implant survivorship or reoperation rate were identified. The fixed-bearing and mobile-bearing TKA designs are both capable of producing excellent long-term results with excellent clinical outcomes if properly implanted; however, the mobile-bearing TKA have superiority in mid- to long-term clinical results. Trial registration number for PROSPERO was CRD42019126402.

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