scholarly journals The arithmetic HKA (aHKA) predicts the constitutional alignment of the arthritic knee compared to the normal contralateral knee

2020 ◽  
Vol 1 (7) ◽  
pp. 339-345
Author(s):  
Samuel J MacDessi ◽  
William Griffiths-Jones ◽  
Ian A Harris ◽  
Johan Bellemans ◽  
Darren B Chen
Keyword(s):  
Lower Limb ◽  
Mean Difference ◽  
Normal Knee ◽  
Significant Difference ◽  
Total Knee ◽  
Grade 3 ◽  
Similar Accuracy ◽  
Tibiofemoral Osteoarthritis ◽  
Hip Knee Ankle Angle ◽  
Arthritic Knee

Aims An algorithm to determine the constitutional alignment of the lower limb once arthritic deformity has occurred would be of value when undertaking kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to determine if the arithmetic hip-knee-ankle angle (aHKA) algorithm could estimate the constitutional alignment of the lower limb following development of significant arthritis. Methods A matched-pairs radiological study was undertaken comparing the aHKA of an osteoarthritic knee (aHKA-OA) with the mechanical HKA of the contralateral normal knee (mHKA-N). Patients with Grade 3 or 4 Kellgren-Lawrence tibiofemoral osteoarthritis in an arthritic knee undergoing TKA and Grade 0 or 1 osteoarthritis in the contralateral normal knee were included. The aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA) measured on standing long leg radiographs. The primary outcome was the mean of the paired differences in the aHKA-OA and mHKA-N. Secondary outcomes included comparison of sex-based differences and capacity of the aHKA to determine the constitutional alignment based on degree of deformity. Results A total of 51 radiographs met the inclusion criteria. There was no significant difference between aHKA-OA and mHKA-N, with a mean angular difference of −0.4° (95% SE −0.8° to 0.1°; p = 0.16). There was no significant sex-based difference when comparing aHKA-OA and mHKA-N (mean difference 0.8°; p = 0.11). Knees with deformities of more than 8° had a greater mean difference between aHKA-OA and mHKA-N (1.3°) than those with lesser deformities (-0.1°; p = 0.009). Conclusion This study supports the arithmetic HKA algorithm for prediction of the constitutional alignment once arthritis has developed. The algorithm has similar accuracy between sexes and greater accuracy with lesser degrees of deformity. Cite this article: Bone Joint Open 2020;1-7:339–345.

scholarly journals The arithmetic HKA (aHKA) predicts the constitutional alignment of the arthritic knee compared to the normal contralateral knee

2020 ◽  
Vol 1 (7) ◽  
pp. 339-345 ◽  
Author(s):  
Samuel J MacDessi ◽  
William Griffiths-Jones ◽  
Ian A Harris ◽  
Johan Bellemans ◽  
Darren B Chen
Keyword(s):  
Lower Limb ◽  
Mean Difference ◽  
Normal Knee ◽  
Significant Difference ◽  
Total Knee ◽  
Grade 3 ◽  
Similar Accuracy ◽  
Tibiofemoral Osteoarthritis ◽  
Hip Knee Ankle Angle ◽  
Arthritic Knee

Aims An algorithm to determine the constitutional alignment of the lower limb once arthritic deformity has occurred would be of value when undertaking kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to determine if the arithmetic hip-knee-ankle angle (aHKA) algorithm could estimate the constitutional alignment of the lower limb following development of significant arthritis. Methods A matched-pairs radiological study was undertaken comparing the aHKA of an osteoarthritic knee (aHKA-OA) with the mechanical HKA of the contralateral normal knee (mHKA-N). Patients with Grade 3 or 4 Kellgren-Lawrence tibiofemoral osteoarthritis in an arthritic knee undergoing TKA and Grade 0 or 1 osteoarthritis in the contralateral normal knee were included. The aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA) measured on standing long leg radiographs. The primary outcome was the mean of the paired differences in the aHKA-OA and mHKA-N. Secondary outcomes included comparison of sex-based differences and capacity of the aHKA to determine the constitutional alignment based on degree of deformity. Results A total of 51 radiographs met the inclusion criteria. There was no significant difference between aHKA-OA and mHKA-N, with a mean angular difference of −0.4° (95% SE −0.8° to 0.1°; p = 0.16). There was no significant sex-based difference when comparing aHKA-OA and mHKA-N (mean difference 0.8°; p = 0.11). Knees with deformities of more than 8° had a greater mean difference between aHKA-OA and mHKA-N (1.3°) than those with lesser deformities (-0.1°; p = 0.009). Conclusion This study supports the arithmetic HKA algorithm for prediction of the constitutional alignment once arthritis has developed. The algorithm has similar accuracy between sexes and greater accuracy with lesser degrees of deformity. Cite this article: Bone Joint Open 2020;1-7:339–345.

scholarly journals ACL status in arthroplasty patients, why not to preserve?

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 1 ◽  
Author(s):  
Ahmed Abdelbadie ◽  
Ahmed Ali Toreih ◽  
Mohamed Ahmed Radwan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Cruciate Ligaments ◽  
Normal Knee ◽  
Replacement Surgery ◽  
Total Knee ◽  
Grade 3

Introduction: Only 70–85% of patients that had total knee arthroplasty (TKA) are satisfied with their knees. The need for a near to normal knee kinematics is crucial and maybe the solution to their needs. Addressing the cruciate ligaments during surgery along with the extent of arthrosis may give a solution to this problem. Material and methods: One hundred consecutive patients in whom a total knee arthroplasty was indicated and performed were prospectively documented. During the knee replacement surgery, the condition of the anterior and posterior cruciate ligaments and the degree of osteoarthritis (OA) in the medial and lateral compartments as well as in the patello-femoral joint were documented using the Outerbridge classification. The patients’ average age was 72.3 years, with the majority being female. In all patients, a total bi-compartmental knee replacement was indicated. Results: Our results showed that in 78% of all patients the anterior, and in 98% the posterior cruciate ligament was still intact. Seventy-one percent of cases suffered from grade 4 medial osteoarthritis, 19% from grade 3 and 10% from grade 2. Thirty-six of patients suffered from grade 4 lateral osteoarthritis, 36% from grade 3, 24% from grade 2 and 4% from grade 1. Grade 4 patello-femoral osteoarthritis was present in 32% of all patients, grade 3 in 60% and grade 2 in 8% of all patients. Discussion: The goal of arthroplasty is to approximate the function of a normal knee. The retention of the anterior cruciate ligament (ACL) allows for better knee, kinematics, improved proprioception, increased flexion and an overall improvement in knee function. The decreased constraint that is possible with retention of both cruciates may decrease implant stresses and improve the implant survivorship. The distribution of OA shows that the medial and patello-femoral compartments of the joint are primarily affected. This could also allow for a more conservative and patient-tailored prosthetic design.

scholarly journals No difference of survival between cruciate retaining and substitution designs in high flexion total knee arthroplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gun-Woo Kim ◽  
Quan He Jin ◽  
Jun-Hyuk Lim ◽  
Eun-Kyoo Song ◽  
Jong-Keun Seon
Keyword(s):  
Survival Rate ◽  
Survival Rates ◽  
Cruciate Retaining ◽  
High Flexion ◽  
Significant Difference ◽  
Ankle Angle ◽  
Total Knee ◽  
The Mean ◽  
Hip Knee Ankle Angle

AbstractThe aim of this study was to compare the long-term implant survival and outcomes in patients with high-flexion cruciate-retaining (CR) or high-flexion posterior cruciate-substituting (PS) knee implants. A total of 253 knees (CR group: 159 vs. PS group: 94) were available for examination over a mean follow-up of 10 years. Clinical outcomes were assessed including the Hospital for Special Surgery score, Knee Society score and Western Ontario and McMaster Universities Osteoarthritis Index score at the final follow-up. Radiologic measurements were also assessed including the hip-knee-ankle angle and radiolucent lines according to the KSS system at the final follow-up. The survival rate was analyzed using the Kaplan–Meier method. At the final follow-up, the mean total HSS scores were similar between the two groups (p = 0.970). The mean hip-knee-ankle angle at the final follow-up was similar between groups (p = 0.601). The 10- and 15-year survival rates were 95.4% and 93.3% in the CR group and 92.7% and 90.9% in the PS group, respectively, with no significant difference. Similar clinical and radiographic outcomes could be achieved with both the high-flexion CR and high-flexion PS total knee designs without a difference in survival rate after a 10-year follow-up.

Comparison of bupivacaine plus intrathecal fentanyl and bupivacaine alone for spinal anesthesia with intravenous dexmedetomidine sedation: a randomized, double-blind, noninferiority trial

2019 ◽  
Vol 44 (4) ◽  
pp. 459-465 ◽  
Author(s):  
Sun-Kyung Park ◽  
Joon Hee Lee ◽  
Seokha Yoo ◽  
Won Ho Kim ◽  
Young-Jin Lim ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Sensory Block ◽  
Mean Difference ◽  
Double Blind ◽  
Significant Difference ◽  
Registration Number ◽  
Total Knee ◽  
The Mean ◽  
Secondary Outcomes ◽  
Group B

Background and objectivesFentanyl is widely used as an intrathecal adjuvant to local anesthetics to enhance the duration of spinal anesthesia. Recent evidence suggests that intravenous dexmedetomidine prolongs the duration of spinal anesthesia. This noninferiority study evaluated whether bupivacaine alone could provide a noninferior duration of block compared with bupivacaine and fentanyl when intravenous dexmedetomidine was administered intraoperatively.MethodsFifty-six patients scheduled for total knee arthroplasty under spinal anesthesia were randomly allocated to receive either bupivacaine 13 mg with intrathecal fentanyl 20 µg (Group BF) or bupivacaine 13 mg (Group B). Both groups underwent intravenous dexmedetomidine sedation throughout the surgery (1 µg kg–1 for 10 min, followed by 0.5 µg kg–1 h–1). The primary outcome was the time to two-segment regression of the sensory block. The noninferiority margin for the mean difference was predefined as −10 min. Secondary outcomes included postoperative pain scores, analgesics consumptions, and the incidences of pruritus, nausea, and vomiting.ResultsThere was no significant difference in the two-segment regression time of sensory block (Group B 109.1±25.0 min vs Group BF 104.3±25.9 min; p=0.484). The mean difference in the two-segment regression time between the 2 groups was 4.8 min (95 % CI −8.9 to 18.6), demonstrating the noninferiority of bupivacaine alone. Secondary outcomes showed no significant differences between the two groups.ConclusionsThe duration of spinal anesthesia with bupivacaine alone is noninferior to that of bupivacaine plus fentanyl in patients receiving intravenous dexmedetomidine intraoperatively. Our results suggest that intrathecal fentanyl may not be required when intravenous dexmedetomidine is administered.Trial registration numberNCT03105115.

Computed Tomography System for Total Knee Replacement Planning and Comparison with Plain Radiography Measured by an Orthopedic Surgeon

2019 ◽  
Vol 63 (5) ◽  
pp. 50503-1-50503-6
Author(s):  
Yu-Jui Huang ◽  
Yi-Cheng Huang ◽  
Siang-Cyun Wang ◽  
Ming-Chou Ku
Keyword(s):  
Computed Tomography ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Measurement System ◽  
Lower Limb ◽  
Preoperative Evaluation ◽  
Plain Radiographs ◽  
Orthopedic Surgeon ◽  
Significant Difference ◽  
Total Knee

Abstract In this study, a new CT measurement system was developed for preoperation evaluation of total knee replacement (TKR). To validate the developed imaging processing systems, TKR patients with and without a bowed lower limb were recruited. All patients underwent plain radiographs and CT scan before a TKR procedure. The precision and effectiveness of two measurements validated by an orthopedic surgeon and evaluated using the developed 3D computed tomography image system were compared. In vivo statistics data, particularly for Taiwanese patients, showed no difference between bowed lower limb and normal lower limb groups. The results of this study did not reveal a significant difference between the 3D-reconstructed CT images and 2D plain radiographs. However, the proposed 3D-reconstructed CT image measurement system demonstrated consistent measurements for TKR patients and for the bowed lower limb group in preoperative evaluation. The implemented system could be used in conjunction with the current 2D radiograph approach. The proposed system assist surgeons and patients when discussing operations and clinical approaches. Clinical results validated the system.

scholarly journals Role of tourniquet in post-operative pain after total knee replacement surgery: a case control study

2018 ◽  
Vol 4 (6) ◽  
pp. 924
Author(s):  
Mayur Rai ◽  
Amlan Mohapatra ◽  
Radhesh . ◽  
Bhaskar Bhandary
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Case Control ◽  
Mean Difference ◽  
P Value ◽  
Replacement Surgery ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> Intraoperative use of tourniquet to double the systolic blood pressure during total knee replacement (TKR) is used commonly for maintaining bloodless field. The aim of this study is to understand the role of tourniquet in post-operative pain after a TKR.</p><p class="abstract"><strong>Methods:</strong> Using a case-control design we enrolled 20 patients who underwent TKR with intraoperative use of tourniquet and 20 age and gender matched controls who underwent TKR without the use of tourniquet, from November 2014 till May 2016 in the Department of Orthopedics at the A.J. Institute of Medical Sciences, Mangalore. Baseline demographic information was collected for all patients and pain was measured using simplified verbal scale (SVS). Statistical analysis was performed using unpaired t-test and ANOVA.<strong></strong></p><p class="abstract"><strong>Results:</strong> Average age of cases and controls was 62.8±7.47 and 63.1±7.21 years respectively, with no significant difference between them. The average SVS score on Day 1 was significantly different between the cases and controls, p value 0.0032. On Day 2 and Day 3 SVS scores were not different significant. For cases the mean difference was 0.77 and -1.3 when we compared scores of SVS on Day 2 and Day 1. For control subjects mean difference was 0.939 and 0.760 when we compared SVS scores on Day 3 and Day 1.</p><p class="abstract"><strong>Conclusions:</strong> We found significantly lower post-operative pain upto Day 3 in patients who underwent TKR without a tourniquet.</p><p> </p>

scholarly journals COMPARISON OF DEXMEDETOMIDINE AND ONDANSETRON FOR PREVENTION OF SHIVERING IN LOWER LIMB SURGERIES AFTER SPINAL ANAESTHESIA

2020 ◽  
Vol 28 (4) ◽  
pp. 356-360
Author(s):  
Afia Arshed Dodhy
Keyword(s):  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Lower Limbs ◽  
Placebo Control ◽  
Double Blind ◽  
Operation Theatre ◽  
Significant Difference ◽  
Grade 3 ◽  
One Way Anova ◽  
Control Study

Objective: The purpose of the study was to compare the effectiveness of dexmedetomidine and ondansetron to prevent shivering in patients  undergoing lower limb surgeries after spinal anaesthesia . Methods: This  randomised  double-blind and  placebo-control study trial was held in orthopaedic operation theatre of Lahore General Hospital, Lahore from February 2020 to June 2020. Total of 120  adult patients  who underwent elective orthopaedic surgery of lower limbs after spinal anaesthesia  were divided  into 3 batches. In Batch S, saline was given as  placebo, in Batch O ondansetron and in Batch D dexmedetomidine was administered and shivering score were assessed for 45 min. A shivering score of   ? 3 was considered as primary outcome. Results: There is  statistically considerable difference, in the incidence of significant shivering (grade 3 & 4), among batches, as established by one way ANOVA. The significance value is 0.004 (i.e. p=0.004). There was no significant difference statistically between batch D and batch O (p=0.878) Conclusion: The incidence of shivering in batch S  was considerably higher than  that of both Batch O and  batch D while no significant relationship could be proved in between batch D and batch O Key words: Dexmedetomedine, Ondansetron, Shivering, Spinal Anaesthesia

scholarly journals Arithmetic hip-knee-ankle angle (aHKA): An algorithm for estimating constitutional lower limb alignment in the arthritic patient population

2021 ◽  
Vol 2 (5) ◽  
pp. 351-358
Author(s):  
William Griffiths-Jones ◽  
Darren B. Chen ◽  
Ian A. Harris ◽  
Johan Bellemans ◽  
Samuel J. MacDessi
Keyword(s):  
Lower Limb ◽  
Normal Population ◽  
Population Based ◽  
Normal Group ◽  
Limb Alignment ◽  
Cross Sectional ◽  
Straightforward Method ◽  
Significant Difference ◽  
Total Knee ◽  
The Difference

Aims Once knee arthritis and deformity have occurred, it is currently not known how to determine a patient’s constitutional (pre-arthritic) limb alignment. The purpose of this study was to describe and validate the arithmetic hip-knee-ankle (aHKA) algorithm as a straightforward method for preoperative planning and intraoperative restoration of the constitutional limb alignment in total knee arthroplasty (TKA). Methods A comparative cross-sectional, radiological study was undertaken of 500 normal knees and 500 arthritic knees undergoing TKA. By definition, the aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA). The mechanical HKA (mHKA) of the normal group was compared to the mHKA of the arthritic group to examine the difference, specifically related to deformity in the latter. The mHKA and aHKA were then compared in the normal group to assess for differences related to joint line convergence. Lastly, the aHKA of both the normal and arthritic groups were compared to test the hypothesis that the aHKA can estimate the constitutional alignment of the limb by sharing a similar centrality and distribution with the normal population. Results There was a significant difference in means and distributions of the mHKA of the normal group compared to the arthritic group (mean -1.33° (SD 2.34°) vs mean -2.88° (SD 7.39°) respectively; p < 0.001). However, there was no significant difference between normal and arthritic groups using the aHKA (mean -0.87° (SD 2.54°) vs mean -0.77° (SD 2.84°) respectively; p = 0.550). There was no significant difference in the MPTA and LDFA between the normal and arthritic groups. Conclusion The arithmetic HKA effectively estimated the constitutional alignment of the lower limb after the onset of arthritis in this cross-sectional population-based analysis. This finding is of significant importance to surgeons aiming to restore the constitutional alignment of the lower limb during TKA. Cite this article: Bone Jt Open 2021;2(5):351–358.

INFLUENCE OF FOOT INSOLE ON THE GAIT PERFORMANCE IN SUBJECTS WITH FLAT FOOT DISORDER

2019 ◽  
Vol 19 (06) ◽  
pp. 1950050
Author(s):  
M. T. KARIMI ◽  
R. B. TAHMASEBI ◽  
B. SATVATI ◽  
F. FATOYE
Keyword(s):  
Range Of Motion ◽  
Ankle Joint ◽  
Lower Limb ◽  
Walking Speed ◽  
Force Plate ◽  
Flat Foot ◽  
Gait Performance ◽  
Positive Effects ◽  
Significant Difference ◽  
Foot Disorder

Flat foot is the most common foot disorder that influences the alignment of the lower limb structure. It is controversial whether the use of foot insole influences kinetic and kinematic of the leg or not. Therefore, this study investigated the influence of foot insole on the gait performance in subjects with flat foot disorder. A group of flat foot subject was recruited into this study (the number of subjects was 15). The motion of the leg joints was determined using the Qualysis motion analysis system. Moreover, the force applied on the lower limb was recorded by a Kistler force plate. The range of motion of the lower limb joints, the moments applied on the lower limb joints and force transmitted through the leg were the parameters used in this study. The difference between these parameters during walking with and without insole was evaluated using the paired [Formula: see text]-test. Significant value was set at [Formula: see text]. There was no significant difference between the range of motion of ankle joint while walking with and without insole. However, the medial directed force applied on the leg decreased significantly [Formula: see text]. The use of foot insole did not influence the moments transmitted through the hip and knee joints. The walking speed of the subjects improved while walking with foot insole. Use of foot insole influenced the magnitude of the force applied on the leg and the adductor moment of ankle joint due to its influence on foot alignment. As the walking speed of the improved subjects follows the use of insole, it can be concluded that it may have a positive effects on the performance of flat foot subjects.

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