scholarly journals Significant reduction of patellar height affected lower clinical outcomes and knee flexion over five-year follow-up after total knee arthroplasty

2021 ◽  
Vol 2 (12) ◽  
pp. 1075-1081
Author(s):  
Ashish Suthar ◽  
Kiminori Yukata ◽  
Yoshikazu Azuma ◽  
Yutaka Suetomi ◽  
Kazuhiro Yamazaki ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Measurement Error ◽  
Clinical Outcomes ◽  
Knee Flexion ◽  
Patellar Height ◽  
Fixed Bearing ◽  
Patella Baja ◽  
Total Knee ◽  
The Relationship

Aims This study aimed to investigate the relationship between changes in patellar height and clinical outcomes at a mean follow-up of 7.7 years (5 to 10) after fixed-bearing posterior-stabilized total knee arthroplasty (PS-TKA). Methods We retrospectively evaluated knee radiographs of 165 knees, which underwent fixed-bearing PS-TKA with patella resurfacing. The incidence of patella baja and changes in patellar height over a minimum of five years of follow-up were determined using Insall-Salvati ratio (ISR) measurement. We examined whether patella baja (ISR < 0.8) at final follow-up affected clinical outcomes, knee joint range of motion (ROM), and Knee Society Score (KSS). We also assessed inter- and intrarater reliability of ISR measurements and focused on the relationship between patellar height reduction beyond measurement error and clinical outcomes. Results The ISR gradually decreased over five years after TKA, and finally 33 patients (20.0%) had patella baja. Patella baja at the final follow-up was not related to passive knee ROM or KSS. Interestingly, when we divided into two groups - patella baja and patella normal-alta (ISR ≥ 0.8) - the patella baja group already had a lower patellar height before surgery, compared with the patella normal-alta group. The ISR measurement error in this study was 0.17. Both passive knee flexion and KSS were significantly decreased in the group with a decrease in ISR of ≥ 0.17 at final follow-up. Conclusion Patellar height gradually decreased over five years of follow-up after TKA. The reduction in patellar height beyond measurement error following TKA was associated with lower clinical outcomes. Cite this article: Bone Jt Open 2021;2(12):1075–1081.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

Cementless Tritanium Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 5-Year Minimum Follow-Up

2020 ◽  
Vol 33 (09) ◽  
pp. 862-865
Author(s):  
John M. Tarazi ◽  
Hytham S. Salem ◽  
Joseph O. Ehiorobo ◽  
Nipun Sodhi ◽  
Michael A. Mont ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Porous Titanium ◽  
Septic Loosening ◽  
Cement Interface ◽  
Implant Survivorship ◽  
Total Knee ◽  
Highly Porous

Abstract Background Newer generation cementless total knee arthroplasty (TKA) designs have provided stronger osteointegration between the implant and bone. Despite excellent survivorship and outcomes with cemented TKAs, areas of concern within the bone–cement interface remain a concern and necessitate studies on alternative constructs. This study assesses: (1) implant survivorship; (2) clinical outcomes; and (3) complications with radiographic outcomes at a 5-year minimum follow-up of cementless highly porous titanium-coated baseplates in TKAs. Methods Part of this study has been reported. We retrospectively reviewed a prospectively collected database at a single high-volume institution between July 1, 2013 and June 30, 2014 for patients who underwent a primary TKA using cementless highly porous titanium-coated baseplate implants. Patients were evaluated clinically at postoperative follow-up visits at a minimum of 5 years. To calculate the survivorship, Kaplan–Meier analysis was performed to determine all-cause, aseptic, and septic implant survivorship at each final follow-up for all patients. Results A total of 228 TKAs were performed and followed for a minimum of 5 years (range, 5–6 years). As of the latest follow-up, one case of septic loosening of the patellar button and one case of patellar dislodgment secondary to physical manipulation were recorded and revised. Overall, the cohort displayed implant survivorship of 99.5% at 5-year minimum follow-up. Improvements were seen in both Knee Society pain and function scores and were 37 points (range, 17–60 points) and 28 points (range, 15–47 points), respectively. The mean improvement in flexion was 17.8 (range, –20 to 40 degrees) and mean improvement in extension was –5.5 (range, –30 to 5 degrees). Discussion Cementless TKAs serve as strong alternative choice to cemented TKAs. Although cemented fixation is commonly known as the gold standard, results of this study confirm the findings of previous investigations on the survivorship of cementless TKA implants. Therefore, patients who undergo primary TKA with a cementless tritanium baseplate can expect excellent clinical outcomes at a 5-year minimum follow-up.

Rotating platform versus fixed bearing total knee arthroplasty at mid-term follow-up

The Knee ◽  
2016 ◽  
Vol 23 (6) ◽  
pp. 1055-1058 ◽  
Author(s):  
J. Ryan Martin ◽  
Taylor R. Beahrs ◽  
Keith A. Fehring ◽  
Robert T. Trousdale
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Fixed Bearing ◽  
Rotating Platform ◽  
Total Knee

scholarly journals Long-term follow up of Navigation TKA using multi directional mobile bearing design

10.29007/3724 ◽  
2018 ◽  
Author(s):  
Eun-Kyoo Song ◽  
Jong-Keun Seon ◽  
Dong-Hyun Lee ◽  
Je-Hyoung Yeo
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Survival Rates ◽  
Mobile Bearing ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Bearing Design

Total knee arthroplasty using navigation system is known to be more effective than conventional methods in achieving more accurate bone resection and neutral alignment.1 Mobile bearing is also known to reduce wear and automatically correct rotational malalignment of the tibia but the long-term follow-up results of more than 10 years are extremely rare.2, 3 The purpose of this study is to investigate the results of clinical and radiologic long-term follow-up and complications of total knee arthroplasty using navigation and multi-directional mobile bearing.From 2003 to 2006, a total of 111 navigation TKAs using multi-directional mobile bearing design were carried out and reviewed retrospectively. TKAs were performed by two experienced surgeons at one institute. Of the 111 patients, 102 were women and 9 were men. The mean duration of follow-up was 11.4 ± 1.0 years (range, 10.1 to 14.08 years). Clinical outcomes were evaluated in terms of Knee Society Score, Hospital for Special Surgery score, Western Ontario and McMaster University (WOMAC) score, range of motion and complications. Long-term radiological outcomes and survival rates were evaluated at least 10 years.Average preoperative HSS score was 66.5 ± 9.8 and KSS pain and function score were 25.0 ± 11.8 and 44.5 ± 12.3, respectively. Scores improved to 94.1 ± 8.2, 46.6 ± 11.6 and 88.2 ± 14.6 at the last follow up, respectively. Mean preoperative WOMAC scores of 75.8 ± 16.5 improved to 13.8 ± 16.0 at last follow-up. Five knees required re-operation, two for liner breakage, one for liner wear, one for distal femoral fracture and one for infection. The estimated 10-year prosthesis survival rates for any reason and for prosthesis-related problems were 95.5% and 97.4% , respectively.TKAs using each techniques resulted in similar good clinical outcomes and postoperative leg alignments. Robotic and navigation TKA appeared to reduce the number of postoperative leg alignment outliers and revision rate compared to conventional TKA.

scholarly journals Noise after total knee arthroplasty has limited effect on joint awareness and patient reported clinical outcomes.

2020 ◽  
Author(s):  
Hiroto Taniguchi ◽  
Masafumi Itoh ◽  
Nobuyuki Yoshimoto ◽  
Junya Itou ◽  
Umito Kuwashima ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Correlation Coefficients ◽  
Range Of Movement ◽  
Limited Effect ◽  
Residual Symptoms ◽  
Patient Reported ◽  
Total Knee ◽  
The Relationship

Abstract Background: Some patients complain of noise after total knee arthroplasty (TKA). Controversy still exists how the noise affect the clinical outcomes including joint awareness after TKA. Forgotten Joint Score-12 (FJS-12) measures the clinical outcomes focusing on joint awareness after surgery. The Knee Society Scoring System-2011 (KSS-2011) includes questionnaires for satisfaction, expectation, and functional activities. The aim of this study is to clarify the relationship among FJS-12, KSS-2011 and the noise. Furthermore, the relationship between FJS-12 and KSS-2011 was validated. Methods: Using the FJS-12 and KSS-2011, 295 knees from 225 patients who underwent TKA was retrospectively evaluated. Noise perception was evaluated by a questionnaire with five grades which is a method that follows the questionnaire form of FJS-12 [“Are you aware of the noise of your artificial joint?” ; never, almost never, seldom, sometimes, mostly]. The correlations among FJS-12, KSS-2011, and noise were analyzed. In addition, patients were divided into four groups based on the mechanism of their implant [cruciate retaining, posterior stabilized, cruciate sacrificed, and bicruciate stabilized (BCS)]. FJS-12, KSS-2011, and noise were compared among the groups. Results: A strong correlation was observed between FJS-12 and the total score of KSS-2011 (0.70; P < 0.001). FJS-12 also was correlated with KSS-2011 subcategories for “symptoms,” “satisfaction,” and “standard activities” that these correlation coefficients were approximately 0.60. Noise was limited to have weak correlations with FJS-12 (0.28; P < 0.001) and KSS-2011 (0.20 P < 0.001). With comparison among the TKA mechanisms, BCS showed significantly better KSS-2011 and greater range of movement but worse noise scores. Conclusions: Noise perception after TKA had limited effect on joint awareness and clinical outcomes. FJS-12 was correlated strongly with KSS-2011 and associated with satisfaction, residual symptoms, and daily activities as assessed by KSS-2011 subscores.

scholarly journals The iAssist Navigation System Demonstrated Superior Radiological Outcomes in Restoring Mechanical Alignment and Component Sagittal Positioning in Total Knee Arthroplasty

2020 ◽  
Author(s):  
Jiaxiang Gao ◽  
Yunfei Hou ◽  
Zhichang Li ◽  
Runjun Li ◽  
Yan Ke ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Clinical Parameters ◽  
Mechanical Alignment ◽  
Absolute Deviation ◽  
Total Knee ◽  
The Absolute

Abstract Background: This study aimed to determine whether the iAssist navigation system (NAV) could improve the accuracy of restoring mechanical axis (MA), component positioning, and clinical outcomes compared to conventional (CON) total knee arthroplasty (TKA). Methods: A total of 301 consecutive patients (NAV: 27, CON: 274) were included. A 1:4 propensity score matching (PSM) was performed between the two groups according to preoperative demographic and clinical parameters. The postoperative MA, femoral coronal angle (FCA), femoral sagittal angle (FSA), tibial coronal angle (TCA) and tibial sagittal angle (TSA) were compared. Absolute deviations of aforementioned angles were calculated as the absolute value of difference between the exact and ideal value and defined as appropriate if within 3°, otherwise regarded as outliers. Additional clinical parameters, including the Knee Society knee and function scores (KSKS and KSFS) and range of motion (ROM), were assessed at the final follow-up (mean follow-up time was 21.88 and 21.56 months respectively for NAV and CON group). Results: A total of 98 patients/102 knees were analyzed after the PSM (NAV: 21 patients/24 knees, CON: 77 patients/78 knees). In the NAV group, the mean MA, FCA and TSA were significantly improved (p = 0.019, 0.006, <0.001, respectively). Proportions of TKAs within a ±3°deviation were significantly improved in all the postoperative radiological variables except for TCA (p = 0.003, 0.021, 0,017, 0.013, respectively for MA, FCA, FSA, and TSA). The absolute deviations of FSA and TSA were also significantly lower in the NAV group (p = 0.016, 0.048, respectively). In particular, no significant differences were found in either mean value, absolute deviation or outlier ratio of TCA between two groups. For the clinical outcomes, there were no significant differences between two groups, although KSKS, KSFS and ROM (p<0.01, respectively) dramatically improved compared to baseline. Conclusions: We suggested that the iAssist system could improve the accuracy and precision of mechanical alignment and component positioning without significant improvement of clinical outcomes. Further long-term high-quality studies are necessary to validate the results.

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