scholarly journals Impact of Anterior Cruciate Ligament Status on Early Satisfaction and Clinical Outcomes Following Total Knee Arthroplasty

2020 ◽  
Vol 10 ◽  
Author(s):  
Ali Etemad-Rezaie ◽  
Tori A. Edmiston ◽  
Sean M. Kearns ◽  
Philip H. Locker ◽  
Daniel D. Bohl ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Anterior Cruciate Ligament ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Outcome Scores ◽  
Operative Outcome ◽  
Total Knee ◽  
Anterior Cruciate ◽  
The Impact

Introduction While total knee arthroplasty (TKA) is a successful treatment for debilitating arthritis, up to 20% of patients may be dissatisfied with their outcome. One hypothesis for dissatisfaction is the distortion of native knee kinematics following sacrifice of the anterior cruciate ligament (ACL) during TKA. The purpose of this study was to determine the impact of ACL status at the time of surgery in patients undergoing Posterior Stabilized (PS) TKA for osteoarthritis (OA). Methods A consecutive prospective series of patients undergoing TKA by a single surgeon underwent prospective intraoperative assessment of their ACL status divided into three different groups:1) intact, 2) attenuated, or 3) deficient. Demographic, preoperative, intraoperative, and postoperative data were collected for each patient by two blinded, independent observers. Outcomes included patient satisfaction and Knee Society Score for Pain (KSS) and Function (KSF), Kellgren and Lawrence (K&L), UCLA Activity Score (UCLA), Short Form-12 (SF12), EuroQol (EQ5D) and patient satisfaction. Results: Of 116 patients, 33 (28.4%) patients had an ACL deficient knee, 40 (34.5%) patients had an attenuated ACL, and 43 (37.1%) patients had an intact ACL. Those with absent ACL were significantly more likely to have a higher BMI (p=.007) and be male (p=.003). Patient with a deficient ACL had significantly lower preoperative KSF and higher K&L scores (p=.009, p=1.26 x 10-7). Attenuated and deficient groups had the greatest change in SF12PCS scores at their one-year follow-up with increases of 9.9 (±10.0) and 10.8 (±8.0), respectively (p=.037). No significant differences in overall postoperative KSS, KSF and satisfaction scores based on ACL status (p=.574 and p=.529, respectively) were found. Conclusion In a relatively large series, patient with ACL deficiency were more likely to have worse pre-operative outcome scores and similar or better post-operative outcome scores. This suggests that those with ACL insufficiency may experience more subjective improvement from TKA. ACL status can be used as an additional surgical marker to help orthopaedic surgeons identify which patients would most benefit from TKA.

Leveraging subject-specific musculoskeletal modeling to assess effect of anterior cruciate ligament retaining total knee arthroplasty during walking gait

2020 ◽  
Vol 234 (12) ◽  
pp. 1445-1456 ◽  
Author(s):  
Qida Zhang ◽  
Zhenxian Chen ◽  
Zhifeng Zhang ◽  
Zhongmin Jin ◽  
Orhun K Muratoglu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Anterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Musculoskeletal Modeling ◽  
Cruciate Retaining ◽  
Walking Gait ◽  
Total Knee ◽  
Anterior Cruciate

Bi-cruciate retaining total knee arthroplasty has several potential advantages including improved anteroposterior knee stability compared to contemporary posterior cruciate-retaining total knee arthroplasty. However, few studies have explored whether there is significant differences of knee biomechanics following bi-cruciate retaining total knee arthroplasty compared to posterior cruciate-retaining total knee arthroplasty. In the present study, subject-specific lower extremity musculoskeletal multi-body dynamics models for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty were developed based on the musculoskeletal modeling framework using force-dependent kinematics method and validated against in vivo telemetric data. The experiment data of two subjects who underwent total knee arthroplasty were obtained for the SimTK “Grand Challenge Competition” repository, and integrated into the musculoskeletal model. Five walking gait trials for each subject were used as partial inputs for the model to predict the knee biomechanics for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty. The results revealed significantly greater range of anterior/posterior tibiofemoral translation, and significantly more posterior tibial location during the early phase of gait and more anterior tibial location during the late phase of gait were found in bi-cruciate retaining total knee arthroplasty without anterior cruciate ligament when compared to the bi-cruciate retaining total knee arthroplasty. No significant differences in tibiofemoral contact forces, rotations, translations, and ligament forces between bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty during normal walking gait, albeit slight differences in range of tibiofemoral internal/external rotation and anterior/posterior translation were observed. The present study revealed that anterior cruciate ligament retention has a positive effect on restoring normal knee kinematics in bi-cruciate retaining total knee arthroplasty. Preservation of anterior cruciate ligament in total knee arthroplasty and knee implant designs interplay each other and both contribute to restoring normal knee kinematics in different types of total knee arthroplasty. Further evaluation of more demanding activities and subject data from patients with bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty via musculoskeletal modeling may better highlight the role of the anterior cruciate ligament and its stabilizing influence.

scholarly journals Massive osteolysis due to galvanic corrosion after total knee arthroplasty: a rare cause for early revision?

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Mark Johannes Maria Zee ◽  
Barbara Catharina van Bemmel ◽  
Jos Jacobus Arnoldus Maria van Raay
Keyword(s):  
Total Knee Arthroplasty ◽  
Anterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Galvanic Corrosion ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Lytic Lesion ◽  
Early Revision ◽  
Total Knee ◽  
Anterior Cruciate

Abstract A 66-year-old male underwent a total knee arthroplasty for osteoarthritis after previous anterior cruciate ligament (ACL) reconstruction. Seven years postoperatively, a symptomatic large lytic lesion was present surrounding the tibial stem. A titanium interference screw, which was used prior to fixate the Anterior Cruciate Ligament (ACL) graft, was in direct contact with the tibial component. Galvanic corrosion may have attributed to the development of the lytic lesion. It is advised to remove any metal hardware in the vicinity of joint prosthesis in order to prevent a possible galvanic corrosive reaction.

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