scholarly journals Patellar Tilt in Two Modern Total Knee Arthroplasty Systems: A Matched-Cohort Analysis

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Braeden W. Estes, BS ◽  
Lauren Pitz, BS ◽  
Evan R. Deckard, BSE ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Activity Level ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Premature Failure ◽  
Patient Reported ◽  
Total Knee

Background and Hypothesis: Excessive patellar tilt is undesirable in total knee arthroplasty (TKA) and can result in patellofemoral complications and premature failure/wear. Few studies have investigated patellar tilt between TKA systems with different femoral component geometries and bearing articulations. The purpose of this study was to (1) compare patellar tilt between TKA systems with differing femoral component geometries and (2) evaluate related differences in patient-reported outcome measures (PROMS). The study hypothesis was neutral patellar tilt would correlate with improved postoperative PROMS. Experimental Design or Project Methods: 380 symmetric trochlear groove TKAs were matched to 380 asymmetric lateralized trochlear groove TKAs on age, sex, body mass index, and preoperative patellar tilt. All cases were performed by one surgeon between 12/2010 and 10/2018. Patellar tilt (in degrees) was measured by two independent blinded raters on preoperative and 4-week postoperative merchant view radiographs per the modern Knee Society Radiographic Evaluation System. Prospectively collected and validated PROMS including UCLA Activity Level, components of the Knee Society Score, and Likert satisfaction were evaluated at minimum one-year. Results: There were no differences between study cohorts for demographics, covariates, or preoperative patellar tilt (p≥0.479). Asymmetric lateralized trochlear groove TKAs had significantly less postoperative patellar tilt compared with symmetric trochlear groove TKAs (p<0.001). Patellar tilt and femoral implant type had no correlation to pain scores (Knee Society), UCLA Activity Level, or satisfaction (p≥0.138); however, postoperative patellar tilt was significantly less for patients who stated their knee “always” felt normal compared to patients who stated their knee “sometimes” felt normal but not “never” felt normal (p=0.033). Conclusion and Potential Impact: Findings suggest implant type and patellar tilt have minimal effect on overall PROMS. However, minimizing patella maltracking may provide patients with a more normal feeling TKA and could potentially provide long-term benefits of preventing polyethylene wear or other complications leading to premature implant failure.

scholarly journals Correlation Between Asymmetric Resection of Posterior Femoral Condyles and Femoral Component Rotation in Total Knee Arthroplasty

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0014
Author(s):  
Harun Reşit Güngör ◽  
Nusret Ök ◽  
Kadir Ağladıoğlu ◽  
Semih Akkaya ◽  
Esat Kıter
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Trochlear Groove ◽  
Femoral Component Rotation ◽  
Component Rotation ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean ◽  
The Asymmetry

Objectives: Pertaining to peculiar designs of current knee prostheses, more bone is removed from posteromedial femoral condyle than posterolateral condyle to obtain desired femoral component rotation. The aim of our study was to evaluate whether there is a correlation between the asymmetry of the cuts and the femoral component rotation in total knee arthroplasty. Methods: We built a model to simulate anterior chamfer cut (ACC) performed during total knee arthroplasty for measuring posterior condylar offset (PCO). Right knee axial MRI slices of a total 290 consecutive patients (142 male, 138 female, and mean age 31.39 ± 6.6) were examined. A parallel line to surgical transepiphyseal axis was drawn, and placed at the deepest part of trochlear groove. Posteromedial and posterolateral condylar offsets were measured by drawing perpendicular lines to ACC beginning from the intersection points of both anteromedial and anterolateral cortices to posterior joint line (PJL), respectively. Differences between posteromedial and posterolateral PCO were calculated, and femoral rotation angles (FRA) relative to PJL were measured. Results: The mean surgical FRA was 4.76 ± 1.16 degrees and the mean PCO differencesss- was 4.35 ± 1.04 mm for the whole group and there was no statistically significant difference between genders. There was a strong correlation between surgical FRA and PCO difference (p<0.0001, r=0.803). Linear regression analyses revealed that 0.8 mm of difference between the anteroposterior dimensions of medial and lateral PCO corresponds to 1 degree of surgical FRA (p<0.0001, R2=0.645). Conclusion: Correlation between the asymmetry of posterior chamfer cuts and achieved femoral component rotation can verify the accuracy of desired rotation, intraoperatively. However, further clinical investigations should be planned to test the results of our morphometric study.

scholarly journals The Influence of Medial Collateral Ligament and Lateral Collateral Ligament Pie Crusting in Primary Total Knee Arthroplasty on Patient Reported Outcomes

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ethan Cornwell ◽  
Evan R. Deckard ◽  
Kevin A. Sonn ◽  
R. Michael Meneghini
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Lateral Collateral Ligament ◽  
Activity Level ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Study Results ◽  
Patient Reported ◽  
Total Knee

Background and Hypothesis: Pie-crusting of the collateral ligaments can help achieve balanced gaps in total knee arthroplasty (TKA) in knees with varus or valgus deformity. However, the effect of this technique on patient-reported outcome measures (PROMs) is unknown.  The purpose of this study was to compare PROMs following primary TKA for patients with and without medial collateral ligament (MCL) or lateral collateral ligament (LCL) pie-crusting. Experimental Design or Project Methods: We retrospectively reviewed 1,305 primary TKAs. Intraoperative MCL or LCL pie-crusting was documented in all operative reports and recorded. Prospectively collected preoperative, 4-month postoperative, and minimum 1-year postoperative PROMs related to overall knee health, pain during functional activities, activity level, and overall satisfaction were compiled and compared between patients with and without MCL or LCL pie-crusting.  Medians were evaluated with Kruskal-Wallis test adjusted for ties. Results: The cohort was 67% female with mean age 66 years and BMI 34.0 kg/m2. MCL or LCL pie-crusting was performed in 13.0% of the cohort.  There were no intraoperative or postoperative ruptures of the MCL or LCL. 6.3% of conforming bearing TKAs required a collateral ligament pie crusting versus 21.5% of standard bearing TKA (p<0.001). No significant differences were found in preoperative, 4-month, minimum 1-year, or change from preoperative baseline to minimum 1-year PROMs with and without pie-crusting of the collateral ligaments (p≥0.095).  However, the LCL pie-crusting group had slightly better PROMs at minimum 1-year. Conclusion and Potential Impact: These study results corroborate existing literature that pie-crusting of collateral ligaments is safe and effective to achieve a balanced TKA.  Additionally, no significant outcome differences were found between groups with and without MCL or LCL pie-crusting. However, LCL pie-crusting for valgus knee correction had slightly better PROMs.  Interestingly, conforming bearings may impart enhanced stability and mitigate the need for pie-crusting ligament releases in TKA.

Patellar tilt does not affect patient reported outcomes after modern total knee arthroplasty

The Knee ◽  
2022 ◽  
Vol 34 ◽  
pp. 167-177
Author(s):  
Neal B. Naveen ◽  
Evan R. Deckard ◽  
Mary Ziemba-Davis ◽  
Logan F. Hanson ◽  
Lucian C. Warth ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Patellar Tilt ◽  
Patient Reported ◽  
Total Knee

Tibial Tubercle-Trochlear Groove Distance Influences Patellar Tilt After Total Knee Arthroplasty

2019 ◽  
Vol 34 (12) ◽  
pp. 3080-3087 ◽  
Author(s):  
Shinichiro Nakamura ◽  
Koichiro Shima ◽  
Shinichi Kuriyama ◽  
Kohei Nishitani ◽  
Hiromu Ito ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Total Knee

Femoral Component Malrotation Produces Quadriceps Weakness and Impaired Ambulatory Function following Total Knee Arthroplasty: Results of a Forward-Dynamic Computer Model

2019 ◽  
Vol 33 (11) ◽  
pp. 1121-1127
Author(s):  
John F. Nettrour ◽  
Swithin S. Razu ◽  
James A. Keeney ◽  
Trent M. Guess
Keyword(s):  
Total Knee Arthroplasty ◽  
Internal Rotation ◽  
Femoral Component ◽  
Computer Model ◽  
Knee Arthroplasty ◽  
Vastus Lateralis ◽  
Patient Specific ◽  
Patient Reported ◽  
Total Knee ◽  
The Individual

AbstractProper placement of the prosthetic components is believed to be an important factor in successful total knee arthroplasty (TKA). Implant positioning errors have been associated with postoperative pain, suboptimal function, and inferior patient-reported outcome measures. The purpose of this study was to investigate the biomechanical effects of femoral component malrotation on quadriceps function and normal ambulation. For the investigation, publicly available data were used to create a validated forward-dynamic, patient-specific computer model. The incorporated data included medical imaging, gait laboratory measurements, knee loading information, electromyographic data, strength testing, and information from the surgical procedure. The ideal femoral component rotation was set to the surgical transepicondylar axis and walking simulations were subsequently performed with increasing degrees of internal and external rotation of the femoral component. The muscle force outputs were then recorded for the quadriceps musculature as a whole, as well as for the individual constituent muscles. The quadriceps work requirements during walking were then calculated for the different rotational simulations. The highest forces generated by the quadriceps were seen during single-limb stance phase as increasing degrees of femoral internal rotation produced proportional increases in quadriceps force requirements. The individual muscles of the quadriceps displayed different sensitivities to the rotational variations introduced into the simulations with the vastus lateralis showing the greatest changes with rotational positioning. Increasing degrees of internal rotation of femoral component were also seen to demand increasing quadriceps work to support normal ambulation. In conclusion, internal malrotation of the femoral component during TKA produces a mechanically disadvantaged state which is characterized by greater required quadriceps forces (especially the vastus lateralis) and greater quadriceps work to support normal ambulation.

Patient-Reported Activity Level After Total Knee Arthroplasty

2008 ◽  
Vol 23 (3) ◽  
pp. 401-407 ◽  
Author(s):  
Diane L. Dahm ◽  
Sunni A. Barnes ◽  
Jeffrey R. Harrington ◽  
Siraj A. Sayeed ◽  
Daniel J. Berry
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Activity Level ◽  
Patient Reported ◽  
Total Knee
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