scholarly journals Treatment Strategies and Clinical Outcomes of Knee Osteoarthritis With Extra-Articular Deformity

2021 ◽  
Author(s):  
Mingzhen Tao ◽  
Yufan Bu ◽  
Jiabang Huo ◽  
Xinjie Wang ◽  
Guangxin Huang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Femoral Osteotomy ◽  
Lower Limbs ◽  
Average Deviation ◽  
Total Knee

Abstract ObjectiveTo evaluate the methods, indications, and efficacy of the treatment of knee osteoarthritis with extra-articular deformity. MethodsA retrospective study of eight patients (three males and five females) with knee osteoarthritis complicated with extra-articular femoral deformity from February 2011 to April 2019; with an average age of 62.9 years (range 57 to 70 years). There were eight cases of coronal malformation with a mean angle of 15.5° (range 5° to 24°), and three cases of sagittal deformity with a mean angle of 14.0° (range12–16°). All eight patients underwent total knee arthroplasty (TKA). Three patients underwent femoral osteotomy and one-stage total knee arthroplasty, and one underwent femoral osteotomy and second-stage total knee joint replacement. ResultsThe mean follow-up time was 45.6 months (range 2 to 96 months). The average HSS score improved from 41.1 points (range, 28–53) preoperatively to 88.5 points (range, 71–95) at the time of the last follow-up. The average VAS score improved from 6.6 points (range, 3–10) preoperatively to 0.3 points (range, 0–1) at the time of the last follow-up. The average arc of knee motion improved from 66.3° (range 50° to 85°), preoperatively to 104.4°(range 95° to 120°) postoperatively. The average deviation of the mechanical axis of the knee improved from 17.3° (range 13° to 20°) preoperatively to 2.6°(range -6° to 6°) postoperatively. The differences between the preoperative data and postoperative follow-up data were statistically significant (P < 0.05). At the last follow-up visit, none of the eight patients had postoperative complications such as prosthesis loosening, infection, or deep vein thrombosis of the lower limbs. No bone nonunion, delayed union, or other complications occurred in the four patients with osteotomy. ConclusionAlthough it is difficult and complex to perform TKA surgery in patients with extra-articular deformity, a preoperative surgical plan should be made individually according to the patient's condition, and if necessary, the mechanical axis of the lower limbs can be effectively restored with the help of computer navigation technology or 3D printing technology, to achieve satisfactory surgical results.

scholarly journals Single-stage total knee arthroplasty and femoral osteotomy for osteoarthritis with severe supracondylar deformity

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jing-yang Sun ◽  
Guo-qiang Zhang ◽  
Jun-min Shen ◽  
Yin-qiao Du ◽  
Tie-jian Li ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Corrective Osteotomy ◽  
Femoral Osteotomy ◽  
Single Stage ◽  
Cemented Stem ◽  
Total Knee

Abstract Background Knee osteoarthritis associated with extra-articular deformity (EAD) can confront the arthroplasty surgeons with challenges of bone resection and soft tissue balancing. The aim of this study was to describe a single-stage procedure associating corrective osteotomy with total knee arthroplasty (TKA), and to determine the outcome at mid- to long-term follow-up. Methods A total of seven patients (seven knees) with knee osteoarthritis and supracondylar deformity were included in this study. Six patients were female, and one was male, with the median age of 62 years (range, 37-76 years). All patients were treated with single-stage TKA and femoral osteotomy. Osteotomy was fixed with long cemented stem. Hospital of Special Surgery (HSS) scores, collateral ligament laxity, and range of motion (ROM) were clinically evaluated preoperatively and at each follow-up. Radiographic parameters including the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), mechanical proximal tibial angle (mMPTA), and joint line congruence angle (JLCA) were also measured. The occurrence of perioperative complications was recorded. Results The median follow-up time was 91 months (range, 38-104 months). At the last follow-up, all components were stable and no patients required revision. Nonunion of the osteotomy occurred in one patient. In all patients, the lower limb mechanical alignment improved greatly. The mean angle of MAD was restored from 10.49±6.05 cm preoperatively to 1.11±4.97 cm postoperatively. The 90° mLDFA was almost acquired in all cases, with the postoperative value of 90.79±2.40°. After operation, the mMPTA improved from 84.18±6.13° to 91.33±3.13°. The JLCA changed from 2.94±1.61° to −0.71±3.50°. The median HSS score improved from 45 (range, 34-56) preoperatively to 90 (range, 82-97) postoperatively, with the outcome of all patients rated good to excellent. The median ROM improved from 70° (range 0–110°) preoperatively to 105° (range 90–125°) postoperatively. No instability of knee joint was observed. Complications included an intraoperative split fracture of distal femur and one case of wound exudation resulting from fat liquefaction. Conclusions For knee osteoarthritis with femoral supracondylar deformity, single-stage TKA and corrective osteotomy was feasible but technically demanding. The use of long cemented stem for osteotomy fixation can provide reliable rotational control of the bone segments.

scholarly journals Predictive value of preoperative erythrocyte electrophoresis exponent for acute deep vein thrombosis after total knee arthroplasty in patients with knee osteoarthritis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Dai Xiaoyu ◽  
Chen Kai ◽  
Huang Zhihui ◽  
Li Huan ◽  
Zhang Naidong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Deep Vein Thrombosis ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Predictive Value ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Post Surgery ◽  
Total Knee ◽  
Deep Vein

Abstract Background Hemorheological parameters have been confirmed to be related with deep vein thrombosis (DVT). This study is aimed to verify whether preoperative erythrocyte electrophoresis exponent was associated with postoperative deep vein thrombosis (DVT) risk after total knee arthroplasty (TKA) in patients with primary knee osteoarthritis (KOA). Methods From March 2010 to May 2020, a total of 750 consecutive KOA patients who accepted unilateral TKA were enrolled. They were divided into DVT (176 patients) and non-DVT groups (574 patients) according to the examination results of the Doppler ultrasound of deep veins in both lower limbs on postoperative day 3. The Chi-square test, Student’s t test, and multivariate logistic regression analysis were performed to analyze the correlation of erythrocyte electrophoresis exponent and DVT risk in 2 groups. Receiver operating characteristic (ROC) analysis was used to assess predictive value of erythrocyte electrophoresis exponent for DVT. Results A low erythrocyte electrophoresis exponent was a significant risk factor for DVT in patients with primary KOA (p < 0.05), especially in females when stratified by gender (p < 0.05). Conclusions The findings suggest that lower erythrocyte electrophoresis before surgery may be independently associated with a higher post-surgery DVT risk in primary KOA patients. It is necessary to optimize prophylaxis strategies for DVT in these patients.

scholarly journals Correction of Varus Alignment with Peripheral Osteophyte Removal during Total Knee Arthroplasty: An Assessment with Computer Navigation

2021 ◽  
Author(s):  
Nobuhiro Nishihara ◽  
Hironari Masuda ◽  
Naoya Shimazaki ◽  
Seikai Toyooka ◽  
Hirotaka Kawano ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Repeated Measures ◽  
Soft Tissues ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Varus Deformity ◽  
Varus Alignment ◽  
Valgus Stress ◽  
Total Knee

AbstractTechniques for symmetrical balancing in flexion and extension have been described; however, the ideal technique is unclear. This study aimed to clarify whether resection of peripheral osteophytes could restore neutral hip–knee–ankle (HKA) angle of varus deformity of arthritic knees. Data from 90 varus arthritic knees that had undergone total knee arthroplasty (TKA) using a nonimage-based navigation system were analyzed. The change in the coronal mechanical axis, while applying manual valgus stress at extension and 90 degrees of knee flexion, was recorded after the following sequential procedures: (1) anterior cruciate ligament (ACL) sectioning, (2) subperiosteal stripping of the deep medial collateral ligament (MCL) from the underlying osteophytes on the medial tibia, and (3) complete removal of peripheral osteophytes from the proximal medial tibia and distal medial femoral condyle. Repeated measures of analysis of variance (ANOVA) were performed to compare the varus angle among each step, and a post hoc analysis by paired t-test was utilized to compare the parameters between baseline and each step. The varus alignment with valgus stress at extension and 90 degrees of flexion (mean: 6.0 ± 3.6 and 5.2 ± 3.9 degrees of varus, respectively) was significantly corrected to a near-neutral mechanical axis (mean: 0.9 ± 2.4 and 1.4 ± 4.2 degrees of varus, respectively) after peripheral osteophyte resection (p < 0.01, both). In many cases, varus deformity of arthritic knees could be corrected to near-neutral HKA angle by applying manual valgus stress after complete peripheral osteophyte resection. These procedures could facilitate soft tissue balancing in TKA, minimizing the risk of overrelease of the medial soft tissues.

Patellar Resurfacing Does Not Improve Clinical Outcome in Patients with Symptomatic Tricompartmental Knee Osteoarthritis. An RCT Study of 40 Patients Receiving Primary Cruciate Retaining Total Knee Arthroplasty

2020 ◽  
Author(s):  
Tom M. van Raaij ◽  
Evelien van der Meij ◽  
Astrid J. de Vries ◽  
Jos J.A.M. van Raay
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Outcome Measurement ◽  
Measurement Tool ◽  
Patellar Resurfacing ◽  
Cruciate Retaining ◽  
Alignment Procedure ◽  
Total Knee

AbstractThere is some evidence that patellofemoral (PF) joint osteoarthritis (OA) causes anterior knee pain (AKP) after total knee arthroplasty (TKA). We hypothesized that patellar resurfacing in primary TKA for patients with symptomatic tricompartmental knee OA yields better clinical results after 2 years than non-resurfacing. A single center randomized controlled clinical trial comparing 40 patients receiving 42 cruciate retaining TKAs with (n = 21) or without patellar resurfacing (n = 21) was conducted. Primary outcome was the specific PF joint score HSS Baldini and secondary outcomes were the Knee Society Score (KSS) and the Knee Osteoarthritis Outcome Scale (KOOS). After 2 years no significant differences between both groups and between the groups in time for HSS Baldini, KSS, and KOOS were found. HSS Baldini score improved significantly after 6 weeks in both groups (p < 0.001) and did not improve in time afterward. At final follow-up the HSS Baldini mean score improved from a preoperative mean of 39 to 88 (difference of 49 points; p < 0.001)) for without patellar resurfacing group, and from a preoperative mean of 37 to 81 for patellar resurfacing group (difference of 47 points; p < 0.001). One patient in the patellar resurfacing group underwent a soft tissue re-alignment procedure because of patellar subluxation. Two patients in without patellar resurfacing group received secondary patellar button placement. Patellar resurfacing in primary TKA for patients with symptomatic tricompartmental OA has no beneficial effect over non-resurfacing and seems unnecessary. A special PF joint outcome measurement tool (HSS Baldini) and common knee scores showed no better knee function or AKP outcomes for with patellar resurfacing over without patellar resurfacing group in time and after 2 years of follow-up.

scholarly journals Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?

2008 ◽  
Vol 33 (6) ◽  
pp. 1567-1570 ◽  
Author(s):  
Yogeesh D. Kamat ◽  
Kamran M. Aurakzai ◽  
Ajeya R. Adhikari ◽  
Daniel Matthews ◽  
Yegappan Kalairajah ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Computer Navigation ◽  
Improve Patient Outcome ◽  
Total Knee ◽  
Improve Patient

scholarly journals Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Rohan Bhimani ◽  
Fardeen Bhimani ◽  
Preeti Singh
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Primary Total Knee Arthroplasty ◽  
P Value ◽  
Mechanical Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Introduction. Malpositioning of the implant results in polyethylene wear and loosing of implant after total knee arthroplasty. Scanogram is often used for measurement of limb alignment. Computer navigation provides real time measurements and thus, the aim is to see any association pre- and postoperatively between coronal alignments measured on scanogram to computer navigation during total knee arthroplasty. Material and Methods. We prospectively gathered data of 200 patients with advanced degenerative symptomatic arthritis, who were consecutively selected for primary total knee arthroplasty with computer navigation. Every patient’s pre- and postoperative scanogram were compared to the intraoperative computer navigation findings. Results. The results show that the preoperative mean mechanical axis on navigation was 10.65° (SD ± 6.95) and on scanogram it was 10.38° (SD ± 6.89). On the other hand, the mean postoperative mechanical axis on navigation was 0.69° (SD ± 0.87) and on scanogram it was 2.73° (SD ± 2.10). Preoperatively, there was no significant difference (p value = 0.46) between the two. However, the postoperative outcomes suggest that there was a noteworthy difference, with no correlation between the mean Hip-Knee Ankle Axis (HKA) and intraoperative mechanical axis (p value <0.0001). Conclusion. Postoperative mechanical alignment values after total knee arthroplasty are lower on navigation than measured on standing full length hip to ankle scanogram.

scholarly journals Effect of Coronal Alignment on 10-Year Survivorship of a Single Contemporary Total Knee Arthroplasty

2021 ◽  
Vol 10 (1) ◽  
pp. 142
Author(s):  
Meagan E. Tibbo ◽  
Afton K. Limberg ◽  
Kevin I. Perry ◽  
Mark W. Pagnano ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Coronal Alignment ◽  
Radiographic Evidence ◽  
Outlier Group ◽  
Axis Alignment ◽  
Total Knee

Debate remains regarding the utility of mechanical axis alignment as a predictor of durability after total knee arthroplasty (TKA). Our study aimed to assess the effects of coronal alignment on implant durability, clinical outcomes, and radiographic results with a single fixed-bearing TKA design. All patients undergoing primary cemented TKA of a single design (Stryker Triathlon) from 2005–2007 with >10 years of follow-up and available pre-operative and post-operative hip–knee–ankle radiographs were included (n = 89). Radiographs were measured to determine coronal alignment and assessed for loosening. Mean preoperative mechanical axis alignment was −6° ± 6.7° (varus, range, −16°–23°), while mean post-operative alignment was −1° ± 2.7° (varus, range, −3°–15°). The aligned group was defined as knees with a post-operative mechanical axis of 0° ± 3° (n = 73) and the outlier group as those outside this range (n = 16). No patients underwent revision. Ten-year survivorship free from any reoperation was 99% and 100% in the aligned and outlier groups, respectively (p = 0.64). Knee Society scores improved significantly in both groups (p < 0.001) and did not differ at final follow-up (p = 0.15). No knees demonstrated radiographic evidence of loosening. Post-operative mechanical axis alignment within 3° of neutral was not associated with improved implant durability, clinical outcomes, or radiographic results at 10 years following primary TKA.

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