scholarly journals Good clinical outcomes of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis: a case-matched cohort comparative study of PFA with TKA

2020 ◽  
Author(s):  
Fei Wang ◽  
Wei Lin ◽  
Jia Chen ◽  
Yike Dai ◽  
Jinghui Niu ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Short Form ◽  
Oxford Knee Score ◽  
Knee Score ◽  
Patellofemoral Osteoarthritis ◽  
Patellofemoral Arthroplasty ◽  
Scale Range ◽  
Activity Scale ◽  
Tegner Activity Scale

Abstract Background: Severe isolated patellofemoral osteoarthritis is usually treated by total knee arthroplasty (TKA) in the majority of the world but patellofemoral arthroplasty (PFA) has been a viable alternative for many years although there have been concerns about implant longevity. The purpose of this research was to compare the clinical outcome of patients with isolated patellofemoral osteoarthritis who received PFA or TKA. Methods: From January 2015 to December 2017, 42 patients with isolated patellofemoral osteoarthritis who received PFA were included in the PFA group. In this period, a matched cohort of 42 patients with isolated patellofemoral osteoarthritis who received TKA (TKA group) was chosen for comparison. The results of the two groups were compared before surgery and at last follow-up using Tegner Activity Scale, Range of motion of the knee, Oxford Knee Score and Short Form 36 Health Survey. Differences were considered statistically significant at p < 0.05.Results: The mean follow-up time was 3.5 ± 0.3 and 3.4 ± 0.3 years in the PFA and TKA groups (p = 0.13), respectively. No significant difference in preoperative knee scores were found between the two groups (p > 0.05). However, postoperative, compared with Tegner Activity Scale, Range of motion, Oxford Knee Score and Short Form 36 Health Survey, the PFA group performed significantly better results (p < 0.05). The Kaplan-Meier implant survivorship with 95% confidence intervals was 94.12 % in the PFA group and 94.74% in the TKA group (p = 0.49).Conclusions: The patients with isolated patellofemoral osteoarthritis who underwent PFA had shown better clinical outcomes and higher quality of life. We believed that for the treatment of isolated patellofemoral osteoarthritis, the PFA was a less invasive procedure with improved patient satisfaction and range of motion at medium term follow-up.

Patellofemoral Arthroplasty Improves Patellofemoral Alignment in Patients with Patellofemoral Osteoarthritis with Trochlear Dysplasia

2020 ◽  
Author(s):  
Guangmin Yang ◽  
Jue Wang ◽  
Yike Dai ◽  
Wei Lin ◽  
Jinghui Niu ◽  
...  
Keyword(s):  
Trochlear Dysplasia ◽  
Oxford Knee Score ◽  
Trochlear Groove ◽  
Knee Score ◽  
Patellofemoral Osteoarthritis ◽  
Patellofemoral Arthroplasty ◽  
Patient Reported ◽  
Patellofemoral Alignment ◽  
The Impact

AbstractThe impact of trochlear dysplasia on patellofemoral arthroplasty (PFA) has rarely been reported in the literature. The purpose of this study was to explore the effectiveness of PFA in patients with patellofemoral osteoarthritis (PFOA) associated with trochlear dysplasia. From January 2014 to March 2018, 35 patients with PFOA and trochlear dysplasia (29 females and 6 males), underwent PFA, were included in the present retrospective study. Radiological measurements including the patellar tilt (PT), congruence angle (CA), Blackburne–Peel ratio (BPR), tibial tuberosity–trochlear groove (TT–TG) distance, and lateral trochlear inclination (LTI) were assessed pre- and postoperatively to evaluate the changes in patellofemoral alignment. The patient-reported functional outcome was assessed using the Oxford Knee Score. The mean follow-up time was 24 months (range, 18–42 months). The intraclass correlation coefficients were excellent for all measurements. The patellofemoral alignment and knee function were significantly improved postoperatively. The PT decreased from 23.3 ± 6.3 degrees preoperatively to 6.4 ± 2.3 degrees postoperatively (p < 0.001). The CA decreased from 32.3 ± 8.6 degrees preoperatively to 10.2 ± 3.6 degrees postoperatively (p < 0.001). The lateral trochlear inclination increased from 8.3 ± 4.1 degrees preoperatively to 16.0 ± 1.2 degrees postoperatively (p < 0.001). The TT–TG distance decreased from 18.2 ± 3.8 mm preoperatively to 11.5 ± 3.3 mm postoperatively (p < 0.001). The BPR did not significantly change postoperatively (p = 0.390). The average Oxford Knee Score improved from 19.5 preoperatively to 29.2 at 6 months postoperatively (p < 0.001), 37.9 at 1 year postoperatively (p < 0.001), and 39.1 at final follow-up (p < 0.001). No patient developed patellofemoral malalignment or prosthesis loosening during short-term follow-up. PFA achieved favorable therapeutic results in patients with PFOA associated with trochlear dysplasia.

Patellofemoral arthroplasty versus total knee arthroplasty for patients with patellofemoral osteoarthritis

2019 ◽  
Vol 101-B (1) ◽  
pp. 41-46 ◽  
Author(s):  
N. D. Clement ◽  
T. A. Howard ◽  
R. J. Immelman ◽  
D. MacDonald ◽  
J. T. Patton ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Short Form ◽  
Patellofemoral Osteoarthritis ◽  
Patellofemoral Arthroplasty ◽  
Significant Difference ◽  
Total Knee

Aims The primary aim of this study was to compare the knee-specific functional outcome of patellofemoral arthroplasty with total knee arthroplasty (TKA) in the management of patients with patellofemoral osteoarthritis. Patients and Methods A total of 54 consecutive Avon patellofemoral arthroplasties were identified and propensity-score-matched to a group of 54 patients undergoing a TKA with patellar resurfacing for patellofemoral osteoarthritis. The Oxford Knee Score (OKS), the 12-Item Short-Form Health Survey (SF-12), and patient satisfaction were collected at a mean follow up of 9.2 years (8 to 15). Survival was defined by revision or intention to revise. Results There was no significant difference in the mean OKS (p > 0.60) or SF-12 scores (p > 0.28) between the groups. There was a lower rate of satisfaction at the final follow-up for the TKA group (78% vs 87%) but this was not statistically significant (odds ratio 0.56, p = 0.21). Length of stay was significantly shorter (p = 0.008) for the Avon group (difference 1.8 days, 95% confidence interval (CI) 0.4 to 3.2). The ten-year survival for the Avon group was 92.3% (95% CI 87.1 to 97.5) and for the TKA group was 100% (95% CI 93.8 to 100). This difference was not statistically significant (log-rank test, p = 0.10). Conclusion Patients undergoing an Avon patellofemoral arthroplasty have a shorter length of stay, and a functional outcome and rate of satisfaction that is equal to that of TKA. The benefits of the Avon arthroplasty need to be balanced against the increased rate of revision when compared with TKA.

scholarly journals Arthroscopic revision surgery in the arthrofibrotic knee: who benefits?

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0002
Author(s):  
Christian Weber ◽  
Jochen Müller-Stromberg ◽  
Nicola Weber
Keyword(s):  
Quality Of Life ◽  
Revision Surgery ◽  
Oxford Knee Score ◽  
Consecutive Series ◽  
Knee Score ◽  
Sports Activity ◽  
Activity Scale ◽  
Group 2 ◽  
Group 1

Arthrofibrotic stiffness of the knee joint has been recognized as a highly debilitating complication after complex knee reconstruction. The clinical impact of arthroscopic revision surgery was evaluated for patients with knee arthrofibrosis following total knee arthroplasty (TKA) and after joint preserving procedures. Hypothesis: Arthroscopic revision surgery is associated with functional benefits in both groups. We retrospectively reviewed a consecutive series of adult patients (#CHR: greaterlike#18 years) at a single institution who underwent arthroscopic revision for knee stiffness. Minimum follow-up: 24 months. The analysis included demographic, surgical and histological data. The following outcome parameters were evaluated: pain (Visual Analog Scale, VAS); objective score systems (Oxford Knee Score) and patient activity (Tegner Activity Scale (TAS), Univ. of California Activity Scale (UCLA)). Furthermore, range of motion (ROM) was compared pre-, intra- and postoperatively. Finally, we compared body mass index (BMI) and quality of life (EQ-5D) changes. We identified a total of 57 patients who underwent arthroscopic adhesiolysis for knee arthrofibrosis: 45 after TKA (Group 1) and 12 patients with ligament reconstruction (Group 2). The patient cohort included thirty (43.5%) males and thirty-six (56.5%) females. Mean age was 69 (SD 10.6) years in the TKA group and 41 (SD 12.7) years in group 2 (p=0.01). Mean length of stay (LOS) was 4.6 days in Group 1 and 2.8 days in Group 2. Pain levels (VAS) were reduced significantly in both groups (p=0.004); from 7.5 to 4.8 in Group 1 and from 7.8 to 2.9 (Group 2). In terms of sports activity, 26 patients (37.7%) reported an improved sports activity (UCLA score). The TAS improved from 2.58 to 4.08 in Group 2. The Oxford Knee Score improved from 23.5 to 27.2 in Group 1 and from 16.5 to 36.3 in Group 2. No reduction in BMI was observed. However, quality of life (EQ-5D) improved from 47.6 to 51.9 Group 1; and from 52.9 to 71.7 in Group 2. Arthroscopic revision of the stiff knee may offer clinical benefits in terms of significant pain reduction, an improved level of activity and quality of life in stiffness following both TKA and joint preserving surgical reconstruction.

The effect of tibial and femoral component coronal alignment on clinical outcomes and survivorship in unicompartmental knee arthroplasty

2021 ◽  
Vol 103-B (2) ◽  
pp. 338-346
Author(s):  
Yong Zhi Khow ◽  
Ming Han Lincoln Liow ◽  
Merrill Lee ◽  
Jerry Yongqiang Chen ◽  
Ngai Nung Lo ◽  
...  
Keyword(s):  
Femoral Component ◽  
Short Form ◽  
Oxford Knee Score ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Knee Score ◽  
Unicompartmental Knee ◽  
Unicompartmental Knee Arthroplasties ◽  
Implant Survivorship ◽  
Patient Reported

Aims This study aimed to identify the tibial component and femoral component coronal angles (TCCAs and FCCAs), which concomitantly are associated with the best outcomes and survivorship in a cohort of fixed-bearing, cemented, medial unicompartmental knee arthroplasties (UKAs). We also investigated the potential two-way interactions between the TCCA and FCCA. Methods Prospectively collected registry data involving 264 UKAs from a single institution were analyzed. The TCCAs and FCCAs were measured on postoperative radiographs and absolute angles were analyzed. Clinical assessment at six months, two years, and ten years was undertaken using the Knee Society Knee score (KSKS) and Knee Society Function score (KSFS), the Oxford Knee Score (OKS), the 36-Item Short-Form Health Survey questionnaire (SF-36), and range of motion (ROM). Fulfilment of expectations and satisfaction was also recorded. Implant survivorship was reviewed at a mean follow-up of 14 years (12 to 16). Multivariate regression models included covariates, TCCA, FCCA, and two-way interactions between them. Partial residual graphs were generated to identify angles associated with the best outcomes. Kaplan-Meier analysis was used to compare implant survivorship between groups. Results Significant two-way interaction effects between TCCA and FCCA were identified. Adjusted for each other and their interaction, a TCCA of between 2° and 4° and a FCCA of between 0° and 2° were found to be associated with the greatest improvements in knee scores and the probability of fulfilling expectations and satisfaction at ten years. Patients in the optimal group whose TCCA and FCCA were between 2° and 4°, and 0° and 2°, respectively, had a significant survival benefit at 15 years compared with the non-optimal group (optimal: survival = 100% vs non-optimal: survival = 92%, 95% confidence interval (CI) 88% to 96%). Conclusion Significant two-way interactions between the TCCA and FCCA demonstrate the importance of evaluating the alignment of the components concomitantly in future studies. By doing so, we found that patients who concomitantly had both a TCCA of between 2° and 4° and a FCCA of between 0° and 2° had the best patient-reported outcome measures at ten years and better survivorship at 15 years. Cite this article: Bone Joint J 2021;103-B(2):338–346.

scholarly journals BM-MSCs differentiated to chondrocytes for treatment of full-thickness cartilage defect of the knee

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Rodrigo Mardones ◽  
Alessio Giai Via ◽  
Gennaro Pipino ◽  
Claudio M. Jofre ◽  
Sara Muñoz ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Articular Cartilage ◽  
Cartilage Defect ◽  
Collagen Type ◽  
Oxford Knee Score ◽  
Collagen Type I ◽  
Type I ◽  
Knee Score ◽  
Full Thickness

Abstract Background Full-thickness articular cartilage injury of the knee is a major cause of disability. The aim of this study is to assess the outcome of patients treated with differentiated to chondrocytes bone marrow mesenchymal stem cells (BM-MSCs) cultured on a collagen type I/III (Chondro-Gide®) scaffold. The secondary aim was to confirm the absence of adverse events. Methods Fifteen patients (19 knees) with symptomatic full-thickness cartilage defects of the knee were enrolled. Bone marrow was harvested from the iliac crest, BM-MSCs were prepared, and expanded cells were grown in a standard medium or in a standard culture medium containing TGF-β. BM-MSCs differentiated to chondrocytes were seeded in a porcine collagen type I/III scaffold (Chondro-Gide®) and cultured in TGF-β containing media. After 4 weeks, the membrane was sutured on the cartilage defect. All patients underwent plain radiographs (antero-posterior, lateral, and axial view of the patella) and MRI of the affected knee. The Oxford knee score, the Lyhsolm scale, and the VAS score were administered to all patients. At final follow-up a MRI for the study of articular cartilage was undertaken. Results The mean size of the cartilage lesions was 20 × 17 mm (range, 15 × 10 mm–30 × 30 mm). At final follow-up, the median Oxford knee score and Lyhsolm scale scores significantly improved from 29 (range 12–39; SD 7.39) to 45 (range 24–48; SD 5.6) and from 55.5 (range 25–81; SD 17.7) to 94.5 (58–100; SD 10.8), respectively. Pain, according to the VAS score, significantly improved. Sixty percent of patients reported their satisfaction as excellent, 20% as good, 14% as fair, and 1 patient as poor. Conclusion The treatment of full-thickness chondral injuries of the knee with differentiated to chondrocytes BM-MSCs and Chondro-Gide® scaffold showed encouraging outcomes. Further studies involving more patients, and with longer follow-up, are required to evaluate the effectiveness of the treatment and the long-term results.

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

2020 ◽  
Vol 34 (01) ◽  
pp. 115-120
Author(s):  
Ali Utkan ◽  
Emrah Caliskan ◽  
Batuhan Gencer ◽  
Bulent Ozkurt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Histopathological Analysis ◽  
Knee Score ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractAlthough there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

2019 ◽  
Vol 41 (1) ◽  
pp. 69-78 ◽  
Author(s):  
Xi Liu ◽  
Jingjing An ◽  
Hui Zhang ◽  
Yaxing Li ◽  
Yu Chen ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Short Form ◽  
Young Patients ◽  
Joint Surface ◽  
Posttraumatic Arthritis ◽  
Osteochondral Graft ◽  
Tibiotalar Joint ◽  
Sf 36 ◽  
Pilon Fractures

Background: Posttraumatic arthritis of tibiotalar joints after AO/OTA type C3 pilon fractures, especially in young patients with a significant osteochondral defect in the tibial plafond joint surface, is a challenging situation. We report a joint-preserving technique using autologous osteochondral graft in combination with ankle distraction and supramalleolar osteotomy (SMOT), if necessary, to improve its outcome. Methods: Seventeen patients with an average age of 32.1 years with Takakura grade 1 to 3A posttraumatic arthritis of the tibiotalar joint after AO/OTA type C3 pilon fractures received osteochondral autograft transplantation, ankle distraction, and SMOT, when supramalleolar malalignment was present, between February 2010 and November 2015. The visual analog scale (VAS), Short-Form 36 (SF-36) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and ankle range of motion were used for outcome analysis. Radiographic assessment of any SMOT and the apparent joint space was performed. Fourteen patients were followed for an average of 18 months. Results: The VAS, SF-36, and AOFAS scores as well as the ankle range of motion all improved significantly at the last follow-up after the surgery ( P < .01). No deep surgical site infection, donor site complication, nonunion, osteochondral block loosening, or resorption was noted. No secondary arthrodesis was needed at the end of follow-up. Conclusion: Autologous osteochondral graft transplantation in combination with ankle distraction and SMOT was a promising joint-preserving technique for early posttraumatic arthritis of tibiotalar joint after severe pilon fractures in young patients. Level of Evidence: Level IV, case series.

scholarly journals BM-MSCs differentiated to chondrocytes for treatment of full-thickness cartilage defect of the knee

2020 ◽  
Author(s):  
Rodrigo Mardones ◽  
Alessio Giai Via ◽  
Gennaro Pipino ◽  
Claudio Jofrè ◽  
Sara Muñoz ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Articular Cartilage ◽  
Cartilage Defect ◽  
Collagen Type ◽  
Oxford Knee Score ◽  
Collagen Type I ◽  
Type I ◽  
Knee Score ◽  
Full Thickness

Abstract Background Full-thickness articular cartilage injury of the knee is a major cause of disability. The aim of this study is to assess the results of patients treated with differentiated to chondrocytes bone marrow Mesenchymal Stem Cells (BM-MSCs) cultured on a collagen Type I/III (Chondro-Gide®) scaffold. The secondary aim was to confirm the absence of adverse events. Methods Fifteen patients (19 knees) with symptomatic full-thickness cartilage defects of the knee have been enrolled for the study. Bone marrow was harvested from the iliac crest, BM-MSCs were prepared, and expanded cells were grown in a standard medium or in a standard culture medium containing TGF-β. BM-MSCs differentiated to chondrocytes were seeded in a porcine collagen Type I/III scaffold (Chondro-Gide®), and cultured in TGF- β containing media. After 4 weeks, the membrane was sutured on the cartilage defect. All patients underwent plain radiographs of the knee (antero-posterior, lateral, and axial view of the patella), and MRI of the affected knee. The Oxford knee score, the Lyhsolm scale, and the VAS score were administered to all patients. At final follow-up a MRI for the study of articular cartilage was undertaken. Results The mean size of the cartilage lesions was 20 × 17 mm (range, 15 × 10 mm − 30 × 30 mm). At final follow-up, the median Oxford knee score and Lyhsolm scale scores significantly improved from 29 (range 12–39; SD 7,39) to 45 (range 24–48; SD 5,6) and from 55.5 (range 25–81; SD 17,7) to 94.5 (58–100; SD 10,8) respectively. Pain, according the VAS score, significantly improved. 60% of patients reported their satisfaction as excellent, 20% as good, 14% as fair, and 1 patient as poor. Conclusion The treatment of full-thickness chondral injuries of the knee with differentiated to chondrocytes BM-MSCs and Chondro-Gide® scaffold showed encouraging outcomes. Further studies involving more patients, and with longer follow-up, are required in order to evaluate the effectiveness of the treatment and the long-term results.

scholarly journals Results of Using a “2-in-1” Single-Stage Revision Total Knee Arthroplasty for Infection with Associated Bone Loss: Prospective 2-Year Follow-Up

2019 ◽  
Author(s):  
George Holland ◽  
Gavin Brown ◽  
Stuart Goudie ◽  
Ivan Brenkel ◽  
Philip J. Walmsley
Keyword(s):  
Bone Loss ◽  
Range Of Motion ◽  
Short Form ◽  
Oxford Knee Score ◽  
Single Stage ◽  
Tissue Samples ◽  
Physical Status Classification ◽  
Prosthetic Joint Infections ◽  
Total Knee ◽  
The Mean

Abstract Objective Prosthetic joint infections provide a complex challenge for management, owing to their often difficult diagnoses, need for multiple surgeries, and increased technical and financial requirements. The ‘2 in 1’ single-stage approaches have been recently advocated in the field of arthroplasty on account of their reduction in risks, costs, and complications. The aim of our study was to investigate the outcomes of this variant of single-stage revision, which is used in the setting of infection following primary total knee replacement (TKR) and associated bone loss. Methods Prospective data were collected from all patients presenting with an infection following primary TKR over an 8-year period (2009–2017). We examined revision procedures that were undertaken as a single-stage procedure and had bone loss present. Patients were followed-up for evidence of recurrent infection. Functional assessments were conducted using range of motion, Oxford Knee Score (OKS), American Knee Society Score (AKSS), and Short Form-12 (SF-12) survey. Results Twenty-six patients were included in the analysis, two of whom had previously failed 2 stage revision; another three among them had failed debridement, antibiotics, irrigation, and implant retention procedures. The mean age was 72.5 years, mean body mass index was 33.4, and median American Society of Anesthesiologists (ASA) physical status classification was 2. The mean time to revision was 3.5 years (3 months to 12 years). Six patients had actively been discharging sinuses at the time of surgery. Only 4/26 patients possessed no positive microbiological cultures from deep tissue samples or joint aspirates. One patient was afflicted with a recurrence of infection. This patient did not require further surgery and was successfully treated with the help of long-term antibiotic suppression. There were statistically significant improvements in both the pain component of AKSS scores (preoperative 4.3 to postoperative 32.4) and the functional component of AKSS scores (preoperative 10.7 to postoperative 15.7). There was no significant improvement in flexion; however, mean extension (increased from 18.5 to 6.9 postoperative) and total range of motion (increased from 69.2 preoperative to 90.3 postoperative) both showed statistically significant improvements. Conclusion The use of “2-in-1” single-stage revision can be considered as an effective option for treating infection following TKR and associated bone loss.

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