scholarly journals Lateral Shift of the Femoral Condyle After Total Knee Arthroplasty: Simulation Using 2d-templates of the Medial Pivot Design on Knee Radiographs of Young Japanese Patients

2021 ◽  
Author(s):  
Arata Nakajima ◽  
Masato Sonobe ◽  
Yorikazu Akatsu ◽  
Manabu Yamada ◽  
Keiichiro Yamamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Young Patients ◽  
Japanese Patients ◽  
Lateral Shift ◽  
Component Size ◽  
Medial Pivot ◽  
Total Knee

Abstract Background: Total knee arthroplasty (TKA) is an established surgical treatment for advanced knee osteoarthritis by which patients can expect improvement of knee pain and function. Although many surgeons have investigated limb alignment after TKA, changes in coronal positional relation between the femur and tibia are not known well.Methods: Radiographs of 105 knees of young patients without osteoarthritic changes who received arthroscopic surgeries at our hospital were used in this study. Using 2D-templates of the medial pivot design (the FINE total knee), we simulated TKA on the knee radiographs. First, the femoral component was placed in normal knee alignment and then was merged to the medial concave of the insert where the tibial component was placed in neutral alignment. The length of the mediolateral shift of the femoral component was measured as an estimate of lateral shift of the femoral condyle, of which association with radiographic parameters for the knee was analyzed. Subjects were classified into three groups according to the femoral component size that was chosen in simulation of TKA.Results: The estimated mean lateral shift of the femoral condyle was 5.99 ± 1.98 mm and was greater in males than females (p < 0.05). Also, it was most highly correlated with the medial proximal tibial angle (MPTA) (r = -0.553, p < 0.01). A group receiving larger component sizes significantly shifted more laterally compared with a group receiving smaller component sizes (p < 0.01). Conclusions: These results suggest that the coronal positional relation between the femur and tibia is altered and subsequent ligament imbalance may occur after mechanically aligned TKA using the medial pivot design.

scholarly journals Variation of Femoral Component Size by Reference Points and Target Alignments in Total Knee Arthroplasty

2021 ◽  
Author(s):  
Shojiro Ishibashi ◽  
Hideki Mizu-uchi ◽  
Shinya Kawahara ◽  
Hidetoshi Tsushima ◽  
Yukio Akasaki ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Reference Points ◽  
Component Size ◽  
Reference Guide ◽  
Standard Position ◽  
Total Knee ◽  
Cutting Direction

Abstract Selecting appropriately sized components is important in total knee arthroplasty because they can affect postoperative knee function and pain. This study investigated size differences of 19 different femoral component placements from the standard position by three-dimensional virtual surgery using three-dimensional bone models of 101 varus osteoarthritic knees. Distal femoral bone was cut perpendicular to the femoral mechanical axis (MA) in the coronal plane. Twenty different component placements consisting of five cutting directions (perpendicular to MA, 3° and 5° extension/flexion relative to MA in the sagittal plane), two rotational alignments (clinical and surgical epicondylar axes), and two rotational types of anterior reference guide (central and medial) were simulated. The mean anteroposterior dimension of the standard position was 55.5 mm which means that the difference compared to 19 different methods ranged from -1.2 ± 0.2 mm to 7.1 ± 1.3 mm. Multiple regression analysis revealed that flexion cutting direction, surgical epicondylar axis, and central were associated with smaller component size. In conclusion, the femoral component size can be affected easily by not only cutting direction but also the reference guide type and the target alignment. Our findings could provide surgeons with clinically useful information to fine-tune for unintended loose or tight joint gaps by adjusting the component size.

scholarly journals Which is better? Anterior or posterior referencing for femoral component position in total knee arthroplasty

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110023
Author(s):  
Sho Nojiri ◽  
Kazue Hayakawa ◽  
Hideki Date ◽  
Yasushi Naito ◽  
Keigo Sato ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Standard Technique ◽  
Component Position ◽  
Intermediate Size ◽  
Total Knee ◽  
Left And Right ◽  
Anterior Posterior

When sizing the femoral component or determining its placement in total knee arthroplasty (TKA), if the anterior–posterior diameter of the femoral condyle is between component sizes, the selected size will differ depending on whether anterior referencing (AR) or posterior referencing (PR) is used. As a result, the amount of resected bone will also vary. In the present prospective study, we compared the two referencing methods to determine which is more suitable for individual patients. We recruited 58 patients (92 joints) who received TKA using the standard technique with intermediate-size components. AR was used in 26 joints, and PR in 23 joints. Seventeen of the patients underwent same-day bilateral TKA in which components of different sizes were used for the left and right joints. AR resulted in significantly smaller anterior and posterior offsets than PR. Preoperative clinical evaluation revealed no significant differences among cases in which intermediate-size components were indicated, or those in which components of different sizes were indicated. When an intermediate-sized component was indicated using the AR method, moving the sizer forward resulted in a larger posterior gap, but this technique was nevertheless considered acceptable. AR is likely to be more suitable than PR as it achieves more physiological anterior clearance.

Effects of Femoral Component Size on Proximal Tibial Strain With Anatomic Graduated Components Total Knee Arthroplasty

2010 ◽  
Vol 25 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Michael E. Berend ◽  
Scott R. Small ◽  
Merrill A. Ritter ◽  
Christine A. Buckley ◽  
James C. Merk ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Component Size ◽  
Total Knee

Effect of Surgeon Experience on Femoral Component Size Selection During Total Knee Arthroplasty

2013 ◽  
Vol 22 (02) ◽  
pp. 118-122 ◽  
Author(s):  
Sumon Nandi ◽  
James V. Bono ◽  
Mark Froimson ◽  
Morgan Jones ◽  
Boris Bershadsky
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Component Size ◽  
Size Selection ◽  
Surgeon Experience ◽  
Total Knee

scholarly journals Femoral Component Size in Total Knee Arthroplasty.

2001 ◽  
Vol 50 (2) ◽  
pp. 316-319
Author(s):  
Hiroo Sato ◽  
Kazutoshi Nomura ◽  
Mako Hirano ◽  
Noburou Hashimoto ◽  
Tetsuya Fukumoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Component Size ◽  
Total Knee

scholarly journals Restoration of Femoral Condylar Anatomy for Achieving Optimum Functional Expectations: Component Design and Early Results

2016 ◽  
Vol 6 (3) ◽  
Author(s):  
Sridhar Durbhakula ◽  
Laura F. Rego
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Component Size ◽  
Component Sizing ◽  
Early Results ◽  
Component Design ◽  
Total Knee

BACKGROUND: Many total knee arthroplasty (TKA) systems are used across a variety of markets in which outcome will be influenced by patient morphology and normal activities of daily living, for that patient population. Femoral component sizing in primary total knee arthroplasty is of paramount importance for optimizing complication free post-operative function across all patients. The purpose of this study was to report the early results of a primary TKA system in support of the component design characteristics for achievement of increased functional expectations.METHODS: A prospective, continuous series of 176 primary posterior stabilized (PS) TKAs were performed in 172 patients by a single surgeon. Femoral component size distribution was assessed and all patients were followed for a minimum of two-years post-operatively. Total Hospital for Special Surgery (HSS) scores and range of motion (ROM) was assessed for the entire cohort and by gender.RESULTS: There were no patients lost to follow-up. Two patients required incision and drainage for superficial wound infection of the indicated knees. There was no radiographic evidence of component failure. As expected, femoral component size frequency use was skewed by gender with the larger sizes in males. There were no pre- or post-operative clinical or functional differences by gender and at the recent follow-up (avg. 3.8 years). In addition, there was an average significant increase in change of HSS score (p<0.01) and ROM (P<0.01) when compared to pre-operative baseline.CONCLUSIONS: The design characteristic for component sizing and functional expectations were confirmed in the reported Western population cohort series. Further continued use and study of this primary TKA system is warranted across all ethnic cultures.

Isolated Liner Revision for Total Knee Arthroplasty Instability: A Road That Should Remain Less Taken

2020 ◽  
Author(s):  
Jason D. Tegethoff ◽  
Rafael Walker-Santiago ◽  
William M. Ralston ◽  
James A. Keeney
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
P Value ◽  
Surgical Morbidity ◽  
Exact Test ◽  
Total Knee ◽  
Component Revision

AbstractIsolated polyethylene liner exchange (IPLE) is infrequently selected as a treatment approach for patients with primary total knee arthroplasty (TKA) prosthetic joint instability. Potential advantages of less immediate surgical morbidity, faster recovery, and lower procedural cost need to be measured against reoperation and re-revision risk. Few published studies have directly compared IPLE with combined tibial and femoral component revision to treat patients with primary TKA instability. After obtaining institutional review board (IRB) approval, we performed a retrospective comparison of 20 patients treated with IPLE and 126 patients treated with tibial and femoral component revisions at a single institution between 2011 and 2018. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and reoperation (90 days, <2 years, and >2 years) were assessed using paired Student's t-test or Fisher's exact test with a p-value <0.01 used to determine significance. Patients undergoing IPLE were more likely to undergo reoperation (60.0 vs. 17.5%, p = 0.001), component revision surgery (45.0 vs. 8.7%, p = 0.002), and component revision within 2 years (30.0 vs. 1.6%, p < 0.0001). Differences in 90-day reoperation (p = 0.14) and revision >2 years (p = 0.19) were not significant. Reoperation for instability (30.0 vs. 4.0%, p < 0.001) and infection (20.0 vs. 1.6%, p < 0.01) were both higher in the IPLE group. IPLE does not provide consistent benefits for patients undergoing TKA revision for instability. Considerations for lower immediate postoperative morbidity and cost need to be carefully measured against long-term consequences of reoperation, delayed component revision, and increased long-term costs of multiple surgical procedures. This is a level III, case–control study.

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