scholarly journals Title Anterior Prominence of the Femoral Condyle Varies among Prosthesis Designs and Surgical Techniques in Total Knee Arthroplasty

2021 ◽  
Author(s):  
Junya Itou ◽  
Umito Kuwashima ◽  
Masafumi Itoh ◽  
Ken Okazaki
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Surgical Simulation ◽  
Femoral Condyle ◽  
Surgical Techniques ◽  
Planning System ◽  
Implant Design ◽  
Transepicondylar Axis ◽  
Limited Range Of Motion ◽  
Total Knee

Abstract BackgroundPatellofemoral overstuffing after total knee arthroplasty can cause limited range of motion and anterior knee pain. This study compared anterior prominence of femoral components among different prothesis designs in surgical simulation models utilizing the anterior reference (AR) and posterior reference (PR) techniques.MethodsSurgical simulations were performed using preoperative computed tomography data of 30 patients on a three-dimensional planning system. Four implant models were used: Attune, Persona, Journey II, and Legion. Rotational alignment was set parallel to the transepicondylar axis and size selection was based on absence of notch formation in the femoral anterior cortex and best fit to the shape of the medial posterior femoral condyle. For each combination of surgical technique (AR or PR method) and implant model, measurements were taken of the maximum medial, central, and lateral prominence of the implant from the anterior femoral cortex (mm).ResultsUsing either the AR or PR method, the medial and central prominences were significantly lower with Journey II than with other models. The lateral prominence was the lowest with Attune in the AR method. The AR method was associated with significantly less prominence than the PR method, regardless of implant model.ConclusionsDegree of anterior prominence of the femoral implant is affected by implant design when the AR method is used. The PR method is associated with greater anterior prominence compared with the AR method, with size pitch an additional influencing factor. Journey II is associated with the least anterior prominence when using either method.

scholarly journals Anterior prominence of the femoral condyle varies among prosthesis designs and surgical techniques in total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Junya Itou ◽  
Umito Kuwashima ◽  
Masafumi Itoh ◽  
Ken Okazaki
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Surgical Simulation ◽  
Femoral Condyle ◽  
Surgical Techniques ◽  
Planning System ◽  
Implant Design ◽  
Transepicondylar Axis ◽  
Limited Range Of Motion ◽  
Total Knee

Abstract Background Patellofemoral overstuffing after total knee arthroplasty (TKA) can cause limited range of motion and anterior knee pain. This study compared anterior prominence of femoral components among different prothesis designs in surgical simulation models utilizing the anterior reference (AR) and posterior reference (PR) techniques. Methods Surgical simulations were performed using on a three-dimensional planning system preoperative computed tomography data of consecutive 30 patients with knee osteoarthritis scheduled to undergo TKA. Four implant models were used: Attune, Persona, Journey II, and Legion. Rotational alignment was set parallel to the transepicondylar axis and size was selected based on the absence of notch formation in the femoral anterior cortex and the best fit with the shape of the medial posterior femoral condyle. For each combination of surgical technique (AR or PR method) and implant model, measurements were taken of the maximum medial, central, and lateral prominence of the implant from the anterior femoral cortex. Results Using either the AR or PR method, the medial and central prominences were significantly lower with Journey II than with the other models. The lateral prominence was the lowest with Attune in the AR method. The AR method was associated with significantly less prominence compared with the PR method, regardless of implant model. Conclusions The degree of anterior prominence of the femoral implant is affected by the implant design when the AR method is used. The PR method is associated with greater anterior prominence compared with the AR method, and the pitch size is an additional factor in the PR method. Surgeons should be familiar with implant designs, including the thickness of the anterior flange and the available size selections.

scholarly journals Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Melinda K. Harman ◽  
Stephanie J. Bonin ◽  
Chris J. Leslie ◽  
Scott A. Banks ◽  
W. Andrew Hodge
Keyword(s):  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Entire Cohort ◽  
Total Knee ◽  
And Function

Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee(96±7)and function(92±13)scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged124˚±9˚, with 126 knees exhibiting≥120°flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL.

Changes in Tibiofemoral Joint Space Following Total Knee Arthroplasty During Weight-Bearing Knee Motion

2009 ◽  
Author(s):  
Kartik M. Varadarajan ◽  
Angela L. Moynihan ◽  
Jong Keun Seon ◽  
Andrew A. Freiberg ◽  
Harry E. Rubash ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Weight Bearing ◽  
Surgical Techniques ◽  
Joint Space ◽  
Extensor Mechanism ◽  
Implant Design ◽  
Tibiofemoral Joint ◽  
Total Knee

Increasing the range of knee flexion following total knee arthroplasty (TKA) remains an important objective for design of new implants and advancement of surgical techniques. With the excellent long term (10–15 year) outcome of TKA, surgeons are more confident about performing the procedure on younger, more active patients demanding increased range of knee flexion [1–3]. Numerous factors have been linked to limited flexion (<120°) following TKA, including patient factors such as preoperative range of motion, intraoperative factors such as component malposition, and implant design [1–3]. Extensor mechanism overstretching due to overstuffing of the knee joint is hypothesized to be a contributing factor limiting knee flexion [1–4]. However, no study to date has investigated the changes in tibiofemoral joint space following TKA. The aim of this study was to examine pre- and post-operative tibiofemoral joint space in a group of TKA patients during weight-bearing knee flexion and to compare it to that in the normal/healthy knee. This could help determine if changes in the proximal-distal distance between the femur and the tibia (tibiofemoral joint space) could lead to extensor mechanism overstretching and consequently limited range of flexion.

An imaging measurement study of normal knee parameters in southeast China

2021 ◽  
Vol 17 ◽  
Author(s):  
Huitong Liu ◽  
Bingqiang Xu ◽  
Eryou Feng ◽  
Shizhang Liu ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Age Groups ◽  
Young Group ◽  
Normal Female ◽  
Valgus Angle ◽  
Significant Difference ◽  
Total Knee

Background: Imaging measurement of distal femur and proximal tibia has been the hot point in the research of total knee arthroplasty and prosthesis development, which is an important treatment for patients with advanced knee joint disease. This study retrospectively investigated the digital imaging measurement of normal knee parameters in southeast China and evaluated their clinical value. Methods: From February 2010 to May 2014, and in accordance with the inclusion criteria, a total of 677 knees (334 female knees and 343 male knees) were categorized into 3 age groups. Clinical and digital imaging data, including the distal femoral condyle diameter (FCD), tibial plateau diameter (TPD), the distance between the medial tibial plateau and fibular head (DPF), tibiofemoral valgus angle, distal femoral valgus angle, proximal tibia (PT) varus angle and the angle from femoral condyle to tibial perpendicular (FT), were measured by using AutoCAD 10.0 software. All measured variables were statistically analyzed by SPSS statistical software (version 18.0). Results: Data are presented as the mean ± standard deviation. The normal female and male femoral condyle diameter was (7.69 ± 0.46) cm and (8.68 ± 0.55) cm, while the normal female and male tibial plateau diameter was (7.66 ± 0.46) cm and (8.60 ± 0.55) cm, respectively. The normal female and male DPF was (0.76 ± 0.36) cm and (0.79 ± 0.36) cm. For females and males, the tibiofemoral valgus angle and distal femoral valgus angle were (3.89 ± 2.20) ° and (3.29 ± 2.12) °, (9.03 ± 2.18) ° and (8.25 ± 2.20) °. As the two methods to measure tibial plateau varus angle, PT angle of normal female and male was (4.29 ± 1.86) ° and (4.84 ± 2.23) °, while the normal female and male FT angle was (5.34 ± 1.95) ° and (5.52 ± 2.07) °. Based on the data obtained, we found significant differences between the two genders in terms of the femoral condyle diameter and tibial plateau diameter in all age groups (P < 0.01). The DPF parameter showed an obvious difference between the young group and the middle-aged group (P < 0.05), and no significant difference was observed between the sides and genders (P > 0.05). The distal femoral valgus angle showed statistical differences between genders in the left side of the young group and middle-aged group (P < 0.05), while angle PT and FT showed no significant difference (P > 0.05). Conclusion: A large number of knee measurements was obtained, and a local knee database was developed in this study. Imaging measurement prior to total knee arthroplasty is clinically important for increasing the accuracy and long-term efficacy of total knee arthroplasty. These data can also provide useful information for knee surgery and sports medicine as well as prosthesis development.

The Epidemiology of Revision Total Knee Arthroplasty

2021 ◽  
Author(s):  
John M. Tarazi ◽  
Zhongming Chen ◽  
Giles R. Scuderi ◽  
Michael A. Mont
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Polyethylene Wear ◽  
Failure Mechanisms ◽  
Surgical Techniques ◽  
Index Procedure ◽  
Total Knee ◽  
Modern Era ◽  
Causes Of Failure

AbstractWith an expected increase in total knee arthroplasty (TKA) procedures, revision TKA (rTKA) procedures continue to be a burden on the United States health care system. The evolution of surgical techniques and prosthetic designs has, however, provided a paradigm shift in the etiology of failure mechanisms of TKA. This review can shed light on the current reasons for revision, which may lead to insights on how to improve outcomes and lower future revision risks. We will primarily focus on the epidemiology of rTKA in the present time, but we will also review this in the context of various time periods to see how the field has evolved. We will review rTKAs: 1) prior to 1997; 2) between 1997 and 2000; 3) between 2000 and 2012; and 3) in the modern era since 2012. We will further subdivide each of the sections into reasons for early (first 2 years after index procedure) versus late revisions (greater than 2 years after index procedure). In doing so, it was determined that prior to 1997, the most prevalent causes of failure were infection, patella failure, polyethylene wear, and aseptic loosening. After a major shift of failure mechanisms was described by Sharkey et al, polyethylene wear and aseptic loosening became the leading causes for revision. However, with the improved manufacturing technology and implant design, polyethylene wear was replaced with aseptic loosening and infection as the leading causes of failure between 2000 and 2012. Since that time, in the modern era of TKA, mechanical loosening and infection have taken over the most prevalent causes for failure. Hopefully, with continued developments in component design and surgical techniques, as well as increased focus on infection reduction methods, the amount of rTKA procedures will decline.

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