scholarly journals Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

2017 ◽  
Vol 11 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Hagen Hommel ◽  
Kai Wilke
Keyword(s):  
Total Knee Arthroplasty ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Functional Results ◽  
Similar Rate ◽  
Osteoarthritis Of The Knee ◽  
Early Results ◽  
Total Knee

Background: Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer. Objective: The current study was undertaken to assess whether the use of this TKA system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. Material and Methods: This retrospective study enrolled 257 consecutive patients (257 knees) undergoing TKA for osteoarthritis of the knee, with the first 153 receiving cemented Journey BCS I implants and the remaining 104 receiving cemented Journey BCS II implants when these became available. Results: Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness. Incidence of iliotibial friction syndrome was considered low: three (2.0%) knees in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no clinically relevant differences in any of the clinical outcomes. Conclusion: When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant.

scholarly journals Good early results obtained with a guided-motion implant for total knee arthroplasty: a consecutive case series

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Hagen Hommel
Keyword(s):  
Total Knee Arthroplasty ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Knee Score ◽  
Function Score ◽  
Early Results ◽  
Total Knee ◽  
One Year

A bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design was introduced to improve knee kinematics by more closely approximating those of a normal knee. Previous studies have shown a high incidence of complications with this implant type, which led to recent modifications of the design by the manufacturer. The current study was undertaken to assess whether the use of a guided-motion knee system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. The secondary aim was to assess if there were any differences between the original and modified implant designs. This retrospective study enrolled 204 consecutive patients (204 knees) undergoing TKA for osteoarthritis of the knee, with the first 154 receiving cemented Journey BCS I implants and the remaining 51 receiving cemented Journey BCS II implants when these became available. At follow-up, patients were tested for the presence of iliotibial friction syndrome (ITB-F) and midflexion instability. Knee score and function score were taken preoperatively, at one year, and at final follow-up. Outcome data between the two implant types were compared using the Mann-Whitney test. No patients were lost to follow-up. Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness (flexion < 90°). Incidence of ITB-F syndrome was considered low: three (2.0%) knees in the BCS I group and two (3.9%) in the BCS II group (p = 0.367). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (3.9%) in the BCS II group (p = 0.367). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no significant differences in range of motion, knee score, or function score. When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant. Long-term follow-up studies are needed to confirm our findings.

scholarly journals FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 807.3-807
Author(s):  
I. Moriyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Osteoarthritis Of The Knee ◽  
Patellar Resurfacing ◽  
Criterion A ◽  
Total Knee ◽  
The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

scholarly journals Cement Arthrodesis of the Knee with a Custom Long Recon Nail After Failed Total Knee Arthroplasty: Surgical Technique and Results

2018 ◽  
Vol 12 (1) ◽  
pp. 554-566
Author(s):  
Malcolm R. DeBaun ◽  
Stuart B. Goodman ◽  
David W. Lowenberg
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Treatment Algorithm ◽  
Case Series ◽  
Cement Spacer ◽  
Knee Arthrodesis ◽  
Retrospective Case ◽  
Total Knee

Background and Objective: Persistent periprosthetic joint infection (PJI) is a devastating complication after Total Knee Arthroplasty (TKA). We hypothesize that our novel treatment algorithm utilizing a customized knee spanning recon nail combined with an antibiotic eluting cement spacer improves ambulation status and prevents recurrent PJI in patients with failed TKA and severe bone loss. Methods: In a retrospective case series, 15 consecutive patients who underwent knee arthrodesis after failed ipsilateral TKA secondary to infection from 2004-2017 with at least 1 year of follow-up were enrolled. The average age of patients at the time surgery was 68 (range 50-81) years with an average follow-up of 3.2 (range 1-6) years. Post-surgical ambulation status and eradication of index infection were analyzed as primary outcomes using McNemar’s test for before-and-after study design with p<0.05 for significance. Results: Cement arthrodesis significantly improved ambulation with 67% (10/15) of patients unable to ambulate before arthrodesis and 93% (14/15) of patients able to ambulate at final follow-up (p=0.004). The complication rate was 20% (3/15). There were no periprosthetic fractures. Amongst patients who presented with active PJI, 91% (10/11) had eradication of their index infection final follow-up (p=0.002). Overall prevention of recurrent index infection was 93% (14/15) (p=0.0001). Conclusion: Cement arthrodesis utilizing a custom knee spanning recon nail combined with an antibiotic eluting spacer improves ambulation status and prevents or treats recurrent infection in the majority of patients who have failed total knee arthroplasty.

scholarly journals The Advantage of a Total Knee Arthroplasty with Rotating Platform is Only Theoretical: Prospective Analysis of 1,152 Arthroplasties

2013 ◽  
Vol 7 (1) ◽  
pp. 635-640 ◽  
Author(s):  
H.P. Delport
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Research Question ◽  
Functional Results ◽  
Functional Score ◽  
Osteoarthritis Of The Knee ◽  
Fixed Bearing ◽  
Rotating Platform ◽  
Total Knee ◽  
End Stage

Background: The aim of total knee surgery is to provide patients with end-stage osteoarthritis of the knee with both pain relief and a functional range of motion with a securely fixed prosthesis for the long term. Many types of implants are designed to achieve these goals. Only clinical outcome studies are able to substantiate the superiority of one design over another. Our primary research question was to determine whether patients receiving a rotating platform implant had a better functional outcome. Methods: A total of 1,152 Performance Total Knee Arthroplastiesin 943 patients were studied prospectively. In 561 cases, the cruciate retaining model (CR) was used. In 591 cases the cruciate substituting with posterior-stabilized model (PS) was implanted (324 cases with a fixed bearing (PSFB) and 267 cases with a rotating platform (PSRP)). Results: The Clinical KSS score was similar for the three types at 1, 5, 10 and 15 years post-operatively. The Functional score also remained similar for all types until 10 years; at 15 years functional results of the CR group decreased. Conclusions: Neither clinically nor radiographically did the use of a rotating platform prove to be more advantageous than fixed bearing tibial components. Thus, the advantage of a Total Knee Arthroplasty with Rotating Platform remains theoretical.

The fate of Baker’s cysts at mid-term follow-up after total knee arthroplasty

2020 ◽  
Vol 102-B (1) ◽  
pp. 132-136
Author(s):  
Hagen Hommel ◽  
Roland Becker ◽  
Peter Fennema ◽  
Sebastian Kopf
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Short Term ◽  
Cyst Size ◽  
Baker’S Cyst ◽  
Baker's Cyst ◽  
Total Knee ◽  
The Mean

Aims We report the natural course of Baker’s cysts following total knee arthroplasty (TKA) at short- and mid-term follow-up. Methods In this prospective case series, 105 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker’s cyst. Sonography and MRI were performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at a mean follow-up time of 1.0 years (0.8 to 1.3; short-term) and 4.9 years (4.0 to 5.6; mid-term) after TKA. Symptoms potentially attributable to the Baker’s cyst were recorded at each assessment. Results At the one-year follow-up analysis, 102 patients were available. Of those, 91 patients were available for the 4.9-year assessment (with an 86.7% follow-up rate (91/105)). At the short- and mid-term follow-up, a Baker’s cyst was still present in 87 (85.3%) and 30 (33.0%) patients, respectively. Of those patients who retained a Baker’s cyst at the short-term follow-up, 31 patients (35.6%) had popliteal symptoms. Of those patients who continued to have a Baker’s cyst at the mid-term follow-up, 17 patients (56.7%) were still symptomatic. The mean preoperative cyst size was 14.5 cm2 (13.1 to 15.8). At the short- and mid-term follow-up, the mean cyst size was 9.7 cm2 (8.3 to 11.0) and 10.4 cm2 (9.8 to 11.4), respectively. A significant association was found between the size of the cyst at peroperatively and the probability of resolution, with lesions smaller than the median having an 83.7% (36/43) probability of resolution, and larger lesions having a 52.1% (25/48) probability of resolution (p < 0.001). At the mid-term follow-up, no association between cyst size and popliteal symptoms was found. Conclusion At a mean follow-up of 4.9 years (4.0 to 5.6) after TKA, the majority (67.0%, 61/91) of the Baker’s cysts that were present preoperatively had disappeared. The probability of cyst resolution was dependent on the size of the Baker’s cyst at baseline, with an 83.7% (36/43) probability of resolution for smaller cysts and 52.1% (25/48) probability for larger cysts. Cite this article: Bone Joint J. 2020;102-B(1):132–136

scholarly journals Age, Sex, Body Mass Index, Education, and Social Support Influence Functional Results After Total Knee Arthroplasty

2017 ◽  
Vol 8 (2) ◽  
pp. 71-77 ◽  
Author(s):  
Tomas Sveikata ◽  
Narunas Porvaneckas ◽  
Paulius Kanopa ◽  
Alma Molyte ◽  
Dalius Klimas ◽  
...  
Keyword(s):  
Social Support ◽  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Functional Results ◽  
Related Factors ◽  
Patient Groups ◽  
Total Knee

Introduction: Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis. Patient-reported outcome after TKA is influenced by multiple patient-related factors. The aim of this study was to prospectively evaluate preoperative patient-related factors and to compare the self-reported outcomes 1 year after TKA among groups differing by age, sex, body mass index (BMI), education, and social support level. Methods: 314 patients, who underwent TKA in Vilnius Republican University Hospital between the end of 2012 and the middle of 2014, were included in a study. The preoperative and 12-month follow-up measurements were obtained using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-12 (SF-12). Differences between patient groups according to gender, age, BMI, level of education, and level of social support were analyzed. Results: At 12-month follow-up men demonstrated better results than women in WOMAC ( P = .003) and SF-12 both domains ( P < .05). Patients with a higher social support demonstrated higher scores in physical function according to SF-12 ( P = .008). Better preoperative WOMAC and SF-12 scores were a predictor of better outcome 1 year after surgery. There was no difference in postoperative scores in different age, BMI, and education groups according to WOMAC and SF-12. Conclusion: There is no difference in self-reported functional outcome between patient groups differing in age, BMI, and education. Men and socially supported patients demonstrate better postoperative functional results 12 months after TKA. Better preoperative knee function and overall physical and mental function are predictors of better outcome 1 year after TKA. Age and obesity should not be limiting factors when considering who should receive this surgery.

scholarly journals Bicruciate retaining total knee arthroplasty : results throughout history

2021 ◽  
Vol 87 (1) ◽  
pp. 73-83
Author(s):  
Jef De Mulder ◽  
Pieter Berger ◽  
Hilde Vandenneucker
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Kinematics ◽  
Functional Results ◽  
Clinical Results ◽  
High Rate ◽  
Total Knee ◽  
High Level ◽  
Bcr Tka

Approximately 20% amongst patients are dissatisfied after total knee arthroplasty (TKA). Bicruciate retaining (BCR) TKA offers superior knee kinematics and proprioception, but many surgeons abandoned its use because of complications and technical difficulties. Recently, two new BCR implant designs were introduced : Vanguard XP (Zimmer Biomet) and Journey XR (Smith&Nephew). We searched Pubmed, Limo, Embase and Cochrane, screened reference lists of eligible studies and included studies that met the inclusion criteria. We included 35 articles reporting on ten different BCR implants, including three articles presenting results of the Vanguard XP prosthesis. Unfortunately, no articles reporting on the results of the Journey XR prosthesis had been published. The BCR implants of the early 1970s showed good functional results, but a high rate of complications, mainly loosening and infections. The Townley Anatomic TKA was the first BCR implant with good clinical results, a low incidence of loosening and a high survivorship. One article of the three reporting on the Vanguard XP yielded high patient satisfaction (94%) with two revisions (1.4%). The two other articles reported three revisions (5%) after one year of follow-up and 19 revisions (13.4%) after three years of follow-up. Throughout history, the functional results of BCR TKA improved, with lessening of the complications. The short-term results of the Vanguard XP implant showed good functional results, but two out of three articles reported a high rate of loosening. Based on the results reported in this review, the use of BCR TKA is still debatable. Further high-level evidence research is necessary to assess the clinical benefit of BCR TKA.

scholarly journals Direct Repair of Extensor Mechanism Disruption After Total Knee Arthroplasty “A Case Series of 31 Patients”

2021 ◽  
Author(s):  
Tie-jian Li ◽  
Jing-yang Sun ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
Bo-han Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Quadriceps Tendon ◽  
Clinical Results ◽  
Extensor Mechanism ◽  
Direct Repair ◽  
Kaplan Meier ◽  
Total Knee

Abstract Background Extensor mechanism disruption following total knee arthroplasty is a destructive complication with poor outcomes. Presently, limited data exists regarding the direct repair therapy and long-term outcomes. This study was to evaluate the clinical results and complications of direct repair therapy, and compare it with similar studies to determine whether there is a better treatment. Methods During the period of 2008 to 2020, 31 patients underwent direct repair for an extensor mechanism disruption after total knee arthroplasty (15 patellar fractures, 9 patellar tendon disruptions, and 7 quadriceps tendon disruptions). Mean follow-up was 4.9 years. Demographic, operative, and clinical data were collected. The following statistical methods will be employed to analyze the data: descriptive statistics, paired t test, and the Kaplan-Meier method. Results For all 31 patients underwent direct repair for extensor mechanism disruption, 6 patients failed : 2 knees (6%) of infections and 4 knees (13%) of re-rupture. ROM was 94.1° ± 15.7° preoperatively to 73° ±52° postoperatively, average extensor lag reduced from 45° to 20.2° at follow-up, and the WOMAC and HSS averaged 65 and 72 points. The Kaplan-Meier estimated survivorship with failure for complications as the end point was 81% (95% confidence interval [95% CI], 42.7% to73.3%) at 12 years. Conclusion Direct repair of the extensor mechanism disruption is not an ideal therapy, it’s actually ineffective for the recovery of knee joint function in patients, and will remain severe knee extension lag. No matter which part of the extensor mechanism disruption, direct repair should not be the preferred treatment

scholarly journals Patellar reconstruction following previous patellectomy: a review of the literature and a case series using distal femoral autograft during total knee arthroplasty

2017 ◽  
Vol 99 (3) ◽  
pp. e97-e101
Author(s):  
DA George ◽  
A Dosani ◽  
R Morgan-Jones
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Condyle ◽  
Case Series ◽  
Knee Kinematics ◽  
Alternative Methods ◽  
Small Series ◽  
Total Knee ◽  
Resected Femoral

During total knee arthroplasty, the reconstruction of the patella following a previous patellectomy is challenging, and is undertaken to improve functional outcomes and patient satisfaction. In this case series, we have reconstructed the patella using a femoral condyle resected during total knee arthroplasty. The resected femoral condyle with best available bone stock is selected and secured to the extensor mechanism. We reviewed the preoperative indications and postoperative outcomes of two patients who underwent the above procedure at our Institute, and compared this to the literature. The cases include a 68-year old male (6 months follow-up) who sustained a multi-fragmentary fracture of his right patella and underwent a patellectomy 30 years previously, and a 45-year old female (4 years follow-up) who underwent a left-sided patellectomy 15 years previously following polytrauma. As a result of progressive osteoarthritis they required total knee arthroplasty, and simultaneous patella reconstruction with a femoral condyle autograft. Compared to their preoperative range of motion, both patients demonstrated an improvement post-operatively with successful pain-free knee function, with no radiological signs of graft resorption. In this limited, small series we have reported two patients who are clinically and functionally satisfied by the outcome of surgery, with comparable outcomes to alternative methods. We believe the use of a femoral condyle autograft for patellar reconstruction is a safe and simple technique that optimises knee kinematics, without associated donor morbidity.

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