scholarly journals Rationale of Cruciate Retaining Design in Rheumatoid Arthritis: A Review of Clinical Analysis and its Role in Rheumatoid Arthritis

2017 ◽  
Vol 11 (1) ◽  
pp. 1023-1027 ◽  
Author(s):  
Munis Ashraf ◽  
Om Prakash Sharma ◽  
Sruthi Priyavadhana ◽  
Senthil Nathan Sambandam ◽  
Varatharaj Mounasamy
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Clinical Analysis ◽  
Implant Design ◽  
Cruciate Retaining ◽  
Follow Up Studies ◽  
Total Knee

Background: Over the years, proponents of total knee designs (cruciate retaining and posterior stabilised) have conducted several long-term studies to claim the potential of these designs in several subsets of patients. Total knee arthroplasty (TKA) in patients with rheumatoid arthritis has also been one such domain where numerous studies were conducted in the past. A general perception among majority of arthroplasty surgeons is that, posterior stabilised (PS) is the implanted design of choice among patients with Rheumatoid arthritis (RA). However, with the available literature there is a significant disparity related to the selection of implants in patients with rheumatoid RA. In this review of literature, an attempt is made to identify the clinical performance and role of one such implant design, the cruciate retaining (CR) prosthesis in rheumatoid arthritis. Method: The review was conducted after a series of advanced search in the following medical databases; Pub med, Biomed central, Cochrane and Google scholar for articles related to long term follow up studies of cruciate retaining total knee arthroplasty in rheumatoid arthritis using the keywords cruciate retaining prosthesis, total knee arthroplasty, rheumatoid arthritis. Results: The available data demonstrate that the CR design is attributed with an excellent long term survivorship and functional outcome even in follow up studies up to twenty-five years. Conclusion: The advantages of using a CR design are long term survivorship, controlled femoral roll back and preservation of bone stock. Thus, the data gathered in this review lead to a consideration that the CR design is an implant design on par with PS design in patients with RA.

scholarly journals Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up

2020 ◽  
Vol 35 (1) ◽  
pp. 272-277 ◽  
Author(s):  
Jordan S. Broberg ◽  
Silvio Ndoja ◽  
Steven J. MacDonald ◽  
Brent A. Lanting ◽  
Matthew G. Teeter
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Posterior Stabilized ◽  
Cruciate Retaining ◽  
Contact Kinematics ◽  
Long Term Follow Up ◽  
Total Knee

scholarly journals Better clinical outcome of total knee arthroplasty for rheumatoid arthritis with perioperative glucocorticoids and disease-modifying anti-rheumatic drugs after an average of 11.4-year follow-up

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yi Ren ◽  
Qi Yang ◽  
Tim Luo ◽  
Jin Lin ◽  
Jin Jin ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Arthroplasty ◽  
Drug Therapy ◽  
Knee Arthroplasty ◽  
The Other ◽  
Total Knee ◽  
Disease Modifying ◽  
Hss Score

Abstract Background Previous evidence suggested that perioperative anti-rheumatic therapy for patients receiving total knee arthroplasty (TKA) helped improve postoperative rehabilitation for rheumatoid arthritis (RA), yet long-term effects and outcomes of perioperative drug therapy in TKA presently remain unclear. This study investigated whether perioperative treatment with glucocorticoids (GC) and disease-modifying anti-rheumatic drugs (DMARDs) can improve clinical outcomes for patients with RA undergoing TKA. Methods Patients between January 2000 and December 2011 were allocated into three groups based on perioperative drug therapy: A, control group (no GC or DMARDs), B, DMARD group (DMARDs given without GC), and C, co-therapy group (DMARDs plus GC). The patients were followed up for average 11.4 years. Baseline characteristics, pre- and post-operative Hospital for Special Surgery score (HSS), laboratory parameters, and complications were recorded by follow-up. Results Fifty-six RA patients undergoing 91 TKAs were included in this study. Patients who received perioperative GC with DMARDs (group C) achieved larger/increased range of motion (ROM) (C:122.17 vs A:108.31 vs B:108.07, p = 0.001, partial eta squared (η2 p) = 0.18) at 1 year, better HSS score (C, 83.01 vs A, 79.23 vs B, 77.35, p = 0.049, η2 p = 0.067), pain relief (C, 1.09 vs A, 1.17 vs B, 1.75, p = 0.02, η2 p = 0.094), and ROM (C, 130.81 vs A, 112.82 vs B, 113.58, p = 0.001, η2p = 0.142) at latest follow-up comparing with the other treatment groups. No differences were noted in laboratory tests, blood loss, volume of transfusion, or complications among groups. Conclusions Compared with the other perioperative anti-rheumatic treatments, the combination of GC and DMARDs results in improved HSS score, better function, larger range of motion, and reduced postoperative pain for TKA patients with RA in the long term. Further investigation is warranted to look for a better understanding of more specific medication effects and strike a good balance between the benefits and complications for long-term pharmacotherapy.

scholarly journals Double-high insert presents with worse mid-term outcomes in cruciate-retaining medial-pivotal total knee arthroplasty – a propensity score matched analysis with averaged 8-year follow-up

2021 ◽  
Author(s):  
Shuai Xiang ◽  
Yingzhen Wang ◽  
Chengyu Lv ◽  
Changyao Wang ◽  
Haining Zhang
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Womac Score ◽  
Cruciate Retaining ◽  
Radiographic Outcomes ◽  
Clinical Scores ◽  
Total Knee ◽  
Knee Society Function Score

Abstract Background The aim of this study was to compare the mid-term clinical and radiographic outcomes between medial-pivotal (MP) insert and double-high (DH) insert used under cruciate-retaining condition in ADVANCE® total knee arthroplasty (TKA). Methods The follow-up was conducted for 158 consecutive patients underwent unilateral ADVANCE® TKA from January 2011 to April 2014. 84 MP inserts and 74 DH inserts were used under cruciate-retaining condition. A 1:1 propensity score matching (PSM) analysis was performed between MP insert and DH insert to compare the clinical and radiographic outcomes. Results After a 1:1 PSM, 120 patients (60 pairs) were matched between MP insert and DH insert. The baseline demographic parameters and clinical scores were comparable between the two groups. The postoperative clinical outcomes at an averaged 8-year follow-up of both groups were significantly improved. The range of motion (ROM) of DH group was better than that of MP group and equivalent Knee Society Function Score (KSFS) between the two groups was found. However, the Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Forgotten Joint Score (FJS) of MP group were found to be significantly superior than those of DH group. Comparable complication rate and revision rate were observed between the two groups. The radiographic results were also equally good between MP and DH group. Conclusions Although the mid-term clinical and radiographic outcomes of DH insert are fairly good, the clinical scores of DH group were worse than those of MP group.

scholarly journals Titanium-Nitride Coating Does Not Result in a Better Clinical Outcome Compared to Conventional Cobalt-Chromium Total Knee Arthroplasty after a Long-Term Follow-Up: A Propensity Score Matching Analysis

Coatings ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 442 ◽  
Author(s):  
Georg Hauer ◽  
Lukas Leitner ◽  
Marc C. Ackerl ◽  
Sebastian Klim ◽  
Ines Vielgut ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Cobalt Chromium ◽  
Tin Coating ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Cocr Alloy

Background: The impact of titanium nitride (TiN) coating on implant components is controversial. TiN coating is proposed as having superior biomechanical properties compared to conventional cobalt-chromium (CoCr) alloy. This study compared long-term clinical data as well as meteoro-sensitivity in patients who underwent total knee arthroplasty (TKA), with either CoCr alloy or TiN coating. Methods: In this retrospective observational study, the clinically approved cemented “low contact stress” (LCS) TKA with conventional CoCr coating, was compared to un-cemented TiN-coated “advanced coated system” (ACS) TKA. Propensity score matching identified comparable patients based on their characteristics in a one-to-one ratio using the nearest-neighbor method. The final cohort comprised 260 knees in each cohort, with a mean follow-up of 10.1 ± 1.0 years for ACS patients and 14.9 ± 3.0 years for the LCS group. Physical examinations, meteoro-sensitivity, and knee scoring were assessed. Results: The clinical and functional Knee Society Score (KSS) (82.6 vs. 70.8; p < 0.001 and 61.9 vs. 71.1; p = 0.011), the postoperative Visual Analogue Scale (VAS) (2.9 vs. 1.4; p = 0.002), and the postoperative Tegner Score (2.6 vs. 2.2; p = 0.001) showed significant intergroup differences. The postoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) was similar (79.9 vs. 81.3; p = 0.453) between groups. Meteoro-sensitivity of the artificial joint was significantly more prevalent in the ACS patient cohort (56% vs. 23%; p < 0.001). Conclusion: This study suggests that TiN coating does not provide improved clinical outcomes in this patient cohort after a long-term follow-up. Interestingly, sensitivity to weather changes were more correlated with un-cemented ACS implants.

scholarly journals Long-Term Postoperative Total Knee Arthroplasty Flexion Scores in Relation to Body Mass Index

2020 ◽  
Author(s):  
Matthew A. Siegel ◽  
Michael J. Patetta ◽  
Angie M. Fuentes ◽  
Armaan S. Haleem ◽  
Craig W. Forsthoefel ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
P Value ◽  
Preoperative Body Mass Index ◽  
Total Knee

AbstractKnee range of motion (ROM) is an important postoperative measure of total knee arthroplasty (TKA). There is conflicting literature whether patients who are obese have worse absolute ROM outcomes than patients who are not obese. This study analyzed whether preoperative body mass index (BMI) influences knee ROM after patients' primary TKA. A retrospective investigation was performed on patients, who underwent primary TKA at an academic institution, by one of three fellowship-trained adult reconstruction surgeons. Patients were stratified according to their preoperative BMI into nonobese (BMI < 30.0 kg/m2) and obese (BMI ≥ 30.0 kg/m2) classifications. Passive ROM was assessed preoperatively as well as postoperatively at patients' most recent follow-up visit that was greater than 2 years. Mann–Whitney U tests were performed to determine statistical significance at p-value <0.05 for ROM outcomes. No statistically significant differences were observed when ROM in the nonobese group was compared with ROM in the obese group both preoperatively (105.73 ± 11.58 vs. 104.14 ± 13.58 degrees, p-value = 0.417) and postoperatively (105.83 ± 14.19 vs. 104.49 ± 13.52 degrees, p-value = 0.777). Mean follow-up time for all patients was 4.49 ± 1.92 years. In conclusion, long-term postoperative ROM outcomes were similar between patients who were nonobese and patients who were obese.

scholarly journals Cruciate Retaining compared with Posterior Stabilised Nexgen total knee arthroplasty: results at 10 years in a matched cohort

2017 ◽  
Vol 99 (8) ◽  
pp. 602-606 ◽  
Author(s):  
AIW Mayne ◽  
HP Harshavardhan ◽  
LR Johnston ◽  
W Wang ◽  
A Jariwala
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Functional Score ◽  
Range Of Movement ◽  
Cruciate Retaining ◽  
Score Improvement ◽  
Total Knee

INTRODUCTION Debate has persisted for many years about whether to sacrifice or replace the posterior cruciate ligament when performing total knee arthroplasty. A paucity of long-term follow-up studies comparing outcomes between cruciate-retaining and posterior-stabilised knees exist. We aimed to compare results at ten-year follow-up. METHODS A matched paired study comparing a cohort of 107 Zimmer Nexgen® Cruciate Retaining (CR) patients with a cohort of 107 Nexgen Posterior-Stabilised (PS) knees matched for age, sex, body mass index and preoperative American Knee Society score was undertaken. All patients underwent independent clinical assessment and knee society scoring preoperatively and at 1, 3, 5, 7 and 10 years postoperatively. RESULTS Fifty-three patients (49.5%) in the CR group and 44 patients (41.1%) in the PS group were alive at 10-year follow-up. There were no significant differences between the CR and PS groups with regards to functional assessment (P = 0.95), overall range of movement (P = 0.46) or patient satisfaction (P = 1.0) at 10 years. However, there was a significantly better score improvement in range of movement in PS knees compared with CR knees (P = 0.027). There were six revisions (5.6%) in the PS group and 1 (0.93%) in the CR group (P = 0.12). Both CR and PS knees showed excellent survivorship with no significant difference at 10 years (P = 0.068). CONCLUSIONS There were no significant differences in functional score, overall range of motion or patient satisfaction between the Nexgen cruciate retaining and posterior stabilised total knee arthroplasty at 10-year follow-up. However, PS knees had a greater score improvement in range of motion compared with CR knees.

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