scholarly journals Total knee arthroplasty in patients with fixed flexion deformity

KYAMC Journal ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. 2-7
Author(s):  
Abdus Salam ◽  
Md Ashraful Islam ◽  
Muhammad Zakir Hossain Khan ◽  
Md Sayeed Bin Sharif ◽  
Md Hafizur Rahman Milon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Soft Tissue ◽  
Intraoperative Complications ◽  
Flexion Contracture ◽  
Flexion Deformity ◽  
Postoperative Evaluation ◽  
Total Knee ◽  
Fixed Flexion Deformity

Background: Fixed flexion deformity is a common accompaniment in advanced arthritis of the knee joint. Complete correction of fixed flexion deformity at the time of surgery remains challenging and technically demanding.Objectives: The purpose of our study was to assess the result of total knee replacement using a preset algorithm to assess the effect that a preoperative flexion deformity has on postoperative correction.Materials & Methods: This retrospective study reviewed severe flexion contracture of patients who underwent primary TKA and soft tissue balancing from June 2010 to July 2016. The data included preoperative, intraoperative, and postoperative evaluation at standard intervals and annual follow-up reports.Results: There were no intraoperative complications in this study. The average flexion contractures and ROM were not different between SF and MF groups (1.14 ± 0.27 vs. 1.12 ± 0.35 and 115.72 ± 15.13 vs. 118.34 ± 12.68).Conclusion: TKA can be performed successfully in knees with severe flexion contracture.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 2-7

The Impact of Intraoperative Gap Difference Between Extension and Flexion on Perception of Joint Function After Total Knee Arthroplasty: a Comparative Retrospective Study

2021 ◽  
Author(s):  
Tomohiro Okayoshi ◽  
Yoshinori Okamoto ◽  
Hitoshi Wakama ◽  
Shuhei Otsuki ◽  
Masashi Neo
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Soft Tissue ◽  
Knee Joint ◽  
Predictive Factors ◽  
Knee Arthroplasty ◽  
Difference Threshold ◽  
Joint Function ◽  
Flexion Gap ◽  
Total Knee

Abstract Background: The argument presupposes that intra-operative soft tissue balance is associated with patient-reported outcome measures after total knee arthroplasty (TKA). Our aim was to assess the association between the extension-to-flexion gap and patients’ reported perception of knee joint function.Methods: This was a retrospective study of 60 cases of primary cruciate-retaining TKAs performed for the treatment of medial-compartment knee osteoarthritis, at a mean follow-up of 2.6 (range, 2.0–5.2) years. Knee perception was evaluated by asking patients whether they considered their knee joint as “natural” (grade I) or “artificial”, with or without restrictions (grades II–V). The following factors were compared between the two groups: age, sex, and the extension-to-flexion gap difference. A multiple logistic regression analysis was used to identify predictive factors of an artificial knee joint perception. A receiver operating characteristic curve analysis was used to identify cut-off values of predictive factors. Result: Compared to a natural knee joint perception (26 knees, 43%), an artificial perception (34 knees, 57%) was associated with a smaller gap difference at the distraction force of 20 lbf (p < .001), 30 lbf (p = .022), and 40 lbf (p = .038), a lower EuroQol 5-Dimension score (p = .029), and self-reported joint health (Knee injury and Osteoarthritis Outcome Score-Joint Replacement [KOOS-JR], p = .032). A gap difference <1.0 mm was a predictive of an artificial perception (odds ratio, 1.63; 95% confidence interval, 1.33–4.54; p < .001). A cut-off gap difference of 0.99 mm at 20 lbf predicted an artificial perception with a sensitivity of 81.5% and a specificity of 87.9%. Post-operative satisfaction (p < .001), KOOS-JR (p < .001), patient’s joint perception (p = .006), pain (p = .015), and EuroQol 5-Dimension (p = .032) differed between the two groups when the gap difference threshold was set to 1.0 mm.Conclusion: Careful balancing of soft tissue during TKA to achieve an extension-to-flexion gap ≥ 1.0 mm can improve patients’ perception of knee joint function and quality of life.

scholarly journals The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yunfei Hou ◽  
Jiaxiang Gao ◽  
Jian Chen ◽  
Jianhao Lin ◽  
Lei Ni ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Recurrence Rate ◽  
Revision Rate ◽  
Knee Score ◽  
Function Score ◽  
Prosthesis Revision ◽  
Total Knee ◽  
Symptom Recurrence

Abstract Background To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA). Methods A retrospective review of patients undertaking arthroscopy for PI, AF and GS was conducted. Outcome measures included complications, postoperative range of motion (ROM), Knee Society Score (KSS) and rates of symptom recurrence, prosthesis revision. Intraoperative findings and surgical procedures were also recorded. Paired t test, Fisher’s exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used for statistical evaluation. Results A total of 74 patients, including 35 patients with peripatellar impingement, 25 patients with arthrofibrosis and 14 patients with generalized synovitis, with a mean age of 66.1 ± 7.9 years, were analysed. The mean follow-up (FU) duration was 81.3 ± 40.6 months. All patients underwent arthroscopic surgery safely without intraoperative complications. However, there were 4 postoperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Overall, patients acquired improvements in ROM from 81.7 ± 23.1° to 96.8 ± 20.5° (p < 0.05), in KSS knee score from 64.2 ± 9.6 to 78.7 ± 12.1 (p < 0.05) and in KSS function score from 61.1 ± 7.4 to 77.3 ± 12.2 (p < 0.05) postoperatively. Patients in all 3 groups had improvements in ROM (p < 0.05), KSS knee score (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (95% confidence interval (CI) 15.1–34.9%), and the overall revision rate was 14.9% (95% CI 8.6–25.6%). There were significant differences in both the symptom recurrence and prosthesis revision rates among the groups (p < 0.05). The PI group had a significantly lower symptom recurrence rate (11.4%, 95% CI 4.5–28.7%) and revision rate (8.6%, 95% CI 2.9–25.3%) (p < 0.017), while the GS group had a significantly higher recurrence rate (42.9%, 95% CI 23.4–78.5%) and revision rate (35.7%, 95% CI 17.6–72.1%) (p < 0.017). Conclusions In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. Patients with PI had the best outcomes, while patients with GS had the worst outcomes. Level of evidence Level IV

scholarly journals Hinged total knee arthroplasty for fracture cases: Retrospective study of 52 patients with a mean follow-up of 5 years

2020 ◽  
Vol 106 (3) ◽  
pp. 389-395 ◽  
Author(s):  
Pascal Kouyoumdjian ◽  
Rémy Coulomb ◽  
Adrien d’Ambrosio ◽  
Salomé Ravoyard ◽  
Etienne Cavaignac ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Knee Arthroplasty ◽  
Total Knee ◽  
Hinged Total Knee Arthroplasty

Outcomes in Patients with a Calipered Kinematically Aligned TKA That Already Had a Contralateral Mechanically Aligned TKA

2019 ◽  
Vol 34 (01) ◽  
pp. 087-093 ◽  
Author(s):  
Trevor J. Shelton ◽  
Manpreet Gill ◽  
Gurbir Athwal ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Outcome Measures ◽  
Knee Arthroplasty ◽  
Contralateral Limb ◽  
Primary Tkas ◽  
Clinical Benefits ◽  
History Of ◽  
Total Knee

AbstractPrior studies suggest kinematically aligned (KA) total knee arthroplasty (TKA) provides some clinical benefits. There are no reports of self-reported outcome measures in patients treated with a calipered KA TKA that already had a contralateral mechanically aligned (MA) TKA. We performed a retrospective study and asked the following questions: (1) Were you satisfied with your MA TKA when you were treated with the KA TKA? (2) What are the Forgotten Joint Scores (FJS) and Oxford Knee Scores (OKS) in each of your knees? (3) Do you favor one knee? and (4) Did one knee recover faster? From January 2013 to January 2017, 2,378 consecutive primary TKAs were performed of which all were treated with calipered KA that uses serial verification checks incorporating measurements of bone resections and positions to restore the prearthritic or native joint lines accurately. A records review identified patients with a prior primary MA TKA in the contralateral limb. Excluded were those with a history of fracture, osteotomy, infection, or revision knee surgery in either limb. In September 2018, 78 patients (57 females) with a mean age of 73 years (range, 50–91 years) completed a follow-up evaluation consisting of the FJS and OKS questionnaires and three anchor questions. A total of 83% of patients were satisfied with the MA TKA and 92% were satisfied with the KA TKA. The KA TKA had a 15 point higher median FJS and a comparable OKS to that of the MA TKA. Also, 56% of patients favored the KA TKA, and 8% favored the MA TKA. Seventy four percent of patients favored the recovery of the KA TKA, and 6% favored the recovery of the MA TKA. Accordingly, a patient considering a contralateral KA TKA can expect that more often than not the KA TKA will have a higher FJS, a similar OKS, be their favorite knee, and recover faster. Present study is therapeutic and reflects level IV evidence.

scholarly journals Risk factors for a post-operative neutrally aligned total knee arthroplasty in the sagittal plane developing fixed flexion deformity at 2 years follow up study

2019 ◽  
Vol 5 (2) ◽  
pp. 211 ◽  
Author(s):  
Amila Silva ◽  
Sharon Tan ◽  
Adriel Tay ◽  
Hee Nee Pang ◽  
Ngai Nung Lo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Sagittal Plane ◽  
P Value ◽  
Flexion Deformity ◽  
Maximum Flexion ◽  
Total Knee ◽  
Independent Risk Factors ◽  
Fixed Flexion Deformity

<p class="abstract"><strong>Background:</strong> The incidence of fixed flexion deformity (FFD) following total knee arthroplasty (TKA) has been reported to be as high as 17%, increasing demand on the quadriceps and hindering mobility. The aim of this study is then to identify these predictors for the development of FFD.</p><p class="abstract"><strong>Methods:</strong> In this retrospective study, all patients who underwent primary TKA from January 2008 to June 2009 at a single institution were identified. All patients with neutral alignment in the sagittal place of the knee intra-operatively were identified and followed up. The knee motion was measured in both operated and contralateral knees and followed-up for a minimum of 24 months post-operatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> Multivariate analysis demonstrated pre-operative FFD of the non-operated knee (p-value 0.03), pre-operative range of motion of the operated knee (p-value 0.01) and non-operated (p-value 0.01) knee and pre-operative maximum flexion of the operated knee (p-value 0.001) to be independent risk factors for development of FFD at 24 months.</p><p class="abstract"><strong>Conclusions:</strong> Independent risk factors for the development of post-operative FFD in TKA are pre-operative FFD of the operated knee, FFD of the non-operated knee and the maximum flexion of the operated knee. The relative risk of a male developing FFD is also as high as 1.34.</p>

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