scholarly journals Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing

2021 ◽  
Vol 10 (6) ◽  
pp. 1227
Author(s):  
Leandra Bauer ◽  
Matthias Woiczinski ◽  
Christoph Thorwächter ◽  
Oliver Melsheimer ◽  
Patrick Weber ◽  
...  
Keyword(s):  
Contact Area ◽  
Biomechanical Testing ◽  
Patellar Resurfacing ◽  
Posterior Stabilized ◽  
Arthroplasty Registry ◽  
Secondary Patellar Resurfacing ◽  
Fresh Frozen ◽  
Quadriceps Force ◽  
Lower Contact ◽  
Knee Rig

The German Arthroplasty registry (EPRD) has shown that different prosthesis systems have different rates of secondary patellar resurfacing: four years after implantation, the posterior-stabilized (PS) Vega prosthesis has a 3.2% risk of secondary patellar resurfacing compared to the cruciate-retaining (CR) Columbus prosthesis at 1.0% (both Aesculap AG, Tuttlingen, Germany). We hypothesized that PS implants have increased retropatellar pressure and a decreased retropatellar contact area compared to a CR design, which may lead to an increased likelihood of secondary patellar resurfacing. Eight fresh frozen specimens (cohort 1) were tested with an established knee rig. In addition, a possible influence of the registry-based patient collective (cohort 2) was investigated. No significant differences were found in patient data–cohort 2-(sex, age). A generally lower number of PS system cases is noteworthy. No significant increased patella pressure could be detected with the PS design, but a lower contact area was observed (cohort 1). Lower quadriceps force (100°–130° flexion), increased anterior movement of the tibia (rollback), greater external tilt of the patella, and increasing facet pressure in the Vega PS design indicate a multifactorial cause for a higher rate of secondary resurfacing which was found in the EPRD patient cohort and might be related to the PS’ principle function.

Plantar Pressure and Load in Cadaver Feet After a Weil or Chevron Osteotomy

2005 ◽  
Vol 26 (2) ◽  
pp. 158-165 ◽  
Author(s):  
John Snyder ◽  
John Owen ◽  
Jennifer Wayne ◽  
Robert Adelaar
Keyword(s):  
Contact Area ◽  
Plantar Pressure ◽  
Metatarsal Osteotomy ◽  
Plantar Surface ◽  
First Metatarsal ◽  
The Third ◽  
Load Transmission ◽  
Chevron Osteotomy ◽  
First Ray ◽  
Fresh Frozen

Background: Since metatarsal osteotomy was first used to treat metatarsalgia in the early twentieth century, many techniques have been described to accomplish the basic aim of reduction of load transmission through the operated metatarsal and reduction of localized high pressure on the plantar surface of the metatarsal. Our study examined two popular distal metatarsal neck osteotomies used for the relief of central metatarsalgia and the biomechanical changes that result from their use in a cadaver forefoot model. Methods: After applying 445N (100 lbs) of axially directed force, we measured plantar pressure using the TekScan HR Mat™ (TekScan, Inc., South Boston, MA) in twelve paired, thawed, fresh-frozen intact cadaver legs, then after either a Weil or chevron osteotomy of the second metatarsal and finally after the addition of the same osteotomy of the third metatarsal. Results: Load in the forefoot was not significantly affected by the Weil osteotomy. A significant increase in load was produced in the first metatarsal region, and significant decreases in load were produced beneath the operated metatarsal heads after the chevron osteotomy. Average pressure in the contact area of the forefoot showed similar trends; however, load and pressure changes occurred independently, owing to the changes in contact area produced by the osteotomies. No significant changes were observed in the nonoperated metatarsal regions. Conclusions: In this model, the chevron osteotomy more effectively reduced load and plantar pressure in the operated metatarsal regions; however, increases in load and pressure were observed in the first metatarsal region. The increase in pressure without a change in load in region 3 (third metatarsal) after a Weil osteotomy of the third metatarsal was attributed to the creation of a plantar prominence. This study did not show a reduction in load transmission as a result of the Weil osteotomy, which contradicts the proposed mechanism of clinical benefit. An intact first ray likely prevents transfer of load or pressure to adjacent lesser metatarsals with chevron osteotomy.

Patient Satisfaction and Functional Outcomes Following Secondary Patellar Resurfacing

Orthopedics ◽  
2016 ◽  
Vol 39 (5) ◽  
pp. e850-e856 ◽  
Author(s):  
Hans-Peter W. van Jonbergen ◽  
Ashvin V. Boeddha ◽  
Jos J. A. M van Raaij
Keyword(s):  
Patient Satisfaction ◽  
Functional Outcomes ◽  
Patellar Resurfacing ◽  
Secondary Patellar Resurfacing

Kinematic and Kinetic Comparison of Fresh Frozen and Thiel-Embalmed Human Feet for Suitability for Biomechanical Educational and Research Settings

2019 ◽  
Vol 109 (2) ◽  
pp. 113-121 ◽  
Author(s):  
Alfred Gatt ◽  
Pierre Schembri-Wismayer ◽  
Nachiappan Chockalingam ◽  
Cynthia Formosa
Keyword(s):  
Human Subjects ◽  
Biomechanical Testing ◽  
Biomechanical Properties ◽  
Kinetic Properties ◽  
Foot Pressure ◽  
Human Foot ◽  
Observational Study Design ◽  
Fresh Frozen ◽  
Research And Education

Background: In vitro biomechanical testing of the human foot often involves the use of fresh frozen cadaveric specimens to investigate interventions that would be detrimental to human subjects. The Thiel method is an alternative embalming technique that maintains soft-tissue consistency similar to that of living tissue. However, its suitability for biomechanical testing is unknown. Thus, the aim of this study was to determine whether Thiel-embalmed foot specimens exhibit kinematic and kinetic biomechanical properties similar to those of fresh frozen specimens. Methods: An observational study design was conducted at a university biomechanics laboratory. Three cadavers had both limbs amputated, with one being fresh frozen and the other preserved by Thiel's embalming. Each foot was tested while undergoing plantarflexion and dorsiflexion in three states: unloaded and under loads of 10 and 20 kg. Their segment kinematics and foot pressure mapping were assessed simultaneously. Results: No statistically significant differences were detected between fresh frozen and Thiel-embalmed sample pairs regarding kinematics and kinetics. Conclusions: These findings highlight similar kinematic and kinetic properties between fresh frozen and Thiel-embalmed foot specimens, thus possibly enabling these specimens to be interchanged due to the latter specimens' advantage of delayed decomposition. This can open innovative opportunities for the use of these specimens in applications related to the investigation of dynamic foot function in research and education.

scholarly journals Outcome of secondary patellar resurfacing

2012 ◽  
Vol 10 (8) ◽  
pp. S54
Author(s):  
Mouhamed El Sayad ◽  
Gaffar Dudhniwala ◽  
Andrew Davies
Keyword(s):  
Patellar Resurfacing ◽  
Secondary Patellar Resurfacing

Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage Without Restricting Motion in the Setting of an Engaging Hill-Sachs Defect

2017 ◽  
Vol 45 (9) ◽  
pp. 1982-1989 ◽  
Author(s):  
Brian C. Werner ◽  
Xiang Chen ◽  
Christopher L. Camp ◽  
Andreas Kontaxis ◽  
Joshua S. Dines ◽  
...  
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Biomechanical Testing ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Anterior Translation ◽  
Capsular Plication ◽  
Fresh Frozen ◽  
Surgical Options ◽  
Joint Loads

Background: Numerous surgical options for the management of engaging Hill-Sachs lesions exist, of which remplissage has emerged as one of the most popular arthroscopic techniques. Remplissage is not without disadvantages, however, and has been demonstrated to potentially result in a loss of external rotation (ER) due to nonanatomic tethering of the infraspinatus tendon and a potential decrease in infraspinatus strength clinically. Purpose: The efficacy of posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen human cadaveric shoulders were utilized for the study. After testing baseline translation and motion, 30% Hill-Sachs lesions were created in each specimen. Three experimental groups were assembled: (1) isolated Bankart repair (HSD), (2) Bankart repair with remplissage (RM), and (3) Bankart repair with posterior medial capsular plication (PL). Biomechanical testing was performed to determine anterior translation, range of motion, and Hill-Sachs engagement. Translation and motion measurements were normalized to the baseline laxity values for each specimen. Results: A significant reduction in anterior translation was noted at 60° of abduction and 60° of ER for both the PL and RM groups compared with the HSD group throughout most of the joint loads tested ( P < .05), but no significant differences were noted between the PL and RM groups at any load. The RM group had significantly less normalized ER at 60° of abduction compared with the HSD and PL groups ( P < .05). There were no differences in internal rotation between the groups. All 8 specimens in the HSD group engaged, while no specimens in the RM and PL groups engaged ( P < .001). Conclusion: In a cadaveric model, medial posterior capsular plication as an adjunct to Bankart repair offers similar resistance to anterior translation and Hill-Sachs engagement as compared with remplissage in the setting of an engaging Hill-Sachs defect. Medial posterior capsular plication results in less restriction of ER compared with remplissage without any significant limitation of internal rotation. Clinical Relevance: Posterior medial capsular plication reduces translation and engagement similarly to remplissage, without any restriction in motion.

scholarly journals The Effect on Long Term Survivorship of Surgeon Preference for Posterior Stabilized or Minimally Stabilized Total Knee Replacement: An Analysis of 63416 Cases from the AOANJRR

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0017
Author(s):  
Christopher Vertullo ◽  
Peter Lewis ◽  
Michelle Lorimer ◽  
Stephen Graves
Keyword(s):  
Total Knee Replacement ◽  
Selection Bias ◽  
Knee Replacement ◽  
High Volume ◽  
Patellar Resurfacing ◽  
Posterior Stabilized ◽  
Observational Series ◽  
Total Knee ◽  
Optimum Management

Introduction & Aims: Controversy still exists as to the optimum management of the PCL in TKR, with registry data suggesting Posterior Stabilised TKR have a higher Cumulative Percent Revision (CPR) compared to Minimally Stabilised TKR. Proponents of PS TKR suggest this difference is due to selection bias as result of preferential use of PS TKR in complex or more severe cases. To remove this selection bias, we aimed to compare CPR based on surgeon TKR stability preference to treat with PS or MS TKR rather than actual prosthesis type received. Method: Observational series. An analysis of AOANJRR data from 1999 – 2014 was utilized to identify two cohorts of high volume surgeons who preferred to use routinely either MS or PS TKR. Only fixed tibial inserts and patellar resurfacing TKR were included. A MS preferring surgeon used MS TKR at least 90% of the time and a PS preferring surgeon used PS TKR at least 90% of the time. Consequently, each patient cohort included both PS and MS TKR in differing proportions. Results: Procedures undertaken by PS preferring surgeons had a significantly higher risk of revision (CPR (Hazard Ratio = 1.45 (95% CI 1.30, 1.63), p< 0.001). There was a higher rate of revision for loosening and infection in the PS group. Of the 39 941 TKR with cemented fixation of both femur and tibia, the PS preferring surgeons had a higher CPR than the MS preferring cohort (HR = 1.55 (1.33, 1.80), p< 0.001). Regardless of whether the polyethylene was crosslinked or non-crosslinked, the MS preferring surgeons had a lower CPR compared to the PS preferring surgeons. Conclusions: In this analysis, procedures undertaken by surgeons who mainly preferred to use PS TKR had a higher rate of revision than those that mainly used MS TKR. This finding was irrespective of patient age and was also evident when fixation and the type of polyethylene used was taken into account.

Secondary patellar resurfacing in painful total knee arthroplasty

2008 ◽  
Vol 52 (6) ◽  
pp. 366-371
Author(s):  
A. Ortiz-Espada ◽  
R. Pérez-Mañanes ◽  
F. Corella-Montoya ◽  
F. Chana-Rodríguez ◽  
E. Medina-Herráez ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patellar Resurfacing ◽  
Secondary Patellar Resurfacing ◽  
Total Knee

Does malrotation of components correlate with patient dissatisfaction following secondary patellar resurfacing?

The Knee ◽  
2014 ◽  
Vol 21 (1) ◽  
pp. 247-251 ◽  
Author(s):  
Ghias Bhattee ◽  
Pradeep Moonot ◽  
Raj Govindaswamy ◽  
Andrew Pope ◽  
Nick Fiddian ◽  
...  
Keyword(s):  
Patellar Resurfacing ◽  
Patient Dissatisfaction ◽  
Secondary Patellar Resurfacing

scholarly journals Effect of Post-Cam Design for Normal Knee Joint Kinematic, Ligament, and Quadriceps Force in Patient-Specific Posterior-Stabilized Total Knee Arthroplasty by Using Finite Element Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Yong-Gon Koh ◽  
Juhyun Son ◽  
Oh-Ryong Kwon ◽  
Sae Kwang Kwon ◽  
Kyoung-Tak Kang
Keyword(s):  
Lateral Collateral Ligament ◽  
Posterior Stabilized ◽  
Collateral Ligament ◽  
Element Analysis ◽  
Normal Knee ◽  
Cam Design ◽  
Knee Mechanics ◽  
Total Knee ◽  
Quadriceps Force ◽  
Femoral Rollback

The purpose of this study is to investigate post-cam design via finite element analysis to evaluate the most normal-like knee mechanics. We developed five different three-dimensional computational models of customized posterior-stabilized (PS) total knee arthroplasty (TKA) involving identical surfaces with the exception of the post-cam geometry. They include flat-and-flat, curve-and-curve (concave), curve-and-curve (concave and convex), helical, and asymmetrical post-cam designs. We compared the kinematics, collateral ligament force, and quadriceps force in the customized PS-TKA with five different post-cam designs and conventional PS-TKA to those of a normal knee under deep-knee-bend conditions. The results indicated that femoral rollback in curve-and-curve (concave) post-cam design exhibited the most normal-like knee kinematics, although the internal rotation was the closest to that of a normal knee in the helical post-cam design. The curve-and-curve (concave) post-cam design showed a femoral rollback of 4.4 mm less than the normal knee, and the helical post-cam design showed an internal rotation of 5.6° less than the normal knee. Lateral collateral ligament and quadriceps forces in curve-and-curve (concave) post-cam design, and medial collateral ligament forces in helical post-cam design were the closest to that of a normal knee. The curve-and-curve (concave) post-cam design showed 20% greater lateral collateral ligament force than normal knee, and helical post-cam design showed medial collateral ligament force 14% greater than normal knee. The results revealed the variation in each design that provided the most normal-like biomechanical effect. The present biomechanical data are expected to provide useful information to improve post-cam design to restore normal-like knee mechanics in customized PS-TKA.

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