Outcome of Midvastus versus Subvastus Approach in Single Stage Bilateral Total Knee Arthroplasty

Objective: To compare midvastus and subvastus approach regarding operative parameters(lateral retinacular release, operative time, neurovascular injury) and outcome (Knee Society Score, Straight Leg Raise) at 12 weeks in single stage bilateral total knee arthroplasty. Study Design: Randomized clinical trial study Place and Duration of Study: Institute of Orthopaedic Surgery and South City Hospital Karachi from 1st January 2016 to 31st December 2018. Methodology: Fifty two patients of both genders ofmore than 50 years with osteoarthritis grade III or IV and bony changes confirmed by AP and lateral radiographs of knee were included. Patients with previous knee surgeries including high tibial osteotomy, deformities >20°(on mechanical axis), any neuromuscular problem and BMI ≥30 were excluded. Final assessment was done at 12 weeks. Isometric quadriceps strength was assessed by holding of contraction in seconds during the lifting (10cm above the plinth) phase of SLR (patient lying supine).Knee score (preoperative and final follow-up) was performed by Knee Society Score. Results: Thirty five were females and 21 males with mean age 65.3 years (50-78 years). Mean body mass index was 27.8 Kg/m2 (26.4-29.9). In midvastus TKR, the mean operative time was 61.7 minutes (range 52-70) whereas the same was 68.3 minutes (range 58-74) in subvastus TKR with p value 0.002. Rate of lateral retinacular release (LLR) was significantly (p=0.011) different between the midvastus TKR 5 (8.9%) and subvastus TKR 11 (19.6%). Neither group had neurovascular injury or early infection of the knee. Active SLR in subvastus group was achieved in shorter time (mean 3.1 days) as compared to midvastus group (mean 4.7 days). There was no difference (p=0.173) in isometric quadriceps strength at 12 weeks between subvastus TKR (mean 18 seconds) and midvastus TKR (mean 17 seconds). Knee society pain and functional scores were comparable between the two approaches at final follow up. Conclusion: Subvastus exposure has advantage of achieving active straight leg raise earlier while midvastus has lower frequency of lateral retinacular release. No difference in hospital stay and postoperative pain scores. Both subvastus and midvastus approaches are safe and offer comparable Knee Society Score outcomes. Keywords: Midvastus, Subvastus, Total knee arthroplasty, Knee Society Score, Straight leg raise

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Arthroscopic Treatment of Patients with Arthrofibrosis Following Total Knee Replacement

Revista de Chimie ◽

10.37358/rc.18.11.6733 ◽

2018 ◽

Vol 69 (11) ◽

pp. 3292-3294

Author(s):

Daniel Oltean Dan ◽

Gabri Jozsef Zsolt ◽

Dragos Apostu ◽

Mihai Gheorghe Paiusan ◽

Cristian Paul Dan ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Total Knee Replacement ◽

Range Of Motion ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Knee Society Score ◽

Arthroscopic Treatment ◽

Arthroscopic Arthrolysis ◽

Total Knee

The main objective of the current study was to evaluate the success of arthroscopic arthrolysis treatment of patients with knee stiffness after total knee arthroplasty. Six patients who underwent arthroscopic arthrolysis were evaluated retrospectively, all of them being treated conservatively before going for surgery. Results showed significant improvement of range of motion and Knee Society Score at the latest follow up compared to the preoperative values. This study concludes that arthroscopic arthrolysis is an effective and reproductible technique for the treatment of knees stiffness after total knee arthroplasty.

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Pigmented villonodular synovitis does not influence the outcomes following cruciate-retaining total knee arthroplasty: a case-control study with minimum five year follow-up

10.21203/rs.3.rs-16062/v2 ◽

2020 ◽

Author(s):

Wei Lin ◽

Yike Dai ◽

Jinghui Niu ◽

Guangmin Yang ◽

Ming Li ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Society Score ◽

Pigmented Villonodular Synovitis ◽

Control Group ◽

Villonodular Synovitis ◽

Cruciate Retaining ◽

Total Knee ◽

Pigmented Villonodular

Abstract Background: Pigmented villonodular synovitis (PVNS) is a rare synovial disease with benign hyperplasia, which has been successfully treated with total knee arthroplasty (TKA). The purpose of this study was to investigate the middle-term follow-up outcomes of cruciate-retaining (CR) TKA in patients with PVNS.Methods: From January 2012 to December 2014, a retrospective study was conducted in 17 patients with PVNS who underwent CR TKA as PVNS group. During this period, we also selected 68 patients with osteoarthritis who underwent CR TKA (control group) for comparison. The two groups matched in a 1:4 ratio based on age, sex, body mass index and follow-up time. The range of motion, Knee Society Score, revision rate, disease recurrence, wound complications and the survivorship curve of Kaplan-Meier implant were assessed between the two groups.Results: All patients were followed up at least five years. There were no difference in range of motion, and Knee Society Score between the two groups before surgery and at last follow-up after surgery (p > 0.05). In the PVNS group, no patients with the recurrence of PVNS were found at the last follow-up, one patient underwent revision surgery due to periprosthetic fracture, and three patients had stiffness one year after surgery (17.6% vs 1.5%, p = 0.005; ROM:16°- 81°), but no revision was needed. At seven years, the implant survivorship was 90.0% in the PVNS group and 96.6% in the control group (p = 0.54).Conclusions: This study demonstrated that the function of patients with PVNS who underwent CR TKA had been significantly improved, and the survival rate of implants in these patients were similar to the patients with OA. Consequently, the patients with PVNS who underwent CR TKA might be an achievable option. However, these patients should pay more attention to the occurrence of postoperative stiffness complication.

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Mid-Term Follow Up Results of Mini-Subvastus Approach for Total Knee Arthroplasty in Obese Patients

Reconstructive Review ◽

10.15438/rr.7.3.174 ◽

2017 ◽

Vol 7 (3) ◽

Author(s):

Aditya laxmikant Kekatpure ◽

Nilen A Shah ◽

Prithviraj Prabhakar Nistane ◽

Pritam K Agrawal

Keyword(s):

Total Knee Arthroplasty ◽

Obese Patient ◽

Knee Arthroplasty ◽

Patient Population ◽

Morbidly Obese ◽

Obese Patients ◽

Subvastus Approach ◽

Functional Scores ◽

Total Knee

Background: Use of mini-subvastus approach for total knee arthroplasty (TKA ) in obese patients is still debated . We had hypothesized in our study published in July 2010 , that obesity should not be considered as a problem for patients undergoing a TKA with the mini-subvastus approach as the anatomy of the quadriceps in the obese and the non-obese patient population is the same. We present a mid-term follow-up study of the same set of patients with an average follow up of 96 months.Materials and Methods: 97 obese patients (109 knees) 81 females + 16 males with mean age 64 years underwent TKA by mini-subvastus approach between January 2006 to July 2007. 16 patients (18 knees) were morbidly obese. Out of the total number of patients, 08 were lost in follow up and 01 died because of unrelated causes. Out of these 09 patients, two were operated for bilateral TKR. Thus, we have a midterm follow up results of 98 knees in 88 patients. Knee society and functional scores were used for patient evaluation and compared to their pre-operative and earlier follow up scores.Results: At our latest follow-up of 96 months the Knee Society Score and functional scores were 84(range 64-90) and 58(range 45-75) respectively. One morbidly obese lady had aseptic loosening of tibial component at 42 months which needed a revision.Conclusion: Our mid-term results show that the mini-subvastus approach can be considered for TKA in obese and morbidly obese patient population with outcomes comparable to standard surgical approach.Keywords: Mini-subvastus approach, Total knee arthroplasty ,Obesity

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Total Knee Arthroplasty Outcome for 129 Knees 80 Years and Older in Chinese Population

10.21203/rs.3.rs-910379/v1 ◽

2021 ◽

Author(s):

Cheng-Qi Jia ◽

Zhi-Lai Zhao ◽

Yu-Jie Wu ◽

Jun Fu ◽

Chi Xu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Chinese Population ◽

Operative Time ◽

Inclusion Criteria ◽

Tourniquet Time ◽

Patients Satisfaction ◽

Functional Scores ◽

Total Knee

Abstract BackgroundSince China is aging rapidly, it is necessary to evaluate the reliability, durability, and satisfaction of total knee arthroplasty (TKA) among patients over 80 years.MethodsBetween February 2009 and December 2017, 98 patients (129 knees) met the inclusion criteria and were postoperatively followed-up ≥ 3 years. TKAs included 67 unilateral TKAs and 31 bilateral TKAs. The indexes included operative time, intraoperative blood loss, tourniquet time, Knee Society Score (KSS), Visual Analogue Scale (VAS), Range of Motion (ROM), “Forgotten Joint” Scale (FJS), crutches usage and patients’ satisfaction.ResultsKSS clinical and functional scores improved significantly from preoperative mean of 33 and 27 to latest follow-up of 87 and 51, respectively (p <0.05). The VAS decreased significantly from preoperative mean scores of 8 to latest follow-up of 0 (p <0.05). The proportion of patients without crutches at last follow-up was 52%, satisfaction rate was 94% and FJS ≥ 50 was 85%. However, ROM did not improve significantly from preoperative mean 89° to latest follow-up 93° (p >0.05). The preoperative hemoglobin and survival proportions between bilateral and unilateral TKAs were not statistically different (p >0.05).ConclusionTKA was reliable, durable, and satisfied in patients older than 80 years in Chinese population.

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A study of clinical and functional outcome of primary total knee arthroplasty using posterior cruciate substitute design

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171567 ◽

2017 ◽

Vol 3 (3) ◽

pp. 380

Author(s):

Radhakrishna A. M. ◽

Shivananda S. ◽

Girish S.

Keyword(s):

Total Knee Arthroplasty ◽

Functional Outcome ◽

Knee Arthroplasty ◽

Knee Society Score ◽

Clinical Score ◽

Functional Score ◽

Consecutive Series ◽

Total Knee ◽

Primary Total Knee

Background: To study the clinical and functional outcome in a consecutive series of Total Knee Arthroplasty using Posterior cruciate substituting (PS) design using the Knee Society Score(KSS). The objectives of the study was 1) To assess the improvement in pain relief post-operatively, stability, mobility of the joint and to assess the correction of deformities. 2) To compare the knee clinical score (KCS) pre-operatively and post-operatively. 3) To compare the knee functional score (KFS) pre-operatively and post-operatively. 4) To assess the radiological outcome of total knee arthroplasty. 5) To study the association between the KCS and the KFS.Methods: The study was conducted on patients who have undergone Primary total knee replacement, in Department of Orthopaedics, KIMS hospital from June 2014 to February 2017. The patient was assessed clinically, functionally using the Knee Society Score and a radiographic evaluation was done. These evaluations were performed at 6weeks, 12 weeks, 24 weeks and 1year follow up visits.Results: At 1 year follow up of 60 knees, the average pre-op knee clinical score and functional score of 24.7 and 41.2 improved to an average post-op score of 89.9 and 87.8 respectively. Knee clinical and functional score grade of excellent to good was seen in 96.7% (58 knees of 60). Significant association was seen between KCS and KFS. 5 patients had delayed wound healing and one patient had deep infection. Alignment of prosthesis was found satisfactory in all patients. Flexion deformity, valgus and varus correction achieved in all the patients. Conclusions: Total knee arthroplasty using posterior cruciate substituting designs resulted in excellent relief of pain, range of motion, restoration of function, low prevalence of patellofemoral complications and continues to function well during the follow-up period. Improvement in clinical score correlated significantly with improvement in functional score. Knee society scoring system effective in evaluating clinical, functional and radiological outcomes.

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SMOC Approach for Total Knee Arthroplasty in Valgus Knees

10.21203/rs.3.rs-107449/v1 ◽

2020 ◽

Author(s):

Tao Li ◽

Yingzhen Wang ◽

Haiyan Li ◽

Pengcheng Guo ◽

Haining Zhang

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Soft Tissues ◽

Primary Total Knee Arthroplasty ◽

Valgus Deformity ◽

Early Recovery ◽

Subvastus Approach ◽

Total Knee ◽

The Mean

Abstract Purpose The subvastus approach sometimes can not provide adequate exposure and lateral approach has disadvantages of closure of the soft tissues and patellar tracking. The hypothesis of this study was that SMOC approach could be used in valgus knees and would offer good function.Methods We retrospectively reviewed 25 patients (25 knees) with valgus deoformity undergoing primary total knee arthroplasty (TKA) with SMOC approach. Necessary soft tissue releases, Visual Analog Scale (VAS), straight leg raising (SLR), International Knee Society score (KSS), radiological alignment were assessed with average follow-up of 16 months.Results KSS improved significantly from 38.5 to 90.3. The mean range of motion increased from 89.5°to 121.8°.The mean tibiofemoral valgus was corrected from preoperative 17.1° to 6.3°. No instability, recurrent valgus deformity, or radiographic loosening was found during follow-up.Conclusions SMOC approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.

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Reemplazo Total de Rodilla en pacientes menores de 55 años de edad con gonartrosis Seguimiento de 2 a 13 años. [Total Knee Arthroplasty for gonarthrosis in patients 55 years old or younger. 2-13 years follow-up.]

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/618 ◽

2017 ◽

Vol 82 (2) ◽

pp. 94

Author(s):

German Garabano ◽

Fernando Lopreite ◽

Hernán Del Sel

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Society Score ◽

El Sistema ◽

Total Knee

IntroducciónEl número de reemplazos totales de rodilla (RTR) en pacientes jóvenes continua en aumento. La literatura muestra resultados contradictorios y la mayoría incluyen pacientes con Artritis Reumatoide (AR). El propósito de este estudio fue analizar un grupo de RTR en menores de 55 años, excluyendo pacientes con AR, evaluando la sobrevida protésica, las fallas radiológicas y sus resultados funcionales.Materiales y MétodosSe analizaron retrospectivamente 53 RTR en 46 pacientes, con una edad promedio de 49 (26-54) años y un seguimiento promedio de 6,5 (2-15) años. Los diagnósticos preoperatorios correspondieron a 46 gonartrosis idiopáticas, 5 postraumáticas y 2 osteonecrosis. 22 presentaban antecedentes de cirugías previas. Se utilizaron 49 implantes importados y 4 nacionales. Los resultados clínico-funcionales se objetivaron mediante Knee Society Score y WOMAC, mientras que para la evaluación radiológica se utilizo el sistema de la Knee Society.ResultadosLa puntuación funcional del KSS mejoró de 49,3 a 92,6 en promedio, mientras que la puntuación propia de rodilla paso de 46,8 a 91,4 puntos en el posoperatorio. La puntuación WOMAC en promedio fue de 2,3 para dolor, 2,6 para rigidez y 27,3 para la capacidad funcional. El 16% presento líneas de radiolúcidas <1mm que no progresaron en el tiempo. Hubieron 3 infecciones que requirieron de una revisión en dos tiempos evolucionando favorablemente y 4 rigideces que fueron tratadas mediante movilización artrocópica. La sobrevida protésica fue del 94,34%.ConclusionesEl RTR en pacientes <55 años mostró ser un procedimiento confiable en lo que respecta a la mejora de la función, con una aceptable sobrevida protésica teniendo en cuenta los antecedentes quirúrgicos previos. No observamos fallas radiológicas al final del seguimiento.

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Quadriceps strength impairment in the mid- to long-term follow-up period after total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-016-4333-5 ◽

2016 ◽

Vol 25 (11) ◽

pp. 3372-3377 ◽

Cited By ~ 6

Author(s):

Yoshinori Ishii ◽

Hideo Noguchi ◽

Junko Sato ◽

Tetsuya Sakurai ◽

Shin-ichi Toyabe

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Quadriceps Strength ◽

Long Term Follow Up ◽

Total Knee

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FUNCTIONAL OUTCOME ANALYSIS OF TOTAL KNEE ARTHROPLASTY IN OSTEOARTHRITIC PATIENTS IN INDIAN POPULATION.

10.36106/ijsr/5240376 ◽

2021 ◽

pp. 51-53

Author(s):

Sanjiv Gaur ◽

Kashif Iqbal ◽

Manoj Kumar ◽

Rohit Bansal ◽

Mohd Zuber

Keyword(s):

Total Knee Arthroplasty ◽

Knee Joint ◽

Functional Outcome ◽

Knee Arthroplasty ◽

Knee Society Score ◽

Osteoarthritis Of Knee ◽

Functional Capabilities ◽

Total Knee ◽

The Mean

Osteoarthritis of knee joint is a common disease affecting mostly elderly population and some younger individuals causing a painful joint limited by mobility, deformity and functional capabilities. Total Knee Arthroplasty is an excellent modality for treating painful severe osteoarthritis of knee providing the patient with pain relief, correcting joint instability and deformity and improving the functional capabilities of the patients which is assessed using knee society score. This is a prospective study including 20 patients of both sexes having severe painful osteoarthritis of knee joint. 14 patients underwent unilateral TKA and 6 patients underwent bilateral TKA. The functional outcome of total of 26 TKA were assessed. Out of 20 study subjects, 12(60%) were male and 08(40%) were females and the mean age was 57.35years and mean follow up period was 12.46months. The mean score of part A of knee society score before surgery was 42.08 and at nal follow up it increased to 90.92 and the mean score of part B of knee society score was 37.5 before surgery and it increased to 93.08 at nal follow up suggesting improvement from poor at preoperative period to excellent at nal follow up. This study showed that all patients achieved excellent early results with total knee arthroplasty. This study is limited by small sample size and short follow up.

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Pigmented villonodular synovitis does not influence the outcomes following cruciate-retaining total knee arthroplasty: a case-control study with minimum 5-year follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01933-x ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Wei Lin ◽

Yike Dai ◽

Jinghui Niu ◽

Guangmin Yang ◽

Ming Li ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Society Score ◽

Pigmented Villonodular Synovitis ◽

Control Group ◽

Villonodular Synovitis ◽

Cruciate Retaining ◽

Total Knee ◽

Pigmented Villonodular

Abstract Background Pigmented villonodular synovitis (PVNS) is a rare synovial disease with benign hyperplasia, which has been successfully treated with total knee arthroplasty (TKA). The purpose of this study was to investigate the middle-term follow-up outcomes of cruciate-retaining (CR) TKA in patients with PVNS. Methods From January 2012 to December 2014, a retrospective study was conducted in 17 patients with PVNS who underwent CR TKA as PVNS group. During this period, we also selected 68 patients with osteoarthritis who underwent CR TKA (control group) for comparison. The two groups matched in a 1:4 ratio based on age, sex, body mass index, and follow-up time. The range of motion, Knee Society Score, revision rate, disease recurrence, wound complications, and the survivorship curve of Kaplan-Meier implant were assessed between the two groups. Results All patients were followed up at least 5 years. There was no difference in range of motion and Knee Society Score between the two groups before surgery and at last follow-up after surgery (p > 0.05). In the PVNS group, no patients with the recurrence of PVNS were found at the last follow-up, one patient underwent revision surgery due to periprosthetic fracture, and three patients had stiffness one year after surgery (17.6% vs 1.5%, p = 0.005; ROM 16–81°), but no revision was needed. At 7 years, the implant survivorship was 90.0% in the PVNS group and 96.6% in the control group (p = 0.54). Conclusions This study demonstrated that the function of patients with PVNS who underwent CR TKA had been significantly improved, and the survival rate of implants in these patients was similar to the patients with OA. Consequently, the patients with PVNS who underwent CR TKA might be an achievable option. However, these patients should pay more attention to the occurrence of postoperative stiffness complications.

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