Intra and Inter-Rater Reliability of brief balance Evaluation system test in Patients with total Knee Arthroplasty

2018 ◽  
Vol 12 (1) ◽  
pp. 144
Author(s):  
B Mital Shah ◽  
A Thangamani Ramalingam ◽  
D Bid Dibyendunarayan ◽  
Patel KeniK ◽  
S Patel Krishna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Rater Reliability ◽  
Total Knee

The Effect of Cement Viscosity in Total Knee Arthroplasty

2012 ◽  
Author(s):  
Kevin Abbruzzese ◽  
Richard O’Laughlin ◽  
Daniel Lee ◽  
D. Gordon Allan ◽  
Manish Paliwal
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Sagittal Plane ◽  
Mechanical Tests ◽  
Lateral View ◽  
Superior Performance ◽  
Posterior View ◽  
Total Knee

Aseptic loosening of the tibial implant remains one of the major reasons of failure in Total Knee Arthroplasty (TKA). Currently, there is no consensus on the role that cement viscosity at the time of application to the bone plays in ensuring the long-term success of the arthroplasty. The purpose of this study was to investigate the relationship between cement viscosity and aseptic loosening of tibial implants. Three cements (Depuy 2, Palacos R (high viscosity cements) and Simplex-P, a medium viscosity cement) were compared during TKA through radiographic analysis and mechanical loading tests using surrogate tibia. Cement penetration was measured from radiographs of the constructs and analyzed according to the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation System. Simplex-P had the maximum cumulative penetration in seven zones in the mediolateral view, and three zones in antero-posterior view. Simplex exhibited maximum penetration in zone 7 in the antero-posterior view, and in zone 3 in the lateral view. For the mechanical tests the TKA constructs were subjected to cyclic compressive loading in the sagittal plane. Simplex-P had the smallest micro-motion in sagittal plane, the results were significant when compared to Palacos R. The consistently superior performance of Simplex-P suggests that cement viscosity does indeed play a role in arthroplasty success. These results have direct clinical relevance for TKA patients suffering from aseptic loosening.

scholarly journals Patellar Tilt in Two Modern Total Knee Arthroplasty Systems: A Matched-Cohort Analysis

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Braeden W. Estes, BS ◽  
Lauren Pitz, BS ◽  
Evan R. Deckard, BSE ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Activity Level ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Premature Failure ◽  
Patient Reported ◽  
Total Knee

Background and Hypothesis: Excessive patellar tilt is undesirable in total knee arthroplasty (TKA) and can result in patellofemoral complications and premature failure/wear. Few studies have investigated patellar tilt between TKA systems with different femoral component geometries and bearing articulations. The purpose of this study was to (1) compare patellar tilt between TKA systems with differing femoral component geometries and (2) evaluate related differences in patient-reported outcome measures (PROMS). The study hypothesis was neutral patellar tilt would correlate with improved postoperative PROMS. Experimental Design or Project Methods: 380 symmetric trochlear groove TKAs were matched to 380 asymmetric lateralized trochlear groove TKAs on age, sex, body mass index, and preoperative patellar tilt. All cases were performed by one surgeon between 12/2010 and 10/2018. Patellar tilt (in degrees) was measured by two independent blinded raters on preoperative and 4-week postoperative merchant view radiographs per the modern Knee Society Radiographic Evaluation System. Prospectively collected and validated PROMS including UCLA Activity Level, components of the Knee Society Score, and Likert satisfaction were evaluated at minimum one-year. Results: There were no differences between study cohorts for demographics, covariates, or preoperative patellar tilt (p≥0.479). Asymmetric lateralized trochlear groove TKAs had significantly less postoperative patellar tilt compared with symmetric trochlear groove TKAs (p<0.001). Patellar tilt and femoral implant type had no correlation to pain scores (Knee Society), UCLA Activity Level, or satisfaction (p≥0.138); however, postoperative patellar tilt was significantly less for patients who stated their knee “always” felt normal compared to patients who stated their knee “sometimes” felt normal but not “never” felt normal (p=0.033). Conclusion and Potential Impact: Findings suggest implant type and patellar tilt have minimal effect on overall PROMS. However, minimizing patella maltracking may provide patients with a more normal feeling TKA and could potentially provide long-term benefits of preventing polyethylene wear or other complications leading to premature implant failure.

scholarly journals Intra- and inter-rater reliability of the Knee Society Knee Score when used by two physiotherapists in patients post total knee arthroplasty

2010 ◽  
Vol 66 (1) ◽  
Author(s):  
S. Gopal ◽  
W. Wood ◽  
H. Myezwa ◽  
A. Stewart
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Intraclass Correlation ◽  
Time Interval ◽  
Knee Score ◽  
Clinical Testing ◽  
Good Reliability ◽  
Rater Reliability ◽  
Knee Society Knee Score ◽  
Total Knee

Background and Purpose: It has yet to be shown whether routine physiotherapy plays a role in the rehabilitation of patients post totalknee arthroplasty (Rajan et al 2004). Physiotherapists should be using validoutcome measures to provide evidence of the benefit of their intervention. The aim of this study was to establish the intra and inter-rater reliability of the Knee Society Knee Score, a scoring system developed by Insall et al(1989). The Knee Society Knee Score can be used to assess the integrity of theknee joint of patients undergoing total knee arthroplasty. Since the scoreinvolves clinical testing, the intra-rater reliability of the clinician should be established prior to using the scores as datain clinical research. W here multiple clinicians are involved, inter-rater reliability should also be established.Design: This was a correlation study.Subjects: A  sample of thirty patients post total knee arthroplasty attending the arthroplasty clinic at Johannesburg Hospital between six weeks and twelve months postoperatively.M ethod: Recruited patients were evaluated twice with a time interval of one hour between each assessment. Statistical A nalysis: The intra- and inter-rater reliability were estimated using Intraclass Correlation Coefficient (ICC). R esults: The intra-rater reliability showed excellent reliability (h= 0.95) for Examiner A  and good reliability (h= 0.71)for Examiner B. The inter-rater reliability showed moderate reliability (h= 0.67 during test one and h= 0.66 during test two).Conclusion: The KSKS has good intra-rater reliability when tested within a period of one hour. The KSKS demonstrated moderate agreement for inter rater reliability.

Polished Cobalt-Chrome vs Titanium Tibial Trays in Total Knee Replacement (a Comparison using the PFC Sigma System)

2012 ◽  
Vol 2 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Kevin T Hug ◽  
Robert A Henderson ◽  
Benjamin J Hansen ◽  
Samuel S Wellman ◽  
Thomas P Vail
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Polyethylene Insert ◽  
Tibial Tray ◽  
Radiolucent Lines ◽  
Total Knee ◽  
Cobalt Chrome

ABSTRACT Fixed-bearing total knee arthroplasty components can cause wear debris due to fretting micromotion between the polyethylene insert and the metal tibial tray, possibly leading to osteolysis and implant failure. This study compared the effects of either a highly polished cobalt-chrome (CoCr) or titanium tibial tray in patients receiving the PFC. Sigma® posterior stabilized knee system with a moderately cross-linked polyethylene insert. One hundred five patients with titanium tibial trays and 70 patients with CoCr tibial trays were prospectively enrolled at the time of follow-up of at least 4 years from surgery. There were two revisions with implant removal in each group. On blinded radiographic review, osteolysis was observed in three of 105 knees in the titanium group and three of 70 knees in the CoCr group. Radiolucent lines were categorized in accordance with the Knee Society roentgenographic evaluation system. In the titanium group 18% showed no radiolucent lines, 65% scored four or less (nonconcerning), and 17% scored between five and nine (requires observation for progression). In the CoCr group 24% showed no radiolucencies, 61% scored four or less, and 14% scored between five and nine. None of the knees in either group scored greater than 10 (possible or impending failure). Knee society scores and radiographic alignment were statistically similar between groups. These results suggest that there may not be a difference in clinical or radiographic mid-term outcome between titanium and CoCr tibial trays in total knee arthroplasty. Hug KT, Henderson RA, Hansen BJ, Wellman SS, Vail TP, Bolognesi MP. Polished Cobalt-Chrome vs Titanium Tibial Trays in Total Knee Replacement (A Comparison using the PFC Sigma System). The Duke Orthop J 2012;2(1):5-11.

Evaluation of the Effect of Cement Viscosity on Cement Mantle in Total Knee Arthroplasty

2008 ◽  
Author(s):  
Manish Paliwal ◽  
Brian Kern ◽  
D. Gordon Allan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
High Viscosity ◽  
Cement Mantle ◽  
P Value ◽  
Cement Penetration ◽  
Wide Range ◽  
Total Knee ◽  
The Difference

Aseptic loosening of the tibial implant remains one of the major reasons of failure in Total Knee Arthroplasty (TKA). The cement viscosity at the time of application to the bone is of great importance to ensure a long-term success of the arthroplasty, as it influences the cement penetration and stability of the prosthesis. Currently, there are number of cements available with a wide range of viscosities and set times. High viscosity faster-setting cements may significantly reduce operating room times. However, the concern is that this positive feature may be at the expense of decreased penetration into the bone, and hence reduced stability of the construct. The use of four cement types ((DePuy II (DePuy Inc. Warsaw, IN), Endurance (DePuy Inc. Warsaw, IN), Simplex-P (Stryker Corp Kalamazoo, MI), and Palacos (Zimmer, Inc, Warsaw, IN)) were compared and evaluated during TKA using surrogate tibiae, with respect to the depth of cement penetration according to the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation System. On radiographic analysis of the implanted surrogate tibiae, it was found that Simplex had the maximum commulative penetration of 19.2 mm in seven zones in Mediolateral view, and 12.7 mm in three zones in anteroposterior view. In zone seven, the difference was statistically significant when comparing Simplex with Palacos (11 mm vs 4.6 mm, two-tailed P value = 0.035), somewhat significant with Depuy 2 (11 mm vs 6 mm, two tailed P value = 0.08), but the different was not significant when compared with Endurance (11 mm vs 10 mm, two-tailed P value = 0.6345). In Zone 5, the difference was statistically significant with Simplex vs Endurance (0.3 mm vs 2.2 mm, P = 0.028), and with Simplex vs Depuy 2 (0.3 mm vs 2.17 mm, P = 0.012). This study enhances the understanding of the relation between cement viscosities and cement penetration into cancellous bone during TKA.

Development of a Modern Knee Society Radiographic Evaluation System and Methodology for Total Knee Arthroplasty

2015 ◽  
Vol 30 (12) ◽  
pp. 2311-2314 ◽  
Author(s):  
R. Michael Meneghini ◽  
Michael A. Mont ◽  
David B. Backstein ◽  
Robert B. Bourne ◽  
Doug A. Dennis ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Evaluation System ◽  
Radiographic Evaluation ◽  
Total Knee

scholarly journals The Imperial Joint Line Congruency Measurement is a valuable tool in total knee arthroplasty

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257325
Author(s):  
Ravi Popat ◽  
Kieran Dhillon ◽  
Piyush Mahapatra ◽  
Hasaan Khan ◽  
Dinesh Nathwani
Keyword(s):  
Total Knee Arthroplasty ◽  
Medical Students ◽  
Knee Arthroplasty ◽  
Joint Line ◽  
Absolute Difference ◽  
The Novel ◽  
Rater Reliability ◽  
Plain Radiographs ◽  
Orthopaedic Surgeons ◽  
Total Knee

Background Preservation of joint line height is an important factor in post-operative function after Total Knee Arthroplasty (TKA). This is the first study investigating the reliability of the novel Imperial Joint Line Congruency Measurement (IJLCM) technique for the assessment of joint line height using plain radiographs. Methods The reliability of two techniques used to measure joint line height on pre-operative and post-operative plain radiographs is presented. 120 patients that underwent TKA from 6 different international centres were included. Measurements were performed using each technique by two senior orthopaedic surgeons at two different timepoints (test-retest). Two undergraduate medical students performed joint line measurements using the most reproducible of the two techniques on 40 pre-operative and post-operative images to establish the reliability of the measurement technique. Results The IJLCM demonstrated an average absolute difference of 1.83mm (CI 1.56–2.10mm) and excellent inter and intra-rater reliability between senior orthopaedic surgeons (>0.92 (CI 0.88–0.94) when measuring joint line height on plain radiographs. Overall Crohnbach’s alpha over 0.92 confirmed internal consistency. Measurements performed using the control technique as previously described by Figgie et al. had an average absolute difference of 5.75mm (5.17–6.32mm). Comparison of measurements by senior orthopaedic surgeons and medical students using the IJLCM technique with ANOVA and student’s t-test demonstrated acceptable agreement and inter-rater reliability of >0.92 (0.87–0.95). Conclusion This study shows excellent accuracy, precision, and reliability of the novel IJLCM technique. Furthermore, excellent agreement between senior orthopaedic surgeons and medical students when using the IJLCM could be shown. The IJLCM technique is reliable for joint line assessment.

Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

2020 ◽  
Author(s):  
Robert Brochin ◽  
Jashvant Poeran ◽  
Khushdeep S. Vig ◽  
Aakash Keswani ◽  
Nicole Zubizarreta ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Trend Test ◽  
Strong Impact ◽  
Hospitalization Costs ◽  
Teaching Status ◽  
Increasing Trend ◽  
Total Knee ◽  
Increasing Trends

AbstractGiven increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

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