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Sample records for posterior-stabilized total knee

  1. Patellar clunk syndrome after posterior stabilized total knee arthroplasty.

    PubMed

    Yau, Wai-Pan; Wong, Jimmy W K; Chiu, Kwong-Yuen; Ng, Tze-Pui; Tang, Wai-Man

    2003-12-01

    Two hundred thirty-six posterior stabilized total knee arthroplasties (TKAs) were performed consecutively. Twenty-seven patellar clunk syndromes were identified in 25 patients. Insall-Salvati ratio, position of joint line, postoperative patellar height, and anterior-posterior position of tibial tray were measured. It was found that postoperative low-lying patella (P<.001) and anterior placement of tibial tray (P=.011) was associated with patellar clunk syndrome. Thirteen patients had bilateral TKAs of the same prosthesis (5 bilateral AMK knees and 8 bilateral Insall Burstein knees) but unilateral patellar clunk syndrome. The nonclunk sides were used as control for comparison with the clunk sides. The congruency and tilting of the patellar button in the skyline view were documented. It was observed that the congruency of the patellar button was less satisfactory in the clunk side (P=.019).

  2. Posterior cruciate ligament removal contributes to abnormal knee motion during posterior stabilized total knee arthroplasty.

    PubMed

    Cromie, Melinda J; Siston, Robert A; Giori, Nicholas J; Delp, Scott L

    2008-11-01

    Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20-60 degrees ) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing the posterior cruciate ligament introduce abnormal anterior femoral translation? Does implanting a posterior stabilized prosthesis change the kinematics from the cruciate deficient case? Using a navigation system, we measured passive knee kinematics of ten male osteoarthritic patients during surgery after initial exposure, after removing the anterior cruciate ligament, after removing the posterior cruciate ligament, and after implanting the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translation and the flexion angle at which femoral rollback began. Removing the posterior cruciate ligament doubled anterior translation (from 5.1 +/- 4.3 mm to 10.4 +/- 5.1 mm) and increased the flexion angle at which femoral rollback began (from 31.2 +/- 9.6 degrees to 49.3 +/- 7.3 degrees). Implanting the prosthesis increased the amount of anterior translation (to 16.1 +/- 4.4 mm), and did not change the flexion angle at which femoral rollback began. Abnormal anterior translation was observed in low and mid flexion (0-60 degrees) after removing the posterior cruciate ligament, and normal motion was not restored by the posterior stabilized prosthesis.

  3. Posterior Cruciate Ligament Removal Contributes to Abnormal Knee Motion during Posterior Stabilized Total Knee Arthroplasty

    PubMed Central

    Cromie, Melinda J.; Siston, Robert A.; Giori, Nicholas J.; Delp, Scott L.

    2017-01-01

    Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20–60°) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing the posterior cruciate ligament introduce abnormal anterior femoral translation? Does implanting a posterior stabilized prosthesis change the kinematics from the cruciate deficient case? Using a navigation system, we measured passive knee kinematics of ten male osteoarthritic patients during surgery after initial exposure, after removing the anterior cruciate ligament, after removing the posterior cruciate ligament, and after implanting the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translation and the flexion angle at which femoral rollback began. Removing the posterior cruciate ligament doubled anterior translation (from 5.1±4.3 mm to 10.4±5.1 mm) and increased the flexion angle at which femoral rollback began (from 31.2±9.6° to 49.3±7.3°). Implanting the prosthesis increased the amount of anterior translation (to 16.1±4.4 mm), and did not change the flexion angle at which femoral rollback began. Abnormal anterior translation was observed in low and mid flexion (0–60°) after removing the posterior cruciate ligament, and normal motion was not restored by the posterior stabilized prosthesis. PMID:18464260

  4. The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty.

    PubMed

    Shi, Xiaojun; Shen, Bin; Kang, Pengde; Yang, Jing; Zhou, Zongke; Pei, Fuxing

    2013-12-01

    To evaluate and quantify the effect of the tibial slope on the postoperative maximal knee flexion and stability in the posterior-stabilized total knee arthroplasty (TKA). Fifty-six patients (65 knees) who had undergone TKA with the posterior-stabilized prostheses were divided into the following 3 groups according to the measured tibial slopes: Group 1: ≤4°, Group 2: 4°-7° and Group 3: >7°. The preoperative range of the motion, the change in the posterior condylar offset, the elevation of the joint line, the postoperative tibiofemoral angle and the preoperative and postoperative Hospital for Special Surgery (HSS) scores were recorded. The tibial anteroposterior translation was measured using the Kneelax 3 Arthrometer at both the 30° and the 90° flexion angles. The mean values of the postoperative maximal knee flexion were 101° (SD 5), 106° (SD 5) and 113° (SD 9) in Groups 1, 2 and 3, respectively. A significant difference was found in the postoperative maximal flexion between the 3 groups (P < 0.001). However, no significant differences were found between the 3 groups in the postoperative HSS scores, the changes in the posterior condylar offset, the elevation of the joint line or the tibial anteroposterior translation at either the 30° or the 90° flexion angles. A 1° increase in the tibial slope resulted in a 1.8° flexion increment (r = 1.8, R (2) = 0.463, P < 0.001). An increase in the posterior tibial slope can significantly increase the postoperative maximal knee flexion. The tibial slope with an appropriate flexion and extension gap balance during the operation does not affect the joint stability.

  5. In vivo polyethylene bearing mobility is maintained in posterior stabilized total knee arthroplasty.

    PubMed

    Komistek, Richard D; Dennis, Douglas A; Mahfouz, Mohamed R; Walker, Scott; Outten, Joel

    2004-11-01

    In vivo knee kinematics, including polyethylene bearing mobility, were determined in a group of nine patients implanted with a posterior stabilized, mobile-bearing total knee arthroplasty. Each patient, while under fluoroscopic surveillance, did a weightbearing deep knee bend and was analyzed using a 3-D computer model-fitting technique. Patients were evaluated at three and 15 months postoperatively. All nine patients had polyethylene bearing rotation relative to the tibial tray at both times, with the maximum amount of polyethylene bearing rotation at any flexion interval averaging 8.5 (range, 5.2-15.5) and 9.8 (range, 4.8-14.2) at 3 and 15 months, respectively. Minimal rotation of the polyethylene bearing relative to the femoral component was observed, averaging only 1.9 and 1.0 of rotation from full extension to maximum knee flexion at three and 15 months, respectively. This study determined that the polyethylene bearing is primarily rotating relative to the tibia rather than the femoral component. Therefore, as the femoral component axially rotates, the polyethylene bearing is rotating a similar magnitude in the same direction. This should result in reduced shear stresses on the superior aspect of the polyethylene bearing, lessening polyethylene wear.

  6. Tibiofemoral Instability After Primary Total Knee Arthroplasty: Posterior-Stabilized Implants for Obese Patients.

    PubMed

    Can, Ata; Erdogan, Fahri; Erdogan, Ayse Ovul

    2017-06-15

    Tibiofemoral instability is a common complication after total knee arthroplasty (TKA), accounting for up to 22% of all revision procedures. Instability is the second most common cause of revision in the first 5 years after primary TKA. In this study, 13 knees with tibiofemoral instability after TKA were identified among 693 consecutive primary TKA procedures. Patient demographics, body mass index, clinical symptoms, previous deformity, previous knee surgery, complications, interval between index TKA and first tibiofemoral instability, causes of instability, and interval between index TKA and revision TKA were retrospectively reviewed. Clinical outcomes were assessed with the Lysholm Knee Scoring Scale. All patients were women, and mean body mass index was 37.7 kg/m(2) (range, 27.2-52.6 kg/m(2)). Mean interval between index TKA and first tibiofemoral instability was 23.4 months (range, 9-45 months), and mean interval between index TKA and revision TKA was 25.6 months (range, 14-48 months). All patients had posterior cruciate ligament-retaining implants. Of the 13 knees, 11 had flexion instability and 2 had global instability. In all patients, instability was caused by incompetence of the posterior cruciate ligament; additionally, 1 patient had undersized and malpositioned implants. In 4 knees, the polyethylene insert was broken as well. All patients underwent revision TKA. Lysholm Knee Scoring Scale score had improved from a mean of 35.8 (range, 30-46) to a mean of 68.3 (range, 66-76). All patients included in this study were female and obese. The main cause of instability was secondary posterior cruciate ligament rupture and incompetence. The use of posterior-stabilized implants for primary TKA may prevent secondary instability in obese patients. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2017, SLACK Incorporated.

  7. Patient function after a posterior stabilizing total knee arthroplasty: cam-post engagement and knee kinematics.

    PubMed

    Suggs, Jeremy F; Hanson, George R; Park, Sang Eun; Moynihan, Angela L; Li, Guoan

    2008-03-01

    Even though posterior substituting total knee arthroplasty has been widely used in surgery, how the cam-post mechanism (posterior substituting mechanism) affects knee joint kinematics and function in patients is not known. The objective of the present study was to investigate posterior femoral translation, internal tibial rotation, tibiofemoral contact, and cam-post engagement of total knee arthroplasty patients during in vivo weight-bearing flexion. Twenty-four knees with a PS TKA were investigated while performing a single leg weight-bearing lunge from full extension to maximum flexion as images were recorded using a dual fluoroscopic system. The in vivo knee position at each targeted flexion angle was reproduced using 3D TKA models and the fluoroscopic images. The kinematics of the knee was measured from the series of the total knee arthroplasty models. The cam-post engagement was determined when the surface model of the femoral cam overlapped with that of the tibial post. The mean maximum flexion angle for all the subjects was 112.5 +/- 13.1 degrees . The mean flexion angle where cam-post engagement was observed was 91.1 +/- 10.9 degrees . The femur moved anteriorly from 0 degrees to 30 degrees and posteriorly through the rest of the flexion range. The internal tibial rotation increased approximately 6 degrees from full extension to 90 degrees of flexion and decreased slightly with further flexion. Both the medial and lateral contact point moved posteriorly from 0 degrees to 30 degrees , remained relatively constant from 30 degrees to 90 degrees , and then moved further posterior from 90 degrees to maximum flexion. The in vivo cam-post engagement corresponded to increased posterior translation and reduced internal tibial rotation at high flexion of the posterior substituting total knee arthroplasty. The initial cam-post engagement was also mildly correlated with the maximum flexion angle of the knee (R = 0.51, p = 0.019). A later cam-post engagement might

  8. Posterior stabilized knee prosthesis for total knee replacement in patients with prior patellectomy

    PubMed Central

    Cameron, Hugh U.; Hu, Cungen; Vyamont, Didier

    1996-01-01

    Objective To determine the outcome of total knee replacement using a posterior cruciate-substituting knee prosthesis in patients who have undergone previous patellectomy. Design A cohort study, with a follow-up ranging from 2 to 9 years. Setting A university-affiliated institution specializing in elective orthopedic surgery. Participants Sixteen patients with arthritis of the knee who had had patellectomy. All agreed preoperatively to a prolonged postoperative follow-up. Intervention A cemented posterior cruciate-substituting knee replacement. Main Outcome Measures Stair climbing ability, the Hospital for Special Surgery knee rating system for clinical results and a radiologic rating using a zonal system. Results Clinical rating was 69% good or excellent. Eighty-one percent of patients could use the replaced knee as the lead leg on stair climbing. Minor radiolucency, mostly single zone only, was found. Two patients required revision because of pain, but no obvious reasons for this pain were found at operation. Conclusion In the absence of a patella, a posterior cruciate-substituting prosthesis gives reasonable results. PMID:8956812

  9. Intraoperative joint gaps and mediolateral balance affect postoperative knee kinematics in posterior-stabilized total knee arthroplasty.

    PubMed

    Watanabe, Toshifumi; Muneta, Takeshi; Sekiya, Ichiro; Banks, Scott A

    2015-12-01

    Adjusting joint gaps and establishing mediolateral (ML) soft tissue balance are considered essential interventions for better outcomes in total knee arthroplasty (TKA). However, the relationship between intraoperative laxity measurements and weightbearing knee kinematics has not been well explored. This study aimed to quantify the effect of intraoperative joint gaps and ML soft tissue balance on postoperative knee kinematics in posterior-stabilized (PS)-TKA. We investigated 44 knees in 34 patients who underwent primary PS-TKA by a single surgeon. The central joint gaps and ML tilting angles at 0°, 10°, 30°, 60°, 90°, 120° and 135° flexion were measured during surgery. At a minimum of two year follow-up, we analyzed in vivo kinematics of these knees and examined the influence of intraoperative measurements on postoperative kinematics. Gap difference of knee flexion at 135° minus 0° was correlated with the total posterior translation of lateral femoral condyle (r=0.336, p=0.042) and femoral external rotation (r=0.488, p=0.002) during squatting, anteroposterior position of lateral femoral condyle (r=-0.510, p=0.001) and maximum knee flexion (r=0.355, p=0.031) in kneeling. Similar correlations were observed between deep flexion gap differences with respect to the 90° reference and postoperative knee kinematics. Well-balanced knees showed less anterior translation of medial femoral condyle in mid- to deep flexion, consistent femoral external rotation, and the most neutral valgus/varus rotation compared with unbalanced knees. These findings indicate the importance of adequate intraoperative joint gaps in deep flexion and ML soft tissue balance throughout the range of motion. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Effect of femoral component design on patellofemoral crepitance and patella clunk syndrome after posterior-stabilized total knee arthroplasty.

    PubMed

    Frye, Benjamin M; Floyd, Mark W; Pham, Dahn C; Feldman, John J; Hamlin, Brian R

    2012-06-01

    The purpose of this study was to determine if recent changes to the femoral component of a particular posterior-stabilized total knee prosthesis would affect the incidence of postoperative patellofemoral crepitance and patella clunk syndrome. One hundred eight total knee arthroplasties were performed with the conventional design; 136 were performed after the femoral component was changed. Complications were compared between the groups with an average follow-up of 17.7 months and 12.4 months, respectively. Thirteen knees with the conventional design (12%) were found to have patellofemoral complications; no complications were noted with the new design (P < .0001). Femoral components with a deep trochlear groove and smooth transition of the intercondylar box appear to better accommodate any peripatellar fibrous nodule that may form after total knee arthroplasty.

  11. Characteristics of polyethylene wear particles isolated from synovial fluid after mobile-bearing and posterior-stabilized total knee arthroplasties.

    PubMed

    Minoda, Yukihide; Kobayashi, Akio; Iwaki, Hiroyoshi; Miyaguchi, Masatsugu; Kadoya, Yoshinori; Ohashi, Hirotsugu; Takaoka, Kunio

    2004-10-15

    The size, shape, and number of polyethylene wear particles found in synovial fluids of patients 1 year after implantation of 22 well-functioning total knee prostheses (11 contemporary mobile-bearing type, 11 posterior-stabilized type) were determined. Polyethylene wear particles were isolated from synovial fluids and examined by scanning electron microscopy. Particle size (equivalent circle diameter) was 0.81 +/- 0.12 microm (mean +/- standard error) in mobile-bearing types and 0.78 +/- 0.08 microm in posterior-stabilized types. Particle shape (aspect ratio) was 1.94 +/- 0.13 in mobile-bearing types and 2.30 +/- 0.22 in posterior-stabilized types. Total numbers of particles were (1.75 +/- 1.02) x 10(8) in mobile-bearing and (1.16 +/- 0.57) x 10(8) in posterior-stabilized types. The differences in these parameters between the two groups were not statistically significant. In the early stages after surgery, contemporary mobile-bearing types were comparable to posterior-stabilized types in terms of polyethylene wear-particle generation. The present results do not support the proposition that has been put forward in the literature; namely, that the contemporary mobile-bearing design has an advantage, in terms of the polyethylene wear rate. These data suggest that the advantage of complete conformity in the femoro-tibial articulating surface of contemporary mobile-bearing design may be offset by wear of the mobile undersurface and slot, apart from the articulating surface.

  12. Effect of Tibial Posterior Slope on Knee Kinematics, Quadriceps Force, and Patellofemoral Contact Force After Posterior-Stabilized Total Knee Arthroplasty.

    PubMed

    Okamoto, Shigetoshi; Mizu-uchi, Hideki; Okazaki, Ken; Hamai, Satoshi; Nakahara, Hiroyuki; Iwamoto, Yukihide

    2015-08-01

    We used a musculoskeletal model validated with in vivo data to evaluate the effect of tibial posterior slope on knee kinematics, quadriceps force, and patellofemoral contact force after posterior-stabilized total knee arthroplasty. The maximum quadriceps force and patellofemoral contact force decreased with increasing posterior slope. Anterior sliding of the tibial component and anterior impingement of the anterior aspect of the tibial post were observed with tibial posterior slopes of at least 5° and 10°, respectively. Increased tibial posterior slope contributes to improved exercise efficiency during knee extension, however excessive tibial posterior slope should be avoided to prevent knee instability. Based on our computer simulation we recommend tibial posterior slopes of less than 5° in posterior-stabilized total knee arthroplasty. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Does Cruciate-Retaining Total Knee Arthroplasty Show Better Quadriceps Recovery than Posterior-Stabilized Total Knee Arthroplasty? - Objective Measurement with a Dynamometer in 102 Knees

    PubMed Central

    Cho, Kye-Youl; Song, Sang-Jun; Bae, Dae-Kyung

    2016-01-01

    Background Cruciate-retaining (CR) prostheses have been considered to produce more physiologic femoral rollback, provide better proprioception, and result in better quadriceps recovery than posterior-stabilized (PS) prostheses after total knee arthroplasty (TKA). However, there are very few studies demonstrating these benefits in an objective manner. We investigated whether CR-TKA could result in (1) better quadriceps recovery; (2) a greater proportion of patients with beyond the preoperative level of recovery; and (3) better clinical outcomes than PS-TKA. Methods This was a prospective non-randomized comparative study on the results of CR-TKA and PS-TKA. CR prostheses were used in 51 knees and PS prostheses in 51 knees. Quadriceps force was measured with a dynamometer preoperatively and at postoperative 6 weeks, 3 months, and 6 months consecutively. The Knee Society score (KSS) and range of motion (ROM) were also evaluated. Results There were no differences between two groups in terms of the objective quadriceps force during the follow-up period. The proportion of patients with beyond the preoperative level of recovery was similar between groups. Moreover, the KSS and ROM were not significantly different between two groups. Conclusions CR-TKA did not result in better quadriceps recovery than PS-TKA during the 6-month follow-up. In other words, PS-TKA could lead to comparable quadriceps recovery despite greater preoperative weaknesses such as more restricted ROM and more severe degenerative changes of the knee. PMID:27904719

  14. Different intraoperative kinematics with comparable clinical outcomes of ultracongruent and posterior stabilized mobile-bearing total knee arthroplasty.

    PubMed

    Kim, Tae Woo; Lee, Sang Min; Seong, Sang Cheol; Lee, Sahnghoon; Jang, Jak; Lee, Myung Chul

    2016-09-01

    There remains no consensus as to whether mobile total knee arthroplasty (TKA) should use a posterior cruciate ligament-sacrificing ultracongruent (UC) or a posterior cruciate ligament-substituting posterior stabilized (PS) prosthesis. The purpose of this study was to assess intraoperative kinematics and clinical outcomes of UC and PS rotating platform mobile-bearing TKA. In this randomized controlled study, mobile UC TKA prostheses (n = 45) were compared with mobile PS TKA prostheses (n = 45) with regard to intraoperative kinematics and clinical outcomes. The passive kinematic study using intraoperative navigation system included anterior/posterior translation, varus/valgus alignment and rotation of femur during flexion. The patients were clinically and radiographically evaluated over a 3-year follow-up. Paradoxical anterior translation of the femur was 10.8 ± 5.2 mm in the UC knee from 0° to 82° of knee flexion and 8.7 ± 3.0 mm in the PS knee from 0° to 70° of knee flexion (p = 0.027). Paradoxical internal rotation of the femur was 5.8° in the UC knees and 9.9° in the PS knees (p = 0.003). But, there was no significant difference between the groups in regard to the coronal alignment. There was no significant difference in the range of motion, KS knee scores, KS function scores, and WOMAC index scores. Despite different intraoperative kinematics between mobile UC and mobile PS TKA, neither design reproduced physiologic knee kinematics and there was no difference in clinical outcomes between the two groups. The clinical relevance of the study is that despite different intraoperative kinematics, UC design can be a considerable alternative to PS design in mobile-bearing TKA in respect of clinical outcomes. II.

  15. Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior-stabilized total knee designs.

    PubMed

    Arnout, N; Vanlommel, L; Vanlommel, J; Luyckx, J P; Labey, L; Innocenti, B; Victor, J; Bellemans, J

    2015-11-01

    Posterior cruciate ligament (PCL)-substituting total knee arthroplasty (TKA) designs were introduced to avoid paradoxical roll forward of the femur and to optimize knee kinematics. The aim of this in vitro study was to investigate post-cam function and contact mechanics and relate it to knee kinematics during squatting in eight contemporary posterior-stabilized TKA designs. All prostheses were fixed on custom-designed metal fixtures and mounted in a knee rig and five sequential-loaded squats were performed between 30° and 130° of flexion. Contact pressure and contact area were measured using pressure-sensitive Tekscan sensors on the posterior face of the post. Kinematics was recorded with reflective markers and infrared light-capturing cameras. The post-cam mechanisms analyzed in this study are very variable in terms of design features. This leads to large variations in terms of the flexion angle at which the post and cam engage maximal contact force, contact pressure and contact area. We found that more functional post-cam mechanisms, which engage at lower flexion angle and have a similar behavior as normal PCL function, generally show more normal rollback and tibial rotation at the expense of higher contact forces and pressures. All designs show high contact forces. A positive correlation was found between contact force and initial contact angle. Post-cam contact mechanics and kinematics were documented in a standardized setting. Post-cam contact mechanics are correlated with post-cam function. Outcomes of this study can help to develop more functional designs in future. Nevertheless, a compromise will always be made between functional requirements and risk of failure. We assume that more normal knee kinematics leads to more patient satisfaction because of better mobility. Understanding of the post-cam mechanism, and knowing how this system really works, is maybe the clue in further development of new total knee designs.

  16. Comparative gravimetric wear analysis in mobile versus fixed-bearing posterior stabilized total knee prostheses.

    PubMed

    Delport, Hendrik P; Sloten, Jos Vander; Bellemans, Johan

    2010-06-01

    Polyethylene (PE) wear is the limiting factor for the longevity of a conventional total knee arthroplasty (TKA). Excessive wear leads to loosening and eventual implant failure. The aim of our in vitro study was to investigate wear of a PE tibial insert on a rotating platform as compared to the same insert fixed to the tibial baseplate and articulating with a similar femoral component. All tests were performed at Endolab Laboratories, Rosenheim, Germany using a knee joint simulator following ISO 14243-1. Three specific configurations were tested and compared to a loaded soak control: (1) the rotating platform using machined polyethylene (PE), (2) fixed bearing using machined PE, (3) fixed bearing using compression-moulded PE. Calf serum with a high protein concentration of 30 g/l was chosen as test lubricant. PE wear was measured gravimetrically using the ISO 14243-2 protocol. The total wear rates found for all systems tested were low. The mean wear rate was 1.40 mg per million cycles for the moulded fixed bearing, 4.07 mg per million cycles for the machined fixed bearing type and 0.82 mg per million cycles for the machined rotating platform bearing type. We conclude that the TKA system we tested (Performance, Biomet, Warsaw, IND, USA) demonstrated very low gravimetric wear. The wear rate of the same implant in the fixed mode compared to the rotating platform mode was four times higher.

  17. Distinctions of introarticular force distribution between genesis-II posterior stabilized and cruciate retaining total knee arthroplasty: An intraoperative comparative study of 45 patients.

    PubMed

    Tang, Hao; Chen, Hong; Yang, Dejin; Jiang, Yi; Zhang, Chunyu; Zhou, Yixin

    2017-02-01

    Although both the posterior stabilized and cruciate retaining total knee arthroplasty have been proven to effectively relieve pain and restore basic functions, the joint gap width during flexion was reported to be different due to the presence or absence of posterior cruciate ligament, which may lead to different intra-articular force distribution. In this study, we investigated the distinctions in intra-articular force distribution between the two types of TKA designs in patients with varus knee osteoarthritis. Forty five patients (50 knees) with varus knee osteoarthritis were prospectively included, with each 25 knees receiving cruciate retaining and posterior stabilized total knee arthroplasty, respectively. With an intra-articular force measurement system, the intra-articular force distribution with knee flexion at 0°, 30°, 45°, 60°, 90°, and 120° were recorded in all patients. The total force was similar for posterior stabilized and cruciate retaining knees at all flexion degrees. However, force in the medial compartment accounted for 59.8%-84.0% of total force in posterior stabilized knees, while 27.4%-65.7% in cruciate retaining knees. In cruciate retaining knees, no significant difference was found between forces in the two compartments at 30° flexion (P=0.444), but force was significantly concentrated in the lateral side during 45°-120° flexion (P=0.000-0.028). Although the entire intra-articular forces were similar between CR and PS knees at different flexion angles, medial part had higher force than lateral part when PS knee was used. The posterior cruciate ligament do a role in soft balance, and make the force more evenly distributed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Factors affecting the achievement of Japanese-style deep knee flexion after total knee arthroplasty using posterior-stabilized prosthesis with high-flex knee design.

    PubMed

    Niki, Yasuo; Takeda, Yuki; Harato, Kengo; Suda, Yasunori

    2015-11-01

    Achievement of very deep knee flexion after total knee arthroplasty (TKA) can play a critical role in the satisfaction of patients who demand a floor-sitting lifestyle and engage in high-flexion daily activities (e.g., seiza-sitting). Seiza-sitting is characterized by the knees flexed >145º and feet turned sole upwards underneath the buttocks with the tibia internally rotated. The present study investigated factors affecting the achievement of seiza-sitting after TKA using posterior-stabilized total knee prosthesis with high-flex knee design. Subjects comprised 32 patients who underwent TKA with high-flex knee prosthesis and achieved seiza-sitting (knee flexion >145º) postoperatively. Another 32 patients served as controls who were capable of knee flexion >145º preoperatively, but failed to achieve seiza-sitting postoperatively. Accuracy of femoral and tibial component positions was assessed in terms of deviation from the ideal position using a two-dimensional to three-dimensional matching technique. Accuracies of the component position, posterior condylar offset ratio and intraoperative gap length were compared between the two groups. The proportion of patients with >3º internally rotated tibial component was significantly higher in patients who failed at seiza-sitting (41 %) than among patients who achieved it (13 %, p = 0.021). Comparison of intraoperative gap length between patient groups revealed that gap length at 135º flexion was significantly larger in patients who achieved seiza-sitting (4.2 ± 0.4 mm) than in patients who failed at it (2.7 ± 0.4 mm, p = 0.007). Conversely, no significant differences in gap inclination were seen between the groups. From the perspective of surgical factors, accurate implant positioning, particularly rotational alignment of the tibial component, and maintenance of a sufficient joint gap at 135º flexion appear to represent critical factors for achieving >145º of deep knee flexion after TKA.

  19. Femorotibial kinematics and load patterns after total knee arthroplasty: An in vitro comparison of posterior-stabilized versus medial-stabilized design.

    PubMed

    Steinbrück, Arnd; Schröder, Christian; Woiczinski, Matthias; Fottner, Andreas; Pinskerova, Vera; Müller, Peter E; Jansson, Volkmar

    2016-03-01

    Femorotibial kinematics and contact patterns vary greatly with different total knee arthroplasty (TKA) designs. Therefore, guided motion knee systems were developed to restore natural knee kinematics and make them more predictable. The medial stabilized TKA design is supposed to replicate physiological kinematics more than the posterior-stabilized TKA system. We conducted this study to compare a newly developed medial stabilized design with a conventional posterior-stabilized design in terms of femorotibial kinematics and contact patterns in vitro. Twelve fresh-frozen knee specimens were tested in a weight-bearing knee rig after implantation of a posterior stabilized and medial-stabilized total knee arthroplasty under a loaded squat from 20° to 120° of flexion. Femorotibial joint contact pressures in the medial and lateral compartments were measured by pressure sensitive films and knee kinematics were recorded by an ultrasonic 3-dimensional motion analysis system. The medial stabilized design showed a reduction of medial femorotibial translation compared to posterior-stabilized design (mean 3.5mm compared to 15.7 mm, P<0.01). In the lateral compartment, both designs showed a posterior translation of the femur with flexion, but less in the medial stabilized design (mean 14.7 mm compared to 19.0mm, P<0.01). In the medial femorotibial compartment of medial stabilized design, we observed an enlarged contact area and lower peak pressure, in contrast in the lateral compartment there was a reduced contact area and an increased peak pressure. While posterior-stabilized design enforces a medio-lateral posterior translation, the medial stabilized arthroplasty system enables a combination of a lateral translation with a medial pivot, which restores the physiological knee kinematics better. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. The influence of the tibial slope on intra-operative soft tissue balance in cruciate-retaining and posterior-stabilized total knee arthroplasty.

    PubMed

    Oka, Shinya; Matsumoto, Tomoyuki; Muratsu, Hirotsugu; Kubo, Seiji; Matsushita, Takehiko; Ishida, Kazunari; Kuroda, Ryosuke; Kurosaka, Masahiro

    2014-08-01

    This study aims to make clear the influence of the tibial slope on intra-operative soft tissue balance measurements using a tensor in cruciate-retaining and posterior-stabilized total knee arthroplasty (TKA). Forty patients with osteoarthritis of the knee received TKAs (20 cruciate-retaining TKAs and 20 posterior-stabilized TKA). Soft tissue balance was measured using an offset type tensor at 0, 10, 45, 90, 135 degrees of knee flexion. The tibial slopes were measured by post-operative lateral radiograph. The correlation between the tibial slope and values of soft tissue balance were assessed. Joint component gap at 90° (R = 0.537, p < 0.01) and 135° (R = 0.463, p < 0.05) of flexion and joint component gap change value of 90-0° (R = 0.433, p < 0.05) showed positive correlations with tibial slope in posterior-stabilized TKA. There was no relationship between the tibial slope and the value of soft tissue balances in cruciate-retaining TKA. In the present study, we confirmed that increasing the tibial slope resulted in a larger flexion gap compared to extension gap in posterior-stabilized TKA. Surgeons should be aware that increasing the tibial slope is one factor responsible for widening the flexion-extension gap difference in posterior-stabilized TKA.

  1. Highly Cross-Linked Versus Conventional Polyethylene in Posterior-Stabilized Total Knee Arthroplasty at a Mean 5-Year Follow-up.

    PubMed

    Meneghini, R Michael; Lovro, Luke R; Smits, Shelly A; Ireland, Philip H

    2015-10-01

    Concerns of highly cross-linked polyethylene (XLPE) in total knee arthroplasty (TKA) exist regarding fatigue resistance and oxidation, particularly in posterior-stabilized (PS) designs. A prospective cohort study of 114 consecutive PS TKAs utilized conventional polyethylene in 50 knees and second-generation annealed XLPE in 64 TKAs. Clinical (Short-Form 36, Knee Society Scores, and LEAS) and radiographic outcomes were evaluated at a mean of 5 years in 103 TKAs. Mean KSS scores were 12 points higher (P=0.01) and SF-36 physical function subset 14 points higher (P=0.005) in the XLPE group. There was no radiographic osteolysis or mechanical failure related to the tibial polyethylene in either group. At 5-year follow-up, no deleterious effects related to highly cross-linked posterior stabilized tibial polyethylene inserts were observed.

  2. The influence of intraoperative soft tissue balance on patellar pressure in posterior-stabilized total knee arthroplasty.

    PubMed

    Matsumoto, Tomoyuki; Shibanuma, Nao; Takayama, Koji; Sasaki, Hiroshi; Ishida, Kazunari; Matsushita, Takehiko; Kuroda, Ryosuke; Kurosaka, Masahiro

    2016-06-01

    Appropriate soft tissue balance is essential for the success of total knee arthroplasty (TKA), and assessment with an offset-type tensor provides useful information about the femorotibial (FT) joint. The purpose of the study was to investigate the relationship between intraoperative soft tissue balance and patellar pressure at both medial and lateral sides. Thirty varus-type osteoarthritis patients who received mobile-bearing posterior-stabilized TKAs were enrolled in the study. Using the tensor, soft tissue balance, including joint component gap and varus ligament balance, was recorded at 0°, 10°, 30°, 60°, 90°, 120°, and 135° with patellofemoral (PF) joint reduction and femoral component placement. Following final prostheses implanted with appropriate insert, the medial and lateral patellar pressures were measured at each flexion angle. A simple regression analysis was performed between each patellar pressure, parameter of soft tissue balance, and postoperative flexion angle. Both lateral and medial patellar pressures increased with flexion. The lateral patellar pressure was significantly higher than the medial patellar pressure at 60°, 90°, and 135° of flexion (p<0.05). The lateral patellar pressure inversely correlated with the varus ligament balance at 60° and 90° of flexion (p<0.05). The lateral patellar pressure at 120° and 135° of flexion inversely correlated with the postoperative flexion angle (p<0.05). Soft tissue balance influenced patellar pressure. In particular, a reduced lateral patellar pressure was found at the lateral laxity at flexion, leading to high postoperative flexion angle. III. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Different pattern in gap balancing between the cruciate-retaining and posterior-stabilized total knee arthroplasty.

    PubMed

    Matsumoto, Tomoyuki; Kubo, Seiji; Muratsu, Hirotsugu; Matsushita, Takehiko; Ishida, Kazunari; Kawakami, Yohei; Oka, Shinya; Matsuzaki, Tokio; Kuroda, Yuichi; Nishida, Kotaro; Akisue, Toshihiro; Kuroda, Ryosuke; Kurosaka, Masahiro

    2013-10-01

    In order to permit soft tissue balance under more physiological conditions during total knee arthroplasties (TKAs), an offset-type tensor was developed to obtain soft tissue balancing throughout the range of motion with reduced patello-femoral (PF) and aligned tibiofemoral joints. The main purpose of the present study was to assess intra-operative soft tissue balance using a navigation system with the offset-type tensor in both cruciate-retaining (CR) and posterior-stabilized (PS) TKAs. One hundred and twenty TKAs--80 CR and 40 PS--were performed in patients with varus-type osteoarthritis using a computed tomography-free navigation system. The offset-type TKA tensor with a reduced and repaired PF joint and femoral component in place was used with the tibia first gap technique to balance soft tissues (joint component gap and ligament balance) at 0°, 10°, 30°, 60°, 90°, and 120° of flexion. The achievement in equalized rectangular gap at extension and flexion--joint component gap within ±3 mm between extension and flexion and ligament balance within ±3° at extension and flexion--was assessed retrospectively. Both types of implants showed similar patterns of soft tissue balance throughout the range of motion, whereas PS TKA had larger values especially at 60° or 90° of flexion than did CR TKA. In the achievement of equalized rectangular gaps at extension and flexion, CR TKA was superior to PS TKA. Using the tibia first gap technique with the tensor allows appropriate soft tissue balancing, especially in CR TKA. Therapeutic studies, Level II.

  4. Comparison of Revision Rates of Non-modular Constrained Versus Posterior Stabilized Total Knee Arthroplasty: a Propensity Score Matched Cohort Study.

    PubMed

    Moussa, Mohamed E; Lee, Yuo-Yu; Westrich, Geoffrey H; Mehta, Nabil; Lyman, Stephen; Marx, Robert G

    2017-02-01

    Attaining stability during total knee arthroplasty (TKA) is essential for a successful outcome. Although traditional constrained total knee prostheses have generally been used in conjunction with intramedullary stems, some devices have been widely used without the use of stems, referred to as non-modular constrained condylar total knee arthroplasty (NMCCK). The aim of this study was to compare revisions rates after total knee replacement with a non-modular constrained condylar total knee (NMCCK) compared to a posterior-stabilized (PS) design. Between 2007 and 2012, primary PS total knees were compared with NMCCK implants from the same manufacturer. Propensity score matching was performed, and implant survivorship was examined using a Cox proportional hazards model. The cohort consisted of 817 PS knees and 817 NMCCKs matched for patient demographics, surgeon volume, and pre-operative diagnosis. All cause revisions occurred in 11 of 817 (1.35%) in the PS group compared to 28 of 817 (3.43%) in the NMCCK group (p = 0.0168). Excluding revisions for infection and fracture, 8 of 817 (0.98%) PS knees required revision for mechanical failure compared to 18 of 817 (2.20%) NMCCK knees (p = 0.0193). While revisions rates in both cohorts were low, there was a significantly higher revision rate with NMCCKs. Given that cases requiring the use of NMCCK implants are likely more complex than those in which PS implants are used, our findings support the judicious use of NMCCK prostheses.

  5. [Case-control study on modified femoral prosthesis in reducing the incidence of patellar clunk syndrome after the initial posterior stabilized total knee arthroplasty].

    PubMed

    Liu, Yang-Bo; Yuan, Jian-Dong; Chen, Cheng-Wei; Zhang, Chao; Chen, Kai; Chen, Lei

    2014-04-01

    To explore therapeutic effects of modified femoral prosthesis applied in the initial posterior stabilized total knee arthroplasty. From April 1, 2012 to January 1, 2013, 156 patients with knee osteoarthritis underwent posterior stabilized total knee arthroplasty by the same director of orthopedic surgeon. Sixty-one patients were treated with modified femoral prosthesis, including 7 males and 54 females, with an average age of (68.34 +/- 5.41) years old; and 95 patients were treated with conventional designed femoral prosthesis, including 14 males and 81 females, with an average age of (69.92 +/- 5.11) years old. Indexes including age, body mass index, Insall-Salvati index, type of prosthesis, occurrence rate of patella click syndrome, postoperative line of force of lower extremity and postoperative function of the knee joint were observed and recorded. And American Knee Society (AKS) score was used to evaluate the clinical results. All the patients were followed up, and the duration ranged from 36 to 56 weeks, with a mean of 45.31 weeks. Among patients in the conventional designed femoral prosthesis group, 7 patients had patella click syndrome, but there was no patient having patellar click syndrome in the modified femoral prosthesis group. Postoperative knee activity of patients in the modified femoral prosthesis group was (110.98 +/- 10.32) degrees, which was better than (107.05 +/- 8.61) degrees in the conventional designed femoral prosthesis group. The AKS score in the modified femoral prosthesis group was 129.79 +/- 9.63 during 21 to 28 days after operation, which was higher than 126.85 +/- 7.79 in the conventional designed femoral prosthesis group. New designed femoral components are effective to reduce the occurrence rate of postoperative patellar click syndrome and obtain better early functional recovery from knee surgery.

  6. Incidence of patellar clunk syndrome in fixed versus high-flex mobile bearing posterior-stabilized total knee arthroplasty.

    PubMed

    Snir, Nimrod; Schwarzkopf, Ran; Diskin, Brian; Takemoto, Richelle; Hamula, Mathew; Meere, Patrick A

    2014-10-01

    The geometry of the intercondylar box plays a significant role in the development of patellar clunk syndrome. We reviewed the incidence of patella clunk at mid-to-long-term follow-up of a rotating high-flex versus fixed bearing posterior stabilized TKA design. 188-mobile and 223-fixed bearing TKAs were reviewed for complications, incidence of patellar clunk, treatment, recurrence rates, range of motion, and patient satisfaction. Patellar clunk developed in 22 knees in the mobile (11.7%) and in 4 (1.8%) in the fixed bearing group (P<0.001). 23 out of 26 cases resolved with a single arthroscopic treatment and 2 resolved with a second procedure. The mean postoperative range of motion was 122.4°. All but one patient reported overall satisfaction with the index procedure. In contrast with other recent studies we found a significant incidence of patellar clunk in high-flex mobile bearings. Despite the high rate of patellar clunk syndrome, overall patients did well and were satisfied with their outcomes.

  7. Kinematic analysis of posterior-stabilized total knee arthroplasty during standing up from and sitting down on a chair.

    PubMed

    Mine, Takatomo; Hoshi, Kenji; Gamada, Kazuyoshi; Ihara, Koichiro; Kawamura, Hiroyuki; Kuriyama, Ryutaro; Date, Ryo

    2016-11-17

    Total knee arthroplasty is effective to regain quality of life. Standing up from and sitting down on a chair and stair stepping motion are important in daily living. We previously reported in vivo kinematics of this implant during a stepping exercise. The purpose of this analysis was to assess in vivo knee motion during standing up from and sitting down on a chair and determine the motion pattern in patients with the unique knee prosthesis. A total of 15 patients implanted with Bi-Surface PS were assessed during standing up from and sitting down on a chair. The Bi-Surface PS knee is a posterior-cruciate substitute prosthesis with a unique ball-and-socket joint in the mid-posterior portion of the femoral and tibial components. Patients were examined during standing up from and sitting down on a chair using a two-dimensional to three-dimensional registration technique. During standing up from and sitting down on a chair from minimum to 30° knee flexion, anterior femoral translation was slight. From 30° knee flexion to maximum flexion, the kinematic pattern was a medial pivot and rollback. This study demonstrated that the knee motion kinematic patterns observed in this study were not similar to normal knee kinematics and derived from the unique design of the Bi-Surface PS.

  8. Clinical evaluation of 292 Genesis II posterior stabilized high-flexion total knee arthroplasty: range of motion and predictors.

    PubMed

    Fuchs, Mathijs C H W; Janssen, Rob P A

    2015-01-01

    The primary aim of the study was to evaluate the range of motion and complications after Genesis II total knee arthroplasty with high-flexion tibia insert (TKA-HF). Furthermore, difference in knee flexion between high flexion and standard inserts was compared. The hypothesis was that knee flexion is better after high-flexion TKA. A total of 292 TKA-HF were retrospectively reviewed. Mean follow-up was 24.3 months. The range of motion was compared between TKA-HF (high-flexion group) and a comparable cohort of 86 Genesis II TKA with a standard tibia insert (control group). Surgeries were performed by one experienced knee orthopedic surgeon. Knee flexion in the high-flexion group increased from 114.8° preoperatively to 118.0° postoperatively (P < 0.01). Knee extension in the high-flexion group increased from -4.5° preoperatively to -0.4° after surgery (P < 0.01). Mean knee flexion was 5.52° (± 1.46°) better in the high-flexion group compared with the control group (P < 0.01). Preoperative range of motion, body mass index, diabetes mellitus and patellofemoral pain significantly influenced range of motion. Few complications occurred after TKA-HF. The Genesis II TKA-HF showed good short-term results with limited complications. Knee flexion after Genesis II TKA-HF was better compared with a standard tibia insert.

  9. Tibiofemoral alignment in posterior stabilized total knee arthroplasty: Static alignment does not predict dynamic tibial plateau loading.

    PubMed

    Miller, Emily J; Pagnano, Mark W; Kaufman, Kenton R

    2014-08-01

    For total knee arthroplasty (TKA), neutral mechanical alignment produces balanced static knee loading. Dynamically, knee loading is affected by more than limb static alignment. We compared static and dynamic knee loading following TKA. Fifteen TKA patients were evaluated pre-operatively and 2 months and 2 years post-operatively. Tibiofemoral angles and medial tibial plateau loading were calculated. Pre-operatively, static medial load was greater for varus than valgus knees. Post-operatively, no relationship existed between tibiofemoral angle and static medial plateau load. Pre-operatively and post-operatively, dynamic medial load was not dependent on tibiofemoral angle. While all patients achieved equal static plateau load distributions at 2 years, only 47% had dynamic medial load distributions of 50 ± 10%. Static tibiofemoral alignment alone does not predict dynamic tibial loading.

  10. Revision Total Knee Arthroplasty with a Cemented Posterior Stabilized, Condylar Constrained or Fully Constrained Prosthesis: A Minimum 2-year Follow-up Analysis

    PubMed Central

    Hwang, Sun-Chul; Kong, Jae-Yeon; Nam, Dae-Cheol; Kim, Dong-Hee; Park, Hyung-Bin; Jeong, Soon-Taek

    2010-01-01

    Background The clinical and radiological outcomes of revision total knee arthroplasty with a cemented posterior stabilized (PS), condylar constrained knee (CCK) or a fully constrained rotating hinge knee (RHK) prosthesis were evaluated. Methods This study reviewed the clinical and radiological results of 36 revision total knee arthroplasties with a cemented PS, CCK, and RHK prosthesis in 8, 25, and 13 cases, respectively, performed between 1998 and 2006. The mean follow-up period was 30 months (range, 24 to 100 months). The reason for the revision was aseptic loosening of one or both components in 15, an infected total knee in 18 and a periprosthetic fracture in 3 knees. The average age of the patients at the time of the revision was 65 years (range, 58 to 83 years). The original diagnosis for all primary total knee arthroplasties was osteoarthritis except for one case of a Charcot joint. All revision prostheses were fixed with cement. The bone deficiencies were grafted with a cancellous allograft in the contained defect and cortical allograft fixed with a plate and screws in the noncontained defect. A medial gastrocnemius flap was needed to cover the wound dehiscence in 6 of the 18 infected cases. Results The mean Knee Society knee score improved from 28 (range, 5 to 43) to 83 (range, 55 to 94), (p < 0.001) and the mean Knee Society function score improved from 42 (range, 10 to 66) to 82 (range, 60 to 95), (p < 0.001) at the final follow-up. Good or excellent outcomes were obtained in 82% of knees. There were 5 complications (an extensor mechanism rupture in 3 and recurrence of infection in 2 cases). Three cases of an extensor mechanism defect (two ruptures of ligamentum patellae and one patellectomy) were managed by the RHK prosthesis to provide locking stability in the heel strike and push off phases, and two cases of recurrent infection used an antibiotic impregnated cement spacer. The radiological tibiofemoral alignment improved from 1.7° varus to 3.0

  11. Evaluation of Postoperative Range of Motion and Functional Outcomes after Cruciate-Retaining and Posterior-Stabilized High-Flexion Total Knee Arthroplasty

    PubMed Central

    Han, Chang Wook; Yang, Ick Hwan; Lee, Woo Suk; Park, Kwan Kyu

    2012-01-01

    Purpose The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. Materials and Methods Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. Results After the 2-year postoperative period, the mean range of motion was 131° in the CR-Flex group and 133° in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2±9.1 points) than in the PS-Flex group (11.9±9.6 points); however, this difference was not statistically significant (p=non-significant). Conclusion The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty. PMID:22665348

  12. Kinematic Analysis of a Posterior-stabilized Knee Prosthesis

    PubMed Central

    Zhao, Zhi-Xin; Wen, Liang; Qu, Tie-Bing; Hou, Li-Li; Xiang, Dong; Bin, Jia

    2015-01-01

    Background: The goal of total knee arthroplasty (TKA) is to restore knee kinematics. Knee prosthesis design plays a very important role in successful restoration. Here, kinematics models of normal and prosthetic knees were created and validated using previously published data. Methods: Computed tomography and magnetic resonance imaging scans of a healthy, anticorrosive female cadaver were used to establish a model of the entire lower limbs, including the femur, tibia, patella, fibula, distal femur cartilage, and medial and lateral menisci, as well as the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments. The data from the three-dimensional models of the normal knee joint and a posterior-stabilized (PS) knee prosthesis were imported into finite element analysis software to create the final kinematic model of the TKA prosthesis, which was then validated by comparison with a previous study. The displacement of the medial/lateral femur and the internal rotation angle of the tibia were analyzed during 0–135° flexion. Results: Both the output data trends and the measured values derived from the normal knee's kinematics model were very close to the results reported in a previous in vivo study, suggesting that this model can be used for further analyses. The PS knee prosthesis underwent an abnormal forward displacement compared with the normal knee and has insufficient, or insufficiently aggressive, “rollback” compared with the lateral femur of the normal knee. In addition, a certain degree of reverse rotation occurs during flexion of the PS knee prosthesis. Conclusions: There were still several differences between the kinematics of the PS knee prosthesis and a normal knee, suggesting room for improving the design of the PS knee prosthesis. The abnormal kinematics during early flexion shows that the design of the articular surface played a vital role in improving the kinematics of the PS knee prosthesis. PMID:25591565

  13. International Comparative Evaluation of Knee Replacement with Fixed or Mobile Non-Posterior-Stabilized Implants

    PubMed Central

    Namba, Robert; Graves, Stephen; Robertsson, Otto; Furnes, Ove; Stea, Susanna; Puig-Verdié, Lluis; Hoeffel, Daniel; Cafri, Guy; Paxton, Elizabeth; Sedrakyan, Art

    2014-01-01

    Background: Mobile-bearing total knee prostheses were designed to reduce wear and improve implant survivorship following total knee arthroplasty. However, the benefit of mobile-bearing total knee arthroplasty remains unproven. Both mobile-bearing and fixed-bearing total knee arthroplasty implants are available in posterior-stabilized and non-posterior-stabilized designs. With the latter, the implant does not recreate the function of the posterior cruciate ligament (PCL) with a posterior-stabilizing cam mechanism. The purpose of the present study was to compare mobile-bearing, non-posterior-stabilized devices with fixed-bearing, non-posterior-stabilized devices used in total knee arthroplasty through a novel multinational study design. Methods: Through the use of a distributed health data network, primary total knee arthroplasties performed for osteoarthritis from 2001 to 2010 were identified from six national and regional total joint arthroplasty registries. Multivariate meta-analysis was performed with use of linear mixed models, with the primary outcome of interest being revision for any reason. Survival probabilities and their standard errors were extracted from each registry for each unique combination of the covariates. Results: A total of 319,616 patients (60% female) underwent non-posterior-stabilized total knee arthroplasty. A fixed-bearing, non-posterior-stabilized design was used in 258,190 (81%) of the knees and a mobile-bearing, non-posterior-stabilized design in 61,426 (19%) of the knees. Sixty-nine percent of the patients who received a fixed-bearing implant were over sixty-five years of age, compared with 63% of those who received a mobile-bearing implant. Mobile-bearing designs had a higher risk of revision, with a hazard ratio of 1.43 (95% confidence interval, 1.36 to 1.51; p < 0.001). Conclusions: Previous comparisons of mobile-bearing and fixed-bearing total knee arthroplasty outcomes have been inconclusive. The current study utilized an advanced

  14. Post-Cam Design and Contact Stress on Tibial Posts in Posterior-Stabilized Total Knee Prostheses: Comparison Between a Rounded and a Squared Design.

    PubMed

    Watanabe, Toshifumi; Koga, Hideyuki; Horie, Masafumi; Katagiri, Hiroki; Sekiya, Ichiro; Muneta, Takeshi

    2017-07-15

    The post-cam mechanism in posterior stabilized (PS) prostheses plays an important role in total knee arthroplasty (TKA). The purpose of this study is to clarify the difference of the contact stress on the tibial post between a rounded post-cam design and a squared design during deep knee flexion and at hyperextension using the three-dimensional (3D) finite element models. We created 2 types of 3D, finite element models of PS prostheses (types A and B), whose surfaces were identical except for the post-cam geometries: type A has a rounded post-cam design, while type B has a squared design. Both types have a similar curved-shape intercondylar notch of the femoral component. Stress distributions, peak contact stresses, and contact areas on the tibial posts at 90°, 120°, and 150° flexion with/without 10° tibial internal rotation and at 10° hyperextension were compared between the 2 models. Type B demonstrated more concentrated stress distribution compared to type A. The peak contact stresses were similar in both groups during neutral flexion; however, the stresses were much higher in type B during flexion with 10° rotation and at hyperextension. The higher peak contact stresses corresponded to the smaller contact areas in the tibial post. A rounded post-cam design demonstrated less stress concentration during flexion with rotation and at hyperextension compared with a squared design. The results would be useful for development of implant designs and prediction of the contact stress on the tibial post in PS total knee arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. The Influence of Joint Distraction Force on the Soft-Tissue Balance Using Modified Gap-Balancing Technique in Posterior-Stabilized Total Knee Arthroplasty.

    PubMed

    Nagai, Kanto; Muratsu, Hirotsugu; Takeoka, Yoshiki; Tsubosaka, Masanori; Kuroda, Ryosuke; Matsumoto, Tomoyuki

    2017-10-01

    During modified gap-balancing technique, there is no consensus on the best method for obtaining appropriate soft-tissue balance and determining the femoral component rotation. Sixty-five varus osteoarthritic patients underwent primary posterior-stabilized total knee arthroplasty using modified gap-balancing technique. The influence of joint distraction force on the soft-tissue balance measurement during the modified gap-balancing technique was evaluated with Offset Repo-Tensor between the osteotomized surfaces at extension, and between femoral posterior condyles and tibial osteotomized surface at flexion of the knee before the resection of femoral posterior condyles. The joint center gap (millimeters) and varus ligament balance (°) were measured under 20, 40, and 60 pounds of joint distraction forces, and the differences in these values at extension and flexion (the value at flexion minus the value at extension) were also calculated. The differences in joint center gap (-6.7, -6.8, and -6.9 mm for 20, 40, and 60 pounds, respectively) and varus ligament balance (3.5°, 3.8°, and 3.8°) at extension and flexion were not significantly different among different joint distraction forces, although the joint center gap and varus ligament balance significantly increased stepwise at extension and flexion as the joint distraction force increased. The difference in joint center gap and varus ligament balance at extension and flexion were consistent even among the different joint distraction forces. This novel index would be useful for the determination of femoral component rotation during the modified gap-balancing technique. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Effect of Joint Line Elevation after Posterior-stabilized and Cruciate-retaining Total Knee Arthroplasty on Clinical Function and Kinematics.

    PubMed

    Ji, Song-Jie; Zhou, Yi-Xin; Jiang, Xu; Cheng, Zhi-Yuan; Wang, Guang-Zhi; Ding, Hui; Yang, Ming-Lei; Zhu, Zhong-Lin

    2015-11-05

    Joint line (JL) is a very important factor for total knee arthroplasty (TKA) to restore. The objective of this study was to evaluate the early clinical and kinematic results of TKAs with posterior-stabilized (PS) or cruciate retaining (CR) implants in which the JL was elevated postoperatively. Data were collected from patients who underwent TKA in our department between April 2011 and April 2014. The patients were divided into two groups based on the prosthesis they received (PS or CR). At 1-year postoperatively, clinical outcomes were evaluated by the American Knee Society (AKS) knee score, AKS function score, and patella score. In vivo kinematic analysis after TKA was performed on all patients and a previously validated three-dimensional to two-dimensional image registration technique was used to obtain the kinematic data. Anteroposterior (AP) translation of the medial and lateral femoral condyles, and axial rotation relative to the tibial plateau, were analyzed. The data were assessed using the Mann-Whitney test. At time of follow-up, there were differences in the AKS knee scores (P = 0.005), AKS function scores (P = 0.025), patella scores (P = 0.015), and postoperative range of motions (P = 0.004) between the PS group and the CR group. In the PS group, the magnitude of AP translation for the medial and lateral condyle was 4.9 ± 3.0 mm and 12.8 ± 3.3 mm, respectively. Axial rotation of the tibial component relative to the femoral component was 12.9 ± 4.5°. In the CR group, the magnitude of AP translation for the medial and lateral condyle was 4.3 ± 3.5 mm and 7.9 ± 4.2 mm, respectively. The axial rotation was 6.7 ± 5.9°. There were statistically different between PS group and CR group in kinematics postoperatively. Our results demonstrate that postoperative JL elevation had more adverse effects on the clinical and kinematic outcomes of CR TKAs than PS TKAs.

  17. International Comparative Evaluation of Knee Replacement with Fixed or Mobile-Bearing Posterior-Stabilized Prostheses

    PubMed Central

    Graves, Stephen; Sedrakyan, Art; Baste, Valborg; Gioe, Terence J.; Namba, Robert; Cruz, Olga Martínez; Stea, Susanna; Paxton, Elizabeth; Banerjee, Samprit; Isaacs, Abby J.; Robertsson, Otto

    2014-01-01

    Background: Posterior-stabilized total knee prostheses were introduced to address instability secondary to loss of posterior cruciate ligament function, and they have either fixed or mobile bearings. Mobile bearings were developed to improve the function and longevity of total knee prostheses. In this study, the International Consortium of Orthopaedic Registries used a distributed health data network to study a large cohort of posterior-stabilized prostheses to determine if the outcome of a posterior-stabilized total knee prosthesis differs depending on whether it has a fixed or mobile-bearing design. Methods: Aggregated registry data were collected with a distributed health data network that was developed by the International Consortium of Orthopaedic Registries to reduce barriers to participation (e.g., security, proprietary, legal, and privacy issues) that have the potential to occur with the alternate centralized data warehouse approach. A distributed health data network is a decentralized model that allows secure storage and analysis of data from different registries. Each registry provided data on mobile and fixed-bearing posterior-stabilized prostheses implanted between 2001 and 2010. Only prostheses associated with primary total knee arthroplasties performed for the treatment of osteoarthritis were included. Prostheses with all types of fixation were included except for those with the rarely used reverse hybrid (cementless tibial and cemented femoral components) fixation. The use of patellar resurfacing was reported. The outcome of interest was time to first revision (for any reason). Multivariate meta-analysis was performed with linear mixed models with survival probability as the unit of analysis. Results: This study includes 137,616 posterior-stabilized knee prostheses; 62% were in female patients, and 17.6% had a mobile bearing. The results of the fixed-effects model indicate that in the first year the mobile-bearing posterior-stabilized prostheses had

  18. Early clinical results of a high-flexion, posterior-stabilized, mobile-bearing total knee arthroplasty: a US investigational device exemption trial.

    PubMed

    Scuderi, Giles R; Hedden, David R; Maltry, John A; Traina, Steven M; Sheinkop, Mitchell B; Hartzband, Mark A

    2012-03-01

    Between May 2001 and June 2004, 388 total knee arthroplasty cases were enrolled in a prospective, randomized, multicenter investigational device exemption trial. Patients received either the investigational high-flexion mobile-bearing knee or a fixed-bearing control. At 2 to 4 years of follow-up, results in 293 patients with degenerative joint disease were compared using Knee Society Assessment and Function scores, radiographic results, complications analysis, and survival estimates. The mobile-bearing and fixed-bearing groups demonstrated similar, significant improvement over preoperative assessments in Knee Scores, maximum flexion, and range of motion. One mobile-bearing arthroplasty required revision. Radiographic results were unremarkable, and implant-related complications were rare in both groups. At this early follow-up, the investigational high-flexion mobile-bearing knee and its fixed-bearing counterpart demonstrated comparable, effective performance. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Analysis of surface damage in retrieved carbon fiber-reinforced and plain polyethylene tibial components from posterior stabilized total knee replacements.

    PubMed

    Wright, T M; Rimnac, C M; Faris, P M; Bansal, M

    1988-10-01

    The performance of carbon fiber-reinforced ultra-high molecular weight polyethylene was compared with that of plain (non-reinforced) polyethylene on the basis of the damage that was observed on the articulating surfaces of retrieved tibial components of total knee prostheses. Established microscopy techniques for subjectively grading the presence and extent of surface damage and the histological structure of the surrounding tissues were used to evaluate twenty-six carbon fiber-reinforced and twenty plain polyethylene components that had been retrieved after an average of twenty-one months of implantation. All of the tibial components were from the same design of total knee replacement. The two groups of patients from whom the components were retrieved did not differ with regard to weight, the length of time that the component had been implanted, the radiographic position and angular alignment of the component, the original diagnosis, or the reason for removal of the component. The amounts and types of damage that were observed did not differ for the two materials. For both materials, the amount of damage was directly related to the length of time that the component had been implanted. The histological appearance of tissues from the area around the component did not differ for the two materials, except for the presence of fragments of carbon fiber in many of the samples from the areas around carbon fiber-reinforced components.

  20. Varus-valgus stability at 90° flexion correlates with the stability at midflexion range more widely than that at 0° extension in posterior-stabilized total knee arthroplasty.

    PubMed

    Hino, Kazunori; Kutsuna, Tatsuhiko; Watamori, Kunihiko; Kiyomatsu, Hiroshi; Ishimaru, Yasumitsu; Takeba, Jun; Watanabe, Seiji; Shiraishi, Yoshitaka; Miura, Hiromasa

    2017-08-28

    Midflexion stability can potentially improve the outcome of total knee arthroplasty (TKA). The purpose of this study was to evaluate the correlation between varus-valgus stability at 0° of extension and 90° of flexion and that at the midflexion range in posterior-stabilized (PS)-TKA. Forty-three knees that underwent PS-TKA were evaluated. Manual mild passive varus-valgus stress was applied to the knees, and the postoperative maximum varus-valgus stability was measured every 10° throughout range of motion, using a navigation system. Correlations between the stability at 0°, 90° of flexion, and that at each midflexion angle were evaluated using Spearman's correlation coefficients. The stability of 0° modestly correlated with that of 10°-20°, but it did not significantly correlate with that of 30°-80°. However, the stability of 90° strongly correlated with that of 60°-80°, modestly correlated with that of 40°-50°, weakly correlated with that of 20°-30°, and did not correlate with that of 10°. The present study confirmed the importance of acquiring stability at 90° flexion to achieve midflexion stability in PS-TKA. However, initial flexion stability did not strongly correlate with the stability at either 0° or 90°. Our findings can provide useful information for understanding varus-valgus stability throughout the range of motion in PS-TKA. Attention to soft tissue balancing is necessary to stabilize a knee at the initial flexion range in PS-TKA.

  1. Fracture of the polyethylene tibial post in a posterior stabilized knee prosthesis: A case report and review of literature.

    PubMed

    Kumar, Nishikant; Yadav, Chandrashekhar; Raj, Rishi; Yadav, Sanjay

    2015-09-01

    We report a case of fracture of tibial polyethylene post fracture from base in a 56 year old lady 10 years from posterior stabilized total knee arthroplasty following trivial trauma. There have been signs of wear at the base especially anteriorly. After revision of tibial polyethylene component patient developed complete relief of symptom.

  2. What have we learned from 100% success of press fit condylar rotating platform posterior stabilized knees?: A 5-10 years followup by a nondesigner

    PubMed Central

    Vaidya, Shrinand V; Virani, Siddharth; Phunde, Rajendra; Mahajan, Abhishek

    2016-01-01

    Background: Total joint arthroplasties of the hip and knee represent a remarkable feat of modern medicine in terms of reducing pain and restoring function to millions of patients afflicted with severe arthritis. Oftentimes, the performance and longevity of new implants and devices are based on limited data. This is the first study by a non-designer on the press fit condylar rotating platform posterior stabilized (PFC-RP-PS) design with 100’ success. This has a relevance, vis-á -vis bias that one may have in terms of reproducibility of technique and funding from the manufacturer. We associate our excellent mid-term results to intra operative technical aspects and stringent intra operative exclusion criteria. Materials and Methods: Our study includes a cohort of 121 selected knees operated between January 2003 and October 2010. We used cemented, posterior stabilized (PS), mobile bearing (MB), and RP prosthesis from the same manufacturer in all these 121 knees. The patients were evaluated bi-annually with the calculation of their Knee Society Scores (KSS) and a radiological assessment for loosening/osteolysis. Results: 120 knees were available for followup. The average Knee Society clinical and functional scores, respectively, were 27 points and 40 points preoperatively and 93 points and 95 points postoperatively. This indicates a mean increase of about 71’ in the clinical score and about 58’ in the functional score, which is statistically significant. The mean postoperative flexion was 124°, a mean increase of 23° from the preoperative flexion of 101°. There were no revisions (Kaplan-–Meier survivorship of 100’). Conclusions: We feel durable and reproducible results of PFC-RP-PS design knees are very technique sensitive. The way ahead with the PFC-RP-PS knees looks promising when the exclusion criteria for this design are strictly met. Coming from a non-designer, this study acquires a higher degree of relevance without any designer's or manufacturer

  3. 180° rotatory dislocation of the rotating platform of a posterior-stabilized mobile-bearing knee prosthesis; possible complication after closed reduction of a posterior dislocation--a case report.

    PubMed

    Lee, Ho Min; Kim, Young Sung; Kim, Jong Pil

    2014-01-01

    Dislocation of the rotating platform is a significant early complication of mobile-bearing total knee arthroplasty. The authors report an unusual case of acute 180° rotatory dislocation of the rotating platform after closed reduction of a posterior dislocation of a posterior-stabilized mobile-bearing total knee prosthesis. A 71-year-old male with knee osteoarthritis underwent TKRA using a posterior-stabilized mobile-bearing prosthesis. Posterior dislocation of the prosthesis occurred at 5 weeks postoperatively, and closed reduction of the posterior dislocation resulted in complete 180° rotatory dislocation of the rotating platform. The patient was treated by open exploration and polyethylene exchange for a larger component. This case illustrates that dislocation of a posterior-stabilized mobile-bearing total knee prosthesis can occur given valgus laxity and causes a 90° spin-out of the polyethylene insert, and that closed reduction attempts may contribute to complete 180° rotatory dislocation of the rotating platform. Special attention should be given to both AP and lateral views to ensure that the platform is truly reduced and not rotated by 180°. Plain digital radiography, which enhances the density of polyethylene, or arthrography is helpful for diagnosing this complication.

  4. Association of increased knee flexion and patella clunk syndrome after mini-subvastus total knee arthroplasty.

    PubMed

    Schroer, William C; Diesfeld, Paul J; Reedy, Mary E; LeMarr, Angela

    2009-02-01

    This study reviewed 747 consecutive posterior stabilized total knee arthroplasty (TKA) to explain the increased incidence of patella clunk syndrome that occurred when the surgeon switched from a medial parapatellar arthrotomy to a mini-subvastus (MIS) TKA technique. The incidence of patella clunk syndrome increased with increased postoperative knee flexion. Six weeks after surgery, knees that developed patella clunk had a mean flexion of 124 degrees vs 117 degrees for knees that did not develop this syndrome (P = .016). As the MIS approach resulted in increased knee flexion, this approach was indirectly associated with the increased incidence of patella clunk. Knee flexion at 6 weeks postoperatively was 117 degrees for the MIS knees vs 108 degrees for traditional medial parapatellar arthrotomy knees (P < .001). The effect of increased knee flexion achieved with the MIS approach, which resulted in an increase in patella clunk, was mitigated by using a new posterior stabilized femoral component designed to minimize soft tissue entrapment.

  5. The Cruciate Ligaments in Total Knee Arthroplasty.

    PubMed

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction.

  6. Total knee arthroplasty in patients with a previous patellectomy.

    PubMed

    Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

    2013-01-01

    Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients.

  7. Cementless total knee arthroplasty

    PubMed Central

    Risitano, Salvatore; Sabatini, Luigi; Giachino, Matteo; Agati, Gabriele; Massè, Alessandro

    2016-01-01

    Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision’s rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation. PMID:27162779

  8. Knee disarticulation after total-knee replacement.

    PubMed

    Lambregts, S A M; Hitters, W M G C

    2002-12-01

    An 89-year-old woman who had a total-knee replacement in the past, underwent a knee disarticulation of the same leg because of an ischaemic foot. Eight (8) months postoperatively the stump is fully weight-bearing and the patient is able to walk safely, using a prosthesis and a walking frame.

  9. Condylar-stabilizing tibial inserts do not restore anteroposterior stability after total knee arthroplasty.

    PubMed

    Sur, Yoo-Joon; Koh, In-Jun; Park, Se-Wook; Kim, Hyung-Jin; In, Yong

    2015-04-01

    The Triathlon condylar-stabilizing (CS) lipped insert is designed to provide anteroposterior (AP) stability of the posterior-stabilized (PS) insert, without a post. The purpose of this study was to compare the AP stability of the knee in patients with Triathlon CS and PS total knee arthroplasty (TKA) with midterm follow-up. Thirty-one patients received a Triathlon PS TKA in one knee and a Triathlon CS TKA in the contralateral knee, and 28 patients were followed up with a minimum duration of 5years. Although there was no difference in functional outcomes, the posterior displacement was significantly greater in the CS TKA group than in the PS TKA group (P<0.001). The Triathlon CS lipped insert could not restore posterior stability with PCL sacrifice.

  10. Design and cadaveric validation of a novel device to quantify knee stability during total knee arthroplasty.

    PubMed

    Siston, Robert A; Maack, Thomas L; Hutter, Erin E; Beal, Matthew D; Chaudhari, Ajit M W

    2012-11-01

    The success of total knee arthroplasty depends, in part, on the ability of the surgeon to properly manage the soft tissues surrounding the joint, but an objective definition as to what constitutes acceptable postoperative joint stability does not exist. Such a definition may not exist due to lack of suitable instrumentation, as joint stability is currently assessed by visual inspection while the surgeon manipulates the joint. Having the ability to accurately and precisely measure knee stability at the time of surgery represents a key requirement in the process of objectively defining acceptable joint stability. Therefore, we created a novel sterilizable device to allow surgeons to measure varus-valgus, internal-external, or anterior-posterior stability of the knee during a total knee arthroplasty. The device can be quickly adjusted between 0 deg and 90 deg of knee flexion. The device interfaces with a custom surgical navigation system, which records the resultant rotations or translations of the knee while the surgeon applies known loads to a patient's limb with a handle instrumented with a load cell. We validated the performance of the device by having volunteers use it to apply loads to a mechanical linkage that simulated a knee joint; we then compared the joint moments calculated by our stability device against those recorded by a load cell in the simulated knee joint. Validation of the device showed low mean errors (less than 0.21 ± 1.38 Nm and 0.98 ± 3.93 N) and low RMS errors (less than 1.5 Nm and 5 N). Preliminary studies from total knee arthroplasties performed on ten cadaveric specimens also demonstrate the utility of our new device. Eventually, the use of this device may help determine how intra-operative knee stability relates to postoperative function and could lead to an objective definition of knee stability and more efficacious surgical techniques.

  11. Tibiofemoral force following total knee arthroplasty: comparison of four prosthesis designs in vitro.

    PubMed

    Nicholls, Rochelle L; Schirm, Andreas C; Jeffcote, Benjamin O; Kuster, Markus S

    2007-11-01

    Despite ongoing evolution in total knee arthroplasty (TKA) prosthesis design, restricted flexion continues to be common postoperatively. Compressive tibiofemoral force during flexion is generated through the interaction between soft tissues and prosthesis geometry. In this study, we compared the compressive tibiofemoral force in vitro of four commonly used prostheses: fixed-bearing PCL (posterior cruciate ligament)-retaining (PFC), mobile-bearing posterior-stabilized (PS), posterior-stabilized with a High Flex femoral component (HF), and mobile-bearing PCL-sacrificing (LCS). Fourteen fresh-frozen cadaver knee joints were tested in a passive motion rig, and tibiofemoral force measured using a modified tibial baseplate instrumented with six load cells. The implants without posterior stabilization displayed an exponential increase in force after 90 degrees of flexion, while PS implants maintained low force throughout the range of motion. The fixed-bearing PFC prosthesis displayed the highest peak force (214 +/- 68 N at 150 degrees flexion). Sacrifice of the PCL decreased the peak force to a level comparable with the LCS implant. The use of a PCL-substituting post and cam system reduced the peak force up to 78%, irrespective of whether it was a high-flex or a standard PS knee. However, other factors such as preoperative range of motion, knee joint kinematics, soft tissue impingement, and implantation technique play a role in postoperative knee function. The present study suggests that a posterior-stabilized TKA design might be advantageous in reducing soft tissue tension in deep flexion. Further research is necessary to fully understand all factors affecting knee flexion after TKA.

  12. Patellar clunk syndrome in a current high flexion total knee design.

    PubMed

    Agarwala, Sanjay R; Mohrir, Ganesh S; Patel, Aashish G

    2013-12-01

    This retrospective study of 208 (204 patients) total knee arthroplasties evaluated the incidence of patellar clunk syndrome for two high-flex posterior stabilized knee prostheses; a high-flex fixed bearing prosthesis and a high-flex mobile bearing prosthesis. Patients were followed for up to two years and were evaluated for patellar clunk and component position. Knees receiving the mobile bearing had a significantly higher (p < 0.001) incidence of patellar clunk (15%) than knees receiving the fixed bearing (0%). There was a significantly higher incidence of patellar clunk in males (34.1%; p < 0.01) compared to females (8.6%). Fibrous nodules were treated surgically in 11 of the knees with patellar clunk. The design of this particular mobile bearing knee seems to contribute to patellar clunk syndrome. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Evolution of knee kinematics three months after total knee replacement.

    PubMed

    Alice, Bonnefoy-Mazure; Stéphane, Armand; Yoshisama, Sagawa Junior; Pierre, Hoffmeyer; Domizio, Suvà; Hermes, Miozzari; Katia, Turcot

    2015-02-01

    In patients with debilitating knee osteoarthritis, total knee replacement is the most common surgical procedure. Numerous studies have demonstrated that knee kinematics one year after total knee replacement are still altered compared to the healthy joint. However, little is known regarding impairments and functional limitations of patients several months after total knee replacement. The aim of this study was to describe the evolution of the knee gait kinematic in patients with knee osteoarthritis before and three months after a total knee replacement. Ninety patients who were to undergo total knee replacement were included in this study. Twenty-three subjects were recruited as the control group. Three-dimensional gait analysis was performed before and three months after surgery. The spatio-temporal parameters and three-dimensional knee kinematics for the operated limb were evaluated during a comfortable gait and compared between groups (the before and after surgery groups and the control group). Three months after surgery, patients always walk with a slower gait velocity and lower knee flexion-extension movements compared to the control group. However, a degree of progress was observed in term of the stride and step length, gait velocity and knee alignment in the coronal plane. Our results suggest that the disability is still significant for most patients three months after total knee replacement. A better understand of the impairments and functional limitations following surgery would help clinicians design rehabilitation programs. Moreover, patients should be informed that rehabilitation after total knee replacement is a long process.

  14. Mobile-bearing total knee arthroplasty improves patellar tracking and patellofemoral contact stress: in vivo measurements in the same patients.

    PubMed

    Sawaguchi, Naohiro; Majima, Tokifumi; Ishigaki, Takayuki; Mori, Noriaki; Terashima, Takashi; Minami, Akio

    2010-09-01

    Controversies exist in clinical study concerning the effect of rotating platform on patellar tracking. The aim of this in vivo study was to compare tibial rotation, patellar tracking, and patellofemoral contact stress in mobile and fixed-bearing platform intraoperatively in the same knee. Sixty-six knees of posterior-stabilized total knee prostheses were evaluated using a computed tomography-guided navigation system. Medial shift and lateral tilt of patella were significantly smaller in mobile knee. Averaged maximum contact stress was significantly smaller in mobile knee than fixed knee. However, tibial rotation during flexion has no significant difference. This study showed that mobile platform total knee arthroplasty significantly improved patellar tracking and decreased patellofemoral contact stress. Copyright 2010 Elsevier Inc. All rights reserved.

  15. Biomechanics of hyperflexion and kneeling before and after total knee arthroplasty.

    PubMed

    Lee, Thay Q

    2014-06-01

    The capacity to perform certain activities is frequently compromised after total knee arthroplasty (TKA) due to a functional decline resulting from decreased range of motion and a diminished ability to kneel. In this manuscript, the current biomechanical understanding of hyperflexion and kneeling before and after TKA will be discussed. Patellofemoral and tibiofemoral joint contact area, contact pressure, and kinematics were evaluated in cadaveric studies using a Tekscan pressure measuring system and Microscribe. Testing was performed on intact knees and following cruciate retaining and posterior stabilized TKA at knee flexion angles of 90°, 105°, 120°, and 135°. Three loading conditions were used to simulate squatting, double stance kneeling, and single stance kneeling. Following TKA with double stance kneeling, patellofemoral contact areas did not increase significantly at high knee flexion angle (135°). Kneeling resulted in tibial posterior translation and external rotation at all flexion angles. Moving from double to single stance kneeling tended to increase pressures in the cruciate retaining group, but decreased pressures in the posterior stabilized group. The cruciate retaining group had significantly larger contact areas than the posterior stabilized group, although no significant differences in pressures were observed comparing the two TKA designs (p < 0.05). If greater than 120° of postoperative knee range of motion can be achieved following TKA, then kneeling may be performed with less risk in the patellofemoral joint than was previously believed to be the case. However, kneeling may increase the likelihood of damage to cartilage and menisci in intact knees and after TKA increases in tibiofemoral contact area and pressures may lead to polyethyelene wear if performed on a chronic, repetitive basis.

  16. Biomechanics of Hyperflexion and Kneeling before and after Total Knee Arthroplasty

    PubMed Central

    2014-01-01

    The capacity to perform certain activities is frequently compromised after total knee arthroplasty (TKA) due to a functional decline resulting from decreased range of motion and a diminished ability to kneel. In this manuscript, the current biomechanical understanding of hyperflexion and kneeling before and after TKA will be discussed. Patellofemoral and tibiofemoral joint contact area, contact pressure, and kinematics were evaluated in cadaveric studies using a Tekscan pressure measuring system and Microscribe. Testing was performed on intact knees and following cruciate retaining and posterior stabilized TKA at knee flexion angles of 90°, 105°, 120°, and 135°. Three loading conditions were used to simulate squatting, double stance kneeling, and single stance kneeling. Following TKA with double stance kneeling, patellofemoral contact areas did not increase significantly at high knee flexion angle (135°). Kneeling resulted in tibial posterior translation and external rotation at all flexion angles. Moving from double to single stance kneeling tended to increase pressures in the cruciate retaining group, but decreased pressures in the posterior stabilized group. The cruciate retaining group had significantly larger contact areas than the posterior stabilized group, although no significant differences in pressures were observed comparing the two TKA designs (p < 0.05). If greater than 120° of postoperative knee range of motion can be achieved following TKA, then kneeling may be performed with less risk in the patellofemoral joint than was previously believed to be the case. However, kneeling may increase the likelihood of damage to cartilage and menisci in intact knees and after TKA increases in tibiofemoral contact area and pressures may lead to polyethyelene wear if performed on a chronic, repetitive basis. PMID:24900891

  17. Hinge total knee replacement revisited

    PubMed Central

    Cameron, Hugh U.; Hu, Cungen; Vyamont, Didier

    1997-01-01

    Objective To determine if aseptic loosening is a major problem in hinge total knee replacement. Design A cohort study. Setting A university-affiliated institute, specializing in elective orthopedic surgery. Patients Fifty-eight patients, mainly those requiring revision, in whom the conditions were such that it was felt only a totally constrained implant was appropriate. In 7 patients the implant was press-fitted; in the remainder it was cemented. Five patients required fusion or revision, and 8 died less than 2 years after implantation, leaving 45 for review. Follow-up was 2 to 13 years. Intervention Total knee replacement with a Guepar II prosthesis. Main outcome measures Radiolucency determined by the Cameron system and clinical scoring using the Hospital for Special Surgery system. Results Of the cemented components, 91% of femoral stems were type IA (no lucency), 9% were type IB (partial lucency), with no type II or III lucency. Tibial lucency was 87% type IA and 13% type IB, with no type II or III lucency. Of the noncemented components, 58% of femoral components were type IA and 42% type IB. Tibial lucency was 71% type IA and 29% type IB. Lucency was mainly present in zones 1 and 2 adjacent to the knee. Clinical rating was 18% excellent, 20% good, 20% fair and 42% poor. Postoperative complications included infection (13%), aseptic loosening (7%), quadriceps lag (16%) and extensor mechanism problems (16%). Conclusions Aseptic loosening is an uncommon problem in hinge total knee replacement. The complication rate in cases of sufficient severity as to require a hinge replacement remains high. Current indications for a hinge prosthesis are anteroposterior instability with a very large flexion gap, complete absence of the collateral ligaments and complete absence of a functioning extensor mechanism. PMID:9267296

  18. Instability following total knee arthroplasty.

    PubMed

    Rodriguez-Merchan, E Carlos

    2011-10-01

    Background Knee prosthesis instability (KPI) is a frequent cause of failure of total knee arthroplasty. Moreover, the degree of constraint required to achieve immediate and long-term stability in total knee arthroplasty (TKA) is frequently debated. Questions This review aims to define the problem, analyze risk factors, and review strategies for prevention and treatment of KPI. Methods A PubMed (MEDLINE) search of the years 2000 to 2010 was performed using two key words: TKA and instability. One hundred and sixty-five initial articles were identified. The most important (17) articles as judged by the author were selected for this review. The main criteria for selection were that the articles addressed and provided solutions to the diagnosis and treatment of KPI. Results Patient-related risk factors predisposing to post-operative instability include deformity requiring a large surgical correction and aggressive ligament release, general or regional neuromuscular pathology, and hip or foot deformities. KPI can be prevented in most cases with appropriate selection of implants and good surgical technique. When ligament instability is anticipated post-operatively, the need for implants with a greater degree of constraint should be anticipated. In patients without significant varus or valgus malalignment and without significant flexion contracture, the posterior cruciate ligament (PCL) can be retained. However, the PCL should be sacrificed when deformity exists particularly in patients with rheumatoid arthritis, previous patellectomy, previous high tibial osteotomy or distal femoral osteotomy, and posttraumatic osteoarthritis with disruption of the PCL. In most cases, KPI requires revision surgery. Successful outcomes can only be obtained if the cause of KPI is identified and addressed. Conclusions Instability following TKA is a common cause of the need for revision. Typically, knees with deformity, rheumatoid arthritis, previous patellectomy or high tibial osteotomy, and

  19. [What's new about total knee arthroplasty].

    PubMed

    Dao Trong, Mai Lang; Helmy, Näder

    2013-10-30

    Osteoarthritis of the knee is one of the most common problems in the orthopedic practice and its surgical technique is still challenging. This Mini-Review presents patient specific cutting blocks for the implantation of a total knee arthroplasty.

  20. Determinants of patellar tracking in total knee arthroplasty.

    PubMed

    Anglin, C; Brimacombe, J M; Hodgson, A J; Masri, B A; Greidanus, N V; Tonetti, J; Wilson, D R

    2008-08-01

    Optimizing patellar tracking in total knee arthroplasty is a surgical priority. Despite this, a comparison of the effects of different component placements on patellar tracking is not available; the biomechanical impact of the patellar resection angle has not been studied; and the similarity between intraoperative and postoperative effects, fundamental to improving patellar tracking, is unknown. Our objective was to compare the impact of the major controllable femoral, tibial and patellar component positions on patellar kinematics during both passive and loaded flexion. We tested eight cadaveric knee specimens in two rigs, simulating intraoperative and weightbearing flexion. Optoelectronic marker arrays were attached to the femur, tibia and patella to record kinematics throughout the range of motion. We modified posterior-stabilized fixed-bearing knee components to allow for five types of variations in component placement in addition to the neutral position: femoral component rotation, tibial component rotation, patellar resection angle, patellar component medialization and additional patellar thickness, for a total of 11 individual variations. The major determinants of patellar tilt and shift were patellar component medialization, patellar resection angle and femoral component rotation. The relative order of these variables depended on the structure (bone or component), kinematic parameter (tilt or shift) and flexion angle (early or late flexion). Effects of component changes were consistent between the intraoperative and weightbearing rigs. To improve patellar tracking, and thereby the clinical outcome, surgeons should focus on patellar component medialization, patellar resection angle and femoral component rotation. These have been linked with anterior knee pain as well. Neither tibial component rotation nor patellar thickness should be adjusted to improve patellar tracking.

  1. Cryotherapy following total knee replacement.

    PubMed

    Adie, Sam; Kwan, Amy; Naylor, Justine M; Harris, Ian A; Mittal, Rajat

    2012-09-12

    Total knee replacement (TKR) is a common intervention for patients with end-stage osteoarthritis of the knee. Post-surgical management may include cryotherapy. However, the effectiveness of cryotherapy is unclear. To evaluate the acute (within 48 hours) application of cryotherapy following TKR on pain, blood loss and function. We searched the Cochrane Database of Systematic Reviews, CENTRAL, DARE, HTA Database, MEDLINE, EMBASE, CINAHL, PEDro and Web of Science on 15th March 2012. Randomised controlled trials or controlled clinical trials in which the experimental group received any form of cryotherapy, and was compared to any control group following TKR indicated for osteoarthritis. Two reviewers independently selected trials for inclusion. Disagreements were discussed and resolved involving a third reviewer if required. Data were then extracted and the risk of bias of trials assessed. Main outcomes were blood loss, visual analogue score (VAS) pain, adverse events, knee range of motion, transfusion rate and knee function. Secondary outcomes were analgesia use, knee swelling, length of hospital stay, quality of life and activity level. Effects of interventions were estimated as mean differences (MD), standardised mean differences (SMD) or given as risk ratios (RR), with 95% confidence intervals (CI). Meta-analyses were performed using the inverse variance method and pooled using random effects. Eleven randomised trials and one controlled clinical trial involving 809 participants met the inclusion criteria. There is very low quality evidence from 10 trials (666 participants) that cryotherapy has a small benefit on blood loss (SMD -0.46, 95% CI, -0.84 to -0.08), equivalent to 225mL less blood loss in cryotherapy group (95% CI, 39 to 410mL). This benefit may not be clinically significant. There was very low quality evidence from four trials (322 participants) that cryotherapy improved visual analogue score pain at 48 hours (MD = -1.32 points on a 10 point scale, 95% CI

  2. NAVIGATION IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    da Mota e Albuquerque, Roberto Freire

    2015-01-01

    Navigation was the most significant advance in instrumentation for total knee arthroplasty over the last decade. It provides surgeons with a precision tool for carrying out surgery, with the possibility of intraoperative simulation and objective control over various anatomical and surgical parameters and references. Since the first systems, which were basically used to control the alignment of bone cutting referenced to the mechanical axis of the lower limb, many other surgical steps have been incorporated, such as component rotation, ligament balancing and arranging the symmetry of flexion and extension spaces, among others. Its efficacy as a precision tool with an effective capacity for promoting better alignment of the lower-limb axis has been widely proven in the literature, but the real value of optimized alignment and the impact of navigation on clinical results and the longevity of arthroplasty have yet to be established. PMID:27026979

  3. Comparison of robot surgery modular and total knee arthroplasty kinematics.

    PubMed

    Yildirim, Gokce; Fernandez-Madrid, Ivan; Schwarzkopf, Ran; Walker, Peter S; Karia, Raj

    2014-04-01

    The kinematics of seven knee specimens were measured from 0 to 120 degrees flexion using an up-and-down crouching machine. Motion was characterized by the positions of the centers of the lateral and medial femoral condyles in the anterior-posterior direction relative to a fixed tibia. A modular unicompartmental knee, trochlea flange, and patella resurfacing (multicompartmental knee [MCK] system) were implanted using a surgeon-interactive robot system that provided accurate surface matching. The MCK was tested, followed by standard cruciate retaining (CR) and posterior stabilized (PS) knees. The motion of the MCK was close to anatomic, especially on the medial side, in contrast to the CR and PS knees that showed abnormal motion features. Such a modular knee system, accurately inserted, has the potential for close to normal function in clinical application. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. Medial pivot knee in primary total knee arthroplasty.

    PubMed

    Atzori, Francesco; Salama, Wael; Sabatini, Luigi; Mousa, Shazly; Khalefa, Abdelrahman

    2016-01-01

    Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.

  5. Soft tissue knee contracture of the knee due to melorheostosis, treated by total knee arthroplasty.

    PubMed

    Moulder, Elizabeth; Marsh, Clayton

    2006-10-01

    Melorheostosis is a rare condition which can cause soft tissue joint contractures. We present a case of melorheostosis causing disabling knee joint contracture, treated successfully by total knee arthroplasty.

  6. The use of highly cross-linked polyethylene in total knee arthroplasty.

    PubMed

    Lachiewicz, Paul F; Geyer, Mark R

    2011-03-01

    Polyethylene wear, with resultant particle-induced osteolysis, is a cause of late failure of total knee arthroplasty. The causes of both wear and osteolysis are multifactorial; still, improvements in the polyethylene liner have been investigated. Available highly cross-linked polyethylene tibial liners and patellar prostheses differ greatly in the amount and method of irradiation, thermal treatments, and sterilization techniques they undergo. Several varieties of highly cross-linked polyethylene reduce the gravimetric and volumetric wear of tibial liners in knee simulator studies. However, reduced fracture toughness and the generation of smaller and possibly more reactive particles also have been reported with some varieties of polyethylene. Clinical studies of the use of highly cross-linked polyethylene in total knee arthroplasty are limited. Two nonrandomized trials of highly cross-linked polyethylene in total knee arthroplasty have reported a nonsignificant decrease in radiolucent lines at 2 and 5 years, respectively. The risks of using highly cross-linked polyethylene include fracture of the liner or of a posterior-stabilized tibial post, liner dislodgement or locking mechanism disruption, and possibly more osteolysis. Highly cross-linked polyethylene tibial liners may be considered for younger, more active patients. However, until additional clinical results are available, a cautious approach is warranted to the widespread use of highly cross-linked polyethylene in total knee arthroplasty.

  7. Mobile and fixed bearing total knee prosthesis functional comparison during stair climbing.

    PubMed

    Catani, F; Benedetti, M G; De Felice, R; Buzzi, R; Giannini, S; Aglietti, P

    2003-06-01

    The purpose of this investigation is to determine the functional performance of the mobile bearing total knee replacement prosthesis as compared to the fixed bearing type total knee replacement prosthesis. Kinematics, kinetics, and electromyography data were gained from 10 patients with mobile bearing and 10 patients with a fixed bearing posterior stabilized Insall Burstein II total knee replacement during ascending and descending stairs. A control group of 10 normal subjects, matched by sex and age, was also analysed. No significant biomechanical differences in patients with different total knee replacement designs have been reported from level-walking studies. Slightly better performance of posterior retaining with respect to cruciate sacrificing total knee replacement designs have been claimed from stair climbing studies. Only one study has been conducted regarding mobile versus fixed bearing total knee replacement assessed by gait analysis. This study did not show any biomechanical differences between the two groups. Motion analysis was used to quantify the knee kinematics, kinetics, and electromyography (right and left longissimus dorsi, gluteus medius, rectus femoris, biceps femoris, semitendinosus, gastrocnemius and tibialis anterior muscles) during stair ascent and descent. The mobile bearing group demonstrated a reduced knee extensor moment during stair climbing and descending, and a reduced knee adductor moment during stair climbing. When ascending stairs, most of the mobile bearing patients show a peak knee flexion and a peak knee flexion moment at the late stance phase during the double support period. This kinematic and kinetic pattern is absent in normal subject. Both mobile bearing and fixed bearing groups showed abnormal electromyography patterns in both descending and ascending. During stair climbing, the mobile bearing design demonstrates a different kinematic pattern to the fixed bearing total knee replacement. Lower limb compensatory mechanisms

  8. Soft tissue balance changes depending on joint distraction force in total knee arthroplasty.

    PubMed

    Nagai, Kanto; Muratsu, Hirotsugu; Matsumoto, Tomoyuki; Miya, Hidetoshi; Kuroda, Ryosuke; Kurosaka, Masahiro

    2014-03-01

    The influence of joint distraction force on intraoperative soft tissue balance was evaluated using Offset Repo-Tensor® for 78 knees that underwent primary posterior-stabilized total knee arthroplasty. The joint center gap and varus ligament balance were measured between osteotomized surfaces using 20, 40 and 60 lbs of joint distraction force. These values were significantly increased at extension and flexion as the distraction force increased. Furthermore, lateral compartment stiffness was significantly lower than medial compartment stiffness. Thus, larger joint distraction forces led to larger varus ligament balance and joint center gap, because of the difference in soft tissue stiffness between lateral and medial compartments. These findings indicate the importance of the strength of joint distraction force in the assessment of soft tissue balance, especially when using gap-balancing technique.

  9. The influence of tibial tray design on the wear of fixed-bearing total knee replacements.

    PubMed

    Galvin, A; Jennings, L M; McEwen, H M; Fisher, J

    2008-11-01

    Debris-induced osteolysis due to surface wear is a potential long-term problem in total knee replacements (TKRs). Wear between the tibial tray and ultra-high molecular weight polyethylene insert is thought to contribute to the wear. This study investigated the influence of tibial tray design on the wear of fixed-bearing TKRs. Specifically, this study investigated the influence of the material's surface finish and design characteristics of the locking mechanism of the tibial tray on the wear in fixed-bearing knees for both cruciate-retaining (CR) and posterior-stabilized designs. A new fixed-bearing tibial tray design using Co-Cr and with an improved locking mechanism significantly reduced polyethylene wear from 22.8 +/- 6.0 mm3 per 10(6) cycles to 15.9 +/- 2.9 mm3 per 10(6) cycles compared with a previous titanium alloy tray with a CR design. The wear rates were similar to those of a fixed-bearing insert clamped into a tibial tray, suggesting that the decrease in wear was due to a reduction in backside wear. There was no significant difference between the wear rates of a cruciate-retaining design and a posterior-stabilized design under the two kinematic conditions tested.

  10. Changes in knee kinematics following total knee arthroplasty.

    PubMed

    Akbari Shandiz, Mohsen; Boulos, Paul; Saevarsson, Stefan Karl; Yoo, Sam; Miller, Stephen; Anglin, Carolyn

    2016-04-01

    Total knee arthroplasty (TKA) changes the knee joint in both intentional and unintentional, known and unknown, ways. Patellofemoral and tibiofemoral kinematics play an important role in postoperative pain, function, satisfaction and revision, yet are largely unknown. Preoperative kinematics, postoperative kinematics or changes in kinematics may help identify causes of poor clinical outcome. Patellofemoral kinematics are challenging to record since the patella is obscured by the metal femoral component in X-ray and moves under the skin. The purpose of this study was to determine the kinematic degrees of freedom having significant changes and to evaluate the variability in individual changes to allow future study of patients with poor clinical outcomes. We prospectively studied the 6 degrees of freedom patellofemoral and tibiofemoral weightbearing kinematics, tibiofemoral contact points and helical axes of rotation of nine subjects before and at least 1 year after total knee arthroplasty using clinically available computed tomography and radiographic imaging systems. Normal kinematics for healthy individuals were identified from the literature. Significant differences existed between pre-TKA and post-TKA kinematics, with the post-TKA kinematics being closer to normal. While on average the pre-total knee arthroplasty knees in this group displayed no pivoting (only translation), individually only five knees displayed this behaviour (of these, two showed lateral pivoting, one showed medial pivoting and one showed central pivoting). There was considerable variability postoperatively as well (five central, two lateral and two medial pivoting). Both preop and postop, flexion behaviour was more hinge-like medially and more rolling laterally. Helical axes were more consistent postop for this group. An inclusive understanding of the pre-TKA and post-TKA kinematics and changes in kinematics due to total knee arthroplasty could improve implant design, patient diagnosis and

  11. Gap balancing in total knee arthroplasty.

    PubMed

    Bottros, John; Gad, Bishoy; Krebs, Viktor; Barsoum, Wael K

    2006-06-01

    It is well known that the success of total knee arthroplasty is collectively dependent on the proper recreation of the joint line, appropriate soft tissue balancing, and respectful management of the extensor mechanism. One of the most decisive factors within the surgeon's control is the reestablishment of proper knee kinematics through both medial-lateral and flexion-extension ligamentous balancing. This can be accomplished only by a comprehensive intraoperative evaluation in full flexion, mid flexion, and full extension to minimize potential gap mismatches. Most of the discussion will focus on this aspect of soft tissue balancing, but this does not undermine the importance of the other aforementioned principles of successful knee arthroplasty.

  12. Intraoperative passive knee kinematics during total knee arthroplasty surgery.

    PubMed

    Young, Kathryn L; Dunbar, Michael J; Richardson, Glen; Astephen Wilson, Janie L

    2015-11-01

    Surgical navigation systems for total knee arthroplasty (TKA) surgery are capable of capturing passive three-dimensional (3D) angular joint movement patterns intraoperatively. Improved understanding of patient-specific knee kinematic changes between pre and post-implant states and their relationship with post-operative function may be important in optimizing TKA outcomes. However, a comprehensive characterization of the variability among patients has yet to be investigated. The objective of this study was to characterize the variability within frontal plane joint movement patterns intraoperatively during a passive knee flexion exercise. Three hundred and forty patients with severe knee osteoarthritis (OA) received a primary TKA using a navigation system. Passive kinematics were captured prior to (pre-implant), and after prosthesis insertion (post-implant). Principal component analysis (PCA) was used to capture characteristic patterns of knee angle kinematics among patients, to identify potential patient subgroups based on these patterns, and to examine the subgroup-specific changes in these patterns between pre- and post-implant states. The first four extracted patterns explained 99.9% of the diversity within the frontal plane angle patterns among the patients. Post-implant, the magnitude of the frontal plane angle shifted toward a neutral mechanical axis in all phenotypes, yet subtle pattern (shape of curvature) features of the pre-implant state persisted.

  13. Anterior knee pain after total knee arthroplasty: a narrative review.

    PubMed

    Petersen, Wolf; Rembitzki, Ingo Volker; Brüggemann, Gerd-Peter; Ellermann, Andree; Best, Raymond; Koppenburg, Andreas Gösele-; Liebau, Christian

    2014-02-01

    Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary.

  14. [Rehabilitation after total knee arthroplasty of hip and knee].

    PubMed

    Jansen, E; Brienza, S; Gierasimowicz-Fontana, A; Matos, C; Reynders-Frederix-Dobre, C; HateM, S M

    2015-09-01

    Numbers of total hip and knee arthroplasties are increasing on a regular basis. Clinical pathways tend to shorten the duration of hospitalization in acute care after surgery. Therefore, the preoperative preparation of the patient and his abilities for postoperative rehabilitation should be carefully addressed. Before the surgical intervention, it is recommended that the patient receives an educational program and a physical preparation. After the surgical intervention, the patient can benefit from a home-based rehabilitation program supervised by a physiotherapist, if there were no preoperative reasons for prolonging the hospital stay and if the surgery took place without complications. Some patients may benefit from postsurgical rehabilitation in a specialized locomotor rehabilitation long-stay care unit. The indications for inpatient multidisciplinary rehabilitation are : two simultaneous arthroplasties, revision of a previous hip or knee arthroplasty, postsurgical complications, advanced age, comorbidities influencing the rehabilitation process, social difficulties, necessity for adaptation of the environment, insufficient or unadapted out-patient (para)medical care. The goals of the rehabilitation treatment depend on the patient's characteristics and environment, on the properties of the prosthesis and on the postsurgical complications. The functional prognosis of a total joint arthroplasty of the knee or hip is excellent, provided that there are no post-surgical complications and that the patient benefits from adequate rehabilitation therapy. The present paper describes the different phases of rehabilitation treatment and the general and specific complications of total hip and knee arthroplasties that may influence the rehabilitation outcome.

  15. Acute arterial occlusion after total knee arthroplasty.

    PubMed

    Gregory, Patricia C; Rogic, Roselyn; Eddington, Carolyn

    2006-11-01

    There are a number of complications associated with total knee-joint arthroplasty. These include deep venous thromboses, peroneal palsy, infection, anemia, and Ogilvie's syndrome. An uncommon but potentially limb-threatening complication is acute arterial occlusion. Approximately 35 cases have been reported in the orthopedic literature. Prompt recognition and treatment intervention are the keys to successful outcome. We describe the case of one patient who had mild peroneal palsy and developed acute arterial occlusion 9 days postoperatively while on the inpatient rehabilitation service. Prompt aggressive management restored arterial circulation to the lower limb. Careful management of patients after total knee arthroplasty requires an understanding that arterial occlusion is a rare limb-threatening complication of surgery, but that it is treatable with prompt, deliberate management. Physiatrists should be aware that this condition exists in postoperative knee-joint arthroplasty patients. They should pay careful attention to any patient with a history of peripheral vascular disease or postoperative peroneal palsy.

  16. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer

    PubMed Central

    Saito, Hidetomo; Aizawa, Toshiaki; Miyakoshi, Naohisa; Shimada, Yoichi

    2016-01-01

    One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the x-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning. PMID:27648328

  17. Total knee arthroplasty in vascular malformation

    PubMed Central

    Bhende, Harish; Laud, Nanadkishore; Deore, Sandeep; Shashidhar, V

    2015-01-01

    In Klippel–Trenaunay syndrome, vascular malformations are not only in skin and superficial soft tissues but also in deep tissues like muscles bones and joints. It is well documemted that these recurrent intraarticular bleeds can cause early arthritis and joint pain. Performing arthroplasty in such patients is difficult and fraught with complications. We describe such a case where navigated total knee arthroplasty was performed with success to avoid the problems of intra medullary alignment used in the presence of intra medullary vascular malformations. We also suggest certain measures when knee arthroplasty is considered in such patients. PMID:26538765

  18. Tantalum Cones in Revision Total Knee Arthroplasty.

    PubMed

    Kim, Eric G; Patel, Nirav K; Chughtai, Morad; Elmallah, Randa D K; Delanois, Ronald E; Harwin, Steven F; Mont, Michael A

    2016-11-01

    The best strategy to address large bony defects in revision total knee arthroplasty has yet to be determined. The relatively recent development of porous tantalum cones and their use to address massive bone loss in knee arthroplasty has shown promising short- and intermediate-term results. The purpose of this review is to present the current literature on: (1) basic science of porous tantalum, (2) classification and treatment for bone loss, (3) clinical results, and (4) evolution of newer generation cones. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  19. PERIPROSTHETIC FRACTURES IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    de Alencar, Paulo Gilberto Cimbalista; De Bortoli, Giovani; Ventura Vieira, Inácio Facó; Uliana, Christiano Saliba

    2015-01-01

    The increasing number of total knee arthroplasties, in combination with the population's longer life expectancy, has led to a greater number of long-term complications. These add to the poor bone quality of elderly patients and often culminate in periprosthetic fractures. This complex orthopedic problem has a great diversity of clinical presentation. It may affect any of the bones in the knee and, because of the difficulty in finding solutions, may lead to disastrous outcomes. Its treatment requires that orthopedists should have broad knowledge both of arthroplasty techniques and of osteosynthesis, as well as an elaborate therapeutic arsenal including, for example, access to a bone bank. PMID:27022546

  20. The infected total knee: management options.

    PubMed

    Cuckler, John M

    2005-06-01

    The management of infection after total knee arthroplasty depends on the chronicity of the infection, host factors, and sensitivity of the infecting bacteria. Two-stage salvage consisting of removal of implants and cement, placement of an antibiotic spacer, and appropriate intravenous antibiotic therapy followed by reimplantation with an antibiotic-impregnated cement appears to be the predominant approach to managing this complication. The use of articulated spacers consisting of the sterilized femoral and polyethylene components with antibiotic cement allows maintenance of motion and bone stock. This report details the author's experience with 44 infected knee arthroplasties.

  1. Total hip and total knee replacement: preoperative nursing management.

    PubMed

    Lucas, Brian

    Total hip replacement (THR) and total knee replacement (TKR) surgery are carried out for the relief of hip or knee pain, usually caused by osteoarthritis. This is the first of two articles on THR and TKR. It will outline the different types of replacement used in lower limb joint replacement surgery. Preparation of patients for surgery requires attention to physical, psychological and social factors and these are explored in detail. The organization of services along the patient pathway to ensure comprehensive preparation is considered and the nursing role highlighted. The second article, to be published in the next issue, will discuss recovery and rehabilitation from THR and TKR surgery.

  2. Measured flexion following total knee arthroplasty.

    PubMed

    Mai, Kenny T; Verioti, Christopher A; Hardwick, Mary E; Ezzet, Kace A; Copp, Steven N; Colwell, Clifford W

    2012-10-01

    Postoperative flexion is an important factor in the outcome of total knee arthroplasty. Although normal activities of daily living require a minimum of 105° to 110° of flexion, patients from non-Western cultures often engage in activities such as kneeling and squatting that require higher flexion. The desire to achieve greater flexion serves as the driving force for prosthetic modifications, including high-flexion designs. Techniques used to measure knee flexion and knee position during measurement are not often described or are different depending on the examiner. The purpose of this study was to compare active (self) and passive (assisted) flexion after successful total knee arthroplasty for 5 prostheses (2 standard and 3 high-flexion) using clinical (goniometer) and radiographic (true lateral radiograph) measurement techniques by different independent examiners.At a mean follow-up of 2.7 years (range, 1-5.6 years), a total of 108 patients (144 total knee arthroplasties) had completed the study. Mean postoperative active flexion was 111° clinically and 109° radiographically for the standard designs and 114° clinically and 117° radiographically for the high-flexion designs. Adding passive flexion increased flexion to 115° clinically and 117° radiographically for the standard designs and 119° clinically and 124° radiographically for the high-flexion designs. Flexion differences between the 2 measurement techniques (active vs passive and clinically vs radiographically) were statistically significant (P<.05). These findings demonstrate the importance of describing how flexion is measured in studies and understanding how the method of measurement can affect the findings.

  3. Endo-Modell rotating-hinge total knee for revision total knee arthroplasty.

    PubMed

    Bistolfi, Alessandro; Rosso, Federica; Crova, Maurizio; Massazza, Giuseppe

    2013-10-01

    The goal of this study was to analyze the clinical and radiographic results and the survival rate of a series of rotating-hinge implants used for revision total knee arthroplasties in mild and severe instability. Between December 1991 and June 2004, fifty-three revision total knee arthroplasties were performed using the Endo-Modell (Waldemar LINK GmbH and Co, Hamburg, Germany) rotating-hinge prosthesis; 7 (13.2%) patients underwent partial revision of a previous Endo-Modell. All patients were evaluated preoperatively, 3 and 6 months postoperatively, and annually thereafter using the Hospital for Special Surgery (HSS) knee score and the Knee Society Roentgenographic Evaluation System (KS-RES). Mean follow-up was 155.2±40.1 months (range, 78-240 months), with 32 patients examined at the final follow-up. All HSS knee scores increased from preoperatively to last follow-up. No statistically significance differences were found in the HSS knee scores between septic and aseptic revisions and between total or partial revisions. Progressive radiolucent lines were detected in 8 (25%) patients. Implant failure occurred in 11 (20.7%) patients; the cumulative survival of the implants was 80.4% at 150 months for the final 32 patients. The authors recommend use of this implant for revision total knee arthroplasty, especially in patients with severe instability and bone loss.

  4. Failure of Polyethelene Insert Locking Mechanism after a Posterior Stabilised Total Knee Arthroplasty- A Case Report

    PubMed Central

    Reddy, AY Gurava; Rajan, D Soundar; Chiranjeevi, T; Karthik, C; Kiran, E Krishna

    2016-01-01

    Introduction: Disengagement of polyethylene insert used in total knee arthroplasty is a rare but serious complication. Still rarer is disengagement because of failure of tibial insert locking mechanism. We report a previously unpublished complication of polyethylene insert locking mechanism failure in a 10-months-old posterior stabilized total knee arthroplasty in a 70-year-old woman with osteoarthritis for whom Attune (Depuy) knee implant was used. Case Presentation: A 70-year-old female underwent (Attune, Depuy) primary bilateral posterior stabilised total knee arthroplasty in a private hospital. The patient did not have any complaints and had had been functioning well post her arthroplasty. After five months of surgery she had a fall and sustained injury over right hip which was treated with Cemented Bipolar Hemiarthroplasty. Ten months after index surgery, she sustained trivial fall and presented to the same hospital with knee pain and swelling, where the right knee prosthesis was found to be dislocated. An attempted closed reduction under anaesthesia failed, after which she was referred to our centre with an unstable, painful, swollen right knee in a long knee brace. The physical examination at the time of admission showed posterior sag of the tibia, fullness in the postero-lateral corner, quadriceps muscle atrophy without any neurovascular deficit oflower leg. Postero-lateral dislocation was confirmed with radiographs. Surgical error as a possible causative factor was excluded because patient had been functioning well after surgery. Her comorbidities included hypertension and hyponatremia. ESR and CRP were within normal limits. An open reduction surgery was planned. On exposure, polyethylene was found in the postero-lateral corner of the knee. We were not sure that revising the polyethylene alone would suffice as the poly and locking mechanism was of a relatively new design and hence it was decided to proceed with revision of the components. Revision was done

  5. Anterior knee pain following primary total knee arthroplasty

    PubMed Central

    Shervin, David; Pratt, Katelyn; Healey, Travis; Nguyen, Samantha; Mihalko, William M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2015-01-01

    Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. PMID:26601061

  6. Total knee arthroplasty in elderly osteoporotic patients.

    PubMed

    Spinarelli, Antonio; Petrera, Massimo; Vicenti, Giovanni; Pesce, Vito; Patella, Vittorio

    2011-04-01

    Often in daily practice the choice of a prosthesis does not rise out of considerations about literature evidences, but it seems to be related to the personal experience and "surgical philosophy" of surgeon. The choice of prosthesis in total joint replacement is usually justified by biological and mechanical parameters that the surgeon considers before surgery. Osteoporosis is a disease characterized by a reduced bone mass and a degeneration of the bone tissue; it leads to bone fragility, so to a higher risk of fractures. Bone resistance, as all the changes in the microarchitecture of the bone tissue, is linked to bone density. Because of the bone density variation and/or the changes in the bone micro-architecture, as the bone strength decreases, the risk of fractures increases. It is important to understand all the factors taking part in both normal and abnormal bone remodelling. Osteoporosis does not imply a concrete bone loss, but a change of the bone micro-architecture itself. In these cases the choice of the patient and implant design are very important. In the period between March 1997-July 2002, we implanted 100 consecutive TKA (total knee arthroplasty) Genesis II in 97 subjects (79 female); mean age was 77.1 years old. All TKA were performed because of primary osteoarthritis of the knee. All patients had complete pain relief and excellent knee score. The surgical and medical complications were in accordance with the published literature. We must consider all existing medical conditions, the state of the knee and local needs of the elderly patient. Thus, within these limits, the total knee can improve the ability of patients to manage the activities of daily living and improve their quality of life.

  7. Periprosthetic fractures around total knee arthroplasty

    PubMed Central

    Sarmah, SS; Patel, S; Reading, G; El-Husseiny, M; Douglas, S; Haddad, FS

    2012-01-01

    INTRODUCTION The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function. METHODS A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were ‘periprosthetic fracture(s)’, ‘femur’, ‘tibia’, ‘patella(r)’, ‘complication(s)’, ‘failure(s)’, ‘risk(s)’, ‘prevalence’, ‘incidence’, ‘epidemiology’ and ‘classification(s)’. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified. RESULTS Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement. CONCLUSIONS Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon. PMID:22943223

  8. [Therapy of arthrofibrosis after total knee arthroplasty].

    PubMed

    Gollwitzer, H; Burgkart, R; Diehl, P; Gradinger, R; Bühren, V

    2006-02-01

    Arthrofibrosis is one of the most common complications after total knee arthroplasty with an overall incidence of approximately 10%. Nevertheless, published data are rare and clinical trials mostly include small and heterogeneous patient series resulting in controversial conclusions. Clinically, arthrofibrosis after knee arthroplasty is defined as (painful) stiffness with scarring and soft tissue proliferation. Differentiation between local (peripatellar) and generalized fibrosis is therapeutically relevant. Histopathology typically shows subsynovial fibrosis with synovial hyperplasia, chronic inflammatory infiltration, and excessive and unregulated proliferation of collagen and fibroblasts. Diagnostic strategies are based on the exclusion of differential causes for painful knee stiffness, and especially the exclusion of low-grade infections represents a diagnostic challenge. Early and intensive physiotherapy combined with sufficient analgesia should be initiated as a basic therapy. The next therapeutic steps for persisting arthrofibrosis include closed manipulation and open arthrolysis. Arthroscopic interventions should be limited to local fibrosis. Revision arthroplasty represents a rescue surgery, often associated with recurrence of fibrosis. Prevention of arthrofibrosis by sufficient analgesia and early physiotherapy remains the best treatment option for painful stiffness after knee arthroplasty.

  9. Extensor tendon ruptures after total knee arthroplasty.

    PubMed

    Bonnin, M; Lustig, S; Huten, D

    2016-02-01

    Extensor tendon rupture is a rare but serious complication after total knee arthroplasty (TKA) that impairs active knee extension, thereby severely affecting knee function. Surgery is usually required. Surgical options range from simple suturing to allograft reconstruction of the entire extensor mechanism and include intermediate methods such as reconstruction using neighbouring tendons or muscles, synthetic ligament implantation, and partial allograft repair. Simple suturing carries a high failure rate and should therefore be routinely combined with tissue augmentation using a neighbouring tendon or a synthetic ligament. After allograft reconstruction, outcomes are variable and long-term complications common. Salvage procedures for managing the most severe cases after allograft failure involve reconstruction using gastrocnemius or vastus flaps. Regardless of the technique used, suturing must be performed under tension, with the knee fully extended, and rehabilitation must be conducted with great caution. Weaknesses of available case-series studies include small sample sizes, heterogeneity, and inadequate follow-up duration. All treatment options are associated with substantial failure rates. The patient should be informed of this fact and plans made for a salvage option. Here, the main techniques and their outcomes are discussed, and a therapeutic strategy is suggested.

  10. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    ClinicalTrials.gov

    2012-05-16

    Revision Total Knee Arthroplasty Because of; Loosening; Instability; Impingement; or Other Reasons Accepted as Indications for TKA Exchange.; The Focus is to Determine the Precision of Joint Line Restoration in Navigated vs. Conventional Revision Total Knee Arthroplasty

  11. Bilateral fatigue fracture of the femoral components in a cruciate-retaining cementless total knee prosthesis.

    PubMed

    Saito, Shu; Tokuhashi, Yasuaki; Ishii, Takao; Mori, Sei; Hosaka, Kunihiro; Ryu, Keinosuke; Suzuki, Gen

    2011-10-05

    This article reports a case of bilateral fatigue fracture of the femoral components in a cruciate-retaining uncemented total knee arthroplasty (TKA). A 75-year-old woman (height, 158 cm; weight, 72 kg; body mass index, 29.2) had undergone one-stage bilateral TKA for osteoarthritis 11 years previously at the author's institution. Surgery was performed using an uncemented Flexible Nichidai Knee. Equal tension of the collateral ligaments and normal mechanical axis were achieved during the primary procedure. The patient was an ardent lover of the game of badminton and had higher activity levels with daily playing. At 8 years postoperatively, she started complaining of mild pain in both knees. The pain gradually increased, and at 11 years postoperatively, she had difficulty walking. Anteroposterior radiographs showed narrowing of the medial joint space, indicating wear of the polyethylene insert. Lateral radiographs showed signs of broken implants in both knees. There were no signs of gross implant loosening or osteolysis. One-stage revision surgery was performed, and the knees were converted to cemented posterior-stabilized TKAs. At revision, the bilateral femoral components were found to be fractured at the junction between the trochlear flange and the medial condyle, anteriorly to the medial peg. The polyethylene insert showed mild wear at the medial middle portion. In the majority of case reports, stress fractures of the femoral component have predominantly affected the medial condyle, following uncemented implantation of fixed-bearing knees. In this case, failure of bone ingrowth in uncemented components, higher body mass index, and a higher athletic activity led to fatigue fracture of the femoral components.

  12. 5- to 9-year Survivorship of Single-radius, Posterior-stabilized TKA

    PubMed Central

    Kinsey, Tracy L.

    2008-01-01

    We studied 1030 consecutive cemented primary TKAs performed by the primary author (OMM) using a single-radius, posterior-stabilized total knee prosthesis with 5 years’ minimum followup to determine whether an accelerated early failure rate was associated with this design. At 5 to 9.5 postoperative years, 32 knees had been revised at an average of 2.4 postoperative years (range, 0.1–8.2 years) because of infection (11), periprosthetic fracture (10), aseptic loosening (eight), stiffness (two), and late hemarthrosis (one). Four had only the tibial insert revised. One-half of all failures occurred within 1.5 years. The cases of aseptic loosening involved the femoral component in one patient, tibial component in five, and both components in two. With only seven patients (0.7%) having unknown outcomes, the overall failure rate was 4.9 per 1000 person-years for the study period. The Kaplan–Meier survivorship using any part of the prosthesis removed or revised for any reason as the end point was 95.8% (95% confidence interval, 93.7%–95.5%), and with aseptic loosening as the end point, it was 98.6% (95% confidence interval, 96.5%–99.4%). The midterm survivorship rates were comparable to those of other posterior-stabilized total condylar designs and are not suggestive of excessive risk of early failure. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196429

  13. In vivo kinematic evaluation and design considerations related to high flexion in total knee arthroplasty.

    PubMed

    Argenson, Jean-Noël A; Scuderi, Giles R; Komistek, Richard D; Scott, W Norman; Kelly, Michael A; Aubaniac, Jean-Manuel

    2005-02-01

    In designing a posterior-stabilized total knee arthroplasty (TKA) it is preferable that when the cam engages the tibial spine the contact point of the cam move down the tibial spine. This provides greater stability in flexion by creating a greater jump distance and reduces the stress on the tibial spine. In order to eliminate edge loading of the femoral component on the posterior tibial articular surface, the posterior femoral condyles need to be extended. This provides an ideal femoral contact with the tibial articular surface during high flexion angles. To reduce extensor mechanism impingement in deep flexion, the anterior margin of the tibial articular component should be recessed. This provides clearance for the patella and patella tendon. An in vivo kinematic analysis that determined three dimensional motions of the femorotibial joint was performed during a deep knee bend using fluoroscopy for 20 subjects having a TKA designed for deep flexion. The average weight-bearing range-of-motion was 125 degrees . On average, TKA subjects experienced 4.9 degrees of normal axial rotation and all subjects experienced at least -4.4 mm of posterior femoral rollback. It is assumed that femorotibial kinematics can play a major role in patellofemoral kinematics. In this study, subjects implanted with a high-flexion TKA design experienced kinematic patterns that were similar to the normal knee. It can be hypothesized that forces acting on the patella were not substantially increased for TKA subjects compared with the normal subjects.

  14. Intraoperative passive kinematics of osteoarthritic knees before and after total knee arthroplasty.

    PubMed

    Siston, Robert A; Giori, Nicholas J; Goodman, Stuart B; Delp, Scott L

    2006-08-01

    Total knee arthroplasty is a successful procedure to treat pain and functional disability due to osteoarthritis. However, precisely how a total knee arthroplasty changes the kinematics of an osteoarthritic knee is unknown. We used a surgical navigation system to measure normal passive kinematics from 7 embalmed cadaver lower extremities and in vivo intraoperative passive kinematics on 17 patients undergoing primary total knee arthroplasty to address two questions: How do the kinematics of knees with advanced osteoarthritis differ from normal knees?; and, Does posterior substituting total knee arthroplasty restore kinematics towards normal? Osteoarthritic knees displayed a decreased screw-home motion and abnormal varus/valgus rotations between 10 degrees and 90 degrees of knee flexion when compared to normal knees. The anterior-posterior motion of the femur in osteoarthritic knees was not different than in normal knees. Following total knee arthroplasty, we found abnormal varus/valgus rotations in early flexion, a reduced screw-home motion when compared to the osteoarthritic knees, and an abnormal anterior translation of the femur during the first 60 degrees of flexion. Posterior substituting total knee arthroplasty does not appear to restore normal passive varus/valgus rotations or the screw motion and introduces an abnormal anterior translation of the femur during intraoperative evaluation.

  15. Fracture Blisters After Primary Total Knee Arthroplasty.

    PubMed

    Halawi, Mohamad J

    2015-08-01

    Fracture blisters are tense vesicles that arise on markedly swollen skin overlying traumatized soft tissue. While this relatively uncommon complication has been well described in the trauma literature, this article reports for the first time a case of fracture blisters after primary total knee arthroplasty. The fracture blisters developed within 36 hours of surgery and were associated with profound swelling and erythema. There was no evidence of vascular injury, compartment syndrome, iatrogenic fracture, or deep venous thrombosis. The patient was treated with leg elevation, loosely applied nonadhesive dressings, and a short course of oral antibiotics after skin desquamation. Blood-filled blisters required longer time to reepithelialization than fluid-filled blisters. Knee stiffness developed because of pain and fear of participation with physical therapy, but the patient was able to resume intensive rehabilitation after resolution of the blisters. Patient factors, surgical factors, and review of the literature are discussed.

  16. Tibia valga morphology in osteoarthritic knees: importance of preoperative full limb radiographs in total knee arthroplasty.

    PubMed

    Alghamdi, Ahmed; Rahmé, Michel; Lavigne, Martin; Massé, Vincent; Vendittoli, Pascal-André

    2014-08-01

    Osteoarthritis of the knee is associated with deformities of the lower limb. Tibia valga is a contributing factor to lower limb alignment in valgus knees. We evaluated 97 valgus knees and 100 varus knees. Long-leg films were taken in weight bearing with both knees in full extension. For valgus knees, 52 knees (53%) had a tibia valga deformity. Average tibia valgus deformation was 5.0°. For varus knees, there was only 1 case of tibia valga (1%), with a deformation of 2.5°. The aim of this study was to assess the prevalence of primary tibia valga in valgus and varus knees and understand how it affects our approach to total knee arthroplasty (TKA). We recommend having full-leg length films when planning for TKA in valgus knees.

  17. Metal Hypersensitivity and Total Knee Arthroplasty.

    PubMed

    Lachiewicz, Paul F; Watters, Tyler Steven; Jacobs, Joshua J

    2016-02-01

    Metal hypersensitivity in patients with a total knee arthroplasty (TKA) is a controversial topic. The diagnosis is difficult, given the lack of robust clinical validation of the utility of cutaneous and in vitro testing. Metal hypersensitivity after TKA is quite rare and should be considered after eliminating other causes of pain and swelling, such as low-grade infection, instability, component loosening or malrotation, referred pain, and chronic regional pain syndrome. Anecdotal observations suggest that two clinical presentations of metal hypersensitivity may occur after TKA: dermatitis or a persistent painful synovitis of the knee. Patients may or may not have a history of intolerance to metal jewelry. Laboratory studies, including erythrocyte sedimentation rate, C-reactive protein level, and knee joint aspiration, are usually negative. Cutaneous and in vitro testing have been reported to be positive, but the sensitivity and specificity of such testing has not been defined. Some reports suggest that, if metal hypersensitivity is suspected and nonsurgical measures have failed, then revision to components fabricated of titanium alloy or zirconium coating can be successful in relieving symptoms. Revision should be considered as a last resort, however, and patients should be informed that no evidence-based medicine is available to guide the management of these conditions, particularly for decisions regarding revision. Given the limitations of current testing methods, the widespread screening of patients for metal allergies before TKA is not warranted.

  18. Metal Hypersensitivity and Total Knee Arthroplasty

    PubMed Central

    Lachiewicz, Paul F.; Watters, Tyler Steven; Jacobs, Joshua J.

    2015-01-01

    Metal hypersensitivity in patients with a total knee arthroplasty (TKA) is a controversial topic. The diagnosis is difficult, given the lack of robust clinical validation of the utility of cutaneous and in vitro testing. Metal hypersensitivity after TKA is quite rare and should be considered after eliminating other causes of pain and swelling, such as low-grade infection, instability, component loosening or malrotation, referred pain, and chronic regional pain syndrome. Anecdotal observations suggest that two clinical presentations of metal hypersensitivity may occur after TKA: dermatitis or a persistent painful synovitis of the knee. Patients may or may not have a history of intolerance to metal jewelry. Laboratory studies, including erythrocyte sedimentation rate, C-reactive protein level, and knee joint aspiration, are usually negative. Cutaneous and in vitro testing have been reported to be positive, but the sensitivity and specificity of such testing has not been defined. Anecdotal reports suggest that, if metal hypersensitivity is suspected and nonsurgical measures have failed, then revision to components fabricated of titanium alloy or zirconium coating can be successful in relieving symptoms. Revision should be considered as a last resort, however, and patients should be informed that no evidence-based medicine is available to guide the management of these conditions, particularly for decisions regarding revision. Given the limitations of current testing methods, the widespread screening of patients for metal allergies before TKA is not warranted. PMID:26752739

  19. Blood management in revision total knee arthroplasty.

    PubMed

    Cushner, Fred D; Foley, Iris; Kessler, Debra; Scuderi, Giles; Scott, W Norman

    2002-11-01

    Much attention has been focused on blood management issues in orthopaedic surgery in recent years, but blood management in patients having revision total knee arthroplasty is not well-established. Hematologic values and transfusion records of 100 patients (52 women, 48 men; mean age, 65 years) who had aseptic revision total knee arthroplasty at the authors' institution were evaluated retrospectively. Two- or three-component revisions comprised 66% of the procedures, and 58 patients participated in a preoperative autologous donation program. The mean preoperative hemoglobin level was 12.1 g/dL in the women and 14.1 g/dL in the men, but the men experienced a greater decrease in hemoglobin level (mean largest decrease, 4.2 g/dL versus 3.1 g/dL), possibly caused by the higher allogeneic transfusion rate in women (19.2%) versus men (4.2%). Patient age did not influence hemoglobin level or transfusion rates. Patients who participated in a preoperative autologous donation program had significantly higher hemoglobin levels before donation (14.4 g/dL versus 13.3 g/dL for patients who did not participate in a program) but comparable hemoglobin levels after predonation (12.9 g/dL). Patients with preoperative hemoglobin levels less than 13 g/dL were significantly more likely to have a transfusion. Symptom-based transfusion strategies and blood management approaches such as epoetin alfa that elevate preoperative hemoglobin level therefore may be beneficial in patients having revision total knee arthroplasty.

  20. Perioperative pain management for total knee arthroplasty.

    PubMed

    Baratta, Jaime L; Gandhi, Kishor; Viscusi, Eugene R

    2014-01-01

    Pain management following total knee arthroplasty (TKA) can be challenging. Inadequate pain management following TKA may inhibit rehabilitation, increase morbidity and mortality, decrease patient satisfaction, and lead to chronic persistent postsurgical pain. Traditionally the mainstay of postoperative pain management was opioids; however, the current recommendations to pain management emphasize a multimodal approach and minimizing opioids whenever possible. With careful planning and a multimodal analgesic approach instituted perioperatively, appropriate pain management following TKA can be achieved. Utilizing an extensive review of the literature, this article discusses the analgesic techniques available for the perioperative management of TKA.

  1. Dynamic splinting for knee flexion contracture following total knee arthroplasty: a case report.

    PubMed

    Finger, Eric; Willis, F Buck

    2008-12-29

    Total Knee Arthroplasty operations are increasing in frequency, and knee flexion contracture is a common pathology, both pre-existing and post-operative. A 61-year-old male presented with knee flexion contracture following a total knee arthroplasty. Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch. After 28 physical therapy sessions, the active range of motion improved from -20 degrees to -12 degrees (stiff knee still lacking full extension), and after eight additional weeks with nightly wear of dynamic splint, the patient regained full knee extension, (active extension improved from -12 degrees to 0 degrees ).

  2. [Indication for total knee arthroplasty: evidence mapping].

    PubMed

    Haase, Elisabeth; Lange, Toni; Lützner, Jörg; Kopkow, Christian; Petzold, Thomas; Günther, Klaus-Peter; Schmitt, Jochen

    2015-01-01

    Joint replacement surgery is one of the most often performed routine procedures for the treatment of knee osteoarthritis in Germany. Currently, there is no consensus on indication criteria for total knee arthroplasty (TKA). The topic indication for TKA was processed using six guiding questions concerning: 1) Common practice in determining the indication for TKA; 2) Inclusion criteria in clinical trials; 3) Treatment goals/goal criteria; 4) Predictors for goal attainment; 5) Economic aspects of determining a TKA indication; 6) Guidelines of the "Working Group of Scientific Medical Societies" (AWMF) in other areas. The evidence mapping was conducted by systematically searching Medline via Ovid, the Cochrane Library, through hand searching national guidelines and selected journals as well as the AWMF guideline portal. 1) In Germany there is currently no consented guideline regarding indications for TKA surgery. 2) Indication criteria for clinical trials are: diagnosed osteoarthritis of the knee, limitations of age and BMI. The most common criteria for exclusion include rheumatoid/inflammatory arthritis, secondary diagnoses and allergies. 3) As yet, no international initiatives have been identified which, by involving all relevant stakeholders, have reached consensus regarding the indication criteria for TKA. 4) A variety of predictors were identified with effects on individual treatment goals acting in different directions. 5) Very few studies were identified concerning economic aspects of determining TKA indication. 6) Comparable AWMF guidelines are currently not available. The findings of this study suggest that specific systematic reviews are needed to explore the following questions: What are the treatment goals of a TKA intervention? For whom are these relevant? And how are they measured? Continuous analyses are recommended in the field of predictors for a positive TKA outcome. Copyright © 2015. Published by Elsevier GmbH.

  3. Total knee arthroplasty in patients with prior ipsilateral hip fusion.

    PubMed

    Romness, D W; Morrey, B F

    1992-03-01

    Sixteen total knee arthroplasties performed between 1977 and 1985 in 13 patients with prior ipsilateral hip arthrodesis or ankylosis were studied to determine the preferred sequence and long-term follow-up of procedures in this clinical setting. Twelve of 16 underwent fusion takedown and total hip arthroplasty prior to knee replacement. The average age at total knee arthroplasty was 52.7 years and the average time from hip fusion to total knee arthroplasty was 36.3 years. Mean follow-up after total knee arthroplasty was 5.5 years (range, 2.3 to 10 years). The Hospital for Special Surgery knee score increased from a mean of 31.8 preoperatively to 72.2 after surgery. In patients who had conversion of the hip fusion prior to knee replacement, knee scores were 28 before and 72.5 after both procedures. Patients who retained their hip fusion had mean scores of 43.5 and 72.1, respectively. None of the knees has been removed and 14 of 16 had no pain at last follow-up. One had mild pain and one had moderate pain attributed to pes anserine bursitis. Although the numbers are small, this experience reveals that takedown of the fusion with total hip arthroplasty is an effective technique before performing the knee replacement. Though successful in some instances, the experience is too small to show that if hip fusion is in good position, knee replacement without fusion takedown is acceptable.

  4. Constrained Implants in Total Knee Replacement.

    PubMed

    Touzopoulos, Panagiotis; Drosos, Georgios I; Ververidis, Athanasios; Kazakos, Konstantinos

    2015-05-01

    Total knee replacement (TKR) is a successful procedure for pain relief and functional restoration in patients with advanced osteoarthritis. The number of TKRs is increasing, and this has led to an increase in revision surgeries. The key to long-term success in both primary and revision TKR is stability, as well as adequate and stable fixation between components and underlying bone. In the vast majority of primary TKRs and in some revision cases, a posterior cruciate retaining or a posterior cruciate substituting device can be used. In some primary cases with severe deformity or ligamentous instability and in most of the revision cases, a more constrained implant is required. The purpose of this paper is to review the literature concerning the use of condylar constrained knee (CCK) and rotating hinge (RH) implants in primary and revision cases focusing on the indications and results. According to this review, although excellent and very good results have been reported, there are limitations of the existing literature concerning the indications for the use of constrained implants, the absence of long-term results, and the limited comparative studies.

  5. Patellar options in revision total knee arthroplasty.

    PubMed

    Rorabeck, Cecil H; Mehin, Ramin; Barrack, Robert L

    2003-11-01

    There are numerous options that need to be considered by the surgeon at the time of revision total knee arthroplasty (TKA). One needs to consider the reason for the revision, the type of patella in place, and the length of time the patella has been in place. The surgeon also needs to consider the status of the patellar bone stock, the stability of the patellar component (well-fixed or loose), and the component type (cemented or metal-backed). Assuming that the existing prosthesis is not metal-backed and has minimal PE wear, then it is preferable to retain a well-fixed all-PE cemented patellar button. However, if the button is metal-backed, then it probably is best to remove the button and replace it with an all-PE domed patellar component. Assuming more than 8 mm of patellar bone stock is remaining, it usually is best to cement an all-PE dome-shaped patella. However, if less than 8 mm is remaining, then that patient can be left with a patelloplasty, recognizing that this individual is going to continue with a high likelihood of anterior knee pain, subluxation, and poor functional results. In that situation, it may be preferable to consider a bone stock augmentation.

  6. Posterior femoral condylar offset after total knee replacement in the risk of knee flexion contracture.

    PubMed

    Onodera, Tomohiro; Majima, Tokifumi; Nishiike, Osamu; Kasahara, Yasuhiko; Takahashi, Daisuke

    2013-08-01

    The aim of this study was to clarify the risk of knee flexion contracture associated with a posterior femoral condylar offset after total knee replacement (TKR). Radiographs from 100 healthy Japanese volunteers were included in the study. We evaluated femoral component posterior offset in various implants and compared them with the normal Japanese knee. Posterior offset of the femoral condyle is up to a maximum of 4.7 times greater than that of the healthy Japanese knee in all knee implants. Excess posterior offset of the femoral condyle in TKR prostheses may cause knee joint flexion contracture due to the relative shortening of the posterior soft tissue.

  7. In vivo knee kinematics in patients with bilateral total knee arthroplasty of 2 designs.

    PubMed

    Okamoto, Nobukazu; Breslauer, Leigh; Hedley, Anthony K; Mizuta, Hiroshi; Banks, Scott A

    2011-09-01

    Many younger and highly active patients desire to achieve high flexion after total knee arthroplasty. This study's purpose was to determine if a contemporary total knee arthroplasty design improved functional knee flexion compared with a traditional total knee arthroplasty in patients living a Western lifestyle. Ten patients with bilateral total knee arthroplasty of 2 types were studied during weight-bearing lunge, kneeling, and stair activities using fluoroscopic imaging. There were no differences in maximum knee flexion during lunging or kneeling. Statistically significant differences in tibial rotation and condylar translation were observed during the 3 activities. Although several joint kinematic differences were observed, no important functional differences were observed in clinically excellent, high performing subjects with bilateral total knee arthroplasty of 2 types.

  8. Blood Management Strategies in Total Knee Arthroplasty

    PubMed Central

    Dan, Michael; Martinez Martos, Sara; Beller, Elaine

    2016-01-01

    A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. PMID:27595070

  9. Total knee arthroplasty closure with barbed sutures.

    PubMed

    Eickmann, Tom; Quane, Erika

    2010-09-01

    Bidirectional barbed sutures, which do not require the tying of knots, have the potential to reduce closure times of total knee arthroplasty (TKA) wounds without adverse effect to wound security, cosmesis, or infection risk. In this retrospective study, data were reviewed from TKAs performed between January 2007 and September 2008. For 88 of these procedures, conventional absorbable sutures were used for interrupted closure of the retinacular and subcutaneous layers and for running closure of the subcuticular layer. For 90 procedures, bidirectional barbed absorbable sutures were used for running closure of the retinacular and subcutaneous layers. Surgeries performed with barbed sutures were significantly faster than those performed with conventional sutures (mean times of 74.3 minutes and 85.8 minutes, respectively, p < 0.001) with no detrimental clinical effects.

  10. Trunk muscle action compensates for reduced quadriceps force during walking after total knee arthroplasty.

    PubMed

    Li, Katherine; Ackland, David C; McClelland, Jodie A; Webster, Kate E; Feller, Julian A; de Steiger, Richard; Pandy, Marcus G

    2013-05-01

    Patients with total knee arthroplasty (TKA) frequently exhibit changes in gait biomechanics post-surgery, including decreased ranges of joint motion and changes in joint loading; however, the actions of the lower-limb muscles in generating joint moments and accelerating the center of mass (COM) during walking are yet to be described. The aim of the present study was to evaluate differences in lower-limb joint kinematics, muscle-generated joint moments, and muscle contributions to COM accelerations in TKA patients and healthy age-matched controls when both groups walk at the same speed. Each TKA patient was fitted with a posterior-stabilized total knee replacement and underwent patellar resurfacing. Three-dimensional gait analysis and subject-specific musculoskeletal modeling were used to determine lower-limb and trunk muscle forces and muscle contributions to COM accelerations during the stance phase of gait. The TKA patients exhibited a 'quadriceps avoidance' gait pattern, with the vasti contributing significantly less to the extension moment developed about the knee during early stance (p=0.036). There was a significant decrease in the contribution of the vasti to the vertical acceleration (support) (p=0.022) and forward deceleration of the COM (braking) (p=0.049) during early stance; however, the TKA patients compensated for this deficiency by leaning their trunks forward. This significantly increased the contribution of the contralateral back extensor muscle (erector spinae) to support (p=0.030), and that of the contralateral back rotators (internal and external obliques) to braking (p=0.004). These findings provide insight into the biomechanical causes of post-operative gait adaptations such as 'quadriceps avoidance' observed in TKA patients.

  11. Difference in knee rotation between total and unicompartmental knee arthroplasties during stair climbing.

    PubMed

    Jung, Myung-Chul; Chung, Jun Young; Son, Kwang-Hyun; Wang, Hui; Hwang, Jaejin; Kim, Jay Joong; Kim, Joon Ho; Min, Byoung-Hyun

    2014-08-01

    The purpose of this study was to compare knee kinematics during stair walking in patients with simultaneous total knee arthroplasty (TKA) and unicompartmental knee arthroplasties (UKA). It was hypothesized that UKA would reproduce more normalized knee kinematics than TKA during stair ascent and descent. Six patients who received UKA in one knee and TKA in the other knee were included in the study. For this study, a four-step staircase was assembled with two force platforms being positioned at the centre of the second and third steps. Each patient was attached with 16 reflective markers at both lower extremities and was asked to perform five roundtrip trials of stair climbing. Kinematic parameters including stance duration, knee angle, vertical ground reaction force (GRF), joint reaction force, and moments were obtained and analysed using a10-camera motion system (VICON, Oxford, UK). Nonparametric Friedman test was used to compare the results between two arthroplasty methods and between stair ascent and descent. Compared to TKA, UKA knees exhibited significantly greater degree of rotation in transverse planes (5.0 degrees during ascent and 6.0 degrees during descent on average), but showed no difference in terms of the other parameters. When comparing the results during stair ascent with descent, overall greater knee angle, vertical GRF, joint reaction force, and moment were observed during stair descent. Both UKA and TKA knees have shown overall similar knee kinematics, though UKA knee may allow greater degree of rotation freedom, which resembles normal knee kinematics during stair walking.

  12. Effect of implant design on knee flexion.

    PubMed

    Dennis, Douglas A; Heekin, R David; Clark, Charles R; Murphy, Jeffrey A; O'Dell, Tammy L; Dwyer, Kimberly A

    2013-03-01

    From March 2006 to August 2008, 93 subjects (186 knees) underwent simultaneous bilateral total knee arthroplasty performed by eight surgeons at North American centers. This randomized study was conducted to determine whether non-weight-bearing passive flexion was superior for knees receiving a posterior stabilized high flexion device compared to a posterior stabilized standard device in the contra-lateral knee. Weight-bearing single leg active flexion was one secondary endpoint. Follow-up compliance was 92.5%. Results show small, but significant superiority in the motion metrics for the high flexion device compared to the standard device 12 months after surgery, especially for a subgroup of patients with pre-operative flexion less than 120° in both knees. Thus, the ideal candidate for the high flexion device may be one with lesser pre-operative flexion.

  13. Reverse Engineering Nature to Design Biomimetic Total Knee Implants.

    PubMed

    Varadarajan, Kartik Mangudi; Zumbrunn, Thomas; Rubash, Harry E; Malchau, Henrik; Muratoglu, Orhun K; Li, Guoan

    2015-10-01

    While contemporary total knee arthroplasty (TKA) provides tremendous clinical benefits, the normal feel and function of the knee is not fully restored. To address this, a novel design process was developed to reverse engineer "biomimetic" articular surfaces that are compatible with normal soft-tissue envelope and kinematics of the knee. The biomimetic articular surface is created by moving the TKA femoral component along in vivo kinematics of normal knees and carving out the tibial articular surface from a rectangular tibial block. Here, we describe the biomimetic design process. In addition, we utilize geometric comparisons and kinematic simulations to show that; (1) tibial articular surfaces of conventional implants are fundamentally incompatible with normal knee motion, and (2) the anatomic geometry of the biomimetic surface contributes directly to restoration of normal knee kinematics. Such biomimetic implants may enable us to achieve the long sought after goal of a "normal" knee post-TKA surgery.

  14. Biceps tendinitis as a cause of acute painful knee after total knee arthroplasty.

    PubMed

    Pandher, Dilbans Singh; Boparai, Randhir Singh; Kapila, Rajesh

    2009-12-01

    The case report highlights an unusual case of posterolateral knee pain after total knee arthroplasty. Tendinitis of the patellar tendon or pes anserinus is a common complication after total knee arthroplasty; however, there is no report in the literature regarding the biceps femoris tendinitis causing acute pain in the early postoperative period. In this case, the biceps tendinitis was diagnosed and treated by ultrasound-guided injection into the tendon sheath.

  15. Arthrofibrosis Associated With Total Knee Arthroplasty.

    PubMed

    Cheuy, Victor A; Foran, Jared R H; Paxton, Roger J; Bade, Michael J; Zeni, Joseph A; Stevens-Lapsley, Jennifer E

    2017-08-01

    Arthrofibrosis is a debilitating postoperative complication of total knee arthroplasty (TKA). It is one of the leading causes of hospital readmission and a predominant reason for TKA failure. The prevalence of arthrofibrosis will increase as the annual incidence of TKA in the United States rises into the millions. In a narrative review of the literature, the etiology, economic burden, treatment strategies, and future research directions of arthrofibrosis after TKA are examined. Characterized by excessive proliferation of scar tissue during an impaired wound healing response, arthrofibrotic stiffness causes functional deficits in activities of daily living. Postoperative, supervised physiotherapy remains the first line of defense against the development of arthrofibrosis. Also, adjuncts to traditional physiotherapy such as splinting and augmented soft tissue mobilization can be beneficial. The effectiveness of rehabilitation on functional outcomes depends on the appropriate timing, intensity, and progression of the program, accounting for the patient's ability and level of pain. Invasive treatments such as manipulation under anesthesia, debridement, and revision arthroplasty improve range of motion, but can be traumatic and costly. Future studies investigating novel treatments, early diagnosis, and potential preoperative screening for risk of arthrofibrosis will help target those patients who will need additional attention and tailored rehabilitation to improve TKA outcomes. Arthrofibrosis is a multi-faceted complication of TKA, and is difficult to treat without an early, tailored, comprehensive rehabilitation program. Understanding the risk factors for its development and the benefits and shortcomings of various interventions are essential to best restore mobility and function. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Patient Satisfaction after Total Knee Arthroplasty

    PubMed Central

    Choi, Young-Joon

    2016-01-01

    Total knee arthroplasty (TKA) is one of the most successful and effective surgical options to reduce pain and restore function for patients with severe osteoarthritis. The purpose of this article was to review and summarize the recent literatures regarding patient satisfaction after TKA and to analyze the various factors associated with patient dissatisfaction after TKA. Patient satisfaction is one of the many patient-reported outcome measures (PROMs). Patient satisfaction can be evaluated from two categories, determinants of satisfaction and components of satisfaction. The former have been described as all of the patient-related factors including age, gender, personality, patient expectations, medical and psychiatric comorbidity, patient's diagnosis leading to TKA and severity of arthropathy. The latter are all of the processes and technical aspects of TKA, ranging from the anesthetic and surgical factors, type of implants and postoperative rehabilitations. The surgeon- and patient-reported outcomes have been shown to be disparate occasionally. Among various factors that contribute to patient satisfaction, some factors can be managed by the surgeon, which should be improved through continuous research. Furthermore, extensive discussion and explanation before surgery will reduce patient dissatisfaction after TKA. PMID:26955608

  17. In vivo determination of total knee arthroplasty kinematics

    SciTech Connect

    Komistek, Richard D; Mahfouz, Mohamed R; Bertin, Kim; Rosenberg, Aaron; Kennedy, William

    2008-01-01

    The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee. In addition, a surprising finding was that, on average, subjects without a PCL still achieved posterior femoral rollback from full extension to maximum knee flexion. The findings in this study revealed that implant design did contribute to the normal kinematics demonstrated by subjects having this asymmetrical PCR total knee arthroplasty.

  18. Evaluation of anterior knee pain in a PS total knee arthroplasty: the role of patella-friendly femoral component and patellar size.

    PubMed

    Atzori, F; Sabatini, L; Deledda, D; Schirò, M; Lo Baido, R; Baido, R L; Massè, A

    2015-04-01

    Total knee arthroplasty gives excellent objective results. Nevertheless, the subjective findings do not match the normal knee perception: Often, it depends on patellar pain onset. In this study, we analyzed clinical and radiological items that can affect resurfaced patellar tracking, and role of a patella-friendly femoral component and patellar size on patellar pain onset. Thirty consecutive patients were implanted using the same-cemented posterior-stabilized TKA associated with patella resurfacing. Fifteen patients were implanted using a classical femoral component, while another 15 patients were implanted using a patella-friendly femoral component. The statistical analysis was set to detect a significant difference (p < 0.05) in clinical and radiological outcomes related to several surgical parameters. Clinical and functional outcomes were recorded using the Knee Society Scoring System (KSS) and patellar pain with the Burnett questionnaire. Mean follow-up was 25 months. KSS results were excellent in both groups. Group 2 (patella-friendly femoral model) reached a higher percentage of 100 points in the clinical and functional KSS, but there was no statistical difference. Also, no statistical differences for Burnett Questionnaire results were recorded. We had one case of patellar clunk syndrome in the standard femoral component group and one poor result in the second group. Postoperative radiographic measurements evidenced no statistical differences in both groups. In group 1 (classical femoral component), better significant result (p < 0.05) war recorded at clinical evaluation according to the Knee Society Scoring System (KSS) in case of wider patellar component resurfaced. The present study reveals no statistically significant difference in the incidence of anterior knee pain between classical and "patella-friendly" femoral components. With the particular type of implant design utilized in this study, when the classical femoral component is used, bigger

  19. Does lateral versus medial exposure influence total knee tibial component final external rotation? A CT based study.

    PubMed

    Passeron, D; Gaudot, F; Boisrenoult, P; Fallet, L; Beaufils, P

    2009-10-01

    A previous study demonstrated that performing a total knee arthroplasty through a lateral approach including anterior tibial tuberosity (ATT) osteotomy (refixed in its original position) presented numerous advantages: correcting the preoperative patella lateral tilt and improving postoperative patella tracking. We hypothesized that these improvements in patella centering were, at least in part, due to an increased external rotation of the tibial component. Postoperative scannographic studies were, therefore, undertaken to measure tibial component rotation and analyze the results according the medial and lateral exposure used. Rotational positioning of the tibial component is influenced by the lateral or medial approach selected at surgery. Forty-five CAT scans, performed according to the protocol criteria of the French Hip and Knee Society (SFHG), were studied 3 months postoperatively: 15 knees operated through the lateral approach and 30 knees operated through a standard medial approach. The total knee utilized in all these cases was a posteriorly stabilized, fixed-bearing, design. We measured first the angle formed between the perpendicular to the transverse axis of the tibial component and the axis joining the ATT to the center of the knee; second we also measured the coronal distance between the center of the component and the anterior tibial tuberosity (ATT). In the group using the medial approach, the lateral position of the ATT was 7 + or - 3mm with a rotation angle of 18 degrees . In the group using the lateral approach these measurements were respectively 1 + or - 4mm and 2 degrees (p<0.0001). External rotation of the tibial component is substantially increased by the lateral approach compared to the medial approach. Better exposure of the lateral tibial plateau is probably responsible of this difference. This increased external rotation improves postoperative patella tracking. Prospective; comparative; non-randomized study; level 3. 2009 Elsevier Masson

  20. Stress fracture of the proximal fibula after total knee arthroplasty.

    PubMed

    Vaish, Abhishek; Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-04-22

    We report a rare case of proximal fibular fatigue fracture developing 14 years after total knee arthroplasty in a known case of rheumatoid arthritis. A valgus deformity of the knee can put abnormal stress on the upper fibula leading to its failure. We believe that, as the fibula acts as an important lateral strut, its disruption due to a fracture led to rapid progress of the valgus deformity of the knee in this patient.

  1. Preoperative malalignment increases risk of failure after total knee arthroplasty.

    PubMed

    Ritter, Merrill A; Davis, Kenneth E; Davis, Peter; Farris, Alex; Malinzak, Robert A; Berend, Michael E; Meding, John B

    2013-01-16

    Implant survival after total knee arthroplasty has historically been dependent on postoperative knee alignment, although failure may occur when alignment is correct. Preoperative knee alignment has not been thoroughly evaluated as a possible risk factor for implant failure after arthroplasty. The purpose of this study was to analyze the effect of preoperative knee alignment on implant survival after total knee arthroplasty. We performed a retrospective review of 5342 total knee arthroplasties performed with use of cemented Anatomic Graduated Component implants from 1983 to 2006. Each knee was independently measured preoperatively and postoperatively for overall coronal alignment. Neutral ranges for preoperative and postoperative alignment were defined by means of Cox proportional hazards regression. The overall failure rate was 1.0% (fifty-four of 5342 prostheses); failure was defined as aseptic loosening of the femoral and/or tibial component. The average preoperative anatomical alignment (and standard deviation) was 0.1° ± 7.7° of varus (range, 25° of varus to 35° of valgus), and the average postoperative anatomical alignment (and standard deviation) was 4.7° ± 2.5° of valgus (range, 12° of varus to 20° of valgus). The failure rate in knees in >8° of varus preoperatively (2.2%; p = 0.0005) or >11° of valgus preoperatively (2.4%; p = 0.0081) was elevated when compared with knees in neutral preoperatively (0.71%). Knees with preoperative deformities corrected to postoperative neutral alignment (2.5° through 7.4°) had a lower failure rate (1.9%) than undercorrected or overcorrected knees (3.0%) (p = 0.0103). Knees with postoperative neutral alignment, regardless of preoperative alignment, had a lower failure rate (0.74%) than knees with postoperative alignment of <2.5° or >7.4° of anatomic valgus (1.7%) (p < 0.0001). Patients with excessive preoperative alignment (>8° of varus or >11° of valgus) have a greater risk of failure (2.3%). Neutral

  2. Revision total knee arthroplasty for failure of primary treatment of periprosthetic knee fractures.

    PubMed

    Abbas, Ammar M I; Morgan-Jones, Rhidian L

    2014-10-01

    Periprosthetic knee fractures and their complications are expected to increase as the numbers of knee arthroplasties continue to rise. We report our experience with revision knee arthroplasty for failure of primary fracture treatment. Five periprosthetic knee non-unions and 1 mal-union in 6 patients, with ages ranging from 65 to 83years (average 74.6years) were treated with revision total knee arthroplasty, and were followed up for 3 to 10years (average 4.5years). Union occurred in 8 to 18weeks (average 12.5weeks). All patients were ambulatory at the latest follow-up, with a range of motion averaging 84.2° (P = 0.03), and an Oxford Knee Score averaging 35 (P = 0.03). We conclude that union complications of periprosthetic knee fractures can be satisfactorily addressed with revision arthroplasty.

  3. Effect of patellar thickness on knee flexion in total knee arthroplasty: a biomechanical and experimental study.

    PubMed

    Abolghasemian, Mansour; Samiezadeh, Saeid; Sternheim, Amir; Bougherara, Habiba; Barnes, C Lowry; Backstein, David J

    2014-01-01

    A biomechanical computer-based model was developed to simulate the influence of patellar thickness on passive knee flexion after arthroplasty. Using the computer model of a single-radius, PCL-sacrificing knee prosthesis, a range of patella-implant composite thicknesses was simulated. The biomechanical model was then replicated using two cadaveric knees. A patellar-thickness range of 15 mm was applied to each of the knees. Knee flexion was found to decrease exponentially with increased patellar thickness in both the biomechanical and experimental studies. Importantly, this flexion loss followed an exponential pattern with higher patellar thicknesses in both studies. In order to avoid adverse biomechanical and functional consequences, it is recommended to restore patellar thickness to that of the native knee during total knee arthroplasty.

  4. Total Knee Arthroplasty in Severe Unstable Knee: Case-Report and Literature Review

    PubMed Central

    Tahmasebi, Mohammad Naghi; Amjad, Gholamreza Ghorbani; Kaseb, Mohammad Hassan; Bashti, Kaveh

    2017-01-01

    Multiplanar or global laxity in arthritic knee is rare, most of this patients have neuromuscular disorder (post poliomyelitis, spinal dystrophy) or history of knee trauma. Ligament insufficiency and severe bone loss is significant in this patient. The estimated prevalence for the concurrence of charcot marie-tooth (CMT) with myasthenia gravis (MG) suggests an extremely rare event. We have presented a 54-year-old female patient with CMT and MG complaining of progressive pain, swelling, and crepitation of the knee joints who had been undergone total knee arthroplasty (TKA) with rotating hinge prosthesis. She had an acute myasthenia crisis soon after operation with prolonged intubation and intensive care unit admission. Radiographies and physical examination revealed bilateral severe unstable arthritic knee joints and left knee posterior dislocation. Short-term postoperative follow-up revealed improved knee function and resolution of all symptoms in the operated side. PMID:28271089

  5. Total Knee Arthroplasty for Severe Flexion Contracture in Rheumatoid Arthritis Knees

    PubMed Central

    Hwang, Youn Soo; Moon, Kyu Pill; Kim, Kyung Taek; Kim, Jin Wan; Park, Won Seok

    2016-01-01

    Flexion contracture deformities, as well as severe varus and valgus deformities of the knee joint, accompany osteoarthritis or rheumatoid arthritis (RA). In particular, severe flexion contracture deformity of the knee joint is often found in patients with RA, which renders them nonambulatory. This report describes a 26-year-old female patient diagnosed with RA 10 years ago. She had chronic joint pain, severe flexion contracture, valgus deformity in both knees, and limited range of motion in both knees and became nonambulatory. She underwent a total knee arthroplasty (TKA) and serial casting and physical therapy to restore stable joint movement and correct knee joint deformity. Her pain was successfully relieved, and she was able to walk after surgery. Here, we report the excellent results of TKA in this RA patient with severe flexion contracture of both knees. PMID:27894181

  6. CLINICAL OUTCOME AFTER INFECTED TOTAL KNEE AND TOTAL HIP ARTHROPLASTY.

    PubMed

    Mittag, Falk; Leichtle, Carmen Ina; Schlumberger, Michael; Leichtle, Ulf Gunther; Wünschel, Markus

    2016-01-01

    Infection after total hip (THA) and knee arthroplasty (TKA) is a serious complication which typically leads to a long lasting and intensive surgical and medicamentous treatment. The aim of this study was to identify factors that influence outcome after revision surgery caused by prosthetic infection. We retrospectively analyzed 64 patients who had revision surgery between 1989 and 2009 due to periprosthetic infection. We examined a total of 69 joints (TKA: 36%, THA: 64%), follow-up 5.1 years (0.5-21 years) after the initial surgical intervention. The mean patient age at time of surgery was 67 years old (43-79 years old). Clinical data and scores including the Western Ontario and McMaster Universities (WOMAC)-Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS) were surveyed. There was no difference in clinical scores regarding treatment between a single and a multiple stage treatment regime. Infections with multiple microorganisms and Enterococcus spp. lead to a significantly higher number of interventions. Using a modified Tsukayama system we classified 24% as type I, 34% type II and 42% type III- infections, with no differences in clinical outcome. Overweight patients had a significantly lower HHS and WOMAC-score. Immunosuppression leads to a worse WOMAC and HSS-Score. An increased number of procedures was associated to a limping gait. Thorough surgical technique leads to good clinical results independent of infection-type and treatment philosophy. Level of Evidence III, Case Control Study.

  7. Tibial Tray Thickness Significantly Increases Medial Tibial Bone Resorption in Cobalt-Chromium Total Knee Arthroplasty Implants.

    PubMed

    Martin, J Ryan; Watts, Chad D; Levy, Daniel L; Miner, Todd M; Springer, Bryan D; Kim, Raymond H

    2017-01-01

    Stress shielding is an uncommon complication associated with primary total knee arthroplasty. Patients are frequently identified radiographically with minimal clinical symptoms. Very few studies have evaluated risk factors for postoperative medial tibial bone loss. We hypothesized that thicker cobalt-chromium tibial trays are associated with increased bone loss. We performed a retrospective review of 100 posterior stabilized, fixed-bearing total knee arthroplasty where 50 patients had a 4-mm-thick tibial tray (thick tray cohort) and 50 patients had a 2.7-mm-thick tibial tray (thin tray cohort). A clinical evaluation and a radiographic assessment of medial tibial bone loss were performed on both cohorts at a minimum of 2 years postoperatively. Mean medial tibial bone loss was significantly higher in the thick tray cohort (1.07 vs 0.16 mm; P = .0001). In addition, there were significantly more patients with medial tibial bone loss in the thick tray group compared with the thin tray group (44% vs 10%, P = .0002). Despite these differences, there were no statistically significant differences in range of motion, knee society score, complications, or revision surgeries performed. A thicker cobalt-chromium tray was associated with significantly more medial tibial bone loss. Despite these radiographic findings, we found no discernable differences in clinical outcomes in our patient cohort. Further study and longer follow-up are needed to understand the effects and clinical significance of medial tibial bone loss. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Does vitamin E-stabilized ultrahigh-molecular-weight polyethylene address concerns of cross-linked polyethylene in total knee arthroplasty?

    PubMed

    Haider, Hani; Weisenburger, Joel N; Kurtz, Steven M; Rimnac, Clare M; Freedman, Jordan; Schroeder, David W; Garvin, Kevin L

    2012-03-01

    Concerns about reduced strength, fatigue resistance, and oxidative stability of highly cross-linked and remelted ultrahigh-molecular-weight polyethylene (UHMWPE) have limited its clinical acceptance for total knee arthroplasty. We hypothesized that a highly cross-linked UHMWPE stabilized with vitamin E would have less oxidation and loss of mechanical properties. We compared the oxidation, in vitro strength, fatigue-crack propagation resistance, and wear of highly cross-linked UHMWPE doped with vitamin E to γ-inert-sterilized direct compression-molded UHMWPE (control). After accelerated aging, the control material showed elevated oxidation, loss of small-punch mechanical properties, and loss of fatigue-crack propagation resistance. In contrast, the vitamin E-stabilized material had minimal changes and exhibited 73% to 86% reduction in wear for both cruciate-retaining and posterior-stabilized total knee arthroplasty designs. Highly cross-linked vitamin E-stabilized UHMWPE performed well in vitro.

  9. Astym® Therapy for the Management of Recalcitrant Knee Joint Stiffness after Total Knee Arthroplasty.

    PubMed

    Bhave, Anil; Corcoran, James; Cherian, Jeffery J; Mont, Michael A

    2016-01-01

    Knee stiffness is a common complication after total knee arthroplasty (TKA). Despite studies published on the surgical management of reduced range of motion (ROM) after TKA, there is limited evidence on the nonoperative management of joint and soft tissue imbalances possibly contributing to reduced knee ROM. This report assesses changes in ROM, pain, function, and patellar tendon length after Astym® joint mobilization use. A 38-year-old male professional skier had a right TKA 3 months before presentation with 2 subsequent manipulations under anesthesia secondary to persistent knee stiffness. He had patellar baja on radiograph, a reduced arc of ROM, reduced patellar mobility and muscular extensibility, and pain to palpation along the patellar tendon. He had 12 visits of physical therapy with the use of Astym®, patellar mobilization, and tibio-femoral mobilizations with movement. The patient also used a customized knee device at home for prolonged knee extension stretching. The patient was treated for 12 visits, along with home use of customized bracing for knee extension. Significant improvements were seen in pain, function, and ROM. He returned to work full-time, ambulated prolonged distances, and negotiated stairs pain-free. He also demonstrated resolution of patellar baja radiographically. Conservative management of recalcitrant knee joint stiffness after primary TKA can be effective in restoring knee mobility and reducing pain and activity limitation. A multimodal approach using Astym® treatment, customized knee bracing, and targeted joint mobilization can be effective in resolving knee joint stiffness.

  10. Periprosthetic Bone Remodelling in Total Knee Arthroplasty

    PubMed Central

    GEORGEANU, Vlad; ATASIEI, Tudor; GRUIONU, Lucian

    2014-01-01

    Introduction: The clinical studies have shown that the displacement of the prosthesis components, especially of the tibial one is higher during the first year, after which it reaches an equilibrum position compatible with a good long term functioning. This displacement takes place due to bone remodelling close to the implant secondary to different loading concentrations over different areas of bone. Material and Method: Our study implies a simulation on a computational model using the finite element analysis. The simulation started taking into account arbitrary points because of non-linear conditions of bone-prosthesis interface and it was iterative.. A hundred consecutive situations corresponding to intermediate bone remodelling phases have been calculated according to given loadings. Bone remodelling was appreciated as a function of time and bone density for each constitutive element of the computational model created by finite element method. For each constitutive element a medium value of stress during the walking cycle was applied. Results: Analyse of proximal epiphysis-prosthesis complex slices showed that bone density increase is maintained all over the stem in the immediately post-operative period. At 10 months, the moment considered to be the end of bone remodelling, areas with increased bone density are fewer and smaller. Meanwhile, their distribution with a concentration toward the internal compartment in the distal metaphysis is preserved. Conclusions: After the total knee arthroplasty the tibial bone suffered a process of remodelling adapted to the new stress conditions. This bone remodelling can influence, sometimes negatively, especially in the cases with tibial component varus malposition, the fixation, respectively the survival of the prosthesis. This process has been demonstrated both by clinical trials and by simulation, using the finite elements method of periprosthetic bone remodelling. PMID:25553127

  11. Does the joint line matter in revision total knee replacement?

    PubMed

    Porteous, A J; Hassaballa, M A; Newman, J H

    2008-07-01

    We identified 148 patients who had undergone a revision total knee replacement using a single implant system between 1990 and 2000. Of these 18 patients had died, six had developed a peri-prosthetic fracture and ten had incomplete records or radiographs. This left 114 with prospectively-collected radiographs and Bristol knee scores available for study. The height of the joint line before and after revision total knee replacement was measured and classified as either restored to within 5 mm of the pre-operative height or elevated if it was positioned more than 5 mm above the pre-operative height. The joint line was elevated in 41 knees (36%) and restored in 73 (64%). Revision surgery significantly improved the mean Bristol knee score from 41.1 (SD 15.9) pre-operatively to 80.5 (SD 15) post-operatively (p < 0.001). At one year post-operatively both the total Bristol knee score and its functional component were significantly better in the restored group than in the elevated group (p < 0.01). Overall, revision from a unicondylar knee replacement required less use of bone graft, fewer component augments, restored the joint line more often and gave a significantly better total Bristol knee score (p < 0.02) and functional score (p < 0.01) than revision from total knee replacement. Our findings show that restoration of the joint line at revision total knee replacement gives a significantly better result than leaving it unrestored by more than 5 mm. We recommend the greater use of distal femoral augments to help to achieve this goal.

  12. Improvements in knee biomechanics during walking are associated with increased physical activity after total knee arthroplasty.

    PubMed

    Arnold, John B; Mackintosh, Shylie; Olds, Timothy S; Jones, Sara; Thewlis, Dominic

    2015-12-01

    Total knee arthroplasty (TKA) in people with knee osteoarthritis increases knee-specific and general physical function, but it has not been established if there is a relationship between changes in these elements of functional ability. This study investigated changes and relationships between knee biomechanics during walking, physical activity, and use of time after TKA. Fifteen people awaiting TKA underwent 3D gait analysis before and six months after surgery. Physical activity and use of time were determined in free-living conditions from a high resolution 24-h activity recall. After surgery, participants displayed significant improvements in sagittal plane knee biomechanics and improved their physical activity profiles, standing for 105 more minutes (p=0.001) and performing 64 min more inside chores on average per day (p=0.008). Changes in sagittal plane knee range of motion (ROM) and peak knee flexion positively correlated with changes in total daily energy expenditure, time spent undertaking moderate to vigorous physical activity, inside chores and passive transport (r=0.52-0.66, p=0.005-0.047). Restoration of knee function occurs in parallel and is associated with improvements in physical activity and use of time after TKA. Increased functional knee ROM is required to support improvements in total and context specific physical activity. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  13. Total Knee Post-Cam Design Variations and Their Effects on Kinematics and Wear Patterns.

    PubMed

    Mihalko, William M; Lowell, Julie; Higgs, Genymphas; Kurtz, Steven

    2016-05-01

    Post-cam designs for posterior-stabilized total knee arthroplasy (TKA) implants have evolved over the last 2 decades. These designs have evolved from symmetric post and cam to asymmetric designs that include anterior post interactions to affect a kinematic change in full extension. All design changes have consequences on the resulting femorotibial contact kinematics and, depending on the amount of constraint built into the design, these changes may have significant consequences on the wear patterns on the tibial polyethylene insert. The current authors review the kinematic effects of symmetric and asymmetric cam designs and use a retrieval database of TKA implants obtained at the time of necropsy to show how different design variables may affect polyethylene wear patterns after 10 or more years of implantation or from modeled wear in simulators. More modern designs seem to have moved the post posteriorly and sloped the anterior aspect to avoid impingement of the anterior post in terminal flexion on the inferior aspect of the patella button. [Orthopedics. 2016; 39(3):S45-S49.]. Copyright 2016, SLACK Incorporated.

  14. Biomechanical effects of total knee arthroplasty component malrotation: a computational simulation.

    PubMed

    Thompson, Julie A; Hast, Michael W; Granger, Jeffrey F; Piazza, Stephen J; Siston, Robert A

    2011-07-01

    Modern total knee arthroplasty (TKA) is an effective procedure to treat pain and disability due to osteoarthritis, but some patients experience quadriceps weakness after surgery and have difficulty performing important activities of daily living. The success of TKA depends on many factors, but malalignment of the prosthetic components is a major cause of postoperative complications. Significant variability is associated with femoral and tibial component rotational alignment, but how this variability translates into functional outcome remains unknown. We used a forward-dynamic computer model of a simulated squatting motion to perform a parametric study of the effects of variations in component rotational alignment in TKA. A cruciate-retaining and posterior-stabilized version of the same TKA implant were compared. We found that femoral rotation had a greater effect on quadriceps forces, collateral ligament forces, and varus/valgus kinematics, while tibial rotation had a greater effect on anteroposterior translations. Our findings support the tendency for orthopedic surgeons to bias the femoral component into external rotation and avoid malrotation of the tibial component.

  15. Revision of minimal resection resurfacing unicondylar knee arthroplasty to total knee arthroplasty: results compared with primary total knee arthroplasty.

    PubMed

    O'Donnell, Turlough M P; Abouazza, Omar; Neil, Michael J

    2013-01-01

    We compared a cohort of patients undergoing revision of a minimal resection resurfacing unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with a cohort of patients undergoing primary TKA. Both cohorts were matched in terms of age, sex, and body mass index. We collected data on preoperative and postoperative range of motion, International Knee Society scores, and radiologic data. We also collected data on the modes of failure of the primary UKA. There were 55 patients in each cohort. The average time the UKA was in place was 48.3 months. The average follow-up period from the time of revision was 39.2 months. The most common reason for revision was subsidence of the tibial base plate (58%). Forty percent of patients required particulate bone grafting for contained defects. Two patients required metal augments, and 1 required stems. There was no significant difference between the 2 groups in terms of range of motion, functional outcome, or radiologic outcomes. Revision of these types of implants to TKA is associated with similar results to primary TKA and is superior to revision of other forms of UKA.

  16. CLINICAL OUTCOME AFTER INFECTED TOTAL KNEE AND TOTAL HIP ARTHROPLASTY

    PubMed Central

    Mittag, Falk; Leichtle, Carmen Ina; Schlumberger, Michael; Leichtle, Ulf Gunther; Wünschel, Markus

    2016-01-01

    ABSTRACT Objective: Infection after total hip (THA) and knee arthroplasty (TKA) is a serious complication which typically leads to a long lasting and intensive surgical and medicamentous treatment. The aim of this study was to identify factors that influence outcome after revision surgery caused by prosthetic infection. Methods: We retrospectively analyzed 64 patients who had revision surgery between 1989 and 2009 due to periprosthetic infection. We examined a total of 69 joints (TKA: 36%, THA: 64%), follow-up 5.1 years (0.5-21 years) after the initial surgical intervention. The mean patient age at time of surgery was 67 years old (43-79 years old). Clinical data and scores including the Western Ontario and McMaster Universities (WOMAC)-Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS) were surveyed. Results: There was no difference in clinical scores regarding treatment between a single and a multiple stage treatment regime. Infections with multiple microorganisms and Enterococcus spp. lead to a significantly higher number of interventions. Using a modified Tsukayama system we classified 24% as type I, 34% type II and 42% type III- infections, with no differences in clinical outcome. Overweight patients had a significantly lower HHS and WOMAC-score. Immunosuppression leads to a worse WOMAC and HSS-Score. An increased number of procedures was associated to a limping gait. Conclusion: Thorough surgical technique leads to good clinical results independent of infection-type and treatment philosophy. Level of Evidence III, Case Control Study. PMID:26997914

  17. Does patella position influence ligament balancing in total knee arthroplasty?

    PubMed

    Yoon, Jung-Ro; Oh, Kwang-Jun; Wang, Joon Ho; Yang, Jae-Hyuk

    2015-07-01

    In vivo comparative gap measurements were performed in three different patella positions (reduced, subluxated and everted) using offset-type-force-controlled-spreader-system. Prospectively, 50 knees were operated by total knee arthroplasty using a navigation-assisted gap-balancing technique. The offset-type-force-controlled-spreader-system was used for gap measurements. This commercially available instrument allows controllable tension in patella-reduced position. The mediolateral gaps of knee extension (0°) and flexion (90°) angle were recorded in three different patella positions; reduced, subluxated and everted. Any gap differences of more than 3 mm were considered as a meaningful difference. Correlation between the difference with the demographic data, preoperative radiologic alignment and intraoperative data was analysed. For statistical analysis, ANOVA and Pearson's correlation test were used. The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Statistically significant difference was observed for the lateral gap of patella eversion compared to gap of patella reduction in knee flexion position (p < 0.05). There were notable cases of variability in knee flexion position. Significant portion of 12 (24 %) knees of patella subluxation and 33 (66 %) knees of patella evertion demonstrated either increased or decreased gaps in knee flexion position compared to the gaps of patella reduction position. The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Therefore, the intraoperative patellar positioning has influence on the measurement of the joint gap. Keeping the patella in reduced position is important during gap balancing. I.

  18. Total knee arthroplasty in a rheumatoid arthritic knee with large geode: a case report.

    PubMed

    Shih, H N; Hsu, K Y; Tan, C F; Hsueh, S; Hsu, R W

    1997-09-01

    Geodes (subchondral cysts) are a well-known manifestation of rheumatoid arthritis. Solitary cysts or cysts larger than 2 cm are not generally found in the knee joint of patients with rheumatoid arthritis (RA). We report a case of RA involving both knees with a giant geode over the right proximal tibia. Surgical treatment was performed including synovectomy, cyst enucleation and packing of autogenous bone chips followed by primary total knee arthroplasty. The postsurgical result was excellent with the knee restored to good function and complete healing of the cystic lesion.

  19. Human knee joint anatomy revisited: morphometry in the light of sex-specific total knee arthroplasty.

    PubMed

    Dargel, Jens; Michael, Joern W P; Feiser, Janna; Ivo, Roland; Koebke, Juergen

    2011-04-01

    This study investigates differences in the anatomy of male and female knee joints to contribute to the current debate on sex-specific total knee implants. Morphometric data were obtained from 60 human cadaver knees, and sex differences were calculated. All data were corrected for height, and male and female specimens presenting with an identical length of the femur were analyzed as matched pairs. Male linear knee joint dimensions were significantly larger when compared with females. When corrected for differences in height, medial-lateral dimensions of male knees were significantly larger than female; however, matched paired analysis did not prove these differences to be consistent. Although implant design should focus interindividual variations in knee joint anatomy, our data do not support the concept of a female-specific implant design.

  20. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?

    PubMed

    Miner, Andrew L; Lingard, Elizabeth A; Wright, Elizabeth A; Sledge, Clement B; Katz, Jeffrey N

    2003-04-01

    We investigated the relationship of knee range of motion (ROM) and function in a prospective, observational study of primary total knee arthroplasty (TKA). Preoperative and 12-month data were collected on 684 patients, including knee ROM, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function questionnaire scores, patient satisfaction, and perceived improvement in quality of life (QOL). Only modest correlations were found between knee ROM and WOMAC function (r<0.34). At 12 months we found significantly worse WOMAC function scores for patients with <95 degrees flexion compared with patients with > or =95 degrees (mean, 61.9 vs 75.0; P<.0001). In linear regression models, WOMAC pain and function scores at 12 months were both correlates of patient satisfaction and perceived improvement in QOL (standardized beta>3.5; P<.0001), but knee flexion was not. For assessment of these outcomes, WOMAC function appears to be more important than knee flexion.

  1. Computer-Navigated Total Knee Arthroplasty Utilization.

    PubMed

    Bala, Abiram; Penrose, Colin Thomas; Seyler, Thorsten Markus; Mather, Richard Chad; Wellman, Samuel Secord; Bolognesi, Michael Paul

    2016-07-01

    Computer-navigated total knee arthroplasty (CN-TKA) has been used to improve component alignment, though the evidence is currently mixed on whether there are clinically significant differences in long-term outcomes. Given the established increased costs and operative time, we hypothesized that the utilization rate of CN-TKA would be decreasing relative to standard TKA in the Medicare population given the current health care economic environment. We queried 1,914,514 primary TKAs performed in the entire Medicare database from 2005 to 2012. Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify and separate CN-TKAs. Utilization of TKA was compared by year, gender, and region. Average change in cases per year and compound annual growth rate (CAGR) were used to evaluate trends in utilization of the procedure. We identified 30,773 CN-TKAs performed over this time period. There was an increase in utilization of CN-TKA per year from 984 to 5,352 (average = 572/year, R (2) = 0.85, CAGR = 23.58%) from 2005 to 2012. In contrast, there was a slight decrease in overall TKA utilization from 264,345 to 230,654 (average = 4297/year, R (2) = 0.74, CAGR = - 1.69%). When comparing proportion of CN-TKA to all TKAs, there was an increase from 0.37 to 2.32% (average 0.26%/year, R (2) = 0.88, CAGR = 25.70%). CN-TKA growth in males and females was comparable at 24.42 and 23.11%, respectively. The South region had the highest growth rate at 28.76%, whereas the Midwest had the lowest growth rate at 15.51%. The Midwest was the only region that peaked (2008) with a slow decline in utilization until 2012. Despite increased costs with unclear clinical benefit, CN-TKA is increasing in utilization among Medicare patients. Reasons could include patient preference, advertising, proper of coding the procedure, and increased publicly available information about

  2. Spinal cord stimulation for the treatment of chronic knee pain following total knee replacement.

    PubMed

    Lowry, Angus M; Simopoulos, Thomas T

    2010-01-01

    Chronic pain after total knee replacement is common but remains poorly understood. Management options for patients with this condition are traditionally limited to pharmacological approaches. This article presents a case of using spinal cord stimulation in the management of chronic knee pain following total knee replacement. Case report. Pain management clinic A 68-year old patient presented with a 3-year history of persistent knee pain following total knee replacement. After failing to respond to medications and nerve blocks, a trial of spinal cord stimulation and subsequent permanent implantation of a spinal cord stimulator (SCS) were performed. The Oxford knee score (OKS) was used to assess her pain and functionality before and after SCS implantation. The patient reported improvement in her pain and function. Her baseline OKS was 39 and fell to 26 one year post implantation of an SCS representing a reduction of pain and disability from severe to moderate. A case report. Spinal cord stimulation might be an option in the management of refractory knee pain following total knee replacement.

  3. Radiation Dose Reduction in Digital Plain Radiography of the Knee after Total Knee Arthroplasty.

    PubMed

    Kloth, J K; Tanner, M; Stiller, W; Burkholder, I; Kauczor, H U; Ewerbeck, V; Weber, M A

    2015-08-01

    To reduce radiation exposure of frequently performed radiographs of the knee in follow-up of total-knee arthroplasty ensuring accurate assessment by using objective quality control criteria. In this prospective randomized study 278 radiographs of the knee in follow-up of total-knee arthroplasty were performed with standard and 37% reduced radiation dose. The evaluation of the plain-radiographs was conducted using the following criteria: bone-implant interface, implant-surface character, implant-implant discrimination and periarticular heterotopic ossification. Two radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score ≥ 3 or more than 2 criteria with ≥ 2 points, the radiograph was score das "not assessable". The study was designed as non-inferiority-trial. 100% of examined radiographs were scored as assessable, hence no statistical inferiority between the examinations with standard and reduced dose could be observed. Singular assessment of the defined criteria was likewise dose-independent. Plain-radiography of the knee following total-knee arthroplasty can be performed with 63% of standard dose without loss of diagnostic validity. Due to the non-inferiority of digital radiographs of the knee joint after total-knee arthroplasty done with 37% reduced image receiver dose we recommend the tested speed class of SC 800 as a new reference value for digital radiographs with this indication. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Oxidized Zirconium Bearing Surfaces in Total Knee Arthroplasty: Lessons Learned.

    PubMed

    Schüttler, Karl Friedrich; Efe, Turgay; Heyse, Thomas J; Haas, Steven B

    2015-10-01

    Polyethylene wear in total knee arthroplasty is a still unsolved problem resulting in osteolysis and long-term failure of knee joint replacement. To address the problem of polyethylene wear, research aimed for an optimal implant design and for an optimal combination of bearing surfaces. Oxidized zirconium was introduced to minimize surface wear and thus potentially increase long-term implant survival. This review comprises the current literature related to in vitro and in vivo studies evaluating performance of oxidized zirconium total knee arthroplasty and results from retrieval analyses.

  5. Development of a knee joint motion simulator to evaluate deep knee flexion of artificial knee joints.

    PubMed

    Takano, Y; Ueno, M; Kiguchi, K; Ito, J; Mawatari, M; Hotokebuchi, T

    2008-01-01

    A purpose of this study is to examine the effect that quadriceps femoris force gives to rotation angle and joint reaction force of total knee prosthesis during deep knee flexion such as a unique sitting style called 'seiza' in Japanese. For the evaluation, we developed the knee motion simulator which could bend to 180 degrees continually simulating the passive flexion performed by clinicians. A total knee prosthesis, which is a specially-devised posterior stabilized type and capable of flexion up to 180 degrees, was inserted into bone model. And this prosthesis pulled by three kinds of quadriceps femoris forces to perform parameter study. The results obtained in this study were showed the same tendency with those in the past cadaveric experiment. It is suggested that the rotation angle and joint reaction force of total knee prosthesis are affected by shape of prosthesis, a vector of quadriceps femoris force, and bony aliments during deep knee flexion.

  6. Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty.

    PubMed

    Protzman, Nicole M; Gyi, Jennifer; Malhotra, Amit D; Kooch, Jason E

    2014-04-01

    Recently, investigators began using radiofrequency to manage knee osteoarthritis pain in patients at high risk who cannot undergo surgical intervention. To our knowledge, no study has investigated the use of radiofrequency ablation of the genicular nerves to alleviate chronic knee pain after total knee replacement. A single case is presented here in which genicular nerve ablation successfully improved pain and restored function. We believe that these preliminary results could be used in the development of future prospective cohort studies and randomized controlled trials that focus on the use of radiofrequency ablation to treat persistent knee pain after total knee replacement. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  7. Effect of rotational alignment on outcome of total knee arthroplasty

    PubMed Central

    Breugem, Stefan J; van den Bekerom, Michel PJ; Tuinebreijer, Willem E; van Geenen, Rutger C I

    2015-01-01

    Background and purpose Poor outcomes have been linked to errors in rotational alignment of total knee arthroplasty components. The aims of this study were to determine the correlation between rotational alignment and outcome, to review the success of revision for malrotated total knee arthroplasty, and to determine whether evidence-based guidelines for malrotated total knee arthroplasty can be proposed. Patients and methods We conducted a systematic review including all studies reporting on both rotational alignment and functional outcome. Comparable studies were used in a correlation analysis and results of revision were analyzed separately. Results 846 studies were identified, 25 of which met the inclusion criteria. From this selection, 11 studies could be included in the correlation analysis. A medium positive correlation (ρ = 0.44, 95% CI: 0.27–0.59) and a large positive correlation (ρ = 0.68, 95% CI: 0.64–0.73) were found between external rotation of the tibial component and the femoral component, respectively, and the Knee Society score. Revision for malrotation gave positive results in all 6 studies in this field. Interpretation Medium and large positive correlations were found between tibial and femoral component rotational alignment on the one hand and better functional outcome on the other. Revision of malrotated total knee arthroplasty may be successful. However, a clear cutoff point for revision for malrotated total knee arthroplasty components could not be identified. PMID:25708694

  8. Differential Effect of Total Knee Arthroplasty on Valgus and Varus Knee Biomechanics During Gait.

    PubMed

    Rodriguez, Jose A; Bas, Marcel A; Orishimo, Karl F; Robinson, Jonathan; Nicholas, Stephen J

    2016-09-01

    Total knee arthroplasty and its relation to gait abduction or adduction moment has not been fully described. Gait analysis was performed on 25 patients (27 knees) preoperatively, 6 months and 1 year after total knee arthroplasty. Reflective markers were placed on the lower extremity, and motion data were collected at 60 Hz using 6 infrared cameras. Ground reaction forces were recorded at 960 Hz with a force plate. Stance phase was divided into braking and propulsive phases. Coronal knee angles and moments were calculated. Repeated-measures analysis of variance was used to compare frontal plane knee impulse over time and between the braking and propulsive phases of stance. In varus knees, static alignment was corrected from 2.2° varus to 3.3° valgus and in valgus knees from 15.2° valgus to 2.7° valgus (P < .010). Braking phase adduction impulse decreased from 0.145 to 0.111 at 6 months but increased to 0.126 Nm/kg s (P > .05) at 1 year. Propulsive phase impulse changed from 0.129 to 0.085 and persisted at 1 year. Impulse changed from 0.01 (abduction) to 0.11 Nm/kg s (adduction) at 6 months and persisted (P = .01). Restoration of anatomic alignment and soft tissue balancing changes the lateral loading conditions of valgus knees. Both cases, between 6 months and 1 year, increased peak moment. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Accuracy of knee range of motion assessment after total knee arthroplasty.

    PubMed

    Lavernia, Carlos; D'Apuzzo, Michele; Rossi, Mark D; Lee, David

    2008-09-01

    Measurement of knee joint range of motion (ROM) is important to assess after total knee arthroplasty. Our objective was to determine level of agreement and accuracy between observers with different knowledge on total ROM after total knee arthroplasty. Forty-one patients underwent x-ray of active and passive knee ROM (gold standard). Five different raters evaluated observed and measured ROM: orthopedic surgeon, clinical fellow, physician assistant, research fellow, and a physical therapist. A 1-way analysis of variance was used to determine differences in ROM between raters over both conditions. Limit of agreement for each rater for both active and passive total ROM under both conditions was calculated. Analysis of variance indicated a difference between raters for all conditions (range, P = .004 to P < or =.0001). The trend for all raters was to overestimate ROM at higher ranges. Assessment of ROM through direct observation without a goniometer provides inaccurate findings.

  10. Detection of total knee prostheses at airport security checkpoints.

    PubMed

    Naziri, Qais; Johnson, Aaron J; Hooper, Hasan A; Sana, Said H; Mont, Michael A

    2012-06-01

    Airport security screening measures have changed substantially during the past decade, but few reports have examined how this affects patients who have undergone knee arthroplasties. The purpose of this study was to characterize the efficacy of airport metal detection of total knee prostheses, the delays faced, any inconvenience this may have caused, and the role of implant identification cards. Ninety-seven total knee arthroplasty recipients reported passing through an airport metal detector, with 70 triggering the alarm a mean of 3 times (range, 1-36). The presence of a single-knee prosthesis triggered airport security alarms more than 83% of the time and increased patient inconvenience. Patients should be informed about this chance and be prepared to present documentation of their prosthesis.

  11. Closed Suction Drainage Is Not Necessary for Total Knee Arthroplasty: A Prospective Study on Simultaneous Bilateral Surgeries of a Mean Follow-Up of 5.5 Years.

    PubMed

    Watanabe, Toshifumi; Muneta, Takeshi; Yagishita, Kazuyoshi; Hara, Kenji; Koga, Hideyuki; Sekiya, Ichiro

    2016-03-01

    Closed suction drainage has been widely used for orthopedic surgeries including total knee arthroplasty (TKA) to prevent fluid collections at the operative site such as blood around the wound. However, it is still controversial whether suction drainage is necessary for TKA. The present study aimed to clarify the need for suction drainage by assessing short-term and long-term clinical outcomes of simultaneous bilateral TKA. Our subjects were 63 patients (126 knees) who underwent simultaneous bilateral TKA using a cemented posterior stabilized prosthesis, classified into 3 groups: 20 patients with a closed suction drain on both sides (bilateral group), 22 patients with a closed suction drain on one side and no drain on the other side (unilateral group), and 21 patients with no drain (no-drainage group). Short- and long-term clinical outcomes were evaluated. Mean hemoglobin drop on the day after surgery was significantly greater in the bilateral group (2.2 g/dL, P = .038) and unilateral group (2.2 g/dL, P = .045) compared with the no-drainage group (1.5 g/dL). The incidence of short-term and long-term complications was not significantly different between knees with drainage and those without drainage. In side-to-side comparisons, no significant differences were found in knee extension, flexion, or circumference in the unilateral group. In group comparisons, we found no significant differences in clinical outcomes between the bilateral group and no-drainage group, either. These findings suggest closed suction drainage is not necessary after TKA with cemented posterior-stabilized prostheses. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Evaluation of total knee mechanics using a crouching simulator with a synthetic knee substitute.

    PubMed

    Lowry, Michael; Rosenbaum, Heather; Walker, Peter S

    2016-05-01

    Mechanical evaluation of total knees is frequently required for aspects such as wear, strength, kinematics, contact areas, and force transmission. In order to carry out such tests, we developed a crouching simulator, based on the Oxford-type machine, with novel features including a synthetic knee including ligaments. The instrumentation and data processing methods enabled the determination of contact area locations and interface forces and moments, for a full flexion-extension cycle. To demonstrate the use of the simulator, we carried out a comparison of two different total knee designs, cruciate retaining and substituting. The first part of the study describes the simulator design and the methodology for testing the knees without requiring cadaveric knee specimens. The degrees of freedom of the anatomic hip and ankle joints were reproduced. Flexion-extension was obtained by changing quadriceps length, while variable hamstring forces were applied using springs. The knee joint was represented by three-dimensional printed blocks on to which the total knee components were fixed. Pretensioned elastomeric bands of realistic stiffnesses passed through holes in the block at anatomical locations to represent ligaments. Motion capture of the knees during flexion, together with laser scanning and computer modeling, was used to reconstruct contact areas on the bearing surfaces. A method was also developed for measuring tibial component interface forces and moments as a comparative assessment of fixation. The method involved interposing Tekscan pads at locations on the interface. Overall, the crouching machine and the methodology could be used for many different mechanical measurements of total knee designs, adapted especially for comparative or parametric studies.

  13. A national questionnaire survey on knee manipulation following total knee arthroplasty.

    PubMed

    Vun, Shen Hwa; Shields, David William; Sen, Aroop; Shareef, Sajan; Sinha, Satyajit; Campbell, Alexander Craig

    2015-12-01

    Adequate range of knee motion is critical for successful total knee arthroplasty. While aggressive physical therapy is an important component, manipulation may be a necessary supplement. There seems to be a lack of consensus with variable practices existing in managing stiff postoperative knees following arthroplasty. Hence we aim to determine the current practice and trend among knee surgeons throughout the United Kingdom. Postal questionnaires were sent out to 100 knee surgeons registered with British Association of Knee Surgeons, ensuring that the whole of United Kingdom was well represented. The questions included whether the surgeon used Manipulation Under Anaesthaesia (MUA) as an option for stiff postoperative knees; timing of MUA; use of Continuous Passive Motion (CPM) post-manipulation. We received 82 responses. 46% of respondents performed MUA routinely, 43% sometimes, and 11 never. Majority (71.23%) performed MUA within 3 months of the index procedure. 68% routinely used CPM post-manipulation while 7% of the respondents applied splints or serial cast post MUA. 41% of the surgeons routinely used Patient Controlled Analgaesia ± Regional blocks. Majority (55%) never performed open/arthroscopic debridement of fibrous tissue for adhesiolysis. Knee manipulation requires an additional anaesthetic and may result in complications such as: supracondylar femur fractures, wound dehiscence, patellar tendon avulsions, haemarthrosis, and heterotopic ossification. Moreover studies have shown that manipulation while being an important therapeutic adjunct does not increase the ultimate flexion achieved. Manipulation should be reserved for the patient with difficult and painful flexion in the early postoperative period.

  14. Total Arthroplasty in Ankylosed Knees: A Case Series

    PubMed Central

    Camanho, Gilberto Luiz

    2009-01-01

    OBJECTIVE To present nine patients with ankylosis in their knees that were submitted to a total arthroplasty to lessen their pain and improve their functional limitation. For these patients, arthrodesis remained a possibility in the event of arthroplasty failure. INTRODUCTION Ankylosis of the knee is a severe functional limitation that becomes worse when pain is present. Arthrodesis of the knee is a classical indication for such patients, since it resolves the pain; however, the severe functional limitation remains. METHODS In the present study, we evaluated the clinical course of nine patients who underwent total arthroplasty of the knee, and were followed up for at least five years. RESULTS The results demonstrate that all of the patients experienced a significant reduction in pain and some improvement in the degree of knee flexion and extension. CONCLUSION Based on the latest follow-up, there has been no need to perform arthrodesis for any of our patients, showing that a total arthroplasty could be a option for treatment in knee ankylosis. PMID:19330242

  15. The "banana peel" exposure method in revision total knee arthroplasty.

    PubMed

    Lahav, Amit; Hofmann, Aaron A

    2007-10-01

    We present an exposure technique, the "banana peel," that has been used exclusively for revision total knee arthroplasty (TKA) for more than 20 years. We retrospectively reviewed use of this technique in 102 consecutive patients (mean age, 62 years; range, 41-92 years) who underwent tibial-femoral stemmed revision TKA. There were 5 deaths, leaving 97 patients (98 knees) for the study. The technique involves peeling the patella tendon as a sleeve off the tibia, leaving the extensor mechanism intact with a lateral hinge of soft tissue. A quadriceps "snip" is also done proximally. Patients with a minimum follow-up of 24 months were included. Telephone interviews and chart reviews were conducted, and Knee Society scores were obtained. Mean follow-up was 39 months (range, 24-56 months). No patient reported disruption of the extensor mechanism or decreased ability to extend the operative knee. Mean Knee Society score was 176 (range, 95-200). Mean postoperative motion was 106 degrees. No patient reported pain over the tibial tubercle. The banana-peel technique for exposing the knee during revision TKA is a safe method that can be used along with a proximal quadriceps snip and does not violate the extensor mechanism, maintaining continuity of the knee extensors.

  16. Management and outcome of periprosthetic fractures after total knee arthroplasty.

    PubMed

    Platzer, Patrick; Schuster, Rupert; Aldrian, Silke; Prosquill, Stella; Krumboeck, Anna; Zehetgruber, Isabella; Kovar, Florian; Schwameis, Katrin; Vécsei, Vilmos

    2010-06-01

    The incidence of periprosthetic fractures after total knee arthroplasty is continuously rising because of an increasing number of knee joint replacements and an enhanced survivorship of the elderly population after knee arthroplasty. The purpose of this study was to analyze the practicability and effectiveness of the various treatment methods for management of periprosthetic fractures after total knee arthroplasty, and to determine the clinical and radiographic long-term results of patients following surgical and nonoperative treatment of these injuries. We reviewed the clinical and radiographic records of 41 patients (31 women and 10 men; average age, 78.6 years) with periprosthetic fractures after total knee arthroplasty between 1992 and 2008. Thirty-seven patients showed a periprosthetic fracture of the distal femur, and four patients had a periprosthetic proximal tibial fracture. Thirty-six patients underwent operative stabilization by plate fixation (n = 18), intramedullary nailing (n = 15) or revision arthroplasty (n = 3), and five patients were treated nonoperatively by long-term cast immobilization. Twenty-eight patients returned to their preinjury activity level and were satisfied with their clinical outcome. In 10 patients, we saw a relevant decrease of knee function and severe limitations in gait and activities of daily living. Three patients died related to surgery. Successful fracture healing within 6 months was achieved in 33 (87%) of 38 patients. Failures of reduction or fixation occurred in 8 (21%) of 38 patients. Reoperation due to technical failures was necessary in three patients. Compared with current data in literature, we had a satisfactory outcome in following individualized treatment of periprosthetic fractures after knee joint replacement. Referring to the wide field of treatment options and high rates of complications, periprosthetic femoral fractures around the knee commonly constitute a challenging problem for the treating surgeons and

  17. "Forgotten knee" after total knee replacement: A pragmatic study from a single-centre cohort.

    PubMed

    Eymard, Florent; Charles-Nelson, Anais; Katsahian, Sandrine; Chevalier, Xavier; Bercovy, Michel

    2015-05-01

    After total knee replacement (TKR), some patients find their operated knee totally natural and can be said to have "forgotten" it, while others, although satisfied with their results, remain conscious of their prosthesis. This is not well assessed on conventional end-points. Since 2001, we have studied the prevalence of "forgotten knee" (FK) after TKR in a prospective pragmatic cohort, with comparison to conventional scores. Patients undergoing TKR were enrolled between January 2001 and January 2008. Preoperative medical history and anthropometric and clinical data were recorded, and composite scores (Knee Society Score (KSS), Lequesne) were assessed. At each follow-up visit, FK acquisition was assessed by the closed question "Do you feel the operated knee to be always normal in all everyday activities?". Five hundred and eighty-four TKRs in 485 patients were included. Among the TKR, 91.6% were performed for severe osteoarthritis of the knee. FK frequency at a mean 75.8 months' follow-up was 42.9% while 86.1% of TKRs had excellent (KS Knee Score (KSKS)>80) or 34.9% perfect (KSKS=100) outcome. Only 66.1% of the 204 TKRs with perfect outcome on KSKS were reported as FK. Most patients achieved FK within 18 months. In this prospective study, 42.9% of TKRs were considered always forgotten in all everyday activities. Copyright © 2014 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  18. Arthroscopic knee debridement can delay total knee replacement in painful moderate haemophilic arthropathy of the knee in adult patients.

    PubMed

    Rodriguez-Merchan, E Carlos; Gomez-Cardero, Primitivo

    2016-09-01

    The role of arthroscopic debridement of the knee in haemophilia is controversial in the literature. The purpose of this study is to describe the results of arthroscopic knee debridement (AKD), with the aim of determining whether it is possible to delay total knee replacement (TKR) for painful moderate haemophilic arthropathy of the knee in adult patients. In a 14-year period (1998-2011), AKD was performed for moderate haemophilic arthropathy of the knee in 27 patients with haemophilia A. Their average age at operation was 28.6 years (range 26-39 years). Indications for surgery were as follows: more than 90° of knee flexion, flexion deformity less than 30°, good axial alignment of the knee, good patellar alignment, and pain above >60 points in a visual analogue scale [0 (no pain) to 100 points]. Secondary haematological prophylaxis and rehabilitation (physiotherapy) was given for at least 3 months after surgery. Follow-up was for an average of 7.5 years (range 2-14 years). We assessed the clinical outcome before surgery and at the time of latest follow-up using the Knee Society pain and function scores, the range of motion, and the radiological score of the World Federation of Haemophilia. Knee Society pain scores improved from 39 preoperatively to 66 postoperatively, and function scores improved from 36 to 52. Range of motion improved on an average from -15° of extension and 90° of flexion before surgery, to -5° of extension and 110° of flexion at the last follow-up. A radiological deterioration of 2.8 points on average was found. There were two (7.4%) postoperative complications (haemarthroses resolved by joint aspiration). One patient (3.7%) required a TKR 12.5 years later. AKD should be considered in painful moderate haemophilic arthropathy of the knee in adult patients to delay TKR.

  19. Position controlled Knee Rehabilitation Orthotic Device for Patients after Total Knee Replacement Arthroplasty

    NASA Astrophysics Data System (ADS)

    Wannaphan, Patsiri; Chanthasopeephan, Teeranoot

    2016-11-01

    Knee rehabilitation after total knee replacement arthroplasty is essential for patients during their post-surgery recovery period. This study is about designing one degree of freedom knee rehabilitation equipment to assist patients for their post-surgery exercise. The equipment is designed to be used in sitting position with flexion/extension of knee in sagittal plane. The range of knee joint motion is starting from 0 to 90 degrees angle for knee rehabilitation motion. The feature includes adjustable link for different human proportions and the torque feedback control at knee joint during rehabilitation and the control of flexion/extension speed. The motion of the rehabilitation equipment was set to move at low speed (18 degrees/sec) for knee rehabilitation. The rehabilitation link without additional load took one second to move from vertical hanging up to 90° while the corresponding torque increased from 0 Nm to 2 Nm at 90°. When extra load is added, the link took 1.5 seconds to move to 90° The torque is then increased from 0 Nm to 4 Nm. After a period of time, the speed of the motion can be varied. User can adjust the motion to 40 degrees/sec during recovery activity of the knee and users can increase the level of exercise or motion up to 60 degrees/sec to strengthen the muscles during throughout their rehabilitation program depends on each patient. Torque control is included to prevent injury. Patients can use the equipment for home exercise to help reduce the number of hospital visit while the patients can receive an appropriate therapy for their knee recovery program.

  20. Current surgical strategies for total arthroplasty in valgus knee

    PubMed Central

    Nikolopoulos, Dimitrios; Michos, Ioannis; Safos, George; Safos, Petros

    2015-01-01

    The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees. PMID:26191494

  1. Should the patella be replaced in total knee replacement?

    PubMed

    Badhe, N; Dewnany, G; Livesley, P J

    2001-01-01

    In 170 total knee arthroplasties for osteoarthritis 71 did not receive a patellar replacement (group A), while 99 knees had a cemented polyethylene patella (group B). The mean follow-up time was 36 months (30-50 months). In group A 10 patients underwent second-stage patellar resurfacing and in group B 2 knees underwent revision of the patellar component. Radiologically the average patellar congruency was similar. In both groups there were 21 non-congruent knees. In group A 8 were symptomatic and had low scores compared to 2 in group B (P<0.05). The mean HSS score and patellar score were higher in group B than in group A (P<0.05).

  2. The difficult primary total knee arthroplasty: a review.

    PubMed

    Baldini, A; Castellani, L; Traverso, F; Balatri, A; Balato, G; Franceschini, V

    2015-10-01

    Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.

  3. Metallosis Presenting as Knee Pain 26 years after Primary Total Knee Arthroplasty.

    PubMed

    Sharareh, Behnam; Phan, Duy L; Goreal, Wamda; Schwarzkopf, Ran

    2015-01-01

    Metallosis occurs when periprosthetic soft tissues, synovium, and/or bone is infiltrated by metallic debris secondary to metal-on-metal wear. This debris can cause a chronic inflammatory reaction leading to joint instability, pain, and swelling, and may cause osteolysis, implant looseningand ultimately implant failure. An 81 year old female, with a history of primary left total knee arthroplasty, presented with a 6 month history of left knee pain, swelling, and limited range of motion following a fall. Radiographs and joint aspiration were performed, with results that showed no evidence of periprosthetic trauma or infection but were suspicious for chronic metallosis. The patient underwent revision total knee replacement of the left knee which revealed extensive necrotic black metal debris throughout the joint space. Histopathology confirmed the diagnosis of a foreign body reaction consistent with metallosis. This case is a rare example of chronic metallosis presenting 26 years following total knee replacement. Treatment with revision total knee replacement is the consensus management choice to avoid further destruction of the bone and joint capsule that can occur with metal-induced inflammation.

  4. Blastomycosis infection of the knee treated with staged total knee arthroplasty.

    PubMed

    MacLean, Ian S; Day, Shandra R; Moore, Christopher C; Browne, James A

    2015-12-01

    Blastomycosis is a rare fungal disease that can cause intraarticular infection and joint destruction requiring surgical reconstruction. We describe a patient who presented with destruction of the knee joint of unknown etiology. The patient was initially treated with debridement and spacer placement followed by antifungal therapy after cultures grew blastomycosis. Following adequate treatment of the infection, the patient was taken back to the operating room for reconstruction with a total knee arthroplasty. The patient had a successful outcome with no evidence of infection at two years following surgery. To our knowledge, this case report represents the first documented case in which a blastomycotic infection of a native knee was successfully treated with a two-stage total knee arthroplasty. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Effect of the knee position during wound closure after total knee arthroplasty on early knee function recovery

    PubMed Central

    2014-01-01

    Objective This study investigated the effect of the knee position during wound closure on early knee function recovery after total knee arthroplasty (TKA). Methods This study included 80 primary total knee arthroplasties due to osteoarthritis. The patients were randomized according to the type of wound closure: extension group for full extension and flexion group for 90° flexion. The incision of articular capsule was marked for precise wound alignment. In the flexion group, the knee was kept in high flexion for 1 to 2 min after wound closure. The two groups were treated with the same postoperative rehabilitation exercises. The range of motion (ROM), visual analogue scale (VAS) score of anterior knee pain, Knee Society Score (KSS) and postoperative complications were assessed at 6 weeks, 3 months and 6 months, postoperatively. Results At 6 weeks and 3 months postoperatively, the ROM in flexion group was 98.95 ± 10.33° and 110.05 ± 4.93° respectively, with 87.62 ± 8.92° and 95.62 ± 6.51° in extension group, respectively; The VAS score of anterior knee pain in flexion group was 2.02 ± 1.38 and 2.21 ± 0.87, respectively, with 2.57 ± 1.07 and 2.87 ± 0.83 in extension group, respectively. The ROM and VAS pain score of the two groups were significantly different at these two time points, with no significant difference at 6 months postoperatively. The two groups were not significantly different in KSS, and no apparent complication was observed at three time points. Conclusion Marking the articular capsule incision, wound closure in flexion and high flexion after wound closure can effectively decrease anterior knee pain after TKA and promote the early recovery of ROM. PMID:25149657

  6. Causes of Aseptic Persistent Pain after Total Knee Arthroplasty

    PubMed Central

    Lim, Hong-An; Seon, Jong-Keun; Park, Kyung-Soon; Shin, Young-Joo; Yang, Hong-Yeol

    2017-01-01

    Background Persistent pain after total knee arthroplasty (TKA) is dissatisfying to the patient and frustrating to the surgeon. The purpose of this study is to evaluate the aseptic causes and clinical course of intractable pain following TKA. Methods Of the total 2,534 cases of primary TKA reviewed, 178 cases were classified as having aseptic persistent pain that was not resolved within 1 year after surgery. Except for the cases with periprosthetic fracture (56 knees), 122 cases of aseptic painful TKA were divided into two groups: intra-articular group (83 knees) and extra-articular group (39 knees). Results In the intra-articular group, the main reasons for pain were aseptic loosening (n = 40), polyethylene wear (n = 16), instability (n = 10), recurrent hemarthrosis (n = 5), patellar maltracking (n = 4), tendon ruptures (n = 4), and stiffness (n = 2). In the extraarticular group, 10 knees (25.6%) were found to have nerve entrapment in the spine, 6 knees (15.4%) were found to have hip osteoarthritis or femoral head avascular necrosis. The reasons for persistent knee pain in the remaining 23 knees (59.0%) still remain elusive. Conclusions Persistent pain after TKA originated from pathology of extra-articular origin in a considerable number of cases in this study. Therefore, it is important to perform thorough preoperative evaluations to reduce pain resulting from extra-articular causes. Furthermore, meticulous surgical procedures and optimal alignment are required to reduce pain of intra-articular origin related to implant wear, instability, and patellar maltracking. PMID:28261427

  7. Anterior knee pain after a total knee arthroplasty: What can cause this pain?

    PubMed Central

    Breugem, Stéfanus Jacob Martinus; Haverkamp, Daniël

    2014-01-01

    Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis, and yet approximately 5%-10% of patients experience residual pain, especially in the anterior part of the knee. Many theories have been proposed to explain the etiology of this anterior knee pain (AKP) but, despite improvements having been made, AKP remains a problem. AKP can be described as retropatellar or peripatellar pain, which limits patients in their everyday lives. Patients suffering from AKP experience difficulty in standing up from a chair, walking up and down stairs and riding a bicycle. The question asked was: “How can a ‘perfectly’ placed total knee arthroplasty (TKA) still be painful: what can cause this pain?”. To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain. Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA. This article is a review of what pain is, how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty. PMID:25035818

  8. Kinematics and Mechanical Properties of Knees following Patellar Replacing and Patellar Retaining Total Knee Arthroplasty

    PubMed Central

    Huang, Rongying; Liu, Yanqiang; Zhu, Jun

    2015-01-01

    Knee injury is a common medical issue. A full understanding of the kinematics and mechanical properties of knees following total knee arthroplasty (TKA) repair utilizing patellar replacement (only the base of the patella is replaced) versus patellar retaining surgical techniques is still lacking. In the current paper, we investigated magnetic resonance (MR) imaging data from knees repaired by these two methods and evaluated total knee models created using imaging reconstruction technology that simulated gait conditions. Results revealed that patellar replacement had little influence on tibiofemoral kinematics, although the tibia-surface equivalent stress increased slightly. By contrast, patellar replacement had a significant influence on the patellofemoral joint; patellar internal rotation, external rotation, and medial-lateral translation were all increased. Moreover, the stress distribution on patellar prostheses was altered, resulting in an increased surface maximal equivalent stress on the corresponding area. Moreover, during the gait cycle, we found that the area with maximal equivalent stress shifted its position. Finally, the patellofemoral joint showed decreased motion stability. From the view of kinematics and mechanics, this paper suggests that patella should be retained during TKA if it is possible. The present study presented approaches and technologies for evaluating kinematics and mechanical properties of total knee joint after TKA under gait loads. PMID:27057134

  9. Improved radiographic outcomes with patient-specific total knee arthroplasty.

    PubMed

    Ivie, Conrad B; Probst, Patrick J; Bal, Amrit K; Stannard, James T; Crist, Brett D; Sonny Bal, B

    2014-11-01

    Patient-specific guides can improve limb alignment and implant positioning in total knee arthroplasty, although not all studies have supported this benefit. We compared the radiographs of 100 consecutively-performed patient-specific total knees to a similar group that was implanted with conventional instruments instead. The patient-specific group showed more accurate reproduction of the theoretically ideal mechanical axis, with fewer outliers, but implant positioning was comparable between groups. Our odds ratio comparison showed that the patient-specific group was 1.8 times more likely to be within the desired +3° from the neutral mechanical axis when compared to the standard control group. Our data suggest that reliable reproduction of the limb mechanical axis may accrue from patient-specific guides in total knee arthroplasty when compared to standard, intramedullary instrumentation.

  10. Quality of life after total knee arthroplasty: systematic review.

    PubMed

    da Silva, Robson Rocha; Santos, Ayrton André Melo; de Sampaio Carvalho Júnior, José; Matos, Marcos Almeida

    2014-01-01

    To review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors. this was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design. 31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients' quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients. The factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.

  11. Radiographic and scintigraphic evaluation of total knee arthroplasty

    SciTech Connect

    Schneider, R.; Soudry, M.

    1986-04-01

    Various radiographic and scintigraphic methods are used to supplement clinical findings in the evaluation of total knee arthroplasty and its complications. Serial roentgenograms offer reliable information for diagnosing mechanical loosening. Wide and extensive radiolucency at the cement-bone interface and shift in position and alignment of prosthetic components can be seen in almost all cases by the time revision is necessary. Radiographic abnormalities are usually not present in acute infection, but are often present in chronic infection. Bone scanning has a high sensitivity for diagnosis of infection or loosening, but is nonspecific because increased uptake is often present around asymptomatic total knee arthroplasties with normal radiographs. Differential bone and Gallium scanning and scanning with Indium 111-labeled leukocytes have a greater specificity for diagnosis of infection than does bone or Gallium scanning alone. Routine radiographic and scintigraphic studies have shown a high incidence of deep vein thrombosis in the calf after total knee arthroplasty. Clinically significant pulmonary embolization is infrequent.

  12. Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity.

    PubMed

    Gupta, Ryan; Phan, Duy; Schwarzkopf, Ran

    2015-08-17

    Metal hypersensitivity is an uncommon complication after total knee arthroplasty (TKA) that can lead to significant functional impairment and aseptic prosthesis failure. We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA. The patient had a history of metal hypersensitivity following bilateral metal-on-metal total hip arthroplasty (THA) that was revised to ceramic-on-polyethylene implants. Knee radiographs showed severe osteolysis with implant loosening. Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection. Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure. This case report demonstrates the clinical and laboratory signs that suggest metal hypersensitivity in total knee arthroplasty and the potential for joint function restoration with revision surgery.

  13. Primary Total Knee Arthroplasty for Simple Distal Femoral Fractures in Elderly Patients with Knee Osteoarthritis

    PubMed Central

    Choi, Nam-Yong; Sohn, Jong-Min; Cho, Sung-Gil; Kim, Seung-Chan

    2013-01-01

    Purpose Primary total knee arthroplasty (TKA) can be an alternative method for treating distal femoral fractures in elderly patients with knee osteoarthritis. The purpose of this study was to evaluate the clinical and radiographic results in patients with knee osteoarthritis who underwent TKA with the Medial Pivot prosthesis for distal femoral fractures. Materials and Methods Eight displaced distal femoral fractures in 8 patients were treated with TKA using the Medial Pivot prosthesis and internal fixation. The radiographic and clinical evaluations were performed using simple radiographs and Hospital for Special Surgery (HSS) knee scores during a mean follow-up period of 49 months. Results All fractures united and the mean time to radiographic union was 15 weeks. The mean range of motion of the knee joint was 114.3° and the mean HSS knee score was 85.1 at the final follow-up. Conclusions Based on the radiographic and clinical results, TKA with internal fixation can be considered as an option for the treatment of simple distal femoral fractures in elderly patients who have advanced osteoarthritis of the knee with appropriate bone stock. PMID:24032103

  14. One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures.

    PubMed

    Mittal, Amber; Bhosale, Pradeep B; Suryawanshi, Ashish V; Purohit, Shaligram

    2013-08-01

    PURPOSE. To evaluate the outcome of one-stage long-stem total knee arthroplasty (TKA) for patients with arthritic knees and tibiofemoral stress fractures. METHODS. Records of 11 men and 18 women aged 47 to 78 (mean, 66) years who underwent fixed-bearing posterior-stabilised TKA for osteoarthritis or rheumatoid arthritis of the knee with tibial (n=31) and femoral (n=3) stress fractures were reviewed. All the tibial fractures involved the proximal half. There were 7 associated fibular stress fractures. Of the 31 knees with tibial stress fractures, 26 and 5 manifested varus and valgus deformity, respectively. RESULTS. The mean follow-up period was 51 (range, 24-96) months. The mean tibiofemoral angle improved from 23.2 to 1.9 degrees varus. The mean Knee Society knee score improved from 38.5 (range, 15- 63) to 89.6 (range, 80-95) [p<0.05]. The mean Knee Society functional score improved from 25.5 (range, 0-40) to 86.5 (range, 60-100) [p<0.05]. All fractures were united at the last follow-up. No complications were encountered. CONCLUSION. One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome.

  15. Articular contact kinematics of the knee before and after a cruciate retaining total knee arthroplasty.

    PubMed

    Li, Chunbao; Hosseini, Ali; Tsai, Tsung-Yuan; Kwon, Young-Min; Li, Guoan

    2015-03-01

    Accurate knowledge of tibiofemoral articular contact kinematics of the knee after total knee arthroplasty (TKA) is important for understanding the intrinsic knee biomechanics and improving the longevity of the components. The objective of this study was to compare the in vivo articular contact kinematics of the knees with end-stage medial osteoarthritis (OA) during a weight-bearing, single leg lunge activity before and after a posterior cruciate retaining TKA (CR-TKA) using a dual fluoroscopic imaging technique. We found that the CR-TKA resulted in more posterior contact positions on the tibial surface and a reduced range of motion in the medial and lateral compartments. The distances between medial and lateral contact locations in the CR-TKA knees were statistically larger than the OA knees. The articular contact centers have shifted from medial side of the tibial plateau pre-operatively to the lateral side after operation. This study indicated that the CR-TKA resulted in significant changes in contact kinematics of the knees in both anteroposterior and mediolateral directions. Further studies are needed to determine the influence of the altered in vivo contact kinematics on the longevity of polyethylene liner and long term clinical outcomes of the TKA. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  16. Revision surgery for a dislocated constrained total knee arthroplasty.

    PubMed

    Hagedorn, Jonathan; Levine, Brett R

    2012-07-01

    Knee dislocation after revision total knee arthroplasty (TKA) is a dangerous, albeit rare, injury that can lead to neurovascular compromise and permanent disability. A paucity of peer-reviewed literature exists regarding this complication after revision TKA. Tibiofemoral dislocation commonly occurs with minimal trauma, such as rising from a seated position, and is commonly associated with a flexion-extension gap mismatch. Prompt diagnosis and expedited treatment of this complication is necessary to minimize the risk of adjacent neurovascular structures. Acute management involves attempted reduction, knee stabilization, and thorough neurovascular workup. Long-term management may require revision surgery, with the level of articular constraint necessary being determined intraoperatively. This article describes 2 cases of relatively atraumatic knee dislocations after revision TKA involving the same semiconstrained components. Patient 1 was a 68-year-old man who sustained an atraumatic posterior knee dislocation 2 months after revision TKA. Patient 2 was a 55-year-old woman who presented after an atraumatic posterior knee dislocation 6 months after revision TKA. In both patients, a semiconstrained construct was used with corresponding revision components prior to dislocation. This article includes a synopsis of solutions for flexion-extension gap balancing and a review of the literature regarding this uncommon complication. Copyright 2012, SLACK Incorporated.

  17. Does Patellar Eversion in Total Knee Arthroplasty Cause Patella Baja?

    PubMed Central

    Sharma, Vineet; Tsailas, Panagiotis G.; Maheshwari, Aditya V.; Ranawat, Chitranjan S.

    2008-01-01

    Several proponents of minimally invasive surgery-total knee arthroplasty (MIS-TKA) have suggested patellar eversion during a standard exposure of the knee may cause shortening of the patellar tendon and poorer outcomes secondary to acquired patella baja. To explore this suggestion, we retrospectively reviewed 135 consecutive TKAs in 110 patients to ascertain the effect of TKA on the postoperative Insall-Salvati ratio. All surgeries were performed using standard TKA techniques with a midline incision, medial parapatellar arthrotomy, partial excision of the fat pad, and routine eversion of the patella. One patient developed a postoperative patella baja, defined as an Insall-Salvati ratio of less than 0.8. The Knee Society score for knee and function in this patient was 75 and 70, respectively. Five additional patients had a decrease in Insall-Salvati ratio by 10% or more but without patella baja. Mean Knee Society score for knee and function in these five patients was 94 (range, 73–99) and 96 (range, 90–100), respectively, as compared with 93 (range, 37–99) and 94 (range, 40–100) in the remaining 104 patients. Our data suggest the incidence of patella baja is low after TKA despite routine patellar eversion. Furthermore, a 10% or more decrease in the Insall-Salvati ratio without patella baja was not associated with a worse clinical outcome. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18568378

  18. Total Limb Rotation after Unilateral Total Knee Arthroplasty: Side-to-Side Discrepancy.

    PubMed

    Oh, Kwang-Jun; Yoon, Seok-Tae; Ko, Young-Bong

    2016-08-01

    Total limb rotation, an important anatomical feature of the lower limb, is defined as any rotation of the lower limb on its longitudinal axis. The aim of the present study was to evaluate the discrepancies of rotational profiles of total limb between nonoperated and operated limb following unilateral total knee arthroplasty. We conducted an analysis of the computed tomography (CT) data from 32 patients undergoing primary unilateral total knee arthroplasty. Using these CT scan, rotational profiles of total limb, such as femoral neck anteversion angle expressed as femoral torsion angle (FTA), tibial torsion angle (TTA), knee joint rotation angle (KJRA), and total limb rotation (TLR) were measured. There were significant discrepancies of FTA and KJRA between operated and nonoperated limb following unilateral total knee arthroplasty. The mean difference of operated and nonoperated side for FTA and KJRA were -6.51 ± 11.88 degrees (p = 0.0041) and -6.83 ± 5.04 degrees (p < 0.001), respectively. However, there were no significant discrepancies of TLR, TTA. These results are due to the compensation effect of KJRA. However, excessive external rotation of the femoral component beyond the compensation effect of prosthetic knee joint can lead to a total limb rotational discrepancy in patient undergoing unilateral total knee arthroplasty.

  19. Robotic Total Knee Arthroplasty: Surgical Assistant for a Customized Normal Kinematic Knee.

    PubMed

    Urish, Kenneth L; Conditt, Michael; Roche, Martin; Rubash, Harry E

    2016-09-01

    Although current total knee arthroplasty (TKA) is considered a highly successful surgical procedure, patients undergoing TKA can still experience substantial functional impairment and increased revision rates as compared with those undergoing total hip arthroplasty. Robotic-assisted surgery has been available clinically for almost 15 years and was developed, in part, to address these concerns. Robotic-assisted surgery aims to improve TKA by enhancing the surgeon's ability to optimize soft tissue balancing, reproduce alignment, and restore normal knee kinematics. Current systems include a robotic arm with a variety of different navigation systems with active, semi-active, or passive control. Semi-active systems have become the dominant strategy, providing a haptic window through which the surgeon consistently prepares a TKA based on preoperative planning. A review of previous designs and clinical studies demonstrates that these robotic systems decrease variability and increase precision, primarily with the mechanical axis and restoration of the joint line. Future design objectives include precise planning and consistent intraoperative execution. Preoperative planning, intraoperative sensors, augmenting surgical instrumentation, and biomimetic surfaces will be used to re-create the 4-bar linkage system in the knee. Implants will be placed so that the knee functions with a medial pivot, lateral rollback, screw home mechanism, and patellar femoral tracking. Soft tissue balancing will become more than equalizing the flexion and extension gaps and will match the kinematics to a normal knee. Together, coupled with advanced knee designs, they may be the key to a patient stating, "My knee feels like my natural knee." [Orthopedics. 2016; 39(5):e822-e827.].

  20. Arthroscopic arthrolysis for arthrofibrosis of the knee after total knee replacement.

    PubMed

    Hegazy, Alaa M; Elsoufy, Mohamed A

    2011-07-01

    Arthrofibrosis is an uncommon but potentially debilitating complication following total knee replacement which can result in chronic pain and poor recovery of range of motion. The treatment of this condition remains difficult and controversial. QUESTIONS/AIMS OF STUDY: We reviewed our results of arthroscopic arthrolysis of arthrofibrosis of the knee after total knee replacement to assess the potential for this technique to improve range of motion and provide improvement in knee function and pain as measured by the Knee Society Score (KSS). Eight patients were treated for arthrofibrosis after total knee replacement with arthroscopic management. The patients included five females and three males. The average age was 67.4 years. Initial rehabilitation efforts, which included manipulation under anesthesia, had failed. Arthroscopic arthrolysis was performed to release fibrous bands in the suprapatellar pouch and to reestablish the medial and lateral gutters. Lateral release of the patellar retinaculum was performed. Intensive physiotherapy and continuous passive motion began immediately post-operatively. The average follow-up was 37.4 months. The KSS was used for assessment of pain and function before arthroscopy and at the latest follow-up. Six of the eight patients experienced improvement in the KSS. The average functional score showed improvement from 68 points pre-operatively to 86 at the time of final follow-up. The average pain scores improved from 30 points pre-operatively to 41 at the time of final follow-up. Arthroscopic management can be beneficial for patients suffering from arthrofibrosis following total knee replacement. Pain and KSS clinical scores can markedly improve.

  1. Influence of the posterior tibial slope on the flexion gap in total knee arthroplasty.

    PubMed

    Okazaki, Ken; Tashiro, Yasutaka; Mizu-uchi, Hideki; Hamai, Satoshi; Doi, Toshio; Iwamoto, Yukihide

    2014-08-01

    Adjusting the joint gap length to be equal in both extension and flexion is an important issue in total knee arthroplasty (TKA). It is generally acknowledged that posterior tibial slope affects the flexion gap; however, the extent to which changes in the tibial slope angle directly affect the flexion gap remains unclear. This study aimed to clarify the influence of tibial slope changes on the flexion gap in cruciate-retaining (CR) or posterior-stabilizing (PS) TKA. The flexion gap was measured using a tensor device with the femoral trial component in 20 cases each of CR- and PS-TKA. A wedge plate with a 5° inclination was placed on the tibial cut surface by switching its front-back direction to increase or decrease the tibial slope by 5°. The flexion gap after changing the tibial slope was compared to that of the neutral slope measured with a flat plate that had the same thickness as that of the wedge plate center. When the tibial slope decreased or increased by 5°, the flexion gap decreased or increased by 1.9 ± 0.6mm or 1.8 ± 0.4mm, respectively, with CR-TKA and 1.2 ± 0.4mm or 1.1 ± 0.3mm, respectively, with PS-TKA. The influence of changing the tibial slope by 5° on the flexion gap was approximately 2mm with CR-TKA and 1mm with PS-TKA. This information is useful when considering the effect of manipulating the tibial slope on the flexion gap when performing CR- or PS-TKA. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Analysis of differences in bone removal during femoral box osteotomy for primary total knee arthroplasty

    PubMed Central

    GRACEFFA, ANGELO; INDELLI, PIER FRANCESCO; BASNETT, KAITLYN; MARCUCCI, MASSIMILIANO

    2014-01-01

    Purpose this study was conducted to compare the quantity of intercondylar bone removed during femoral box osteotomy for implantation of three contemporary posterior stabilized (PS) total knee arthroplasty designs: Sigma PS (DePuy), Vanguard (Biomet) and Persona (Zimmer). Methods we compared the maximum volumetric bone resection required for the housing of the PS mechanism of these three designs. Bone removal by each PS box cutting jig was three-dimensionally measured. The differences between the three designs were analyzed by the Kruskal-Wallis test. The Mann-Whitney U-test was used for pairwise comparisons. The level of significance was set at p<0.05. Results for small-size implants, the average box osteotomy volume of Persona was significantly smaller than the Vanguard and Sigma PS volumes (p=0.003). The mean difference between Vanguard and Sigma PS (p=0.01) was also significant. For medium size implants, the mean difference between Persona and Sigma PS (p=0.008) and the mean difference between Vanguard and Sigma PS (p=0.01) were statistically significant. For large size implants, the mean difference between Vanguard and Sigma PS (p=0.01) and the mean difference between Sigma PS and Persona (p=0.008) were statistically significant. Conclusions irrespective of implant size, the Persona cutting jig always resected significantly less bone than did Vanguard and Sigma PS. Clinical Relevance although this study does not establish any clinical relevance of removing more or less bone at primary TKA, its results suggest that if a PS design is indicated, it is preferable to select a model which resects less distal femoral bone. PMID:25606547

  3. Isolated revision of the patellar component in total knee arthroplasty.

    PubMed

    Leopold, Seth S; Silverton, Craig D; Barden, Regina M; Rosenberg, Aaron G

    2003-01-01

    Problems with the patellofemoral articulation are the most common causes of failure after total knee arthroplasty. However, there are few reports describing outcomes following isolated revision of the patellar component. Forty knees with a Miller-Galante I prosthesis underwent isolated patellar revision (with or without lateral retinacular release). The Hospital for Special Surgery knee scores were collected prospectively, and radiographs made preoperatively and at the time of the final follow-up were analyzed with respect to alignment, component position, and patellar tracking. Particular attention was given to patients who had a reoperation or repeat revision and who had clinical or radiographic evidence of failure of the patellar revision. At a mean follow-up of sixty-two months, fifteen (38%) of the forty knees that had had an isolated revision of the patellar component failed a second time. Eight of them required a total of twelve additional operations at a mean of forty-nine months after the patellar revision. Three of the failures were severe enough to require revision of two or more of the components. Of the twenty-five knees that had not failed, the average Hospital for Special Surgery knee score at the time of the final follow-up was 87 points. Of the seven knees that did not undergo reoperation but were deemed to be failures on the basis of the patients' symptoms, the average Hospital for Special Surgery knee score at the time of the final follow-up was 72 points. Isolated patellar revision, with or without concurrent lateral retinacular release, was associated with a high rate of reoperation and a relatively low rate of success. Elements of the implant design and component alignment contributed to the patellar component failure; both should be scrutinized carefully in patients who are seen with this problem, prior to proceeding with isolated revision of the patellar component of a total knee arthroplasty. Therapeutic study, Level IV (case series [no, or

  4. Knee arthrodesis as limb salvage for complex failures of total knee arthroplasty.

    PubMed

    Kuchinad, Raul; Fourman, Mitchell S; Fragomen, Austin T; Rozbruch, S Robert

    2014-11-01

    Patients with multiple failures of total knee arthroplasty (TKA) are challenging limb salvage cases. Twenty one patients over the last 10 years were referred to our service for knee fusion by arthroplasty surgeons who felt they were not candidates for revision TKA. Active infection was present in 76.2% and total bone loss averaged 6.6 cm. Lengthening was performed in 7/22 patients. Total time in Ilizarov frames was 9 months, with 93.3% union. Patients treated with IM fusion nails had 100% union. Average LLD increased from 3.6 to 4.5 cm following intervention, while those with concurrent lengthening improved to 1.6 cm. Findings suggest that bone loss and the soft-tissue envelope dictate knee fusion method, and multiple techniques may be needed. A treatment algorithm is presented.

  5. Knee Joint Loads and Surrounding Muscle Forces during Stair Ascent in Patients with Total Knee Replacement

    PubMed Central

    Rasnick, Robert; Standifird, Tyler; Reinbolt, Jeffrey A.; Cates, Harold E.

    2016-01-01

    Total knee replacement (TKR) is commonly used to correct end-stage knee osteoarthritis. Unfortunately, difficulty with stair climbing often persists and prolongs the challenges of TKR patents. Complete understanding of loading at the knee is of great interest in order to aid patient populations, implant manufacturers, rehabilitation, and future healthcare research. Musculoskeletal modeling and simulation approximates joint loading and corresponding muscle forces during a movement. The purpose of this study was to determine if knee joint loadings following TKR are recovered to the level of healthy individuals, and determine the differences in muscle forces causing those loadings. Data from five healthy and five TKR patients were selected for musculoskeletal simulation. Variables of interest included knee joint reaction forces (JRF) and the corresponding muscle forces. A paired samples t-test was used to detect differences between groups for each variable of interest (p<0.05). No differences were observed for peak joint compressive forces between groups. Some muscle force compensatory strategies appear to be present in both the loading and push-off phases. Evidence from knee extension moment and muscle forces during the loading response phase indicates the presence of deficits in TKR in quadriceps muscle force production during stair ascent. This result combined with greater flexor muscle forces resulted in similar compressive JRF during loading response between groups. PMID:27258086

  6. Knee Joint Loads and Surrounding Muscle Forces during Stair Ascent in Patients with Total Knee Replacement.

    PubMed

    Rasnick, Robert; Standifird, Tyler; Reinbolt, Jeffrey A; Cates, Harold E; Zhang, Songning

    2016-01-01

    Total knee replacement (TKR) is commonly used to correct end-stage knee osteoarthritis. Unfortunately, difficulty with stair climbing often persists and prolongs the challenges of TKR patents. Complete understanding of loading at the knee is of great interest in order to aid patient populations, implant manufacturers, rehabilitation, and future healthcare research. Musculoskeletal modeling and simulation approximates joint loading and corresponding muscle forces during a movement. The purpose of this study was to determine if knee joint loadings following TKR are recovered to the level of healthy individuals, and determine the differences in muscle forces causing those loadings. Data from five healthy and five TKR patients were selected for musculoskeletal simulation. Variables of interest included knee joint reaction forces (JRF) and the corresponding muscle forces. A paired samples t-test was used to detect differences between groups for each variable of interest (p<0.05). No differences were observed for peak joint compressive forces between groups. Some muscle force compensatory strategies appear to be present in both the loading and push-off phases. Evidence from knee extension moment and muscle forces during the loading response phase indicates the presence of deficits in TKR in quadriceps muscle force production during stair ascent. This result combined with greater flexor muscle forces resulted in similar compressive JRF during loading response between groups.

  7. Late infection after total knee arthroplasty caused by Pasteurella multocida.

    PubMed

    Antuña, S A; Méndez, J G; Castellanos, J L; Jimenez, J P

    1997-12-01

    The authors report a case of Pasteurella multocida infection in a total knee arthroplasty as a result of a dog bite. The patient was treated with one-stage reimplantation of a new prosthesis and with intravenous antibiotics, resulting in complete relief of symptoms with no evidence of recurrence of infection after 24 months.

  8. Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty

    PubMed Central

    Jeong, Min; Shin, Sung Jin; Kang, Byoung Youl

    2016-01-01

    Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures. PMID:26981521

  9. [Long-term results in total knee arthroplasty].

    PubMed

    König, A; Kirschner, S

    2003-06-01

    The number of total knee arthroplasties performed per year has increased steadily. This increase will probably continue since the principal risk factors obesity and advanced age will increase as well. The results of total knee arthroplasty are influenced by many physical, psychological, and social factors, which are presented. These factors have not been taken into account sufficiently by most of the investigations performed so far. Therefore, very few long-term data on the quality of life and functional gain are available. Survival analyses of single centers exhibit serious methodological flaws and a simplified data presentation, which reduces the generalizability of these results considerably. A critical analysis of these results was performed. Total knee arthroplasty has positive effects on the patient's pain level, ability to walk, and quality of life. There are a number of reliable uni- and tricompartmental designs. The revision rate is influenced by age, sex, disease, fixation mode, and prosthetic design. Tricompartmental prostheses have a revision rate of about 7% after 10 years. The revision rate has continuously improved over the last decades. Studies on total knee arthroplasty can be improved considerably according to international standards in terms of methodology and presentation of the results. The results from the patient's perspective need to be taken more into account.

  10. [Recovery from total knee arthroplasty through continuous passive motion].

    PubMed

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion.

  11. An unusual cause of locking after total knee replacement.

    PubMed

    Auyeung, J; Doorgakant, A; Shand, J E G; Orr, M M

    2007-09-01

    Locking after total knee replacement is uncommon and is generally caused by the formation of fibrous tissue around the patella. We report an unusual cause of locking resulting from intermittent occlusion of the popliteal artery, which was tethered to cement at the posterior aspect of the tibial component.

  12. Sonographic evaluation of patellar clunk syndrome following total knee arthroplasty.

    PubMed

    Geannette, Christian; Miller, Theodore; Saboeiro, Gregory; Parks, Michael

    2017-02-01

    Patellar clunk syndrome is a painful mechanical phenomenon that may develop following total knee arthroplasty. The diagnosis is usually made clinically, but cross-sectional imaging may be needed to confirm the clinical suspicion. Sonographic confirmation of patellar clunk syndrome can be obtained by directly visualizing the soft tissue proliferation deep to the distal quadriceps tendon and by dynamically demonstrating the clunking tissue during flexion and extension of the knee. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:105-107, 2017. © 2016 Wiley Periodicals, Inc.

  13. Gait analysis of elderly women after total knee arthroplasty.

    PubMed

    Lee, Aenon; Park, Junhyuck; Lee, Seungwon

    2015-03-01

    [Purpose] The purpose of this study was to investigate ability and muscle activities of elderly women after total knee arthroplasty (TKA) and compare them with those of healthy ones. [Subjects and Methods] Fifteen female patients with TKA due to advanced degenerative arthritis of the measured on knee joint and 19 healthy elderly females participated. Tibiofemoral angles of TKA patients were using a gait analysis system anterioposterior X-rays of the weight-bearing knee. The knee flexion angle and gait parameters were measured. Muscle activities and prolongation time were EMG system. The gait of the treated limb of each participant was evaluated in three consecutive trials at fast speed and comfortable speed. [Results] The knee flexion angle %stance phase, stride length, step length, speed, cadence, and gait cycle significantly decreased at both the fast speed and comfortable speeds, and the onset and duration time of rectus femoris activity was significantly increased at the comfortable speed in the TKA group. [Conclusion] In conclusion, elderly women who received TKA showed decreased gait ability and muscle activity compared to the healthy elderly women.

  14. Gait analysis of elderly women after total knee arthroplasty

    PubMed Central

    Lee, Aenon; Park, Junhyuck; Lee, Seungwon

    2015-01-01

    [Purpose] The purpose of this study was to investigate ability and muscle activities of elderly women after total knee arthroplasty (TKA) and compare them with those of healthy ones. [Subjects and Methods] Fifteen female patients with TKA due to advanced degenerative arthritis of the measured on knee joint and 19 healthy elderly females participated. Tibiofemoral angles of TKA patients were using a gait analysis system anterioposterior X-rays of the weight-bearing knee. The knee flexion angle and gait parameters were measured. Muscle activities and prolongation time were EMG system. The gait of the treated limb of each participant was evaluated in three consecutive trials at fast speed and comfortable speed. [Results] The knee flexion angle %stance phase, stride length, step length, speed, cadence, and gait cycle significantly decreased at both the fast speed and comfortable speeds, and the onset and duration time of rectus femoris activity was significantly increased at the comfortable speed in the TKA group. [Conclusion] In conclusion, elderly women who received TKA showed decreased gait ability and muscle activity compared to the healthy elderly women. PMID:25931687

  15. Full versus surface tibial baseplate cementation in total knee arthroplasty.

    PubMed

    Galasso, Olimpio; Jenny, Jean-Yves; Saragaglia, Dominique; Miehlke, Rolf K

    2013-02-01

    The use of a keel in the tibial component during modern primary total knee arthroplasty (TKA) has become common, and its cementation may affect the future performance of the prosthesis. Although proponents of cementing the entire tibial component argue that this technique provides better initial fixation and may prevent aseptic loosening, reasons exist to apply cement only to the tibial baseplate. In this study, 232 patients who underwent TKA using full or surface cementation of the tibial baseplate were evaluated at an average 5.6-year follow-up to assess survivorship and clinical results. The cumulative survival rate at 8 years was 97.1%. With revision of either component for any reason considered the endpoint, no significant difference was noted between full and surface cemented groups. Knee Society Score, range of motion, and femoro-tibial mechanical angle significantly increased postoperatively. Multivariate analysis revealed that good preoperative range of motion and Knee Society Scores were related to good postoperative range of motion and Knee Society Scores. Follow-up length was a negative predictor of postoperative Knee Society Score. The use of full or surface cementation of the baseplate was unrelated to the postoperative clinical outcomes. Clinical outcomes did not differ according to the tibial component cementation technique. The results of this study suggest that cementing the keel of the tibial component during primary TKA has no advantage for patients. Longer-term follow-up and proper patient randomization are required to confirm these findings.

  16. Factors affecting postoperative range of motion after total knee arthroplasty.

    PubMed

    Gatha, Nehal M; Clarke, Henry D; Fuchs, Robin; Scuderi, Giles R; Insall, John N

    2004-10-01

    One hundred thirty five patients with osteoarthritis who underwent total knee arthroplasty (TKA) were evaluated to determine whether specific pre- and postoperative variables were correlated with the postoperative range of motion. Age, sex, pre- and postoperative range of motion, pre- and postoperative Knee Society scores, intraoperative patellar thickness before and after resurfacing, pre- and postoperative radiographic patellar height (as determined by the Insall-Salvati and Blackburn-Peel ratios), and preoperative radiographic alignment were recorded for each patient. Regression analysis was performed to identify whether any variables were correlated with the postoperative range of motion or Knee Society scores. The only variable that was significantly correlated with postoperative range of motion was the preoperative range of motion. This study suggests that among the variables evaluated, the preoperative range of motion was the only significant predictor of postoperative range of motion.

  17. [Management of Flexion Contracture in Primary Total Knee Arthroplasty].

    PubMed

    Hube, R; Mayr, H O; Pfitzner, T; von Roth, P

    2015-06-01

    Flexion contracture is a common deformity of the arthritic knee. The present publication describes causes, clinical relevance and surgical technique in the presence of flexion contractures in total knee arthroplasty. Flexion contracture can be attributed to different causes. Basically it is a mismatch between flexion and extension gaps. Moderate and severe deformities have to be corrected by additional surgical interventions. In most cases soft tissue techniques with release of contracted structures, the removal of osteophytes and additional distal femoral bone resection are necessary. The goal of these interventions is to achieve full extension of the knee. During rehabilitation attention has to be paid to maintain it with intensive physical therapy. A remaining flexion contracture is associated with inferior functional outcome and persistent pain.

  18. Double metal tibial blocks augmentation in total knee arthroplasty.

    PubMed

    Chung, Kyu Sung; Lee, Jin Kyu; Lee, Hee Jae; Choi, Choong Hyeok

    2016-01-01

    Severe uncontained tibial bone defects occurring during total knee arthroplasty are challenging, and which treatment method is the best remains unknown. In this study, clinical and radiographic outcomes of double metal blocks augmentation were examined. Between 2004 and 2012, double metal blocks augmentation was carried out in 17 patients with severe asymmetric uncontained tibial bone defects. The first block was attached to the tibial tray with screws, and then the second block was cemented to the first block. Out of 17 patients, 13 (8 primary, 5 revision) were available for final follow-up at a median of 69 months (range 24-99). For clinical assessment, range of motion and Knee Society score were evaluated preoperatively and annually thereafter. At the final follow-up, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford knee, Short Form-36, Lower extremity functional scale, and Lower extremity activity scale scores were evaluated. Radiographic assessment for radiolucent lines at the block-cement-bone interfaces and signs of failure was performed annually using fluoroscopy and standard radiographs. Range of motion and Knee Society score were significantly improved post-operatively. Other clinical outcomes were favourable. Radiolucent lines were seen on fluoroscopy in three knees, but no sign of failure, such as loosening, collapse, or instability, was observed at the final follow-up. Double metal blocks augmentation is a favourable and useful method, which does not cause mechanical failure or protrusion of the prosthetic because of its modularity, to manage severe asymmetric uncontained proximal tibial bone defects >15 mm in total knee arthroplasty. Case series, Level IV.

  19. [Effectiveness of continuous passive motion after total knee replacement].

    PubMed

    Trzeciak, Tomasz; Richter, Magdalena; Ruszkowski, Krzysztof

    2011-01-01

    Continuous passive motion (CPM) is frequently used method in the early post-operative rehabilitation in patients after knee surgery. Aim of this study was to evaluate the effectiveness of CPM after primary total knee arthroplasty. Efficacy was assesed in terms of clinical score and functional recovery. 93 patients (101 knee joints) undergoing total knee replacement were assigned into two groups. The experimental group received continuous passive motion and active exercises. A control group received conventional physical therapy only. CPM was initiated in the first day after surgery, for 120 minutes, starting with 0-40 degrees range of motion, increased as tolerated (mean 10 degrees per day) and maintained during the hospital stay. Outcome measures were those included in Knee Society Score (KSS). Functional recovery was evaluated using WOMAC. All subjects were evaluated once before the surgery and on 10th day postoperatively. Mean clinical score (KSS) at the day 10 was 70 +/- 15 points in the experimental group and 74 +/- 12 in a control group. There were no statistical difference between the two groups for any outcome measures. CPM group mean range of motion was 83 degrees +/- 14 degrees and a group without CPM 77 degrees +/- 21 degrees. KSS functional score was 66 +/- 9 points in the experimental group compared to 62 +/- 7 points in a control group. Subjective estimation of pain level, joint stiffness and function showed no statistical difference between the two groups regarding total and subscale scores. Mean total score was 24 +/- 19 points in the CPM group and 22 +/- 17 in a group without CPM. These findings show that CPM had no significant advantage in terms of improving clinical measurements. However, there was beneficial effect on subjective assessment of pain level, joint stiffness and functional ability.

  20. A multicenter analysis of axial femorotibial rotation after total knee arthroplasty.

    PubMed

    Dennis, Douglas A; Komistek, Richard D; Mahfouz, Mohamed R; Walker, Scott A; Tucker, Abby

    2004-11-01

    A multicenter analysis was done to determine in vivo femorotibial axial rotation magnitudes and patterns in 1,027 knees (normal knees, nonimplanted ACL-deficient knees, and multiple designs of total knee arthroplasty). All knees were analyzed using fluoroscopy and a three-dimensional computer model-fitting technique during a deep knee bend and/or gait. Normal knees showed 16.5 degrees and 5.7 degrees of internal tibial rotation during a deep knee bend and gait, respectively. Rotation magnitudes and the percent having normal axial rotation patterns decreased in all total knee arthroplasty groups during a deep knee bend. During gait, all knee arthroplasty groups had similar rotational patterns (limited magnitudes). Average axial rotational magnitudes in gait and a deep knee bend were similar among major implant categories (ie, fixed-bearing versus mobile-bearing, etc). Average values in normal knees and ACL-retaining total knee arthroplasty patients (16.5 degrees and 8.1 degrees , respectively) were higher than in groups in which the ACL was absent (< 4.0 degrees ). All total knee arthroplasty groups had at least 19% of patients have a reverse axial rotational pattern during a deep knee bend and at least 31% during gait. Normal axial rotation patterns are essential for good patellar tracking, reduction of patellofemoral shear forces, and maximization of knee flexion.

  1. Knee kinematics during walking at different speeds in people who have undergone total knee replacement.

    PubMed

    McClelland, Jodie A; Webster, Kate E; Feller, Julian A; Menz, Hylton B

    2011-06-01

    People who have undergone total knee replacement (TKR) experience difficulties in some daily activities including walking. Walking at faster speeds requires more knee flexion and may therefore present a greater challenge following TKR. The aim of this study was to compare the knee kinematics of patients following TKR and unimpaired controls during comfortable and fast walking speeds. Forty patients (22 women, 18 men) 12 months following TKR and 40 control participants (matched for age and sex) were assessed during walking at self-selected comfortable and fast speeds using three dimensional motion analysis. The group averages of spatiotemporal and peak kinematic characteristics in the sagittal, coronal and transverse movement planes were compared using univariate analysis of variance with walking speed as a co-variate. The TKR group walked with significantly reduced cadence (p < 0.001 at both speeds) and reduced stride length (p < 0.001 at both speeds), less knee flexion during stance and swing phases (p < 0.001 for both speeds) and less knee extension during stance phase (p < 0.024 for comfortable speed; p < 0.042 for fast speed). The TKR group also walked with less peak knee external rotation than controls at both speeds (p < 0.001 for both speeds). Both groups increased their velocity, cadence and stride length by a similar proportion when walking at fast speed. When walking at a faster speed, spatiotemporal gait parameters and knee motion are altered in a similar manner for both TKR patients and controls. However, at both walking speeds, TKR patients exhibit residual deficits 12 months following surgery.

  2. The influence of pain on knee motion in patients with osteoarthritis undergoing total knee arthroplasty.

    PubMed

    Bennett, Damien; Hanratty, Brian; Thompson, Neville; Beverland, David E

    2009-04-01

    Pain is the predominant symptom of degenerative knee arthritis and the main reason patients undergo total knee arthroplasty (TKA). Variation in patient response to pain has proved difficult to quantify. The effect of removing pain by testing TKA patients' range of motion (ROM) before and after the administration of anesthesia has not previously been analyzed. This study objectively quantifies the effect of eliminating pain on knee joint ROM for a typical group of TKA patients with osteoarthritis. We prospectively recruited 141 patients with osteoarthritis admitted for TKA to assess the inhibitory effect of pain on ROM. Passive maximum flexion, extension, and ROM were measured preoperatively before and after administration of anesthesia (spinal anesthetic followed by femoral and sciatic regional nerve blocks). Following pain abolition, passive maximum flexion increased by an average of 13.4 degrees (SD=11.9 degrees), passive maximum extension improved by an average of 3.0 degrees (SD=4.2 degrees), and passive ROM increased by an average of 16.4 degrees (SD=13.1 degrees). The change in each parameter was statistically significant (P<.0001). Improvements in flexion (P=.01) and ROM (P=.005) were significantly greater in women. Measurements taken before anesthesia reflect knee ROM that the patient will tolerate before pain becomes the limiting factor, while measurements taken after anesthesia is achieved suggest the knee ROM possible once pain is eliminated. Abolition of pain led to significant increases in knee flexion, extension, and ROM, suggesting that pain has a significant inhibitory effect on knee motion.

  3. The patellofemoral joint after total knee arthroplasty without patellar resurfacing.

    PubMed

    Picetti, G D; McGann, W A; Welch, R B

    1990-10-01

    One hundred total knee replacements with a total condylar prosthesis and without patellar resurfacing were followed for a minimum of two years. Eighty-four per cent of the knees were affected by osteoarthrosis. Graded according to the knee-rating system of the Hospital for Special Surgery, there were eighteen excellent, fifty-three good, eighteen fair, and eleven poor results. At the most recent follow-up, twenty-nine knees (29 per cent), nine of which were affected by rheumatoid arthritis, were still painful in the patellofemoral area. The height and weight of the patient definitely influenced the amount of patellofemoral pain postoperatively. Small patients who had osteoarthrosis were exceptionally free of pain, regardless of sex, age, or level of activity. It seems that the best approach to patellofemoral replacement includes resurfacing of the patella in all patients who have rheumatoid arthritis and in patients who have osteoarthrosis if they have preoperative patellofemoral pain, are more than 160 centimeters tall, weigh more than sixty kilograms, and have advanced changes in the patella at the time of the operation.

  4. Preoperative laxity in osteoarthritis patients undergoing total knee arthroplasty

    PubMed Central

    Noguchi, Hideo; Matsuda, Yoshikazu; Kiga, Hiroshi; Takeda, Mitsuhiro; Toyabe, Shin-ichi

    2007-01-01

    A preoperative quantitative evaluation of soft tissues is helpful for planning total knee arthroplasty, in addition to the conventional clinical examinations involved in moving the knee manually. We evaluated preoperative coronal laxity with osteoarthritis in patients undergoing total knee arthroplasty by applying a force of 150 N with an arthrometer. We examined a consecutive series of 120 knees in 102 patients. The median laxity was 0° in abduction and 8° in adduction. The femorotibial angle on non-weight-bearing standard anteroposterior radiographs was 180° and correlated with both abduction (r = −0.244, p = 0.007) and adduction (r = 0.205, p = 0.025) laxity. The results of a regression analysis suggested that the femorotibial angle is helpful for estimating both laxities. Considering the many reports on how to obtain well-balanced soft tissues, stress radiographs might help to improve the preoperative planning for gaining the optimal laxity deemed appropriate by surgeons. PMID:17938923

  5. A computerized bioskills system for surgical skills training in total knee replacement.

    PubMed

    Conditt, M A; Noble, P C; Thompson, M T; Ismaily, S K; Moy, G J; Mathis, K B

    2007-01-01

    Although all agree that the results of total knee replacement (TKR) are primarily determined by surgical skill, there are few satisfactory alternatives to the 'apprenticeship' model of surgical training. A system capable of evaluating errors of instrument alignment in TKR has been developed and demonstrated. This system also makes it possible quantitatively to assess the source of errors in final component position and limb alignment. This study demonstrates the use of a computer-based system to analyse the surgical skills in TKR through detailed quantitative analysis of the technical accuracy of each step of the procedure. Twelve surgeons implanted a posterior-stabilized TKR in 12 fresh cadavers using the same set of surgical instruments. During each procedure, the position and orientation of the femur, tibia, each surgical instrument, and the trial components were measured with an infrared coordinate measurement system. Through analysis of these data, the sources and relative magnitudes of errors in position and alignment of each instrument were determined, as well as its contribution to the final limb alignment, component positioning and ligament balance. Perfect balancing of the flexion and extension gaps was uncommon (0/15). Under standardized loading, the opening of the joint laterally exceeded the opening medially by an average of approximately 4 mm in both extension (4.1 +/- 2.1 mm) and flexion (3.8 +/- 3.4 mm). In addition, the overall separation of the femur and the tibia was greater in flexion than extension by an average of 4.6 mm. The most significant errors occurred in locating the anterior/posterior position of the entry point in the distal femur (SD = 8.4 mm) and the correct rotational alignment of the tibial tray (SD = 13.2 degrees). On a case-by-case basis, the relative contributions of errors in individual instrument alignments to the final limb alignment and soft tissue balancing were identified. The results indicate that discrete steps in the

  6. Early outcomes of patella resurfacing in total knee arthroplasty

    PubMed Central

    Clements, Warren J; Miller, Lisa; Whitehouse, Sarah L; Graves, Stephen E; Ryan, Philip

    2010-01-01

    Background Patella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes. Methods We analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition. Results At 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p < 0.001). Revisions for patellofemoral pain were more common in the NR group (17%) than in the R group (1%), and “patella only” revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1, p < 0.001). Interpretation Rates of early revision of primary total knees were higher when the patella was not resurfaced, and suggest that surgeons may be inclined to resurface later if there is patellofemoral pain. However, 15% of non-resurfaced knees revised for patella addition are re-revised by 4 years. Our results suggest an early beneficial outcome for patella resurfacing at primary arthroplasty based on revision rates up to 5 years. PMID:19968604

  7. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011.

    PubMed

    Schroer, William C; Berend, Keith R; Lombardi, Adolph V; Barnes, C Lowry; Bolognesi, Michael P; Berend, Michael E; Ritter, Merrill A; Nunley, Ryan M

    2013-09-01

    Revision knee data from six joint arthroplasty centers were compiled for 2010 and 2011 to determine mechanism of failure and time to failure. Aseptic loosening was the predominant mechanism of failure (31.2%), followed by instability (18.7%), infection (16.2%), polyethylene wear (10.0%), arthrofibrosis (6.9%), and malalignment (6.6%). Mean time to failure was 5.9 years (range 10 days to 31 years). 35.3% of all revisions occurred less than 2 years after the index arthroplasty, 60.2% in the first 5 years. In contrast to previous reports, polyethylene wear is not a leading failure mechanism and rarely presents before 15 years. Implant performance is not a predominant factor of knee failure. Early failure mechanisms are primarily surgeon-dependent.

  8. Differences in knee joint kinematics and forces after posterior cruciate retaining and stabilized total knee arthroplasty.

    PubMed

    Wünschel, Markus; Leasure, Jeremi M; Dalheimer, Philipp; Kraft, Nicole; Wülker, Nikolaus; Müller, Otto

    2013-12-01

    Posterior cruciate ligament (PCL) retaining (CR) and -sacrificing (PS) total knee arthroplasties (TKA) are widely-used to treat osteoarthritis of the knee joint. The PS design substitutes the function of the PCL with a cam-spine mechanism which may produce adverse changes to joint kinematics and kinetics. CR- and PS-TKA were performed on 11 human knee specimens. Joint kinematics were measured with a dynamic knee simulator and motion tracking equipment. In-situ loads of the PCL and cam-spine were measured with a robotic force sensor system. Partial weight bearing flexions were simulated and external forces were applied. The PS-TKA rotated significantly less throughout the whole flexion range compared to the CR-TKA. Femoral roll back was greater in the PS-TKA; however, this was not correlated with lower quadriceps forces. Application of external loads produced significantly different in-situ force profiles between the TKA systems. Our data demonstrate that the PS-design significantly alters kinematics of the knee joint. Our data also suggest the cam-spine mechanism may have little influence on high flexion kinematics (such as femoral rollback) with most of the load burden shared by supporting implant and soft-tissue structures. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. Above knee amputation following total knee arthroplasty: when enough is enough.

    PubMed

    Khanna, Vickas; Tushinski, Daniel M; Soever, Leslie J; Vincent, Alex D; Backstein, David J

    2015-04-01

    In some cases, above knee amputation (AKA) for a chronically infected total knee arthroplasty is the only option. The purpose of this study was to assess patient satisfaction following AKA and to identify factors which may be indicative of successful outcome following AKA. A review was performed of 7 patients who underwent an AKA for a recurrent peri-prosthetic knee infection. Patient satisfaction was gauged through a modified questionnaire. All patients were satisfied with their AKA and 6 of 7 stated that they would have chosen an amputation earlier. Greater than 6 attempts at limb-salvage and failed gastrocnemius flap were identified by expert opinion as possible poor prognostic factors. Despite poor function, patients with chronically infected TKAs are satisfied following an AKA.

  10. Chronic knee extensor mechanism lesions in total knee arthroplasty: a literature review

    PubMed Central

    COTTINO, UMBERTO; DELEDDA, DAVIDE; ROSSO, FEDERICA; BLONNA, DAVIDE; BONASIA, DAVIDE EDOARDO; ROSSI, ROBERTO

    2016-01-01

    Knee extensor mechanism rupture is a serious complication of total knee arthroplasty (TKA). Its prevalence ranges from 1 to 10% and it is commonly observed as a chronic multifactorial pathology with the patellar tendon as the most common site of rupture. Knee extensor mechanism reconstruction can be performed using allogenic or synthetic grafts. In the literature it is still not clear whether one of these techniques is superior to the other and the choice is usually tailored to the patient case by case. Allografts allow better restoration of the anatomical landmarks, whereas the mesh technique is more reproducible and the graft does not elongate over time. Allografts carry an increased risk of infection compared with synthetic reconstructions, while the mesh technique is cheaper and more readily available. In this paper, we review the etiology, diagnosis and treatment of this pathology, drawing on the most recent literature. PMID:27900308

  11. Risk assessment tools used to predict outcomes of total hip and total knee arthroplasty.

    PubMed

    Konopka, Joseph F; Hansen, Viktor J; Rubash, Harry E; Freiberg, Andrew A

    2015-07-01

    This article reviews recently proposed clinical tools for predicting risks and outcomes in total hip arthroplasty and total knee arthroplasty patients. Additionally, we share the Massachusetts General Hospital experience with using the Risk Assessment and Prediction Tool to predict the need for an extended care facility after total joint arthroplasty.

  12. Total Knee Arthroplasty After Knee Arthroscopy in Patients Older Than 50 Years.

    PubMed

    Boyd, Jason A; Gradisar, Ian M

    2016-11-01

    Several orthopedic registries have described the incidence of total knee arthroplasty (TKA) in patients who have undergone knee arthroscopy. Patient risk factors may play a role in the conversion rate from knee arthroscopy to TKA. This study quantifies the incidence of conversion of knee arthroscopy to TKA from a US mixed-payer database and describes some common patient risk factors for conversion. The medical records of more than 50 million patients who were treated between 1998 and 2014 were mined with a commercially available software platform. During the study period, a total of 68,090 patients older than 50 years underwent knee arthroscopy for partial meniscectomy, chondroplasty, or debridement. Reported rates of TKA at 1, 2, and 3 years after arthroscopy were 10.1%, 13.7%, and 15.6%, respectively. Obesity, depressive disorder, rheumatoid arthritis, diabetes, and age 70 years and older were associated with increased relative risk of conversion to TKA at 2 years. When obesity was combined individually with the top 5 other risk factors, no combination produced a higher relative risk than that of obesity alone. Patients who were 50 to 54 years of age had the lowest incidence of conversion to TKA (8.3%, P<.001). Men had a lower incidence of conversion to TKA (11.3%) than women (15.8%, P<.001). This information can help surgeons to counsel patients on the incidence of TKA after knee arthroscopy and identify preoperative risk factors that increase risk. [Orthopedics. 2016; 39(6):e1041-e1044.].

  13. Intraoperative Manipulation for Flexion Contracture During Total Knee Arthroplasty.

    PubMed

    Matsui, Yoshio; Minoda, Yukihide; Fumiaki, Inori; Nakagawa, Sigeru; Okajima, Yoshiaki; Kobayashi, Akio

    2016-11-01

    Joint gap balancing during total knee arthroplasty (TKA) is important for ensuring postoperative joint stability and range of motion. Although the joint gap should be balanced to ensure joint stability, it is not easy to achieve perfect balancing during TKA. In particular, relative extension gap shortening can induce flexion contracture. Intraoperative manipulation is often empirically performed. This study evaluated the tension required for this manipulation and investigated the influence of intraoperative manipulation on the joint gap in cadaveric knees. Total knee arthroplasty was performed in 6 cadaveric knees from whole body cadavers. Flexion contracture was induced using an insert that was 4 mm thicker than the extension gap, and intraoperative manipulation was performed. Study measurements included the changes in the joint gap after manipulation at 6 positions, with the knee bending from extension to 120° flexion, and the manipulation tension that was required to create a 4-mm increase in the gap. The manipulation tension needed to create a 4-mm increase in the extension gap was 303±17 N. The changes in the joint gap after manipulation were 0.4 mm, 0.6 mm, 0.2 mm, -0.2 mm, -0.4 mm, and -0.6 mm at 0°, 30°, 45°, 60°, 90°, and 120° flexion, respectively. Therefore, the joint gap was not significantly changed by the manipulation. Intraoperative manipulation does not resolve flexion contracture. Therefore, if flexion contracture occurs during TKA, treatment with additional bone cutting and soft tissue release is likely more appropriate than manipulation. [Orthopedics. 2016; 39(6):e1070-e1074.].

  14. Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?

    PubMed

    Kohl, Sandro; Evangelopoulos, Dimitrios S; Hartel, Maximilian; Kohlhof, Hendrik; Roeder, Christoph; Eggli, Stefan

    2011-09-01

    Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA. In 50 patients (21 men, 29 women) undergoing TKA, we compared patellar blood flow at flexions 0° to 30°, 60°, 90°, and 110° before and after medial parapatellar arthrotomy to pre- and postoperative anterior knee pain scores by means of a laser Doppler flowmeter (LDF) probe. Anterior knee pain was assessed using the pain intensity numeric rating scale (NRS) of 0-10 (0-no, 10-worst pain). Based on the NRS pain values, patients were divided into two main groups: group A (n = 34) with no pain or discomfort (NRS range 0-4) and group B (n = 16) with anterior knee pain (NRS range 5-10). Patients of group B demonstrated a significant decrease in blood flow before arthrotomy at flexions from 0° to 90°, and 110° and from 0° to 60°, 90°, and 110° after arthrotomy. For group A, a significant decrease in blood flow was detected at flexions from 0° to 90°, and 110° before and after arthrotomy. For both groups, medial arthrotomy did not have a statistically significant influence on patellar blood flow (margin of significance P < 0.05). Prior to TKA, 16 of the 50 patients of group B (32%) complained of anterior knee pain (mean NRS 7.1 ± 1.7). At 2-year follow-up, pain significantly decreased (NRS 3.1 ± 2.1) and only 4 of the 16 patients (25%) complained of moderate anterior pain (average NRS 5.7 ± 0.5), while 8 of 16 (50%) patients reported discomfort (mean NRS 3.5 ± 1.8) around the patella. Patients in group A also demonstrated a significant decrease in pain intensity (from NRS 1.5 ± 1.4 preoperatively to NRS 0.4 ± 1.5 at 2-year follow-up). Statistical analysis demonstrated no statistically significant correlation between pre-arthrotomy/post-arthrotomy patellar blood flow and the presence of preoperative and

  15. Relationship between obesity and early failure of total knee prostheses

    PubMed Central

    Bordini, Barbara; Stea, Susanna; Cremonini, Sara; Viceconti, Marco; De Palma, Rossana; Toni, Aldo

    2009-01-01

    Background Obesity is a risk factor for knee arthritis. Total knee arthroplasty is the definitive surgical treatment of this disease. Therefore, a high percentage of subjects treated are overweight. Since 2000 in the Emilia-Romagna Region the Register of Orthopedic Prosthetic Implantology, RIPO, has recorded data of all the primary and revision operations performed on the knee; height and weight of patients at the time of surgery have also been recorded. Methods To understand how overweight and obesity affect the outcome of knee arthroplasty, a population of subjects treated with cemented total knee arthroplasty between 2000 and 2005 was studied. 9735 knee prostheses were implanted in 8892 patients; 18.9% of the patients were normal weight, 48.2% were overweight (25 < Body Mass Index <= 30), 31.1% were obese (30 < BMI <= 40), and 1.8% were morbidly obese (BMI > 40). Mean and range of follow-up were respectively 3.1 and 1.5–6 yrs. Implant failure was defined as the exchange of at least one component for whatever reason. Results In normal weight patients there were 36 failures out of 1840 implants (1.96%), in overweight patients there were 87 out of 4692 (1.85%), in obese 59 out of 3031 (1.94%), and in morbidly obese there were 4 out of 172 (2.3%). The mean time to failure for each class was 1.57, 1.48, 1.60, 1.77 yrs. Cox regression analyses showed that the risk of implant failure was not influenced by BMI, absolute body weight, or sex. Conversely, an increased failure risk was observed in mobile meniscus prostheses in comparison with those with a fixed meniscus (Rate Ratio 1.88); an increased failure risk was also related to age (Rate Ratio 1.05 per year). These results were also confirmed when considering septic loosening as the end-point. There were no differences in the rate of perioperative complications and death in the 4 classes of BMI. Conclusion In conclusion, cemented knee prostheses, implanted in patients with arthritis do not have significantly

  16. The effect of preoperative exercise on total knee replacement outcomes.

    PubMed

    D'Lima, D D; Colwell, C W; Morris, B A; Hardwick, M E; Kozin, F

    1996-05-01

    This study compared the effects of preoperative physical therapy of general cardiovascular conditioning exercises with the routine procedure of no preoperative physical therapy on patients undergoing primary total knee replacement. Thirty patients were randomly assigned to 1 of 3 groups. Group 1 was the control group. Group 2 participated in a physical therapy program designed to strengthen the upper and lower limbs and improve knee range of motion. Group 3 participated in a cardiovascular conditioning program, consisting of arm ergometry, cycle ergometry, aquatic exercises, and aerobic activity. All patients were evaluated preoperatively and postoperatively using the Hospital for Special Surgery Knee Rating, the Arthritis Impact Measurement Scale, and the Quality of Well Being instrument. Both experimental groups tolerated their respective exercise protocols extremely well. All 3 groups showed significant improvement postoperatively as measured by the Hospital for Special Surgery Knee Rating, the Arthritis Impact Measurement Scale and the Quality of Well Being measurement scales. However, neither type of preoperative exercise added to the degree of improvement after surgery at any of the postoperative evaluations.

  17. No clinical benefit of gender-specific total knee arthroplasty

    PubMed Central

    Zhu, Chen; Wang, Jiaxing; Cheng, Mengqi; Peng, Xiaochun; Wang, Qi; Zhang, Xianlong

    2014-01-01

    Background and purpose There is no consensus regarding the clinical relevance of gender-specific prostheses in total knee arthroplasty (TKA). We summarize the current best evidence in a comparison of clinical and radiographic outcomes between gender-specific prostheses and standard unisex prostheses in female patients. Methods We used the PubMed, Embase, Cochrane, Science Citation Index, and Scopus databases. We included randomized controlled trials published up to January 2013 that compared gender-specific prostheses with standard unisex prostheses in female patients who underwent primary TKAs. Results 6 trials involving 423 patients with 846 knee joints met the inclusion criteria. No statistically significant differences were observed between the 2 designs regarding pain, range of motion (ROM), knee scores, satisfaction, preference, complications, and radiographic results. The gender-specific design (Gender Solutions; Zimmer Inc, Warsaw, Indiana) reduced the prevalence of overhang. However, it had less overall coverage of the femoral condyles compared to the unisex group. In fact, the femoral prosthesis in the standard unisex group matched better than that in the gender-specific group. Interpretation Gender-specific prostheses do not appear to confer any benefit in terms of clinician- and patient-reported outcomes for the female knee. PMID:24954488

  18. Sagittal plane balancing in the total knee arthroplasty.

    PubMed

    Manson, Theodore T; Khanuja, Harpal S; Jacobs, Michael A; Hungerford, Marc W

    2009-01-01

    Postoperative stiffness or instability may result from a total knee arthroplasty imbalanced in the sagittal plane. Total knee arthroplasty instrumentation systems differ in the basic strategies used to assure this balance. In an anterior referencing system, changes in femoral size affect flexion gap tightness, and femoral size selection is paramount to assure sagittal plane balance. Conversely, in posterior referencing systems, femoral size changes do not affect the flexion gap but, rather, influence femoral component-patella articulation. Flexion/extension gap systems use calibrated spacer blocks to ensure gap balance but do not guarantee midrange stability; if used incorrectly, they may cause component malposition and joint line elevation. The authors reviewed the strengths and weaknesses of system types and provided system-specific troubleshooting guidelines for clinicians addressing intraoperative sagittal plane imbalance.

  19. Knee joint kinematics, fixation and function related to joint area design in total knee arthroplasty.

    PubMed

    Uvehammer, J

    2001-02-01

    The aim was to study the influence of different designs of the joint area on tibial component fixation, kinematics and clinical outcome after a cemented total knee arthroplasty (TKA). The HSS score and a special questionnaire were used at the clinical examination. Conventional radiography was done to record the positioning of the implants and development of radiolucencies. The migration and inducible displacement were evaluated using radiostereometry (RSA). The kinematics of the knee during active extension was studied using dynamic RSA. In randomised and prospective studies 87 knees in 83 patients (28 male, 55 female, age 69, range 50-83) received an AMK (DePuy, Johnson & Johnson) TKA. The patients were divided into two groups. In group 1 the patients had varus/valgus deformities of < or = 5 degrees and the PCL was retained. The PCL was resected in group 2 where the patients had deformities exceeding 5 degrees and/or fixed flexion deformities of more than 10 degrees. In group 1 a flat (F, n = 20) or a concave (C, n = 20) design was implanted (study 3). In group 2 (study 4) the patients received a concave (n = 25) or a posterior-stabilised (PS, n = 22) tibial plateau. The migration of the tibial component, positioning of the prosthesis, development of radiolucencies and the clinical outcome was evaluated after 1 and 2 years. Twenty-two patients (11 F, 11 C) in group 1 (study 1) and 22 knees in 20 patients in group 2 (study 2, 11 C, 11 PS) were examined 1 year post-operatively to evaluate the kinematics of the knee. Eleven normals served as controls. During active extension of the knee the inducible displacements of the tibial component were recorded in 16 knees (15 patients). Based on successful RSA examinations 5 knees (4 F, 1 C) from group 1 and 11 knees (5 C, 6 PS) from group 2 were selected (study 5). Abnormal kinematics and especially increased AP translations compared to normals (p < 0.0005) were recorded in all designs. The concave design showed the widest

  20. Anesthesia and analgesia protocols for total knee arthroplasty.

    PubMed

    Rosenberg, Aaron G

    2006-07-01

    Uncontrolled pain associated with total knee arthroplasty can have significant untoward effects on patient outcomes, leading to delayed recovery, inability to participate in rehabilitation, prolonged hospitalization, and increased use of health care resources. In this article, I review the methodologies and outcomes of several studies and protocols involving preemptive, perioperative, and postoperative use of various anesthetic and analgesic agents. Used together with minimally invasive techniques, appropriate pain control should result in significant improvements in patient outcomes.

  1. Does a standard outpatient physiotherapy regime improve the range of knee motion after primary total knee arthroplasty?

    PubMed

    Mockford, Brian James; Thompson, Neville W; Humphreys, Patricia; Beverland, David E

    2008-12-01

    The aim of this study was to investigate whether a standard course of outpatient physiotherapy improves the range of knee motion after primary total knee arthroplasty. One hundred and fifty patients were randomly assigned into one of 2 groups. One group received outpatient physiotherapy for 6 weeks (group A). Another received no outpatient physiotherapy (group B). Range of knee motion was measured preoperatively and at 1-year review. Validated knee scores and an SF-12 health questionnaire were also recorded. Although patients in group A achieved a greater range of knee motion than those in group B, this was not statistically significant. No difference either was noted in any of the outcome measures used. In conclusion, outpatient physiotherapy does not improve the range of knee motion after primary total knee arthroplasty.

  2. Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry.

    PubMed

    Myles, Christine M; Rowe, Philip J; Walker, Colin R C; Nutton, Richard W

    2002-08-01

    The functional ranges of movement of the knee were investigated in a group of patients with knee osteoarthritis (n = 42, mean age 70 years) before, 4 months and at 18-24 months after total knee arthroplasty and then compared with age matched normal subjects (n = 20, mean age 67 years). Flexible electrogoniometry was used to record the maximum flexion-extension angle, the minimum flexion-extension angle and flexion-extension excursions of both knees during eleven functional activities along with the active and passive knee joint range of motion measured using a manual goniometer. Over the eleven functional activities the patients pre-operatively exhibited 28% less knee joint excursion than normal age matched subjects. By 18-24 months following total knee arthroplasty only 2% of this deficit was recovered. Statistically this recovery was only significant in level walking, slope ascent and slope descent. A greater range of movement was measured in a non-weight bearing position than was used in weight bearing functional activity. It is concluded that total knee arthroplasty gives rise to little improvement in knee motion during functional activities and that functional range of movement of the knee remains limited when compared to normal knee function for a minimum of 18 months following operation.

  3. Knee joint distraction compared with total knee arthroplasty: a randomised controlled trial.

    PubMed

    van der Woude, J A D; Wiegant, K; van Heerwaarden, R J; Spruijt, S; Emans, P J; Mastbergen, S C; Lafeber, F P J G

    2017-01-01

    Knee joint distraction (KJD) is a relatively new, knee-joint preserving procedure with the goal of delaying total knee arthroplasty (TKA) in young and middle-aged patients. We present a randomised controlled trial comparing the two. The 60 patients ≤ 65 years with end-stage knee osteoarthritis were randomised to either KJD (n = 20) or TKA (n = 40). Outcomes were assessed at baseline, three, six, nine, and 12 months. In the KJD group, the joint space width (JSW) was radiologically assessed, representing a surrogate marker of cartilage thickness. In total 56 patients completed their allocated treatment (TKA = 36, KJD = 20). All patient reported outcome measures improved significantly over one year (p < 0.02) in both groups. At one year, the TKA group showed a greater improvement in only one of the 16 patient-related outcome measures assessed (p = 0.034). Outcome Measures in Rheumatology-Osteoarthritis Research Society International clinical response was 83% after TKA and 80% after KJD. A total of 12 patients (60%) in the KJD group sustained pin track infections. In the KJD group both mean minimum (0.9 mm, standard deviation (sd) 1.1) and mean JSW (1.2 mm, sd 1.1) increased significantly (p = 0.004 and p = 0.0003). In relatively young patients with end-stage knee osteoarthritis, KJD did not demonstrate inferiority of outcomes at one year when compared with TKA. However, there is a high incidence of pin track infection associated with KJD. Cite this article: Bone Joint J 2017;99-B:51-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

  4. [Patient expectations and satisfaction concerning total knee arthroplasty].

    PubMed

    Duivenvoorden, T; Verburg, H; Verhaar, J A N; Bierma-Zeinstra, S M A; Reijman, M

    2017-01-01

    Approximately 5-10% of patients is dissatisfied after a total knee arthroplasty. Several studies suggest that unrealistic expectations contribute to this; however, a systematic overview of the literature is missing. Systematic literature review METHOD: Using a systematic search strategy, prospective and retrospective studies with a follow-up of a minimum of six months, were obtained from PubMed publisher, MEDLINE, Embase, Cochrane, PsycINFO, CINAHL, and Web-of-Science. The search terms included 'total knee arthroplasty', 'preoperative expectations' and 'patient satisfaction'. Two reviewers independently selected the studies. Two reviewers independently conducted the quality assessment. Finally, a best evidence synthesis was performed. The search yielded 6802 studies, of which eight met the inclusion criteria. Limited evidence was found that there is no significant relation between expectations and satisfaction regarding limitations in recreation, walking distance, use of a walking aid and expected time to full recovery. Conflicting evidence was found that high expectations regarding general improvement, pain reduction and limitations in activities of daily living are associated with more dissatisfaction. Moderate evidence was found that patients with unfulfilled expectations were more often dissatisfied. Limited prospective research has been published on the relationship between expectations and patient satisfaction concerning total knee arthroplasty. The outcomes are very heterogenous and conclusions from these outcomes should be treated carefully. Future research needs to be more standardised and should utilise validated questionnaires.

  5. Myofascial pain in patients waitlisted for total knee arthroplasty

    PubMed Central

    Henry, Richard; Cahill, Catherine M; Wood, Gavin; Hroch, Jennifer; Wilson, Rosemary; Cupido, Tracy; VanDenKerkhof, Elizabeth

    2012-01-01

    BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA) in patients with osteoarthritis (OA). OBJECTIVES: To determine the presence of myofascial pain in OA patients waitlisted for TKA and to determine whether their knee pain may be alleviated by trigger point injections. METHODS: Following ethics approval, 25 participants were recruited from the wait list for elective unilateral primary TKA at the study centre. After providing informed consent, all participants were examined for the presence of active trigger points in the muscles surrounding the knee and received trigger point injections of bupivacaine. Assessments and trigger point injections were implemented on the first visit and at subsequent visits on weeks 1, 2, 4 and 8. Outcome measures included the Timed Up and Go test, Brief Pain Inventory, Centre for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory and Short-Form McGill Pain Questionnaire. RESULTS: Myofascial trigger points were identified in all participants. Trigger point injections significantly reduced pain intensity and pain interference, and improved mobility. All participants had trigger points identified in medial muscles, most commonly in the head of the gastrocnemius muscle. An acute reduction in pain and improved functionality was observed immediately following intervention, and persisted over the eight-week course of the investigation. CONCLUSION: All patients had trigger points in the vastus and gastrocnemius muscles, and 92% of patients experienced significant pain relief with trigger point injections at the first visit, indicating that a significant proportion of the OA knee pain was myofascial in origin. Further investigation is warranted to determine the prevalence of myofascial pain and whether treatment delays or prevents TKA. PMID:23061082

  6. Periprosthetic tibial bone mineral density changes after total knee arthroplasty

    PubMed Central

    Jaroma, Antti; Soininvaara, Tarja; Kröger, Heikki

    2016-01-01

    Background and purpose Total knee arthroplasty (TKA) may cause postoperative periprosthetic bone loss due to stress shielding. Bone also adapts to mechanical alterations such as correction of malalignment. We investigated medium-term changes in bone mineral density (BMD) in tibial periprosthetic bone after TKA. Patients and methods 86 TKA patients were prospectively measured with dual-energy X-ray absorptiometry (DXA), the baseline measurement being within 1 week after TKA and the follow-up measurements being at 3 and 6 months, and at 1, 2, 4, and 7 years postoperatively. Long standing radiographs were taken and clinical evaluation was done with the American Knee Society (AKS) score. Results The baseline BMD of the medial tibial metaphyseal region of interest (ROI) was higher in the varus aligned knees (25%; p < 0.001). Medial metaphyseal BMD decreased in subjects with preoperatively varus aligned knees (13%, p < 0.001) and in those with preoperatively valgus aligned knees (12%, p = 0.02) between the baseline and 7-year measurements. No statistically significant changes in BMD were detected in lateral metaphyseal ROIs. No implant failures or revision surgery due to tibial problems occurred. Interpretation Tibial metaphyseal periprosthetic bone is remodeled after TKA due to mechanical axis correction, resulting in more balanced bone stock below the tibial tray. The diaphyseal BMD remains unchanged after the initial drop, within 3–6 months. This remodeling process was related to good component survival, as there were no implant failures or revision operations due to tibial problems in this medium-term follow-up. PMID:27120266

  7. Periprosthetic tibial bone mineral density changes after total knee arthroplasty.

    PubMed

    Jaroma, Antti; Soininvaara, Tarja; Kröger, Heikki

    2016-06-01

    Background and purpose - Total knee arthroplasty (TKA) may cause postoperative periprosthetic bone loss due to stress shielding. Bone also adapts to mechanical alterations such as correction of malalignment. We investigated medium-term changes in bone mineral density (BMD) in tibial periprosthetic bone after TKA. Patients and methods - 86 TKA patients were prospectively measured with dual-energy X-ray absorptiometry (DXA), the baseline measurement being within 1 week after TKA and the follow-up measurements being at 3 and 6 months, and at 1, 2, 4, and 7 years postoperatively. Long standing radiographs were taken and clinical evaluation was done with the American Knee Society (AKS) score. Results - The baseline BMD of the medial tibial metaphyseal region of interest (ROI) was higher in the varus aligned knees (25%; p < 0.001). Medial metaphyseal BMD decreased in subjects with preoperatively varus aligned knees (13%, p < 0.001) and in those with preoperatively valgus aligned knees (12%, p = 0.02) between the baseline and 7-year measurements. No statistically significant changes in BMD were detected in lateral metaphyseal ROIs. No implant failures or revision surgery due to tibial problems occurred. Interpretation - Tibial metaphyseal periprosthetic bone is remodeled after TKA due to mechanical axis correction, resulting in more balanced bone stock below the tibial tray. The diaphyseal BMD remains unchanged after the initial drop, within 3-6 months. This remodeling process was related to good component survival, as there were no implant failures or revision operations due to tibial problems in this medium-term follow-up.

  8. Compartment syndrome after total knee arthroplasty: regarding a clinical case.

    PubMed

    Pinheiro, Ana Alexandra da Costa; Marques, Pedro Miguel Dantas Costa; Sá, Pedro Miguel Gomes; Oliveira, Carolina Fernandes; da Silva, Bruno Pombo Ferreira; de Sousa, Cristina Maria Varino

    2015-01-01

    Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury.

  9. Compartment syndrome after total knee arthroplasty: regarding a clinical case☆

    PubMed Central

    Pinheiro, Ana Alexandra da Costa; Marques, Pedro Miguel Dantas Costa; Sá, Pedro Miguel Gomes; Oliveira, Carolina Fernandes; da Silva, Bruno Pombo Ferreira; de Sousa, Cristina Maria Varino

    2015-01-01

    Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury. PMID:26401507

  10. Total ruptures of the extensor apparatus of the knee.

    PubMed

    Moura, Diogo; Fonseca, Fernando

    2016-01-01

    This was a retrospective case-control study on total ruptures of the extensor apparatus of the knee, aimed to compare patella fractures with tendinous ruptures. The sample included 190 patients and 198 total ruptures of the knee extensor apparatus. All patients were evaluated by the same examiner after a minimum one-year follow-up. Tendinous ruptures occurred most frequently in men, in younger patients, and had better clinical and functional outcomes when compared with patella fractures; however, the former presented higher levels of thigh atrophy. Patella fractures occurred most frequently in women and in older patients and caused most frequently caused residual pain, muscle weakness, and limitations in daily activities. Comminuted fractures were related to high-energy trauma, lower clinical and functional outcomes, and higher levels of residual pain and osteosynthesis failure. Early removal of osteosynthesis material was related to better outcomes. Regarding the tendinous ruptures, over half of the patients presented risk conditions for tendinous degeneration; a longer delay until surgery was related to lower Kujala scores. The surgical repair of bilateral ruptures of the knee extensor apparatus resulted in satisfactory clinical and functional outcomes, which were better for tendinous ruptures when compared with patella fractures. However, these lesions are associated with non-negligible levels of residual pain, muscle weakness, atrophy, and other complications.

  11. [Efficacy and safety of drainage after total knee arthroplasty].

    PubMed

    Jing, F; Li, H M; Yang, X D; Li, B; Ji, J; Li, Y L; Sun, C J

    2017-07-18

    Objective: To determine whether suction drainage is safe and effective compared with no-drainage in total knee arthroplasty. Methods: The literature search was based on PubMed, MEDLINE, EMBASE, Highwire, the Cochrane Library, CBM, CNKI, VIP and WFSD.The data were analysed using RevMan 5.3.Fourteen randomised controlled trials involving 1 009 knees were included in our analysis. Results: Suction drainage increases the rate and volume of blood transfusion.No-drainage group increases the rate of wound problems (OR=1.92, 95%CI 1.21-3.04, P<0.05). No significant difference was observed in the incidence of periprosthetic infection (OR=0.68, 95%CI 0.20-2.30, P=0.54), VAS (OR=-0.09, 95%CI -0.32-0.14, P=0.46) and the length of stay (OR=0.41, 95%CI -0.21-1.03; P=0.19) when the drainage group was compared with the no-drainage group (P>0.05). Conclusions: No-drainage for easy total knee arthroplasty may be a better choice. However, orthopedic surgeon need to weigh the pros and cons of no-drainage in some complicated TKAs such as extra-articular deformity .

  12. Finite element analysis of constrained total Condylar Knee Prosthesis

    SciTech Connect

    1998-07-13

    Exactech, Inc., is a prosthetic joint manufacturer based in Gainesville, FL. The company set the goal of developing a highly effective prosthetic articulation, based on scientific principles, not trial and error. They developed an evolutionary design for a total knee arthroplasty system that promised improved performance. They performed static load tests in the laboratory with similar previous designs, but dynamic laboratory testing was both difficult to perform and prohibitively expensive for a small business to undertake. Laboratory testing also cannot measure stress levels in the interior of the prosthesis where failures are known to initiate. To fully optimize their designs for knee arthroplasty revisions, they needed range-of-motion stress/strain data at interior as well as exterior locations within the prosthesis. LLNL developed computer software (especially NIKE3D) specifically designed to perform stress/strain computations (finite element analysis) for complex geometries in large displacement/large deformation conditions. Additionally, LLNL had developed a high fidelity knee model for other analytical purposes. The analysis desired by Exactech could readily be performed using NIKE3D and a modified version of the high fidelity knee that contained the geometry of the condylar knee components. The LLNL high fidelity knee model was a finite element computer model which would not be transferred to Exactech during the course of this CRADA effort. The previously performed laboratory studies by Exactech were beneficial to LLNL in verifying the analytical capabilities of NIKE3D for human anatomical modeling. This, in turn, gave LLNL further entree to perform work-for-others in the prosthetics field. There were two purposes to the CRADA (1) To modify the LLNL High Fidelity Knee Model to accept the geometry of the Exactech Total Knee; and (2) To perform parametric studies of the possible design options in appropriate ranges of motion so that an optimum design could be

  13. Anatomic Versus Mechanically Aligned Total Knee Arthroplasty for Unicompartmental Knee Arthroplasty Revision

    PubMed Central

    Toliopoulos, Panagiota; LeBlanc, Marc-Andre; Hutt, Jonathan; Lavigne, Martin; Desmeules, Francois; Vendittoli, Pascal-Andre

    2016-01-01

    Objectives: The purpose of this study was to compare the intra-operative benefits and the clinical outcomes from kinematic or mechanical alignment for total knee arthroplasty (TKA) in patients undergoing revision of failed unicompartmental kneel arthroplasty (UKA) to TKA. Methods: Ten revisions were performed with a kinematic alignment technique and 11 with a mechanical alignment. Measurements of the hip-knee-ankle angle (HKA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) were performed using long-leg radiographs. The need for augments, stems, and constrained inserts was compared between groups. Clinical outcomes were compared using the WOMAC score along with maximum distance walked as well as knee range of motion obtained prior to discharge. All data was obtained by a retrospective review of patient files. Results: The kinematic group required less augments, stems, and constrained inserts than the mechanical group and thinner polyethylene bearings. There were significant differences in the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) between the two groups (p<0.05). The mean WOMAC score obtained at discharge was better in the kinematic group as was mean knee flexion. At last follow up of 34 months for the kinematic group and 58 months for the mechanical group, no orthopedic complications or reoperations were recorded. Conclusion: Although this study has a small patient cohort, our results suggest that kinematic alignment for TKA after UKA revision is an attractive method. Further studies are warranted. PMID:27563365

  14. Total Knee Arthroplasty for Knee Osteoarthritis: Support for a Foregone Conclusion?

    PubMed

    Steinhaus, Michael E; Christ, Alexander B; Cross, Michael B

    2017-07-01

    Total knee arthroplasty (TKA) is generally accepted as the definitive treatment for advanced knee arthritis after patients fail nonoperative treatments; however, the safety and efficacy of TKA compared to continued nonoperative treatment has never been proven in high-quality, randomized controlled trials. Recently, a 2015 Danish study published a 12-month follow-up on a cohort of patients randomized to either a TKA or continued nonsurgical management for advanced knee osteoarthritis (OA). The authors reported significantly greater improvement in the TKA group in functional outcome scores such as the overall Knee Injury and Osteoarthritis Outcome Score (KOOS4 score), the KOOS subscales, EQ-5D descriptive index, and timed get up-and-go and 20-m walk tests; however, patients in the TKA did suffer significantly more serious adverse events (SAE). The authors concluded that TKA combined with additional nonoperative care postoperatively is more efficacious than nonsurgical treatment alone in terms of improving pain, function, and quality of life at 12 months but is associated with more SAE. The purpose of this review is to identify the strengths and weaknesses of this trial, interpret its outcomes within the context of prior literature, and evaluate the validity of its conclusions.

  15. Mechanical thromboembolic prophylaxis with risk stratification in total knee arthroplasty.

    PubMed

    Hamilton, William G; Reeves, James D; Fricka, Kevin B; Goyal, Nitin; Engh, Gerard A; Parks, Nancy L

    2015-01-01

    The purpose of this study was to determine the rate of thromboembolic and bleeding complications when using mechanical prophylaxis with preoperative risk stratification following total knee arthroplasty (TKA). Between 1994 and 2007, 4037 TKAs were performed on 3144 patients at our institution. Mechanical VTE prophylaxis was used for standard risk patients, which included AV impulse foot pumps, thigh high stockings, and early mobilization. Chemoprophylaxis was only given to patients who were at increased thromboembolic risk. The incidence of DVT identified by ultrasound following TKA was 2.1%. A retrospective review showed 1 patient had a fatal pulmonary embolism, and 5 patients had bleeding complications in the knee. We conclude that mechanical thromboembolic prophylaxis using risk stratification is safe and effective following TKA. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. [Soft tissue balancing in total condylar knee arthroplasty].

    PubMed

    Trepte, C T; Pfanzelt, K

    2003-01-01

    Soft tissue balancing and correct bone cuts are an entity in correcting malalignment in total knee arthroplasty, and cannot be considered isolated. Distinct bony deformations/deviations need enlarged soft tissue management. The extent of resection of the bone stock has to be planned exactly before the operation. Exact soft tissue balancing is necessary to stabilize the corrected knee. Soft tissue balancing has to be done primarily on the side of the contracture by lengthening of the shortened and contracted structures. After balancing the ligaments should have the same tension in extension and flexion together with the same height of the extension and flexion gap. Because of the classic resection of the tibial head, the femoral resection must follow the Insall-Line, that means 3 degrees to 5 degrees outer rotation in relation to the condyles. Only in this way a symmetric flexion gap can be achieved in combination with ligamentous stability in extension and flexion.

  17. [Pain following primary total knee replacement: causes, diagnosis and treatment].

    PubMed

    van Geene, Arnoud R; Saris, Daniël B F; Custers, Roel J H

    2015-01-01

    Total knee prosthesis (TKP) placement is a successful treatment for patients with disabling osteoarthritis of the knee. Despite good results, there is a large group of patients who are not satisfied following the procedure. Men, young patients and patients with chronic pain are more often satisfied after TKP placement, as are patients with a higher social status, better mental-health status and lower preoperative pain scores. The diagnostic workup for patients suffering pain after TKP placement is labour intensive, and should be carried out in a systematic manner. Treatment of pain varies per individual, ranging from medication and physiotherapy to revision surgery. There is limited data on how many patients do actually experience pain reduction following treatment.

  18. Comparative responsiveness of outcome measures for total knee arthroplasty

    PubMed Central

    Giesinger, K.; Hamilton, D.F.; Jost, B.; Holzner, B.; Giesinger, J.M.

    2014-01-01

    Summary Objective The aim of this study was to compare the responsiveness of various patient-reported outcome measures (PROMs) and clinician-reported outcomes following total knee arthroplasty (TKA) over a 2-year period. Methods Data were collected in a prospective cohort study of primary TKA. Patients who had completed Forgotten Joint Score-12 (FJS-12), Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index, EQ-5D, Knee Society Score and range of movement (ROM) assessment were included. Five time points were assessed: pre-operative, 2 months, 6 months, 1 year and 2 years post-operative. Results Data from 98 TKAs were available for analysis. Largest effect sizes (ES) for change from pre-operative to 2-month follow-up were observed for the Knee Society Score (KSS) Knee score (1.70) and WOMAC Total (−1.50). For the period from 6 months to 1 year the largest ES for change were shown by the FJS-12 (0.99) and the KSS Function Score (0.88). The EQ-5D showed the strongest ceiling effect at 1-year follow-up with 84.4% of patients scoring the maximum score. ES for the time from 1- to 2-year follow-up were largest for the FJS-12 (0.50). All other outcome measures showed ES equal or below 0.30. Conclusion Outcome measures differ considerably in responsiveness, especially beyond one year post-operatively. Joint-specific outcome measures are more responsive than clinician-reported or generic health outcome tools. The FJS-12 was the most responsive of the tools assessed; suggesting that joint awareness may be a more discerning measure of patient outcome than traditional PROMs. PMID:24262431

  19. Data Collection and Analysis Using Wearable Sensors for Monitoring Knee Range of Motion after Total Knee Arthroplasty.

    PubMed

    Chiang, Chih-Yen; Chen, Kun-Hui; Liu, Kai-Chun; Hsu, Steen Jun-Ping; Chan, Chia-Tai

    2017-02-22

    Total knee arthroplasty (TKA) is the most common treatment for degenerative osteoarthritis of that articulation. However, either in rehabilitation clinics or in hospital wards, the knee range of motion (ROM) can currently only be assessed using a goniometer. In order to provide continuous and objective measurements of knee ROM, we propose the use of wearable inertial sensors to record the knee ROM during the recovery progress. Digitalized and objective data can assist the surgeons to control the recovery status and flexibly adjust rehabilitation programs during the early acute inpatient stage. The more knee flexion ROM regained during the early inpatient period, the better the long-term knee recovery will be and the sooner early discharge can be achieved. The results of this work show that the proposed wearable sensor approach can provide an alternative for continuous monitoring and objective assessment of knee ROM recovery progress for TKA patients compared to the traditional goniometer measurements.

  20. Data Collection and Analysis Using Wearable Sensors for Monitoring Knee Range of Motion after Total Knee Arthroplasty

    PubMed Central

    Chiang, Chih-Yen; Chen, Kun-Hui; Liu, Kai-Chun; Hsu, Steen Jun-Ping; Chan, Chia-Tai

    2017-01-01

    Total knee arthroplasty (TKA) is the most common treatment for degenerative osteoarthritis of that articulation. However, either in rehabilitation clinics or in hospital wards, the knee range of motion (ROM) can currently only be assessed using a goniometer. In order to provide continuous and objective measurements of knee ROM, we propose the use of wearable inertial sensors to record the knee ROM during the recovery progress. Digitalized and objective data can assist the surgeons to control the recovery status and flexibly adjust rehabilitation programs during the early acute inpatient stage. The more knee flexion ROM regained during the early inpatient period, the better the long-term knee recovery will be and the sooner early discharge can be achieved. The results of this work show that the proposed wearable sensor approach can provide an alternative for continuous monitoring and objective assessment of knee ROM recovery progress for TKA patients compared to the traditional goniometer measurements. PMID:28241434

  1. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty.

    PubMed

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty.

  2. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty

    PubMed Central

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    Background: This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. Method: We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. Findings: The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Interpretation: Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty. PMID:27347334

  3. Recovery in knee range of motion reaches a plateau by 12 months after total knee arthroplasty.

    PubMed

    Zhou, Zhihong; Yew, Khye Soon Andy; Arul, Earnest; Chin, Pak-Lin; Tay, Keng Jin Darren; Lo, Ngai-Nung; Chia, Shi-Lu; Yeo, Seng Jin

    2015-06-01

    The primary aim of this study was to identify the time point at which improvements in knee range of motion reach a plateau, if any. The secondary aim of this study was to investigate the correlation between the improvements in knee range of motion and patient-reported outcomes [Oxford knee score (OKS) and SF-36]. The hypothesis is that there is a time point at which the recovery in the knee range of motion after total knee arthroplasty (TKA) plateaus. A prospective study of 145 patients who underwent TKA was conducted. All TKAs were performed by the same surgeon. OKS and SF-36 scores were measured preoperatively and at 6, 12, and 24 months. Range of motion was measured preoperatively and at 1, 3, 6, 12, and 24 months postoperatively. This study shows that for surgeon/therapist reported range of motion, a plateau in recovery was reached at 12 months after TKA. It was also found that range of extension is significantly correlated with OKS, whereas range of flexion was not significantly correlated with OKS. Knowledge of when patients fully recover after TKA will allow appropriate counseling of patients during preoperative consultation. Also, this knowledge will enable surgeons/therapists to better monitor the rehabilitation progress of TKA patients, and make adjustments to the rehabilitation protocol. In addition, our study shows that objective surgeon-/therapist-measured outcome (range of motion) has a significant correlation with subjective patient-reported outcomes (OKS). Hence, both outcome measures should be employed in the postoperative monitoring of patient progress. Prospective case series, Level IV.

  4. Outcome following total knee arthroplasty in obese versus non-obese Asian patients.

    PubMed

    Goh, Graham Seow-Hng; Liow, Ming Han Lincoln; Mitra, Amit Kanta

    2015-12-01

    To compare the outcome following total knee arthroplasty (TKA) in obese and non-obese Asian patients. 27 obese patients were compared with 27 non-obese controls matched for age, gender, diagnosis (osteoarthritis), prosthesis, preoperative Knee Society knee and function scores, preoperative Oxford Knee Score, and follow-up duration. All TKAs were performed by a single surgeon. Patients were assessed at 6 months and 2 years for the range of motion, Knee Society knee and function scores, Oxford Knee Score, and Short Form-36 Health Survey (SF-36). The obese and non-obese groups did not differ significantly in pre- and post-operative variables: range of motion, Knee Society knee and function scores, Oxford Knee Score, and SF-36 score. Using revision as an end-point, implant survival was 100%. There were no intra- or post-operative complications in either group. Obese and non-obese Asian patients achieved a comparable outcome following TKA.

  5. Pseudo-patella baja after total knee arthroplasty.

    PubMed

    Kazemi, Seyyed Morteza; Daftari Besheli, Laleh; Eajazi, Alireza; Miniator Sajadi, Mohammad Reza; Okhovatpoor, Mohammad Ali; Farhang Zanganeh, Ramin; Minaei, Reza

    2011-05-01

    One of the complications of total knee arthroplasty (TKA) which has not yet been directly addressed is pseudo-patella baja (PPB). True patella baja (PB) is present when the length of the patellar tendon becomes shorter. PPB is present when the patella tendon is not shortened, but the level of the joint line is elevated. This study was conducted to assess PPB in TKA. Sixty patients who had had a primary TKA at our center between 1995 and 2005 were included. The average follow-up was 27.5 months. The Knee Society Scoring (KSS), lateral knee x-rays and the Blackburne-Peel index were used for assessments. Out of the 60 patients, 43 (72%) demonstrated no joint line elevation or patellar tendon shortening (group A). Fifteen patients (25%) had joint line elevation (group B), and both PB and PPB were present in 2 (3%) patients (group C). KSS was lower in groups B and C compared with group A, but this difference was not statistically significant. The average range of motion (ROM) in group A was significantly higher compared with either group B or C, and patients in groups B and C showed significantly more severe pain compared with group A (P<0.001). PPB is not an uncommon finding after TKA and is associated with a statistically significant decrease in ROM and an increase in pain. Furthermore, KSS in the PPB group was less than in patients without PPB, although the difference was not statistically meaningful.

  6. Modern perceptions and expectations regarding total knee arthroplasty.

    PubMed

    Meneghini, Robert Michael; Russo, Glenn S; Lieberman, Jay R

    2014-04-01

    It is established that patients and surgeons share different perceptions regarding total knee replacement (TKA). This study's objective was to determine patient perceptions regarding TKA as well as the influence of the various information sources in shaping these perceptions. All patients presenting with knee pain for evaluation of TKA were offered a questionnaire. Multivariate statistical analysis correlated response and demographic variables. Approximately 81% of patients felt the main reason for TKA was to alleviate pain, whereas only 19% felt return to sports-related activities was the main reason. Approximately 37% of patients felt TKAs should last for 20 years or more, which was strongly correlated with TV, newspaper, or Internet exposure (p ≤ 0.01). Approximately 38% of respondents had heard of partial knee replacement, whereas relatively few had received information regarding patient-specific, gender-specific, mobile-bearing, or high-flexion TKA designs. Men were likelier than women to get their information from friends, family, or another patient (p = 0.04). Although most respondents perceived pain relief as the primary goal, patients getting information from the media are likelier to expect TKA to last longer than 20 years. This suggests direct-to-patient marketing with such claims as 30-year durability may influence patient perceptions regarding TKA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  7. Fibrosis is a common outcome following total knee arthroplasty.

    PubMed

    Abdul, Nicole; Dixon, David; Walker, Andrew; Horabin, Joanna; Smith, Nick; Weir, David J; Brewster, Nigel T; Deehan, David J; Mann, Derek A; Borthwick, Lee A

    2015-11-10

    Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures that alleviates pain and restores function in patients with degenerative knee joint diseases. Arthrofibrosis, abnormal scarring in which dense fibrous tissue prevents normal range of motion, develops in ~3-10% of TKA patients. No prophylactic intervention is available and treatment is restricted to aggressive physiotherapy or revision surgery. Tissue was collected from patients undergoing primary (n = 30) or revision (n = 27) TKA. Revision patients were stratified as non-arthrofibrotic and arthrofibrotic. Tissue was macroscopically and histologically compared to improve our understanding of the pathophysiology of arthrofibrosis. Macroscopically, tissue from primary TKA presents as homogenous, fatty tissue whereas tissue from revision TKA presents as dense, pigmented tissue. Histologically, there was dramatic tissue remodelling, increased collagen deposition and increased (myo)fibroblast staining in tissue from revision TKA. Significantly, tissue architecture was similar between revision patients regardless of clinically diagnosis. There are significant differences in architecture and composition of tissue from revision TKA over primary TKA. Surprisingly, whether revision TKA were clinically diagnosed as arthrofibrotic or non-arthrofibrotic there were still significant differences in fibrotic markers compared to primary TKA suggesting an ongoing fibrotic process in all revision knees.

  8. Fibrosis is a common outcome following total knee arthroplasty

    PubMed Central

    Abdul, Nicole; Dixon, David; Walker, Andrew; Horabin, Joanna; Smith, Nick; Weir, David J.; Brewster, Nigel T.; Deehan, David J.; Mann, Derek A.; Borthwick, Lee A.

    2015-01-01

    Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures that alleviates pain and restores function in patients with degenerative knee joint diseases. Arthrofibrosis, abnormal scarring in which dense fibrous tissue prevents normal range of motion, develops in ~3–10% of TKA patients. No prophylactic intervention is available and treatment is restricted to aggressive physiotherapy or revision surgery. Tissue was collected from patients undergoing primary (n = 30) or revision (n = 27) TKA. Revision patients were stratified as non-arthrofibrotic and arthrofibrotic. Tissue was macroscopically and histologically compared to improve our understanding of the pathophysiology of arthrofibrosis. Macroscopically, tissue from primary TKA presents as homogenous, fatty tissue whereas tissue from revision TKA presents as dense, pigmented tissue. Histologically, there was dramatic tissue remodelling, increased collagen deposition and increased (myo)fibroblast staining in tissue from revision TKA. Significantly, tissue architecture was similar between revision patients regardless of clinically diagnosis. There are significant differences in architecture and composition of tissue from revision TKA over primary TKA. Surprisingly, whether revision TKA were clinically diagnosed as arthrofibrotic or non-arthrofibrotic there were still significant differences in fibrotic markers compared to primary TKA suggesting an ongoing fibrotic process in all revision knees. PMID:26553967

  9. Allergy in Total Knee Replacement. Does It Exist?: Review Article.

    PubMed

    Faschingbauer, Martin; Renner, Lisa; Boettner, Friedrich

    2017-02-01

    There is little data on whether preexisting allergies to implant materials and bone cement have an impact on the outcome of TKA. This review article analyzes the current literature to evaluate the prevalence and importance of metal and cement allergies for patients undergoing total knee arthroplasty. A review of the literature was performed using the following search criteria: "knee," "arthroplasty," and "allergy" as well as "knee," "arthroplasty," and "hypersensitivity." One hundred sixteen articles were identified on PubMed, Seventy articles could be excluded by reviewing the title and abstract leaving 46 articles to be included for this review. The majority of the studies cited patch testing as the gold standard for screening and diagnosis of hypersensitivity following TKA. There is consensus that patients with self-reported allergies against metals or bone cement and positive patch test should be treated with hypoallergenic materials or cementless TKA. Treatment options include the following: coated titanium or cobalt-chromium implants, ceramic, or zirconium oxide implants. Allergies against implant materials and bone cement are rare. Patch testing is recommended for patients with self-reported allergies. The use of special implants is recommended for patients with a confirmed allergy.

  10. Cryotherapy Treatment After Unicompartmental and Total Knee Arthroplasty: A Review.

    PubMed

    Chughtai, Morad; Sodhi, Nipun; Jawad, Michael; Newman, Jared M; Khlopas, Anton; Bhave, Anil; Mont, Michael A

    2017-07-21

    Cryotherapy is widely utilized to enhance recovery after knee surgeries. However, the outcome parameters often vary between studies. Therefore, the purpose of this review is to compare (1) no cryotherapy vs cryotherapy; (2) cold pack cryotherapy vs continuous flow device cryotherapy; (3) various protocols of application of these cryotherapy methods; and (4) cost-benefit analysis in patients who had unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). A search for "knee" and "cryotherapy" using PubMed, EBSCO Host, and SCOPUS was performed, yielding 187 initial reports. After selecting for RCTs relevant to our study, 16 studies were included. Of the 8 studies that compared the immediate postoperative outcomes between patients who did and did not receive cryotherapy, 5 studies favored cryotherapy (2 cold packs and 3 continuous cold flow devices). Of the 6 studies comparing the use of cold packs and continuous cold flow devices in patients who underwent UKA or TKA, 3 favor the use of continuous flow devices. There was no difference in pain, postoperative opioid consumption, or drain output between 2 different temperature settings of continuous cold flow device. The optimal device to use may be one that offers continuous circulating cold flow, as there were more studies demonstrating better outcomes. In addition, the pain relieving effects of cryotherapy may help minimize pain medication use, such as with opioids, which are associated with numerous potential side effects as well as dependence and addiction. Meta-analysis on the most recent RCTs should be performed next. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Location of the ankle center for total knee arthroplasty.

    PubMed

    Asada, Shigeki; Mori, Shigeshi; Inoue, Shinji; Tsukamoto, Ichiroh; Akagi, Masao

    2017-01-01

    The purpose of this study was to investigate the ankle center position as determined from the malleoli for total knee arthroplasty (TKA). We retrospectively analyzed computed tomography data from 102 patients with osteoarthritic knees. The tibial anteroposterior (AP) axis and transmalleolar axis (TMA) were used as rotational reference axes of the knee and ankle joint, respectively. With these axes, we regarded the offset distance from the intermalleolar midpoint as the position of the ankle center and investigated any angular osteotomy errors on the proximal tibia when the ankle center was assumed to the intermalleolar midpoint. The mean offset distances relative to the tibial AP axis were 1.8±0.9mm medial and 4.2±1.2mm anterior, and the distances relative to the TMA were 3.0±0.9 and 3.6±1.1mm in the coronal and sagittal planes, respectively. Mean angular osteotomy errors were 0.3±0.2° in the coronal plane and 0.8±0.2° in the sagittal plane. The ankle center was located around the intermalleolar midpoint. The position of the ankle center observed along the knee reference axis further approached the intermalleolar midpoint than when observed along the ankle reference axis in the coronal plane, but not in the sagittal plane. And the coronal angular osteotomy error was smaller than the sagittal error. Therefore, the intermalleolar midpoint in the coronal plane is a reliable landmark for the ankle center during TKA. However, surgeons should be cognizant of this sagittal angular error. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Bilateral total knee arthroplasty: One mobile-bearing and one fixed-bearing.

    PubMed

    Chiu, K Y; Ng, T P; Tang, W M; Lam, P

    2001-06-01

    We compared the early results of mobile-bearing knee prosthesis with fixed-bearing knee prosthesis in 16 patients who had one-stage, sequential, bilateral replacements. In each patient, a Low Contact Stress (LCS, Depuy) rotating-platform prosthesis was inserted in one side, and an Anatomic Modular Knee (AMK, Depuy) posterior-stabilised prosthesis was inserted in the other side. The same surgical routines were adopted for both sides in each patient. There were significant improvements in the Knee Society knee score and functional score, as well as the Oxford Knee score after both mobile-bearing and fixed-bearing knee replacements (p<0.001). However, we could not find any significant difference between the clinical results of the two prostheses. The authors early experience with the mobile-bearing total knee prosthesis was as favourable as the medium-term experience of the fixed-bearing total knee prosthesis in this prospective, match-pair study.

  13. Algorithmic pie-crusting of the medial collateral ligament guided by sensing technology affects the use of constrained inserts during total knee arthroplasty.

    PubMed

    Amundsen, Spencer; Lee, Yuo-Yu; González Della Valle, Alejandro

    2017-06-01

    Intra-operative sensing technology is an alternative to standard techniques in total knee arthroplasty (TKA) for determining balance by providing quantitative analysis of loads and point of contact throughout a range of motion. We used intra-operative sensing (VERASENSE-OrthoSensor, Inc.) to examine pie-crusting release of the medial collateral ligament in knees with varus deformity (study group) in comparison to a control group where balance was obtained using a classic release technique and assessed using laminar spreaders, spacer blocks, manual stress, and a ruler. The surgery was performed by a single surgeon utilizing measured resection and posterior-stabilized, cemented implants. Seventy-five study TKAs were matched 1:3 with 225 control TKAs. Outcome variables included the use of a constrained insert, functional- and knee-specific Knee Society score (KSS) at six weeks, four months, and one year post-operatively. Outcomes were analyzed in a multivariate model controlling for age, sex, BMI, and severity of deformity. The use of a constrained insert was significantly lower in the study group (5.3 vs. 13.8%; p = 0.049). The use of increased constraint was not significant between groups with increasing deformity. There was no difference in functional KSS and knee-specific KSS between groups at any follow-up interval. An algorithmic pie-crusting technique guided by intra-operative sensing is associated with decreased use of constrained inserts in TKA patients with a pre-operative varus deformity. This may cause a positive shift in value and cost savings.

  14. Gelatin matrix use reduces postoperative bleeding after total knee arthroplasty.

    PubMed

    Velyvis, John H

    2015-02-01

    Bleeding after total knee arthroplasty can result in significant morbidity and increases the need for blood transfusion. The proper use of intraoperative adjunctive topical hemostatic agents can enhance hemostasis perioperatively, potentially reducing blood transfusions. In this prospective study, 157 consecutive patients undergoing primary total knee arthroplasty received FLOSEAL (FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, California), a gelatin thrombin hemostatic matrix, 5 mL (74 patients) or 10 mL (83 patients). All patients received warfarin as thromboprophylaxis starting the day after surgery. Data were extracted via hospital chart review from 100 consecutive patients who underwent total knee arthroplasty and immediately preceded the FLOSEAL groups and did not receive FLOSEAL (control group). Postoperative drainage was significantly lower in the FLOSEAL 5 mL (236.9 mL) and 10 mL (120.5 mL) groups compared with the control group (430.8 mL; P<.0001 for both). The FLOSEAL 10 mL group had significantly less drainage than the FLOSEAL 5 mL group (P<.0001). The predicted probability of transfusion in the FLOSEAL 5 mL group was not significantly different compared with the control group (6.0% vs 7.6%, P=.650). The predicted probability of transfusion was lower in the FLOSEAL 10 mL group compared with the control group (0.5% vs 5.5%; P=.004). Within the FLOSEAL 10 mL group, application of FLOSEAL either before or after tourniquet release had a similarly significant effect on drainage volume and predicted probability of blood transfusion. No differences in outcomes were observed by type of anesthesia used. No adverse events occurred related to FLOSEAL use.

  15. Wear testing of materials and surfaces for total knee replacement.

    PubMed

    Walker, P S; Blunn, G W; Lilley, P A

    1996-01-01

    A simple wear test was investigated for evaluating the wear and damage of material pairs when used in total knee replacement. The test consisted of an axially loaded metallic femoral indentor and a reciprocating ultrahigh molecular weight polyethylene (UHMWPE) flat disk that represented the tibial component. A number of variables were studied including the effect of conformity by varying the radii of the femoral surface, distilled water or serum as a lubricant, different femoral materials, and different types of UHMWPE. In general, the different morphologies of the surface wear of the UHMWPE were similar to those seen on retrieved total knee replacements. Increased conformity with a cylindrical indentor gave a reduced wear rate initially, compared with that of the lower conformity spherical indentor. However, the wear rates were similar subsequent to this initial wearing in phase. Transfer films of UHMWPE were observed on the cobalt-chrome indentors for both serum and distilled water lubrication, although this film was more extensive for distilled water. The lowest wear rate was observed when oxidized zirconium was used on the femoral side, which was attributed to greater wettability, surface hardness, and immunity to oxidative wear. Tests using cobalt-chrome femoral cylinders and different grades of UHMWPE showed different wear rates. Of these PEs, GUR 415 showed less wear than both RCH 1000 and UHMWPE containing numerous fusion defects. For the latter, wear was attributed to a fatigue mechanism, although in most cases it was associated with surface phenomena rather than subsurface cracking. However, in some specimens of UHMWPE subsurface crack propagations occurred with defects. The test method is discussed in relation to its applicability to the evaluation and comparison of bearing materials and surfaces, with particular application to total knee replacements.

  16. Use of a Tourniquet in Total Knee Arthroplasty Causes a Paradoxical Increase in Total Blood Loss.

    PubMed

    Schnettler, Timothy; Papillon, Natalie; Rees, Harold

    2017-08-16

    A tourniquet in total knee arthroplasty has been used in an attempt to decrease perioperative blood loss; however, questions exist regarding safety and efficacy. Tranexamic acid has also been used to decrease blood loss by stabilizing clot formation. Because of these concerns, routine tourniquet use for total knee arthroplasty was discontinued by the senior author and routine tranexamic acid administration was commenced. The purpose of this study was to examine total perioperative blood loss with tourniquet use, with tourniquet use and routine use of tranexamic acid, and with tranexamic acid use alone without tourniquet. A retrospective cohort study of 132 patients in 3 groups was performed. The first group underwent total knee arthroplasty with limited tourniquet use only during cementing, the second group had the same protocol but with tranexamic acid administered, and the third group had tranexamic acid but no tourniquet used. Perioperative blood loss was calculated using the Gross formula. The mean calculated blood loss was highest in the tourniquet-only group at 1,591.39 mL (95% confidence interval [CI], 1,064.97 to 2,117.81 mL), decreased in the second group using tranexamic acid and tourniquet at 1,215.34 mL (95% CI, 1,104.93 to 1,325.75 mL), and was lowest in the third group with tranexamic acid and no tourniquet at 1,007.22 mL (95% CI, 878.78 to 1,135.66 mL). Use of a limited tourniquet protocol during total knee arthroplasty resulted in a paradoxical increase in blood loss. Surgeons should consider omitting routine tourniquet use in total knee arthroplasty. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  17. Highly conforming polyethylene inlays reduce the in vivo variability of knee joint kinematics after total knee arthroplasty.

    PubMed

    Daniilidis, Kiriakos; Skwara, Adrian; Vieth, Volker; Fuchs-Winkelmann, Susanne; Heindel, Walter; Stückmann, Volker; Tibesku, Carsten O

    2012-08-01

    The use of highly conforming polyethylene inlays in total knee arthroplasty (TKA) provides improved anteroposterior stability. The aim of this fluoroscopic study was to investigate the in vivo kinematics during unloaded and loaded active extension with a highly conforming inlay and a flat inlay after cruciate retaining (CR) total knee arthroplasty (TKA). Thirty one patients (50 knees) received a fixed-bearing cruciate retaining total knee arthroplasty (Genesis II, Smith & Nephew, Schenefeld, Germany) for primary knee osteoarthritis. Twenty two of them received a flat polyethylene inlay (PE), nine a deep dished PE and 19 were in the control group (physiological knees). The mean age at the time of surgery was 62 years. Dynamic examination with fluoroscopy was performed to assess the "patella tendon angle" in relation to the knee flexion angle (measure of anteroposterior translation) and the "kinematic index" (measure of reproducibility). Fluoroscopy was performed under active extension and flexion, during unloaded movement, and under full weight bearing, simulated by step climbing. No significant difference was observed between both types of polyethylene inlay designs and the physiological knee during unloaded movement. Anteroposterior (AP) instability was found during weight-bearing movement. The deep-dish inlay resulted in lower AP translation and a non-physiological rollback. Neither inlay types could restore physiological kinematics of the knee. Despite the fact that deep dished inlays reduce the AP translation, centralisation of contact pressure results in non-physiological rollback. The influence of kinematic pattern variability on clinical results warrants further investigation.

  18. PAIN FOLLOWING TOTAL KNEE ARTHROPLASTY – A SYSTEMATIC APPROACH

    PubMed Central

    Alves, Wilson Mello; Migon, Eduardo Zaniol; Zabeu, Jose Luis Amim

    2015-01-01

    Total knee arthroplasty (TKA) is known to be a successful procedure. The aging of the population and the growing demand for quality of life have greatly increased the indications for the procedure. Nonetheless, TKA presents some complications that still lack definitive resolution. Pain after TKA is caused by a myriad of reasons that need to be systematically studied in order to reach the correct diagnosis and treatment. History, physical examination, laboratory tests and imaging examinations must all be included in the workup and repeated until a plausible reason has been identified, since if pain is the only indication for TKA revision, the results may be catastrophic. PMID:27022583

  19. Suprapatellar Nailing of Tibial Shaft Fractures in Total Knee Arthroplasty.

    PubMed

    Woyski, Dustin; Emerson, Jason

    2016-12-01

    Fractures of the tibial shaft in patients with ipsilateral total knee arthroplasty are rare but difficult to treat. Nonoperative treatment of these fractures with casting or bracing limits weight bearing for an extended period and can result in unacceptable malalignment. Operative fixation with plate and screws also limits early weight bearing and requires healing of soft tissue that is of poor quality. The authors present a method of internal fixation that uses a standard intramedullary tibial nail and suprapatellar instrumentation. This method can easily be performed, avoids the tibial baseplate, and does not require alteration of the instrumentation or intramedullary nail.

  20. Acute arterial thrombosis after bilateral total knee arthroplasty.

    PubMed

    Bayne, Christopher O; Bayne, Omar; Peterson, Michael; Cain, Eric

    2008-12-01

    Arterial thrombosis is a rare complication of total knee arthroplasty (TKA). The overall incidence of arterial complications after TKA, including arterial occlusion, arteriovenous fistula, arterial aneurysm, and arterial severance, varies between 0.03% and 0.17% in reports published in the orthopedic literature (J Vasc Surg 1994;20:927-932). We report a case of acute popliteal artery thrombosis and its sequelae immediately following bilateral TKA performed sequentially under the same anesthesia. This is the first reported case of a post-TKA popliteal artery thrombosis in a patient younger than 60 years without the commonly accepted risk factors.

  1. Relationship between leg extensor muscle strength and knee joint loading during gait before and after total knee arthroplasty.

    PubMed

    Vahtrik, Doris; Gapeyeva, Helena; Ereline, Jaan; Pääsuke, Mati

    2014-01-01

    The aim of the present study was to evaluate an isometric maximal voluntary contraction (MVC) force of the leg extensor muscles and its relationship with knee joint loading during gait prior and after total knee arthroplasty (TKA). Custom-made dynamometer was used to assess an isometric MVC force of the leg extensor muscles and 3-D motion analysis system was used to evaluate the knee joint loading during gait in 13 female patients (aged 49-68 years) with knee osteoarthritis. Patients were evaluated one day before, and three and six months following TKA in the operated and non-operated leg. Six months after TKA, MVC force of the leg extensor muscles for the operated leg did not differ significantly as compared to the preoperative level, whereas it remained significantly lower for the non-operated leg and controls. The knee flexion moment and the knee joint power during mid stance of gait was improved six months after TKA, remaining significantly lowered compared with controls. Negative moderate correlation between leg extensor muscles strength and knee joint loading for the operated leg during mid stance was noted three months after TKA. The correlation analysis indicates that due to weak leg extensor muscles, an excessive load is applied to knee joint during mid stance of gait in patients, whereas in healthy subjects stronger knee-surrounding muscles provide stronger knee joint loading during gait. III (correlational study). Copyright © 2013 Elsevier B.V. All rights reserved.

  2. [Total knee and hip prosthesis: variables associated with costs].

    PubMed

    Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo

    2013-01-01

    The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.

  3. Physical functioning four years after total hip and knee arthroplasty.

    PubMed

    Vissers, M M; Bussmann, J B; de Groot, I B; Verhaar, J A N; Reijman, M

    2013-06-01

    Our previous study showed that 6 months after total hip arthroplasty (THA) or total knee arthroplasty (TKA), patients reported having less difficulty with daily activities, showed better functional capacity, and performed activities in their natural environment faster compared to preoperatively. However, their actual daily activity level was not significantly improved. Six months is a rather short follow-up period and the discrepancy in recovery among different aspects of functioning might be explained by this limited duration of follow-up. The objective of the present study was to examine the recovery of different aspects of physical functioning at a follow-up nearly 4 years after THA/TKA. Special attention was given to the actual daily activity level, and whether it had increased 4 years after THA/TKA compared to 6 months postoperatively. Seventy-seven (35 hip, 42 knee) patients who were measured preoperatively and postoperatively (6 months after surgery) in a previous study were invited to participate; 44 patients (23 hip, 21 knee) agreed to participate. The 4-year follow-up data were compared with the preoperative and 6-month postoperative data. The daily activity level after 4 years was found to be actually lower than at 6 months post-surgery (128 min vs. 138 min activity per 24h; p-value 0.48). However, the patients continued to improve in other aspects of physical functioning. In conclusion, 4-year post-surgery patients continued to improve on perceived physical functioning, capacity, and performance of activities in daily life. However, even in this relatively healthy study population, patients did not adopt a more active lifestyle 4 years after surgery.

  4. Revision of medial Oxford unicompartmental knee replacement to a total knee replacement: similar to a primary?

    PubMed

    Wynn Jones, Henry; Chan, Warwick; Harrison, Timothy; Smith, Toby O; Masonda, Patrick; Walton, Neil P

    2012-08-01

    Unicompartmental knee replacement (UKR) is an option for the treatment of isolated medial compartment osteoarthritis. A commonly perceived potential advantage is that revision of a UKR is straightforward. The purpose of this study was to determine the early outcomes and the level of complexity of revisions of Oxford UKRs performed at our hospital. A retrospective review of a prospective database of all phase III Oxford UKRs was undertaken. This identified 89 Oxford UKRs which were revised at our institution between 2002 and 2008. The median time from the primary procedure to revision was 19 months (interquartile range 2-73 months). Nine were revised to another UKR. Eighty were revised to a total knee replacement (TKR). Fifty-three were revised with primary TKR components. Twenty-seven were revised using stems and/or augments. The median overall tibial component thickness (including augments) was 15 mm. Forty-five knees had an overall tibial component thickness greater than 15 mm. A primary Oxford UKR bearing thickness of greater than 6mm was associated with an increased likelihood of requiring revision components. On the basis of this review, tibial bone defects were commonly encountered when revising UKRs. Reconstruction with either an augment and a stem, or thick polyethylene component was often required. We recommend that the potential complexity of revision for UKR failure should be borne in mind when considering a primary Oxford UKR. Copyright © 2011 Elsevier B.V. All rights reserved.

  5. Sensitivity of knee soft-tissues to surgical technique in total knee arthroplasty.

    PubMed

    Schirm, Andreas C; Jeffcote, Benjamin O; Nicholls, Rochelle L; Jakob, Hilaire; Kuster, Markus S

    2011-06-01

    Restricted range of motion and excessive laxity are both potential complications of total knee arthroplasty (TKA). During TKA surgery, the surgeon is frequently faced with the question of how tightly to implant the prosthesis. The most common method of altering implantation tightness is to vary the thickness of the polyethylene inlay after the bone cuts have been made and the trial components inserted. We have sought to quantify how altering the polyethylene thickness may affect post-operative soft tissue tension for a range of prosthetic designs. Four different prosthetic designs were implanted into fresh-frozen cadaveric knee joints. All four designs were implanted in the standard manner, with a 100 Newton distraction force used to set soft tissue balance. The tibiofemoral force was then recorded at 15° intervals throughout the passive flexion range. After the standard implantation of each prosthesis, the tibial component was raised or lowered to mimic increasing and decreasing the polyethylene thickness by 2mm and the force measurements repeated. Tibiofemoral force in extension correlated with implantation tightness for all prosthesis designs. Between 15° and 90° of knee flexion, all four designs were insensitive to changes in implantation tightness. Beyond 90° the effect was more notable in rotating platform mobile-bearing and cruciate-retaining prostheses than in posterior-stabilised mobile-bearing designs. The findings of this research may be useful in assisting surgical decision-making during the implantation of TKA prostheses.

  6. Post traumatic knee arthritis: navigated total knee replacement without hardware removal.

    PubMed

    Manzotti, Alfonso; Pullen, Chris; Cerveri, Pietro; Chemello, Cesare; Confalonieri, Norberto

    2014-01-01

    The Authors present the results of a series of navigated total knee replacements (TKR) without hardware removal in patients with post-traumatic arthritis following femoral fractures. The purpose of the paper was to determine the effectiveness of computer-assisted TKR in these patients compared to routine primary implants. Sixteen patients with post-traumatic knee arthritis following a distal femoral fracture and retained hardware were included in the study (group I). Patients in the study group were matched with patients who had undergone a computer navigated TKR using the same implant and software (group II). The indication for TKR in all group II patients was atraumatic arthritis and surgery was performed in the same period as the study group. Patients were matched for age, gender, pre-operative range of motion, severity of arthritis pre-operatively, type and grade of deformity and implant features. There were no statistically significant differences in surgical time, hospital staying or intra-operative and post-operative complications between the two study groups. At the latest follow-up no statistically significant difference was seen for the Knee Society Score and WOMAC indices. Implant alignment and radiological parameters were similar in both groups. This study demonstrated that post-traumatic knee arthritis following prior distal femoral fracture can be safely managed using a computer navigated TKR without hardware removal. Comparison between this patient group and a matched group with atraumatic arthritis showed similar post-operative results and complication rates. III. Copyright © 2012 Elsevier B.V. All rights reserved.

  7. Fixation of high-flexion total knee prostheses: five-year follow-up results of a four-arm randomized controlled clinical and roentgen stereophotogrammetric analysis study.

    PubMed

    Nieuwenhuijse, Marc J; van der Voort, Paul; Kaptein, Bart L; van der Linden-van der Zwaag, H M J; Valstar, Edward R; Nelissen, Rob G H H

    2013-10-02

    High-flexion total knee arthroplasty was introduced to meet the demands of daily activity requiring increased knee flexion. However, concerns have been raised regarding the fixation of high-flexion total knee arthroplasty components and increased rates of loosening have been reported. To date, migration, and thus fixation, of high-flexion total knee arthroplasty components has not been analyzed and the preferential bearing type (mobile or fixed) is unknown. Of eighty-six consecutive eligible patients, seventy-four patients (seventy-eight knees) scheduled for total knee arthroplasty were randomized to one of four Legacy Posterior Stabilized (LPS) total knee prosthesis designs: (1) LPS-Flex mobile, (2) LPS-Flex fixed, (3) LPS mobile, and (4) LPS fixed. The primary outcome was component migration measured with use of Roentgen stereophotogrammetric analysis, and secondary outcomes were postoperative knee flexion and extension and Knee Society Score. Patients were evaluated postoperatively at six, twelve, twenty-six, and fifty-two weeks and annually thereafter. At the five-year follow-up, eight patients had died and two patients were lost to follow-up. Seventy-seven tibial and forty-two femoral components were suitable for migration measurements. The overall five-year migration of the seventy-seven tibial components was not significantly different among the four total knee prosthesis designs (compared with the LPS fixed design, the range of overall mean differences for the other three designs was 0.02 to 0.25 mm) and migration was comparable at the two and five-year follow-up. Migration stabilized in all but three components (two LPS-Flex mobile and one LPS fixed); one of these components has already been revised and was aseptically loose. The overall five-year migration of the forty-two femoral components was comparable among the four designs (compared with the LPS fixed design, the range of overall mean differences for the other three designs was 0.01 to 0.18 mm) and

  8. The accuracy of femoral intramedullary guides in total knee arthroplasty.

    PubMed

    Reed, S C; Gollish, J

    1997-09-01

    Of the technical factors important in achieving a successful total knee arthroplasty, limb alignment has been demonstrated to be most influential in determining implant survival. Intramedullary femoral guide systems rely on placement of the intramedullary rod along the anatomic axis of the femur. In this article, the accuracy of the femoral intramedullary guide is investigated using radiographs and a mathematical model. The femoral anatomic axis was drawn on 40 consecutive, preoperative, 3-ft standing radiographs. Using a mathematical model, the potential angular error in the distal femoral cut from aberrant placement of the intramedullary rod was estimated. Calculated values correlated with measured values from plain radiographs and an intramedullary guide template. The anatomic axis was found to exit the distal femur at an average of 6.6 mm medial to the center of the femoral notch. Substantial malalignment error resulted from minor malposition of the intramedullary rod. Most books and diagrams demonstrating the use of intramedullary guides indicate that the entry point is at the center of the femoral notch. These results show that the true entry point is medial to the center of the notch, and rod placement error results in excessive valgus alignment. Preoperative drawing of the anatomic axis on a 3-ft or 18-inch anteroposterior radiograph is recommended. The results both demonstrate the importance of correct use of the guide and heighten cognizance among surgeons performing total knee arthroplasty as to the limitations of the intramedullary guides.

  9. Risk factors for total knee arthroplasty aseptic revision.

    PubMed

    Namba, Robert S; Cafri, Guy; Khatod, Monti; Inacio, Maria C S; Brox, Timothy W; Paxton, Elizabeth W

    2013-09-01

    Using a Total Joint Replacement Registry, patient, operative, implant, surgeon, and hospital risk factors associated with aseptic revision after primary total knee arthroplasty (TKA) were evaluated. From 04/2001 to 12/31/2010 64,017 primary TKA cases, followed for a median time of 2.9 years, were registered and included in the analysis. Patients were predominantly female, white, with osteoarthritis, and obese. The crude aseptic revision rate is 1.3% (N=826). The cumulative survival for aseptic revision at 8 years is 97.6% (95% CI 97.3%-97.8%). Adjusted models revealed that age, race, body mass index, diabetic status, bilateral procedures, high-flex implants, and the LCS mobile bearing knee are associated with risk of revision. Gender, general health status, diagnosis, surgeon fellowship training, surgeon volume, hospital volume, fixation, and bearing surface material were not associated with risk of aseptic revision. Recognition of surgical factors associated with TKA failures can help the surgeons with their choices of surgical techniques and implants.

  10. How useful is templating for total knee replacement component sizing?

    PubMed

    Peek, A C; Bloch, B; Auld, J

    2012-08-01

    This study aims to assess the accuracy of digital templating at our institution, by comparing the templated component sizes with those implanted, and to determine whether templating the preoperative films had any measurable difference on the radiographic outcome, and if, where there was a mismatch between the implanted and templated sizes, the templated size would have been preferable. While a number of studies have evaluated the accuracy of both acetate and digital templating, none has to our knowledge looked back at post-operative radiographs and reviewed these in light of the templated and implanted sizes. Data was collected from 90 PFC Sigma (DePuy, UK) total knee replacements done sequentially, 45 of whom were templated digitally using a calibrating ball and Agfa Orthopaedic Tools software. Postoperative radiographs were graded independently for correct sizing. All templates were within one size of the implanted prosthesis. The femoral component appeared to be more often oversized on the postoperative radiographs in the non-templated group. In addition, most tibial trays that were found be too small had been templated to a larger size. There was a trend towards tibial trays templated too large to have been templated to a smaller size. We conclude that digital templating with a calibrating device is a useful part of preoperative planning for total knee arthroplasty.

  11. Training benefits of computer navigated total knee arthroplasty.

    PubMed

    Love, Gavin J; Kinninmonth, Andrew W G

    2013-08-01

    Computer navigation aims to improve the surgical accuracy of total knee replacement by more reliably placing the cutting blocks in the optimum location in order to create a neutral mechanical axis. Aside from the obvious clinical benefit to the patient, we believe computer navigation has a valuable role as a training tool. The aim of this study is to demonstrate the effectiveness of computer navigation as a training tool in total knee arthroplasty. We performed a training exercise using Sawbone plastic models to simulate four common sources of error in the saw technique; 1. cutting guide movement due to inadequate fixation, 2. the effect of using slotted or open cutting guides, 3. the effect of bending the saw blade, and 4. the effect of recutting on the accuracy of the intended resection. We found that bony resection errors resulted from; use of less than three pins to fix the cutting guide, use of open cutting guides, deliberate and inadvertent "hanging" or "lifting" of the saw on the cutting guide and recutting after moving the cutting guide. The immediate feedback provided by computer navigated TKA allows surgeons and trainee surgeons the opportunity to improve the accuracy of their technique and increase awareness of their individual sources of error in TKA. Used as a teaching tool, computer navigation can immediately identify errors in surgical technique and target subsequent training to minimise these errors. Training can be conducted whilst ensuring there is no detriment to patient safety. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Anatomic dimensions of the patella measured during total knee arthroplasty.

    PubMed

    Baldwin, James L; House, C Ken

    2005-02-01

    The anatomic measurements of 92 patellae with normal underlying bony structure were studied during total knee arthroplasty before and after resection of the articular surface. The articular surface of the patella was found to have an oval shape with a width-to-height ratio (46 x 36 mm) of 1.30. The dome was 4.8 mm high and displaced medially 3.6 mm. The medial facet was slightly thicker than the lateral facet (18 vs 17 mm). The lateral facet is 25% wider than the medial facet. Coverage provided by oval patellar prostheses was significantly better than with round prostheses. The patellae in women were significantly smaller than in men. Size differences and deformity need to be taken into account when the patella is prepared for resurfacing. It is recommended that the bony resection should be no greater than one third of the maximum patellar thickness to avoid alteration of normal bony structure. Key words: patella, total knee arthroplasty, anatomy.

  13. Reducing gender disparities in post-total knee arthroplasty expectations through a decision aid.

    PubMed

    Volkmann, Elizabeth R; FitzGerald, John D

    2015-02-07

    Gender disparities in total knee arthroplasty utilization may be due to differences in perceptions and expectations about total knee arthroplasty outcomes. This study evaluates the impact of a decision aid on perceptions about total knee arthroplasty and decision-making parameters among patients with knee osteoarthritis. Patients with moderate to severe knee osteoarthritis viewed a video about knee osteoarthritis treatments options, including total knee arthroplasty, and received a personalized arthritis report. An adapted version of the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain and physical function expectations following total knee arthroplasty before/after the intervention. These scores were compared to an age- and gender-adjusted means for a cohort of patients who had undergone total knee arthroplasty. Decision readiness and conflict were also measured. At baseline, both men and women had poorer expectations about post-operative pain and physical outcomes compared with observed outcomes of the comparator group. Following the intervention, women's mean age-adjusted expectations about post- total knee arthroplasty pain outcomes improved (Pre: 27.0; Post: 21.8 [p =0.08; 95% CI -0.7, 11.0]) and were closer to observed post-TKA outcomes; whereas men did not have a significant change in their pain expectations (Pre: 21.3; Post: 19.6 [p = 0.6; 95% CI -5.8, 9.4]). Women also demonstrated a significant improvement in decision readiness; whereas men did not. Both genders had less decision conflict after the intervention. Both women and men with osteoarthritis had poor estimates of total knee arthroplasty outcomes. Women responded to the intervention with more accurate total knee arthroplasty outcome expectations and greater decision readiness. Improving patient knowledge of total knee arthroplasty through a decision aid may improve medical decision-making and reduce gender disparities in total knee arthroplasty utilization.

  14. Immunohistochemical analysis of the neural structures of the posterior cruciate ligament in osteoarthritis patients submitted to total knee arthroplasty: an analysis of thirty-four cases

    PubMed Central

    Martins, Glaucus Cajaty; Camanho, Gilberto; Rodrigues, Mara Ibis

    2015-01-01

    OBJECTIVES: Many authors recommend posterior cruciate ligament-retaining arthroplasty with the intention to maintain the proprioception properties of this ligament. Preservation of the neuroreceptors and nervous fibers may be essential for retaining the proprioception function of the posterior cruciate ligament. The present study was thus developed to evaluate the presence of neural structures in the posterior cruciate ligament resected during posterior stabilized arthroplasty in osteoarthritis patients. In particular, clinical, radiographic and histological parameters were correlated with the presence or absence of neural structures in the posterior cruciate ligament. METHODS: In total, 34 posterior cruciate ligament specimens were stained with hematoxylin-eosin and Gomori trichrome. An immunohistochemical analysis using antibodies against the S100 protein and neurofilaments was also performed. The presence of neural structures was correlated with parameters such as tibiofemoral angulation, histological degeneration of the posterior cruciate ligament, Ahlbäck radiological classification, age, gender and the histologic pattern of the synovial neurovascular bundle around the posterior cruciate ligament. RESULTS: In total, 67.5% of the cases presented neural structures in the posterior cruciate ligament. In 65% of the cases, the neurovascular bundle was degenerated. Nervous structures were more commonly detected in varus knees than in valgus knees (77% versus 50%). Additionally, severe histologic degeneration of the posterior cruciate ligament was related to neurovascular bundle degeneration. CONCLUSIONS: Severe posterior cruciate ligament degeneration was related to neurovascular bundle compromise. Neural structures were more commonly detected in varus knees. Intrinsic neural structures were detected in the majority of the posterior cruciate ligaments of patients submitted to knee arthroplasty for osteoarthritis. PMID:25789514

  15. Complications involving the extensor mechanism after total knee arthroplasty.

    PubMed

    Papalia, Rocco; Vasta, Sebastiano; D'Adamio, Stefano; Albo, Erika; Maffulli, Nicola; Denaro, Vincenzo

    2015-12-01

    To overview the complications involving extensor apparatus of the knee following total knee arthroplasty (TKA) and to summarize which are the lines of treatment available and their reported outcomes in literature. A comprehensive search of several databases was performed using as basic keywords "complications after TKA", "extensor mechanism disruption", "periprosthetic patellar fracture", "quadriceps tendon rupture", "quadriceps tendon rupture" isolated or combined with other terms by using Boolean operators. The methodological quality of each article was also evaluated using the Coleman methodology score (CMS). Twenty-nine studies were evaluated. The mean CMS of the studies selected was 33.1/100. Patellar fractures, requiring surgical treatment when there is rupture of the extensor mechanism or loosening of the patellar component, were treated surgically in 28.1 % of patients. The patellar and quadriceps tendon ruptures were surgically treated with reconstruction or augmented repair, respectively, in 98.6 and 76.5 %. Complications involving the extensor apparatus of the knee following a TKA need early and appropriate management to avoid their devastating influence on joint functionality. Management has to be evaluated very carefully based on the site of the lesion, integrity of the prosthetic components and surrounding tissue to restore, and the patients' individual characteristics. The surgical approach for comminuted periprosthetic fractures and reconstruction of torn tendons of the extensor apparatus are needed to restore function and decrease pain, but, given the poor methodological quality of the studies published so far, it is not clear which surgical technique or graft leads to better outcomes. Therefore, there is an absolute need for better designed comparative trials producing clearer and stronger evidence on this critical matter. IV.

  16. Pseudo-Patella Baja after total knee arthroplasty

    PubMed Central

    Kazemi, Seyyed Morteza; Besheli, Laleh Daftari; Eajazi, Alireza; Sajadi, Mohammad Reza Miniator; Okhovatpoor, Mohammad Ali; Zanganeh, Ramin Farhang; Minaei, Reza

    2011-01-01

    Summary Background One of the complications of total knee arthroplasty (TKA) which has not yet been directly addressed is pseudo-patella baja (PPB). True patella baja (PB) is present when the length of the patellar tendon becomes shorter. PPB is present when the patella tendon is not shortened, but the level of the joint line is elevated. This study was conducted to assess PPB in TKA. Material/Methods Sixty patients who had had a primary TKA at our center between 1995 and 2005 were included. The average follow-up was 27.5 months. The Knee Society Scoring (KSS), lateral knee x-rays and the Blackburne-Peel index were used for assessments. Results Out of the 60 patients, 43 (72%) demonstrated no joint line elevation or patellar tendon shortening (group A). Fifteen patients (25%) had joint line elevation (group B), and both PB and PPB were present in 2 (3%) patients (group C). KSS was lower in groups B and C compared with group A, but this difference was not statistically significant. The average range of motion (ROM) in group A was significantly higher compared with either group B or C, and patients in groups B and C showed significantly more severe pain compared with group A (P<0.001). Conclusions PPB is not an uncommon finding after TKA and is associated with a statistically significant decrease in ROM and an increase in pain. Furthermore, KSS in the PPB group was less than in patients without PPB, although the difference was not statistically meaningful. PMID:21525812

  17. Tibial forces measured in vivo after total knee arthroplasty.

    PubMed

    D'Lima, Darryl D; Patil, Shantanu; Steklov, Nikolai; Slamin, John E; Colwell, Clifford W

    2006-02-01

    An instrumented tibial prosthesis was developed to measure forces in vivo after total tibial arthroplasty. This prosthesis was implanted in a 67-kg, 80-year-old man. The prosthesis measured forces at the 4 quadrants of the tibial tray. Tibial forces were measured postoperatively during rehabilitation, rising from a chair, standing, walking, and climbing stairs. By the sixth postoperative week, the peak tibial forces during walking averaged 2.2 times body weight (BW). Stair climbing increased from 1.9 times BW on day 6 to 2.5 times BW at 6 weeks. This represents the first direct in vivo measurement of tibial forces, which should lead to refined surgical techniques and enhanced prosthetic designs. Technical design improvements will enhance function, quality of life, and longevity of total knee arthroplasty.

  18. Hydrotherapy after total knee arthroplasty. A follow-up study.

    PubMed

    Giaquinto, S; Ciotola, E; Dall'Armi, V; Margutti, F

    2010-01-01

    The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N=30) or HT (N=28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC) at admission, at discharge and six months later. Kruskal-Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  19. Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty.

    PubMed

    Naili, Josefine E; Wretenberg, Per; Lindgren, Viktor; Iversen, Maura D; Hedström, Margareta; Broström, Eva W

    2017-03-21

    It is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty. Twenty-eight patients (mean age 66 (SD 7) years) were included in this prospective study. Within one month of knee arthroplasty and one year after surgery, patients underwent three-dimensional (3D) gait analysis, completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), and rated perceived pain using a visual analogue scale. A "good outcome" was defined as a change greater than the minimally detectable change in the KOOS knee-related quality of life, and a "poor outcome" was defined as change below the minimally detectable change. Nineteen patients (68%) were classified as having a good outcome. Groups were analyzed separately and knee biomechanics were compared using a two-way repeated measures ANOVA. Differences in pain between groups were evaluated using Mann Whitney U test. Patients classified as having a good outcome improved significantly in most knee gait biomechanical outcomes including increased knee flexion-extension range, reduced peak varus angle, increased peak flexion moment, and reduced peak valgus moment. The good outcome group also displayed a significant increase in walking speed, a reduction (normalization) of stance phase duration (% of gait cycle) and increased passive knee extension. Whereas, the only change in knee biomechanics, one year after surgery, for patients classified as having a poor outcome was a significant reduction in peak varus angle. No differences in pain postoperatively were found between groups. Patients reporting a good outcome in knee-related quality of life improved in knee biomechanics during gait, while patients reporting a poor outcome, despite similar reduction in pain, remained unchanged in knee biomechanics one year after

  20. Surgical waste audit of 5 total knee arthroplasties

    PubMed Central

    Stall, Nathan M.; Kagoma, Yoan K.; Bondy, Jennifer N.; Naudie, Douglas

    2013-01-01

    Background Operating rooms (ORs) are estimated to generate up to one-third of hospital waste. At the London Health Sciences Centre, prosthetics and implants represent 17% of the institution’s ecological footprint. To investigate waste production associated with total knee arthroplasties (TKAs), we performed a surgical waste audit to gauge the environmental impact of this procedure and generate strategies to improve waste management. Methods We conducted a waste audit of 5 primary TKAs performed by a single surgeon in February 2010. Waste was categorized into 6 streams: regular solid waste, recyclable plastics, biohazard waste, laundered linens, sharps and blue sterile wrap. Volume and weight of each stream was quantified. We used Canadian Joint Replacement Registry data (2008–2009) to estimate annual weight and volume totals of waste from all TKAs performed in Canada. Results The average surgical waste (excluding laundered linens) per TKA was 13.3 kg, of which 8.6 kg (64.5%) was normal solid waste, 2.5 kg (19.2%) was biohazard waste, 1.6 kg (12.1%) was blue sterile wrap, 0.3 kg (2.2%) was recyclables and 0.3 kg (2.2%) was sharps. Plastic wrappers, disposable surgical linens and personal protective equipment contributed considerably to total waste. We estimated that landfill waste from all 47 429 TKAs performed in Canada in 2008–2009 was 407 889 kg by weight and 15 272 m3 by volume. Conclusion Total knee arthroplasties produce substantial amounts of surgical waste. Environmentally friendly surgical products and waste management strategies may allow ORs to reduce the negative impacts of waste production without compromising patient care. Level of evidence Level IV, case series. PMID:23351497

  1. Is latero-medial patellar mobility related to the range of motion of the knee joint after total knee arthroplasty?

    PubMed

    Ota, Susumu; Nakashima, Takeshi; Morisaka, Ayako; Omachi, Takaaki; Ida, Kunio; Kawamura, Morio

    2010-12-01

    Diminished range of motion (ROM) of the knee joint after total knee arthroplasty (TKA) is thought to be related to reduced patellar mobility. This has not been confirmed clinically due to a lack of quantitative methods adequate for measuring patellar mobility. We investigated the relationship between patellar mobility by a reported quantitative method and knee joint ROM after TKA. Forty-nine patients [osteoarthritis--OA: 29 knees; rheumatoid arthritis--RA: 20 knees] were examined after TKA. Respective medial and lateral patellar mobility was measured 1 and 6 months postoperatively using a patellofemoral arthrometer (PFA). Knee joint ROM was also measured in each of those 2 sessions. Although the flexion and extension of the knee joints improved significantly from 1 to 6 months after TKA, the medial and lateral patellar displacements (LPDs) failed to improve during that same period. Moreover, only the changes in knee flexion and medial patellar displacement (MPD) between the two sessions were positively correlated (r = 0.31, p < 0.05). However, our findings demonstrated that medial and lateral patellar mobility had no sufficient longitudinal relationship with knee ROM after TKA.

  2. Long-term clinical outcomes and survivorship after total knee arthroplasty using a rotating platform knee prosthesis: a meta-analysis.

    PubMed

    Hopley, Colin D J; Crossett, Lawrence S; Chen, Antonia F

    2013-01-01

    A systematic search identified 29 papers reporting survivorship and clinical and function Knee Society Scores (KSS) of 6437 total knee replacements using the Low Contact Stress (LCS) Rotating Platform (RP) mobile bearing knee. Low Contact Stress RP survivorship and KSS outcomes were compared with non-LCS knees in the Swedish knee registry at comparable time periods and in 2 independent systematic reviews of knee arthroplasty outcomes. There is a substantial body of mainly observational evidence supporting the LCS RP knee. Knee Society Score outcomes were comparable for LCS RP and non-LCS RP knees at up to 15 years of follow-up, with mean clinical and function scores ranging from 72 to 96 and 58 to 90, respectively. Survivorship of LCS RP knees up to 14 years was higher than that for all knees in the Swedish Knee Registry.

  3. Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter?

    PubMed

    Jakobsen, Thomas Linding; Christensen, Malene; Christensen, Stine Sommer; Olsen, Marie; Bandholm, Thomas

    2010-09-01

    Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC(2,1)) and smallest real difference (SRD) were calculated. The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6 degrees and 10 degrees (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester. In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability. (c) 2009 John Wiley & Sons, Ltd.

  4. Comparison of cementless and hybrid cemented total knee arthroplasty.

    PubMed

    Lass, Richard; Kubista, Bernd; Holinka, Johannes; Pfeiffer, Martin; Schuller, Spiro; Stenicka, Sandra; Windhager, Reinhard; Giurea, Alexander

    2013-04-01

    Cementless total knee arthroplasty (TKA) implants were designed to provide long-term fixation without the risk of cement-associated complications. The purpose of this study was to evaluate the outcome of titanium-coated cementless implants compared with hybrid TKA implants with a cemented tibial and a cementless femoral component. The authors performed a case-control, single-center study of 120 TKAs performed between 2003 and 2007, including 60 cementless and 60 hybrid cemented TKAs. The authors prospectively analyzed the radiographic and clinical data and the survivorship of the implants at a minimum follow-up of 5 years. Ninety patients who underwent TKA completed the 5-year assessment. Knee Society Scores increased significantly in both groups (P<.001). In both groups, 2 patients underwent revision due to aseptic tibial component loosening, resulting in a 96% implant survival rate. Radiographs showed significantly less radiolucent lines around the tibial baseplate in the cementless group (n=12) than in the hybrid cemented group (n=26) (P=.009).At 6-year mean follow-up, no significant difference existed between the cementless and hybrid cemented tibial components in TKA in terms of clinical and functional results and postoperative complications. The significantly smaller number of radiolucent lines in the cementless group is an indicator of primary stability with the benefit of long-term fixation durability of TKA.

  5. Physical activity after total knee arthroplasty: A critical review

    PubMed Central

    Paxton, Roger J; Melanson, Edward L; Stevens-Lapsley, Jennifer E; Christiansen, Cory L

    2015-01-01

    Total knee arthroplasty (TKA) is the most commonly performed elective surgery in the United States. TKA typically improves functional performance and reduces pain associated with knee osteoarthritis. Little is known about the influence of TKA on overall physical activity levels. Physical activity, defined as “any bodily movement produced by skeletal muscles that results in energy expenditure”, confers many health benefits but typically decreases with endstage osteoarthritis. The purpose of this review is to describe the potential benefits (metabolic, functional, and orthopedic) of physical activity to patients undergoing TKA, present results from recent studies aimed to determine the effect of TKA on physical activity, and discuss potential sources of variability and conflicting results for physical activity outcomes. Several studies utilizing self-reported outcomes indicate that patients perceive themselves to be more physically active after TKA than they were before surgery. Accelerometry-based outcomes indicate that physical activity for patients after TKA remains at or below pre-surgical levels. Several different factors likely contributed to these variable results, including the use of different instruments, duration of follow-up, and characteristics of the subjects studied. Comparison to norms, however, suggests that daily physical activity for patients following TKA may fall short of healthy age-matched controls. We propose that further study of the relationship between TKA and physical activity needs to be performed using accelerometry-based outcome measures at multiple post-surgical time points. PMID:26396937

  6. Physical activity after total knee arthroplasty: A critical review.

    PubMed

    Paxton, Roger J; Melanson, Edward L; Stevens-Lapsley, Jennifer E; Christiansen, Cory L

    2015-09-18

    Total knee arthroplasty (TKA) is the most commonly performed elective surgery in the United States. TKA typically improves functional performance and reduces pain associated with knee osteoarthritis. Little is known about the influence of TKA on overall physical activity levels. Physical activity, defined as "any bodily movement produced by skeletal muscles that results in energy expenditure", confers many health benefits but typically decreases with endstage osteoarthritis. The purpose of this review is to describe the potential benefits (metabolic, functional, and orthopedic) of physical activity to patients undergoing TKA, present results from recent studies aimed to determine the effect of TKA on physical activity, and discuss potential sources of variability and conflicting results for physical activity outcomes. Several studies utilizing self-reported outcomes indicate that patients perceive themselves to be more physically active after TKA than they were before surgery. Accelerometry-based outcomes indicate that physical activity for patients after TKA remains at or below pre-surgical levels. Several different factors likely contributed to these variable results, including the use of different instruments, duration of follow-up, and characteristics of the subjects studied. Comparison to norms, however, suggests that daily physical activity for patients following TKA may fall short of healthy age-matched controls. We propose that further study of the relationship between TKA and physical activity needs to be performed using accelerometry-based outcome measures at multiple post-surgical time points.

  7. Femoral bow predicts postoperative malalignment in revision total knee arthroplasty.

    PubMed

    Sebastian, Arjun S; Wilke, Benjamin K; Taunton, Michael J; Trousdale, Robert T

    2014-08-01

    Diaphyseal bowing may compromise axial alignment in revision total knee arthroplasty (TKA). 277 patients undergoing revision TKA were evaluated for coronal bowing and hip-knee-ankle (HKA) axis. The mean femoral bow was 1.52° ± 0.18° varus (-10.1° to +8.4°). The mean tibial bow was 1.25° ± 0.13° valgus (-5.9° to +10°). HKA axis averaged 3.08° ± 0.35° varus preoperatively compared to 0.86° ± 0.25° varus postoperatively. Inter-rater and intra-rater reliability was high. Femoral bow greater than 4° significantly correlated with postoperative HKA axis malalignment (r = 0.402, P = 0.008). 39.7% of patients deviated 3° or greater from a neutral mechanical axis with a significant difference in femoral bow (0.94° ± 0.31°, P = 0.003). Diaphyseal bowing clearly has an important effect on postoperative limb alignment in revision TKA.

  8. Indoor and Outdoor Mobility following Total Knee Arthroplasty

    PubMed Central

    Storey, Ava S.T.; Myrah, Ainslie M.; Bauck, Robyn A.; Brinkman, Danielle M.; Friess, Shawn N.

    2013-01-01

    ABSTRACT Purpose: To determine the relationship between indoor and outdoor mobility capacity in older adults with unilateral total knee arthroplasty (TKA) and, secondarily, to determine walking intensity in the same population and to compare all outcomes to a control group of older adults without knee pathology. Method: In this cross-sectional study, participants (TKA=16, mean 22.9 (SD 9.7) mo post TKA; control=22) completed indoor walking tests and a 580 m outdoor course that included varying terrain (e.g., curbs, grass, sidewalk) and frequent changes in direction. Walking capacity was assessed using stopwatches, global positioning system watches and accelerometers. Results: Outdoor walking time was moderately correlated (p<0.05) with the timed up-and-go (TUG) test (r=0.65), stair-climb test (SCT) (r=0.67 ascending, r=0.79 descending), 10 m walk test (10 mWT) (r=0.73), and 6-minute walk test (6 MWT) (r=−0.75). Based on activity counts, walking intensity levels for participants in both groups were moderate (outdoor walk and 6 MWT). There was no significant difference in walking capacity between groups (TUG, SCT, 10 mWT, 6 MWT, outdoor walk). Conclusions: Common clinical walking tests are moderately correlated with outdoor mobility. Mobility capacity of individuals post TKA was similar to controls in both indoor and outdoor environments, and participants in both groups achieved moderate physical activity levels with walking. PMID:24403699

  9. Posterior Cruciate Ligament Function Following Total Knee Arthroplasty

    PubMed Central

    Emodi, George J; Callaghan, John J; Pedersen, Douglas R; Brown, Thomas D

    1999-01-01

    One of the most commonly cited reasons for retaining the posterior cruciate ligament (PCL) during total knee arthroplasty is to preserve femoral rollback and theoretically improve extensor mechanism efficiency (lengthening the moment arm). This study was undertaken to assess PCL function in this regard and to delineate the effects of joint line elevation that can be manipulated intraoperatively by the surgeon. The anterior movement of tibiofemoral contact following PCL resection at flexion angles 60 degrees demonstrated the beneficial effect of the PCL on extensor function. This anterior translation and the concomitant increases in quadriceps tendon load and patellofemoral contact pressures were consistently observed. This study demonstrated that small changes of the joint line position significantly influenced PCL strain and knee kinematics. In order to preserve the desired functions that would be lost with an overly lax PCL and to avoid the potential adverse effects of an overly tight PCL (posterior edge loading and increased tibiofemoral contact), the surgeon should make every effort to restore the preoperative joint line. If this is not possible, consideration should be given to posterior cruciate recession or use of a posterior cruciate substituting design. PMID:10847521

  10. Conversion Total Knee Arthroplasty after Failed High Tibial Osteotomy

    PubMed Central

    Song, Sang Jun; Kim, Kang Il; Lee, Chung Hwan

    2016-01-01

    Clinical results of high tibial osteotomy (HTO) deteriorate over time despite the initial satisfactory results. Several knees may require a conversion to total knee arthroplasty (TKA) because of failure such as the progression of degenerative osteoarthritis and the loss of the correction angle. It is important to know the long-term survival rate and common reason of failure in HTO to inform patients of postoperative expectations before surgery and to prevent surgical errors during surgery. In addition, it has been reported that clinical and radiological results, revision rate, and complication rate were poorer than those in patients without a previous HTO. There are few review articles that describe why conversion TKA after HTO is surgically difficult and the results are poor. Surgeons have to avoid the various complications and surgical errors in this specific situation. We would like to present the considering factors and technical difficulties during conversion TKA after HTO with a review of the literature. We could conclude through the review that the correction of deformity, lower amount of tibial bone resection, and sufficient polyethylene insert thickness, restoration of the joint line height, and adequate ligament balancing can be helpful in overcoming the technical challenges encountered during TKA following HTO. PMID:27274465

  11. Severity of Diabetes Mellitus and Total Hip or Knee Replacement

    PubMed Central

    Nielen, Johannes T.H.; Emans, Pieter J.; Dagnelie, Pieter C.; Boonen, Annelies; Lalmohamed, Arief; de Boer, Anthonius; van den Bemt, Bart J.F.; de Vries, Frank

    2016-01-01

    Abstract It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from osteoarthritis (OA) due to an increased body mass index (BMI), resulting in mechanical destruction of cartilage. However, previous studies have suggested a coexisting metabolic causality. To evaluate the risk of hip or knee replacement, as a proxy for severe OA, in patients with DM. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity. A population-based case–control study was performed, using the Clinical Practice Research Datalink (CPRD). Cases (n = 94,609) were defined as patients >18 years who had undergone TJR between 2000 and 2012. Controls were matched by age, gender, and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) surgery associated with use of antidiabetic drugs (ADs). We additionally stratified current AD users by proxies for DM severity. Current AD use was significantly associated with a lower risk of TKR (OR = 0.86 (95% CI = 0.78–0.94)) and THR (OR = 0.90 (95% CI = 0.82–0.99)) compared to patients not using ADs. Moreover, risk of TKR and THR was decreased with increasing HbA1c. This study does not support the theory that DM patients are more likely to suffer from severe OA as compared to patients without diabetes. Moreover, risk of severe OA necessitating TJR decreases with increasing DM severity. This is possibly due to dissimilarities in methodology, a decrease in eligibility for surgery, or variability of OA phenotypes. PMID:27196498

  12. Prophylaxis for Venous Thromboembolism Following Total Knee Arthroplasty: A Survey of Korean Knee Surgeons

    PubMed Central

    Kim, Nam Ki; Kim, Tae Kyun; Kim, Jong Min

    2016-01-01

    Purpose The purpose of this study is to provide information on the actual status and prevailing trend of prophylaxis for venous thromboembolism (VTE) following total knee arthroplasty (TKA) in South Korea. Materials and Methods The Korean Knee Society (KKS) developed a questionnaire with 6 clinical questions on VTE. The questionnaire was distributed to all members of KKS by both postal and online mail. Participants were asked to supply details on their specialty and to select methods of prophylaxis they employ. Of the total members of KKS, 27.9% participated in the survey. Results The percentage of surgeons who routinely performed prophylaxis for VTE was 60.4%; 19.4% performed prophylaxis depending on the patient's health condition; and the remaining 20.2% never implemented prophylaxis after surgery. The common prophylactic methods among the responders were compression stocking (72.9%), pneumatic leg compression (63.3%), perioral direct factor Xa inhibitor (46.9%), and low-molecular-weight heparin (39.5%). For the respondents who did not perform prophylaxis, the main reason (51.5%) was the low risk of postoperative VTE considering the low incidences in Asians. Conclusions The present study involving members of the KKS will help to comprehend the actual status of VTE prevention in South Korea. The results of this study may be useful to design VTE guidelines appropriate for Koreans in the future. PMID:27595074

  13. Subject-Specific Modeling of Muscle Force and Knee Contact in Total Knee Arthroplasty

    PubMed Central

    Navacchia, Alessandro; Rullkoetter, Paul J.; Schütz, Pascal; List, Renate B.; Fitzpatrick, Clare K.; Shelburne, Kevin B.

    2017-01-01

    Understanding the mechanical loading environment and resulting joint mechanics for activities of daily living in total knee arthroplasty is essential to continuous improvement in implant design. Although survivorship of these devices is good, a substantial number of patients report dissatisfaction with the outcome of their procedure. Knowledge of in vivo kinematics and joint loading will enable improvement in preclinical assessment and refinement of implant geometry. The purpose of this investigation was to describe the mechanics of total knee arthroplasty during a variety of activities of daily living (gait, walking down stairs, and chair rise/sit). Estimates of muscle forces, tibial contact load, location, and pressure distribution was performed through a combination of mobile fluoroscopy data collection, musculoskeletal modeling, and finite element simulation. For the activities evaluated, joint compressive load was greatest during walking down stairs; however, the highest contact pressure occurred during chair rise/sit. The joint contact moment in the frontal plane was mainly varus for gait and walking down stairs, while it was valgus during chair rise/sit. Excursion of the center of pressure on the tibial component was similar during each activity and between the medial and lateral sides. The main determinants of center of pressure location were internal–external rotation, joint load, and tibial insert conformity. PMID:26792665

  14. No Differences Identified in Transverse Plane Biomechanics Between Medial Pivot and Rotating Platform Total Knee Implant Designs.

    PubMed

    Papagiannis, Georgios I; Roumpelakis, Ilias M; Triantafyllou, Athanasios I; Makris, Ioannis N; Babis, George C

    2016-08-01

    Total knee arthroplasties (TKAs) using well-designed, fixed bearing prostheses, such as medial pivot (MP), have produced good long-term results. Rotating-platform, posterior-stabilized (RP-PS) mobile bearing implants were designed to decrease polyethylene wear. Sagittal and coronal plane TKA biomechanics are well examined and correlated to polyethylene wear. However, limited research findings describe this relationship in transverse plane. We assumed that although axial plane biomechanics might not be the most destructive parameters on polyethylene wear, it is important to clarify their role because both joint kinematics and kinetics in all 3 planes are important input parameters for TKA wear testing (International Organization for Standardization 14243-1 and 14343-3). Our hypothesis was that transverse plane overall range of motion (ROM) and/or peak moment show differences that reflect on wear advantages when compared RP-PS implants to MP designs. Two groups (MPs = 24 and RP-PSs = 22 subjects) were examined by using 3D gait analysis. The variables were total internal-external rotation (IER) ROM and peak IER moments. No statistically significant difference was demonstrated between the 2 groups in kinetics (P = .389) or kinematics (P = .275). In the present study, no wear advantages were found between 2 TKAs. Both designs showed identical kinetics at the transverse plane in level-ground walking. Kinematic analysis could not illustrate any statistically significant difference in terms of overall IER ROM. Nevertheless, kinematic gait pattern differences observed possibly reflect different patterns of joint surface motion or abnormal gait patterns. Thus, wear testing with various input waveforms combined with functional data analysis will be necessary to identify the actual effects of gait variability on polyethylene wear. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Are Instrumented Knee Forces Representative of a Larger Population of Cruciate-Retaining Total Knee Arthroplasties?

    PubMed

    Freed, Ryan D; Simon, Jacqueline C; Knowlton, Christopher B; Orozco Villaseñor, Diego A; Wimmer, Markus A; Lundberg, Hannah J

    2017-07-01

    It is not known if the loads and motions reported for instrumented knees are generalizable to a larger population of total knee arthroplasty (TKA) patients. The purpose of this study is to (1) report axial implant force data for chair and stair activities for a population of cruciate-retaining TKA patients and (2) compare the population forces to those measured with instrumented TKAs. Twenty-three subjects with a cruciate-retaining TKA underwent motion analysis during stair ascending, stair descending, chair sitting, and chair rising activities after informed consent in this institutional review board approved study. Axial TKA forces were calculated using a previously validated computational model. Differences between the mean and variability of population instrumented TKA peak forces and force impulses were tested using t tests and Levene test. Peak axial forces were 3.06, 2.74, 2.65, and 2.60 kN for stair ascent, stair descent, chair rising, and chair sitting, respectively. Force impulses were 123.3, 123.4, 153.5, and 154.0 kN*% activity cycle for stair ascent, stair descent, chair sitting, and chair rising, respectively. Population TKA and instrumented TKA peak forces were different for stair ascent (P = .03) and stair descent (P = .03) in the second half of the activity cycles. The variability of the peak forces and impulses were not different (P = .106 to P = .99). The forces and motions presented in this study represent cruciate-retaining TKA patients and could be used for displacement-driven knee wear testing. The forces are similar to those in the literature from instrumented prostheses of an ultracongruent cruciate-sacrificing TKA. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Hydraulic distension of the knee: a novel treatment for arthrofibrosis after total knee replacement (case series).

    PubMed

    Formby, Peter M; Donohue, Michael A; Cannova, Christopher J; Caulfield, J Patrick

    2016-06-01

    Arthrofibrosis following total knee arthroplasty (TKA) is a common problem, which can be frustrating to both the patient and treating physician and can dramatically compromise post-operative function. Current treatment options for TKA arthrofibrosis include watchful waiting, injections, physical therapy, manipulation under anaesthesia, arthroscopic/open lysis of adhesions and revision surgery. We present a novel technique to treat acute and chronic stiffness following TKA, which we call hydraulic distension. A retrospective pre- and post-operative inpatient and outpatient record review of three patients treated with hydraulic distension for arthrofibrosis following TKA at a single institution. Three patients with a mean age of 74 years (68-78) underwent hydraulic distension of the knee at a mean of 23.4 ± 18.4 months (9 weeks to 36 months) following primary TKA. The mean pre-distension maximum flexion was 86.7 ± 10.4°, and the mean post-distension flexion was 110 ± 13.2° (23.3° increase). The patients maintained a mean 110 ± 20° flexion (23.3° increase) at a mean follow-up of 11.7 months (1 week to 29 months). There were no complications. We present a novel technique for managing arthrofibrosis following TKA that has not been previously reported. This is an effective, safe procedure, with our patients experiencing a mean 23° increased knee flexion at the most recent follow-up. Published 2016. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

  17. Fatigue fracture of the femur after navigated total knee replacement.

    PubMed

    Panasiuk, Michał; Bończak, Oktawiusz

    2009-01-01

    We present a case of fatigue fracture of the femur after navigated total knee arthroplasty with the Orthopilot system. A 60-year-old woman with rheumatoid arthritis and osteoporosis (T-score = -3.1) reported increasing pain of the thigh 8 weeks after the surgery. A fatigue fracture of the right femur through the pinholes was diagnosed and stabilized with an intramedullary nail, achieving union and a good functional result. To our knowledge, this is the first described fracture through the pinholes after Orthopilot-assisted surgery with 4.5 mm threaded pins for tracker fixation. We believe that the number of such complications is underestimated because reports are not published. Patients with osteoporosis should be informed about the possibility of this complicating fracture if they are undergoing navigated surgery.

  18. Embolization of Spontaneous Hemarthrosis Post Total Knee Replacement

    SciTech Connect

    Given, M. F. Smith, P.; Lyon, S. M.; Robertson, D.; Thomson, K. R.

    2008-09-15

    Spontaneous nonhemophiliac hemarthrosis is an unusual entity, which has been little described. We present three cases of spontaneous recurrent hemarthrosis post total knee replacement (TKR) and successful management with embolization. Three male patients were referred to our service for angiography and treatment of recurrent hemarthrosis post TKR. In all three patients antegrade ipsilateral common femoral artery punctures and selective angiography of the geniculate branches were performed with a microcatheter. Abnormal vasculature was noted in all cases. Subsequent embolization was performed with Contour (Boston Scientific, Target Vascular, Cork, Ireland) embolization particles (150-250 and 250-355 {mu}m) in two patients and microcoils in the third (TornadoR; Cook Inc., Bloomington, IN, USA). Technical success was 100%. One patient had a recurrence of symptoms requiring a repeat procedure 6 months later. No complications were encountered. Selective angiography and particle embolization is an effective technique for management of this unusual but problematic postoperative sequelae.

  19. The role of isolated polyethylene exchange in total knee arthroplasty

    PubMed Central

    Pang, Hee-Nee; Bin Abd Razak, Hamid Rahmatullah; Petis, Stephen; Naudie, Douglas D. R.; MacDonald, Steven J.

    2017-01-01

    The use of modular total knee arthroplasty (TKA) implants allows surgeons to perform isolated tibial polyethylene insert exchange (IPE) while retaining well-fixed and stable components. The purported advantages of IPE include preservation of bone stock, shorter operating time, less blood loss, faster rehabilitation and lower cost. However, the indications for IPE are limited. IPE for wear and osteolysis has moderate success in the medium term but should be avoided in cases of accelerated wear. In selected cases, debridement and IPE for early infection can result in low morbidity with high success rates in the short term. IPE for arthrofibrosis has poor results. IPE should be undertaken with caution and an institutional algorithm should be followed. Cite this article: EFORT Open Rev 2017;2:66–71 DOI: 10.1302/2058-5241.2.160049 PMID:28507777

  20. Tantalum cones and bone defects in revision total knee arthroplasty.

    PubMed

    Boureau, F; Putman, S; Arnould, A; Dereudre, G; Migaud, H; Pasquier, G

    2015-04-01

    Management of bone loss is a major challenge in revision total knee arthroplasty (TKA). The development of preformed porous tantalum cones offers new possibilities, because they seem to have biological and mechanical qualities that facilitate osseointegration. Compared to the original procedure, when metaphyseal bone defects are too severe, a single tantalum cone may not be enough and we have developed a technique that could extend the indications for this cone in these cases. We used 2 cones to fill femoral bone defects in 7 patients. There were no complications due to wear of the tantalum cones. Radiological follow-up did show any migration or loosening. The short-term results confirm the interest of porous tantalum cones and suggest that they can be an alternative to allografts or megaprostheses in case of massive bone defects. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Total knee arthroplasty and fractures of the tibial plateau

    PubMed Central

    Softness, Kenneth A; Murray, Ryan S; Evans, Brian G

    2017-01-01

    Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation (ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty (TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed. PMID:28251061

  2. Mobile bearing and fixed bearing total knee arthroplasty

    PubMed Central

    Dolfin, Marco; Saccia, Francesco

    2016-01-01

    The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience. PMID:27162777

  3. Rotational alignment of the tibial component in total knee arthroplasty

    PubMed Central

    Graceffa, Angelo; Marcucci, Massimiliano; Baldini, Andrea

    2016-01-01

    Many surgical techniques, correlated to different anatomical landmarks, have been proposed to allow a satisfactory rotational alignment of the tibial component in primary total knee arthroplasty (TKA). Unfortunately, an accurate landmark has not yet been established although many computer models using CT reconstructions and standard radiologic studies have been performed. In this review article, the authors propose a new anatomical rotational reference for a correct positioning of the tibial component during primary TKA; the authors compared the results of their studies with the current literature on rotational alignment references and previously proposed surgical techniques. The authors also analyzed the correlation between classic and newer tibial baseplate designs and different tibial rotational landmarks. PMID:26855939

  4. Mobile bearing and fixed bearing total knee arthroplasty.

    PubMed

    Capella, Marcello; Dolfin, Marco; Saccia, Francesco

    2016-04-01

    The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience.

  5. Acute Popliteal Artery Occlusion after Revision Total Knee Arthroplasty.

    PubMed

    Tsujimoto, Ryu; Matsumoto, Tomoyuki; Takayama, Koji; Kawakami, Yohei; Kamimura, Masato; Matsushita, Takehiko; Kuroda, Ryosuke; Kurosaka, Masahiro

    2015-01-01

    Acute arterial occlusions are a rare complication of total knee arthroplasty (TKA). However, in revision TKA, the risk of such complications is higher and these complications can lead to amputation if not adequately treated. We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital. Revascularization was achieved via bypass grafting and amputation was narrowly avoided despite time lag after symptom onset to revascularization. In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion. Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures.

  6. The role of isolated polyethylene exchange in total knee arthroplasty.

    PubMed

    Pang, Hee-Nee; Bin Abd Razak, Hamid Rahmatullah; Petis, Stephen; Naudie, Douglas D R; MacDonald, Steven J

    2017-03-01

    The use of modular total knee arthroplasty (TKA) implants allows surgeons to perform isolated tibial polyethylene insert exchange (IPE) while retaining well-fixed and stable components.The purported advantages of IPE include preservation of bone stock, shorter operating time, less blood loss, faster rehabilitation and lower cost. However, the indications for IPE are limited.IPE for wear and osteolysis has moderate success in the medium term but should be avoided in cases of accelerated wear. In selected cases, debridement and IPE for early infection can result in low morbidity with high success rates in the short term. IPE for arthrofibrosis has poor results.IPE should be undertaken with caution and an institutional algorithm should be followed. Cite this article: EFORT Open Rev 2017;2:66-71 DOI: 10.1302/2058-5241.2.160049.

  7. Subsequent Total Joint Arthroplasty After Primary Total Knee or Hip Arthroplasty: A 40-Year Population-Based Study.

    PubMed

    Sanders, Thomas L; Maradit Kremers, Hilal; Schleck, Cathy D; Larson, Dirk R; Berry, Daniel J

    2017-03-01

    Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p < 0.0001), but not a predictor of the subsequent risk of total knee arthroplasty. During a mean follow-up of 11 years after an initial total knee arthroplasty, we observed 809 contralateral total knee arthroplasties (45% at 20 years), 31 contralateral total hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p < 0.001). Patients undergoing total hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of

  8. Prevention of pseudo-patella baja during total knee arthroplasty.

    PubMed

    Seo, Jai-Gon; Moon, Young-Wan; Kim, Sang-Min; Park, Sang-Hoon; Lee, Byung-Hoon; Chang, Moon-Jong; Jo, Byung-Chul

    2015-12-01

    Pseudo-patella baja (PPB) is a surgical complication that can arise from total knee arthroplasty and occurs when the patella tendon is not shortened but the level of the femorotibial joint line is elevated. The goal of this study was to assess the performance of a technique specifically designed to prevent the occurrence of PPB and its radiological results. Ninety-nine patients undergoing total knee arthroplasty were included. Patients were divided into a non-correction group and a correction group. The correction group were applied an additional metal block in order to reduce the excess resection of the distal femur. To evaluate PPB, the change in the pre- and postoperative joint line was measured using the modified Blackburne-Peel Index (BPI). In the non-correction group, 68 of 74 cases showed an occurrence of PPB (92 %), in the correction group, 6 of 57 cases showed an occurrence of PPB (11 %). The preoperative-modified BPI of the non-correction group was not significantly different from that of the correction group (0.6 ± 0.1 vs. 0.6 ± 0.2). The modified BPI decreased significantly in the non-correction group after TKA (0.6 ± 0.1 vs. 0.2 ± 0.1, p < 0.05). However, the modified BPI did not change significantly in the correction group after TKA (0.6 ± 0.2 vs. 0.6 ± 0.2). The comparison of preoperative and postoperative radiological results showed that our intervention maintained the joint line without elevation. We proposed an effective method to prevent various complications due to the joint line elevation that occur in PPB. III.

  9. Bioimpedance for oedema evaluation after total knee arthroplasty.

    PubMed

    Pichonnaz, Claude; Bassin, Jean-Philippe; Currat, Damien; Martin, Estelle; Jolles, Brigitte M

    2013-09-01

    Electrical bioimpedance spectroscopy (BIS) allows the evaluation of limb extracellular fluid (R0) and total fluid (Rinf). BIS could facilitate post-surgical oedema evaluation after total knee arthroplasty (TKA), as it is easily performed and is non-invasive. However, neither its applicability in this context nor the influence of metallic implants on measurement has been evaluated. The aim of this study was to evaluate the influence of TKA implants on the BIS R0 and Rinf variables used for oedema evaluation. This was a prospective non-randomized comparative clinical trial. One oedema-free group of patients with TKA was compared with a group presenting similar characteristics except for the arthroplasty, to assess the influence of the implant on BIS measurement in the absence of oedema. The TKA group included 15 patients who had undergone surgery more than a year previously, and the control group included 19 patients awaiting TKA surgery. Volume and perimeter measurements served as reference criterions. The lower limb percentage differences for BIS, knee perimeter and volume were calculated. The significance of differences between groups was calculated for all measurement methods, using the Mann-Whitney test. The setting was a Department of Orthopedic Surgery and Traumatology in a university hospital. The differences between groups were not significant for R0, Rinf, volume and perimeter. R0 showed the smallest mean difference in limb percentage difference between groups [means (SD): TKA 3.98 (8.09), controls 3.97 (5.16)]. The lower-leg percentage difference in the TKA group is comparable with that of healthy subjects. R0 can be used for oedema evaluation following TKA surgery, as there was no sign of alteration from the metallic implant. These findings indicate the potential for early oedema evaluation after TKA. More research is warranted to extensively validate the application of BIS for oedema evaluation after TKA. Copyright © 2012 John Wiley & Sons, Ltd.

  10. Digital templating in primary total hip and knee arthroplasty.

    PubMed

    Levine, Brett; Fabi, David; Deirmengian, Carl

    2010-11-02

    The use of digital radiography is becoming more prevalent in orthopedics. This transition impacts the ability to preoperatively plan for implants in total hip arthroplasty (THA) and total knee arthroplasty (TKA). This article reports on the clinical success of digital templating using the Advanced Case Plan (Stryker Imaging, Flower Mound, Texas) system in primary THA and TKA. Digital radiographs of 269 consecutive patients undergoing primary THA (93 cases) or TKA (176 cases) were templated using the Advanced Case Plan digital software package. A 25.4-mm metallic sphere was used as a calibrating marker. Anteroposterior hip and lateral knee radiographs were digitally templated preoperatively and compared to the actual size of the implants at the time of surgery. The accuracy of calibrating images using the metallic sphere was validated by measuring the diameter of femoral heads on 25 postoperative hip radiographs. Digital templating was accurate in predicting the correct implant size in 58.5% of THAs and 66% of TKAs. In 93% of THAs and 98.5% of TKAs, preoperative templating was within 1 size of the final implant. There were no cases in which the predicted implant size varied from the final components by >2 sizes. Calibrating the image using the metallic sphere marker was found to be highly accurate, predicting the correct femoral head size within 1.5 mm in all 25 cases (7 hemiarthroplasties and 18 THAs). Digital templating is an effective means for predicting the size of THA and TKA components, thus remaining a viable option as we transition into the modern era of digital radiography. Future studies will evaluate interobserver reliability and the impact of level of training on templating accuracy. Copyright 2010, SLACK Incorporated.

  11. Bone cement product and failure in total knee arthroplasty

    PubMed Central

    Birkeland, Øystein; Espehaug, Birgitte; Havelin, Leif I; Furnes, Ove

    2017-01-01

    Background and purpose — The bone cement market for total knee arthroplasty (TKA) in Norway has been dominated by a few products and distributors. Palacos with gentamicin had a market share exceeding 90% before 2005, but it was then withdrawn from the market and replaced by new slightly altered products. We have compared the survival of TKAs fixated with Palacos with gentamicin with the survival of TKAs fixated with the bone cements that took over the market. Patients and methods — Using data from the Norwegian Arthroplasty Register for the period 1997–2013, we included 26,147 primary TKAs in the study. The inclusion criteria were TKAs fixated with the 5 most used bone cements and the 5 most common total knee prostheses for that time period. 6-year Kaplan-Meier survival probabilities were established for each cement product. The Cox proportional hazards regression model was used to assess the association between bone cement product and revision risk. Separate analyses were performed with revision for any reason and revision due to deep infection within 1 year postoperatively as endpoints. Adjustments were made for age, sex, diagnosis, and prosthesis brand. Results — Survival was similar for the prostheses in the follow-up period, between the 5 bone cements included: Palacos with gentamicin, Refobacin Palacos R, Refobacin Bone Cement R (Refobacin BCR), Optipac Refobacin Bone Cement R (Optipac Refobacin BCR), and Palacos R + G. Interpretation — According to our findings, the use of the new bone cements led to a survival rate that was as good as with the old bone cement (Palacos with gentamicin). PMID:27841713

  12. Knee joint biomechanics and neuromuscular control during gait before and after total knee arthroplasty are sex-specific.

    PubMed

    Astephen Wilson, Janie L; Dunbar, Michael J; Hubley-Kozey, Cheryl L

    2015-01-01

    The future of total knee arthroplasty (TKA) surgery will involve planning that incorporates more patient-specific characteristics. Despite known biological, morphological, and functional differences between men and women, there has been little investigation into knee joint biomechanical and neuromuscular differences between men and women with osteoarthritis, and none that have examined sex-specific biomechanical and neuromuscular responses to TKA surgery. The objective of this study was to examine sex-associated differences in knee kinematics, kinetics and neuromuscular patterns during gait before and after TKA. Fifty-two patients with end-stage knee OA (28 women, 24 men) underwent gait and neuromuscular analysis within the week prior to and one year after surgery. A number of sex-specific differences were identified which suggest a different manifestation of end-stage knee OA between the sexes.

  13. Is high flexion following total knee arthroplasty safe?: evaluation of knee joint loads in the patients during maximal flexion.

    PubMed

    Nagura, Takeo; Otani, Toshiro; Suda, Yasunori; Matsumoto, Hideo; Toyama, Yoshiaki

    2005-08-01

    The purpose of this study was to indicate the mechanical loads and the flexion angle at the knee during rise from maximal flexion following total knee arthroplasty (TKA). Twenty three knees were evaluated using skin marker-based motion analysis system during four different activities of daily living. The average maximum flexion was 90 degrees (34 degrees less than passive flexion) and all subjects required support for their weight to rise from maximal flexion. The external moments and the external forces at the knee during the maximal flexion were smaller than those during the stair descending activity. The results indicate that capable flexion angle for the patients following TKA is approximately 90 degrees which has smaller mechanical loads at the knee than the stair descending activity.

  14. Short-interval two-stage approach to primary total knee arthroplasty for acutely septic osteoarthritic knees.

    PubMed

    Hochreiter, Bettina; Strahm, Carol; Behrend, Henrik

    2016-10-01

    Treatment strategies for advanced knee osteoarthritis with coexistent joint infection are not well established. While in periprosthetic joint infection the two-stage approach has been studied extensively, only few case reports on two-stage total knee arthroplasty (TKA) for knee osteoarthritis with coexistent joint infection have been published. The purpose of this paper was to report on our method of implementing a two-stage TKA with intervening antibiotic-loaded articulating cement spacers and a short interval between first- and second-stage procedures to treat two patients with Staphylococcus aureus-infected end-stage knee osteoarthritis. Consistent infection eradication was found at a 1-year follow-up with postoperative range of motion and knee scores comparing favourably with those of other case series. Level of evidence V.

  15. Intraoperative medial pivot affects deep knee flexion angle and patient-reported outcomes after total knee arthroplasty.

    PubMed

    Nishio, Yusuke; Onodera, Tomohiro; Kasahara, Yasuhiko; Takahashi, Daisuke; Iwasaki, Norimasa; Majima, Tokifumi

    2014-04-01

    The aim of this study was to evaluate the relationship between clinical results including patient-reported outcomes and intraoperative knee kinematic patterns after total knee arthroplasty (TKA). A cross-sectional survey of forty consecutive medial osteoarthritis patients who had a primary TKA using a CT-based navigation system was conducted. Subjects were divided into two groups based on intraoperative kinematic patterns: a medial pivot group (n = 20) and a non-medial pivot group (n = 20). Subjective outcomes with the new Knee Society Score and clinical outcomes were evaluated. The functional activities, patient satisfaction and the knee flexion angle of the medial pivot group were significantly better than those of the non-medial pivot group. An intraoperative medial pivot pattern positively influences deep knee flexion and patient-reported outcomes.

  16. Mobile vs fixed-bearing total knee arthroplasty performed by a single surgeon: a 4- to 6.5-year randomized, prospective, controlled, double-blinded study.

    PubMed

    Aggarwal, Aditya K; Agrawal, Anuj

    2013-12-01

    The superiority between posterior-stabilized mobile-bearing and fixed-bearing designs still remains controversial. Fifty-six consecutive patients undergoing primary, unilateral knee arthroplasty for osteoarthritis were randomly assigned to receive either a mobile-bearing (29 patients) or fixed-bearing (27 patients) prosthesis. We report the results at 4 to 6.5 years (mean, 5.5) follow-up. The Knee Society knee scores, pain scores, functional scores and Oxford knee scores were not statistically different (P > 0.05) between the two groups. Mean postoperative range-of-motion of mobile-bearing knees was significantly greater than that of fixed-bearing knees (127º versus 111º, P = 0.011). 72% of patients could sit cross legged, 48% could sit on the floor, and 17% could squat. Kaplan-Meier survival rate was 100%. No spin-out of mobile bearing was observed. The radiological analysis showed no osteolysis or implant loosening.

  17. Closed Incision Negative Pressure Therapy Versus Standard of Care Surgical Dressing in Revision Total Knee Arthroplasty

    ClinicalTrials.gov

    2017-09-06

    Surgical Wound; Revision Total Knee Arthroplasty; Wounds and Injuries; Joint Disease; Musculoskeletal Disease; Prosthesis-Related Infections; Infection; Postoperative Complications; Pathologic Processes

  18. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study.

    PubMed

    Zha, Guo-Chun; Sun, Jun-Ying; Dong, Sheng-Jie

    2014-03-01

    Anterior knee pain is a major cause of complaint in total knee arthroplasty (TKA) without patellar resurfacing. The concept of improved patellar tracking and decreased retropatellar contact pressure for lateral retinacular release theoretically suggests that patients with lateral retinacular release in TKA would achieve a lower incidence of anterior knee pain when compared without lateral retinacular release. We sought to determine (1) whether those patients who received a routine lateral retinacular release in TKA would attain lower incidence of anterior knee pain as compared to patients who received TKA without lateral retinacular release and (2) whether lateral retinacular release would increase the lateral retinacular release-related complications. A total of 148 patients who underwent TKA with the use of the Gemini MK II mobile bearing were randomized to receive either routine lateral retinacular release (intervention group) or not (control group). Patients were assessed by the visual analogue scale for anterior knee pain, the Knee Society clinical scoring system of knee score and function score, and patellar score for clinical function. Patients' satisfaction and lateral retinacular release-related complications were also evaluated. The overall incidence of anterior knee pain in the intervention group at 18 months follow-up was 5.6%, while that of the control group was 20.6% (p = 0.009). No statistical difference was detected between the two groups in terms of lateral retinacular release-related complications (n.s.), patients' satisfaction (n.s.), knee score (n.s.), function score (n.s.), and patellar score (n.s.) at 18 months follow-up. The present study suggests that routine lateral retinacular release can reduce anterior knee pain and does not increase lateral retinacular release-related complications, in TKA with the use of the Gemini MK II mobile bearing without patellar resurfacing. Therapeutic, Level I.

  19. [Osteoarthritis of the knee in the young patient--who should receive total knee arthroplasty and who should not?].

    PubMed

    Dornacher, D; Kappe, T; Reichel, H

    2014-06-01

    The incidence of total knee arthroplasty in young patients continues to rise in certain countries despite evidence of decreased patient satisfaction and increased likelihood for revision in patients 55 years of age or less. As long as sufficient pain relief and functional improvement can be obtained by alternative means, total knee arthroplasty should be avoided whenever possible. In young patients with unicompartmental osteoarthritis, and a partially conserved joint space, correctional osteotomy around the knee accompanied by cartilage surgery should be preferred in the presence of the respective deformity. In cases of advanced unicompartmental arthritis, unicompartmental arthroplasty should be considered even in younger patients. Only if advanced arthritic changes in more than one compartment or accompanying tibiofemoral instability are present in younger patients, is total knee arthroplasty indicated in selected cases. The strongest predictor of satisfaction even in younger patients is, however, a realistic expectation about the outcome of surgery.

  20. Passive knee kinematics before and after total knee arthroplasty: are we correcting pathologic motion?

    PubMed

    Mihalko, William M; Ali, Mounawar; Phillips, Matthew J; Bayers-Thering, Mary; Krackow, Kenneth A

    2008-01-01

    The change in coronal plane deformity throughout a range of flexion before and after total knee arthroplasty (TKA) has not been reported. Unlike most alignment assessments traditionally reporting coronal plane alignment in a standing position under static conditions, this study reports deformity throughout the flexion arc before and after deformity correction. One hundred fifty-two TKA patients using the anteroposterior axis for femoral component rotation and computer navigation techniques were included in the study. Deformity before TKA ranged from 17.5 degrees varus (deformity apex away from the midline) to 20.5 degrees valgus (deformity apex toward the midline) in full extension. Before TKA, deformity was not constant through an arc of motion and significantly decreased with flexion of 60 degrees and more (P < .01). The deformity after performing a TKA was not different (P = .478) throughout the flexion arc. The data determined that deformity is not constant throughout flexion in osteoarthritic knees preoperatively and that deformity throughout flexion can be corrected with the use of conventional alignment techniques during TKA.

  1. Revision of 33 unicompartmental knee prostheses using total knee arthroplasty: strategy and results

    PubMed Central

    Estour, Gilles; Nemer, Charbel; Colle, Pierre-Emmanuel

    2008-01-01

    The purpose of this study was twofold: to evaluate the radiological and clinical results of 33 total knee arthroplasties (TKA) implanted between January 1993 and March 2005, to replace failed medial unicompartmental knee arthroplasty (UKA), and to develop a strategy to deal with bone defects in the tibial plateau. Failure was due to: tibial loosening (15 cases), femoral loosening (five cases), femoral and tibial loosening (two cases), polyethylene wear (five cases), lateral compartment osteoarthritis (two cases), patellofemoral osteoarthritis (two cases), laxity and PE dislocation (one case), and sepsis in one case. In 12 cases the tibial bone defect was filled with a metallic wedge, in seven we used an allograft (femoral head), and in one we used both. We report the results of 27 cases (five patients died and one was lost to follow-up). The mean follow-up was 73±41.7 months (range, 8–153) and the global IKS score was 166.72±21.3 points (range, 128–200). X-rays of the eight allografts showed osteointegration in all cases and no radiolucency was noted. PMID:18563411

  2. Total Knee Arthroplasty in Patients with Blount Disease or Blount-Like Deformity.

    PubMed

    Natoli, Roman M; Nypaver, Chrissy M; Schiff, Adam P; Hopkinson, William J; Rees, Harold W

    2016-01-01

    Blount disease is associated with complex deformity of the proximal tibia, and some patients will develop knee osteoarthritis. Five patients (eight knees) with Blount disease or Blount-like deformity underwent total knee arthroplasty. Mean proximal tibial metaphyseal-diaphyseal angle was 20.75°. Each patient had substantial posteromedial tibial bony defects and six knees required extensive medial releases. Two knees required increased constraint at index procedure. One patient has undergone bilateral revision surgery with rotating hinge prostheses. Mean WOMAC scores were 13.5 and Knee Society scores were 212.5 at average 75.2 month follow-up. Despite technical challenges, patients with these deformities can have successful outcomes after total knee arthroplasty. Surgeons should be prepared to address posteromedial tibial bony defects and consider constrained arthroplasty at the index procedure.

  3. Bilateral custom-fit total knee arthroplasty in a patient with poliomyelitis.

    PubMed

    Tardy, Nicolas; Chambat, Pierre; Murphy, Colin G; Fayard, Jean-Marie

    2014-09-01

    In limbs affected by poliomyelitis, total knee arthroplasty results in satisfactory pain relief. However, the risk of failure is high, especially if the preoperative quadriceps power is low. Therefore, treating osteoarthritis in the current patient represented a challenging procedure. A 66-year-old man presented with tricompartmental osteoarthritis of both knees, with valgus deformity of 14° on the left knee and 11° on the right knee. He walked with a bilateral knee recurvatum of 30° and a grade 1 quadriceps power. The authors treated both knees with cemented custom-fit hinged total knee arthroplasty with 30° of recurvatum in the tibial keel. Clinical scores showed good results 1 year postoperatively, especially on the subjective data of quality of life and function. At follow-up, radiographs showed good total knee arthroplasty positioning on the right side and a small mechanical loosening at the end of the tibial keel on the left side. Only 5 studies (Patterson and Insall; Moran; Giori and Lewallen; Jordan et al; and Tigani et al) have reported total knee arthroplasty results in patients with poliomyelitis. This study reports an original case of bilateral custom-fit hinged total knee arthroplasty in a patient with poliomyelitis. To the authors' knowledge, this is the first report of this type of procedure in the literature. The key point is the degree of recurvatum that is needed to allow walking, avoiding excessive constraints on the implants that can lead to early mechanical failure.

  4. Evolution of trochlear compartment geometry in total knee arthroplasty

    PubMed Central

    Demey, Guillaume; Nover, Luca; Dejour, David

    2016-01-01

    Background The study aimed to compare trochlear profiles in recent total knee arthroplasty (TKA) models and to determine whether they feature improvements compared to their predecessors. The hypothesis was that recent TKA models have more anatomic trochlear compartments and would display no signs of trochlear dysplasia. Methods The authors analyzed the geometry of the 6 following TKA models using engineering software: PFC and Attune (DePuy), NexGen and Persona (Zimmer), Noetos and KneeTec (Tornier). The mediolateral trochlear profiles were plotted at various flexion angles (0°, 15°, 30° and 45°) to deduce the sulcus angle. Results Analysis of sulcus angles reveals general convergence of recent designs towards anatomic values. At 0° of flexion, sulcus angles of recent implant models were between 156.0–157.4°, while those of previous generation models between 154.5–165.5°. At 30° of flexion, sulcus angles of recent models also lie within 145.7–148.6°, but those of previous models are between 149.5–152.0°. All three manufacturers deepened their trochlear profile at 30° of flexion in recent models compared to earlier designs. Sulcus angles converge towards anatomic values but still exceed radiologic signs of dysplasia by 2–5°. Conclusions Recent TKA designs have more anatomic trochlear geometries than earlier TKA models by the same manufacturers, but trochlear compartments still exceed radiologic signs of trochlear dysplasia by 2° to 5°. The hypothesis that recent TKA models display no signs of trochlear dysplasia is therefore refuted. Surgeons should be aware of design limitations to optimize choice of implant and extensor mechanisms alignment. Level of evidence: IV geometric implant analysis. PMID:26855943

  5. Endoplasmic reticulum stress activation during total knee arthroplasty

    PubMed Central

    Hocker, Austin D; Boileau, Ryan M; Lantz, Brick A; Jewett, Brian A; Gilbert, Jeffrey S; Dreyer, Hans C

    2013-01-01

    Total knee arthroplasty (TKA) is the most common remediation for knee pain from osteoarthritis (OA) and is performed 650,000 annually in the U.S. A tourniquet is commonly used during TKA which causes ischemia and reperfusion (I/R) to the lower limb but the effects of I/R on muscle are not fully understood. Previous reports suggest upregulation of cell stress and catabolism and downregulation of markers of cap-dependent translation during and after TKA. I/R has also been shown to cause endoplasmic reticulum (ER) stress and induce the unfolded protein response (UPR). We hypothesized that the UPR would be activated in response to ER stress during TKA. We obtained muscle biopsies from the vastus lateralis at baseline, before TKA; at maximal ischemia, prior to tourniquet deflation; and during reperfusion in the operating room. Phosphorylation of 4E-BP1 and AKT decreased during ischemia (−28%, P < 0.05; −20%, P < 0.05, respectively) along with an increase in eIF2α phosphorylation (64%, P < 0.05) suggesting decreased translation initiation. Cleaved ATF6 protein increased in ischemia (39%, P = 0.056) but returned to baseline during reperfusion. CASP3 activation increased during reperfusion compared to baseline (23%, P < 0.05). XBP1 splicing assays revealed an increase in spliced transcript during ischemia (31%, P < 0.05) which diminished during reperfusion. These results suggest that in response to I/R during TKA all three branches of the ER stress response are activated. PMID:24159375

  6. Predictors of outcomes of total knee replacement surgery.

    PubMed

    Judge, Andy; Arden, Nigel K; Cooper, Cyrus; Kassim Javaid, M; Carr, Andrew J; Field, Richard E; Dieppe, Paul A

    2012-10-01

    To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery. The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome. The strongest determinants of outcome include pre-operative pain/function-those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome-patients with RA did better than those with OA; deprivation-those living in poorer areas had worse outcomes; and anxiety/depression-worse pre-operative anxiety/depression led to worse pain. Differences were observed between predictors of pain and functional outcomes. Diagnosis of RA and anxiety/depression were associated with pain, whereas age and gender were specifically associated with function. BMI was not a clinically important predictor of outcome. This study identified clinically important predictors of attained pain/function post-TKR. Predictors of pain were not necessarily the same as functional outcomes, which may be important in the context of a patient's expectations of surgery. Other predictive factors need to be identified to improve our ability to recognize patients at risk of poor TKR outcomes.

  7. Percutaneous freezing of sensory nerves prior to total knee arthroplasty.

    PubMed

    Dasa, Vinod; Lensing, Gabriel; Parsons, Miles; Harris, Justin; Volaufova, Julia; Bliss, Ryan

    2016-06-01

    Total knee arthroplasty (TKA) is a common procedure resulting in significant post-operative pain. Percutaneous cryoneurolysis targeting the infrapatellar branch of the saphenous nerve and anterior femoral cutaneous nerve could relieve post-operative knee pain by temporarily blocking sensory nerve conduction. A retrospective chart review of 100 patients who underwent TKA was conducted to assess the value of adding perioperative cryoneurolysis to a multimodal pain management program. The treatment group consisted of the first 50 patients consecutively treated after the practice introduced perioperative (five days prior to surgery) cryoneurolysis as part of its standard pain management protocol. The control group consisted of the 50 patients treated before cryoneurolysis was introduced. Outcomes included hospital length of stay (LOS), post-operative opioid requirements, and patient-reported outcomes of pain and function. A significantly lower proportion of patients in the treatment group had a LOS of ≥2days compared with the control group (6% vs. 67%, p<0.0001) and required 45% less opioids during the first 12weeks after surgery. The treatment group reported a statistically significant reduction in symptoms at the six- and 12-week follow-up compared with the control group and within-group significant reductions in pain intensity and pain interference at two- and six-week follow-up, respectively. Perioperative cryoneurolysis in combination with multimodal pain management may significantly improve outcomes in patients undergoing TKA. Promising results from this preliminary retrospective study warrant further investigation of this novel treatment in prospective, randomized trials. III. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Are static and dynamic kinematics comparable after total knee arthroplasty?

    PubMed

    Saevarsson, Stefan K; Romeo, Carolina I; Anglin, Carolyn

    2013-04-05

    Knee kinematics provide information about how the femoral, tibial and patellar bones or prosthetic components move relative to each other. Accurate knowledge of kinematics is valuable for implant design, comparisons between designs or surgical techniques, and to identify differences between patients with good and poor outcomes. Both static and dynamic imaging techniques have been used to evaluate kinematics. In general, static imaging is used to capture better quality images or to capture views that cannot be acquired by dynamic imaging, whereas dynamic imaging is used to capture real-life movements. How well static kinematics represent dynamic kinematics is subject to frequent debate and has not been adequately addressed, especially after total knee arthroplasty (TKA). We compared the static and dynamic weightbearing kinematics of 10 female subjects after TKA. Using the same clinical scanner for both methods, static images were taken using our standard protocol, sequential-biplane radiographs at multiple flexion angles, as well as with dynamic video fluoroscopy during a step up activity. The static method can reliably measure all 12 degrees of freedom (DOF) after TKA, however only seven were compared due to the poorer out-of-plane reliability in the single-plane dynamic imaging. No differences were found between the static and dynamic kinematics for nine out of ten subjects. For one subject, however, a difference of 5-8° in internal/external tibial rotation was found. The research question, study purpose and the advantages and disadvantages of each method need to be considered when determining which imaging method to use.

  9. Sports activity is maintained or increased following total knee arthroplasty.

    PubMed

    Hepperger, Caroline; Gföller, Peter; Abermann, E; Hoser, Christian; Ulmer, Hanno; Herbst, Elmar; Fink, Christian

    2017-03-24

    The purpose of this study was to investigate sports activities and functional abilities in patients following total knee arthroplasty (TKA). It was hypothesized that patients who had undergone TKA would return to a higher activity level as that experienced preoperatively. Two hundred patients were included in this prospective single-cohort study. All the patients completed subjective questionnaires (Tegner Activity Level, Oxford Knee Score, Visual Analog Scale for pain) prior to surgery as well as at 6, 12, and 24 months postoperatively. Additionally, sports behaviour was evaluated. Sports frequency was divided into four categories: more than 5 times a week, 2-3 times a week, occasionally, and no sports activities. Additionally, the patients were asked to state their three favourite summer and winter sports. All patient-reported outcome scores improved significantly over time (p ≤ 0.005). The Tegner Activity Level increased significantly from the preoperative state to 24 months postsurgery (p = 0.005). Six months after surgery, 43% of the patients returned to the same and 35% to a higher Tegner Activity Level than prior to surgery. Gender-related differences were observed for the Tegner Activity Level showing a higher activity level for the male than for the female patients. Overall, 24 months postsurgery 83% of the patients practiced sports in comparison with 79% prior to surgery. Following TKA, the patients were able to increase sports performance, while pain was reduced. Therefore, patients who want to continue their desired sports may safely consider TKA. II.

  10. Patellar height assessment in total knee arthroplasty: a new method.

    PubMed

    Caton, Jacques H; Prudhon, Jean Louis; Aslanian, Thierry; Verdier, Régis

    2016-12-01

    We described in 1981 a method to evaluate patellar height in normal and symptomatic knees on sagittal X-ray view. This index is a frequently used method, yet it is not suitable after a total knee arthroplasty (TKA). The original method measures the distance between the distal margin of the articular surface of the patella (point A) and the anterosuperior angle of the tibial plateau (point T), then the length of the patellar articular surface (AP). The index is AT/AP ratio (normal values range from 0.8 to 1.2). After TKA, the T landmark is no longer available, so we must define a new T' landmark. This point is situated at the intersection between the line perpendicular to the tibial posterior cortex elevated at the tip of the fibular head and the tibial anterior cortex. This remarkable landmark can be identified before and after TKA, with a new relative index AT'/AP ratio. This modified method allows the comparison of patella height before and after TKA. We have used this modified index with the collaboration of several authors during the testing of different models of TKA, with an accurate reproducibility. Repeatability (usually called intra-observer reliability) was good, with intra-class correlation coefficients (ICCs) between 0.58 and 0.75 among the observers. Reproducibility (usually called inter-observer reliability) was also considered as good, with ICC ranging from 0.64 to 0.72. Patella height measurement has to be assessed with the original method (AT/AP) to detect patella infera that could influence the surgical approach. The correlation between original and modified indexes has to be assessed. The modification of patella height after TKA could be evaluated through the modified index and compared with functional results.

  11. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty.

    PubMed

    Dion, Neil T; Bragdon, Charles; Muratoglu, Orhun; Freiberg, Andrew A

    2015-07-01

    This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up.

  12. The Influence Of Component Alignment On The Life Of Total Knee Prostheses

    NASA Astrophysics Data System (ADS)

    Bugariu, Delia; Bereteu, Liviu

    2012-12-01

    An arthritic knee affects the patient's life by causing pain and limiting movement. If the cartilage and the bone surfaces are severely affected, the natural joint is replaced with an artificial joint. The procedure is called total knee arthroplasty (TKA). Lately, the numbers of implanted total knee prostheses grow steadily. An important factor in TKA is the perfect alignment of the total knee prosthesis (TKP) components. Component misalignment can lead to the prosthesis loss by producing wear particles. The paper proposes a study on mechanical behaviors of a TKP based on numerical analysis, using ANSYS software. The numerical analysis is based on both the normal and the changed angle of the components alignment.

  13. Lessons Learned from Selective Soft-Tissue Release for Gap Balancing in Primary Total Knee Arthroplasty: An Analysis of 1216 Consecutive Total Knee Arthroplasties

    PubMed Central

    Peters, Christopher L.; Jimenez, Chris; Erickson, Jill; Anderson, Mike B.; Pelt, Christopher E.

    2013-01-01

    Background: Soft-tissue releases are commonly necessary to achieve symmetrical flexion and extension gaps in primary total knee arthroplasty performed with a measured resection technique. We reviewed the frequency of required releases according to preoperative alignment and the clinical and radiographic results; associations with failure, reoperations, and complications are presented. Methods: We reviewed 1216 knees that underwent primary total knee arthroplasty from 2004 to 2009; 774 (64%) were in female patients and 442 (36%), in male patients. In the coronal plane, 855 knees had preoperative varus deformity, 123 were neutral, and 238 had valgus deformity. The mean age at the time of the index procedure was 62.7 years (range, twenty-three to ninety-four years), and the mean body mass index was 32.7 kg/m2 (range, 17.4 to 87.9 kg/m2). Clinical outcomes included the Knee Society Score (KSS), implant failure, reoperation, and complications. Radiographs were analyzed for component alignment. Results: The only difference in the total KSS was found at the time of final follow-up between valgus knees with zero releases (total KSS = 178) and those with one or two releases (KSS = 160, p = 0.026). Overall, 407 knees (33.5%) required zero releases, 686 (56.4%) required oneor two releases, and 123 (10.1%) required three or more releases. Among varus knees, 37% required zero releases, 55% required one or two releases, and 7.5% required three or more releases. Among neutral knees, 39% required zero releases, 55% required one or two releases, and 5.7% required three or more releases. Only 17% of valgus knees required zero releases whereas 61% required one or two releases and 21.8% required three or more releases. Valgus knees required more releases than neutral or varus knees did (p < 0.001). Conclusions: Selective soft-tissue release for gap balancing in primary total knee arthroplasty is an effective technique that produced excellent clinical and radiographic results

  14. Evaluation of a Patient Decision Aid for Unicompartmental or Total Knee Arthroplasty for Medial Knee Osteoarthritis.

    PubMed

    de Jesus, Christopher; Stacey, Dawn; Dervin, Geoffrey F

    2017-06-17

    Many patients with isolated medial compartment osteoarthritis are candidates for either unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). A novel patient decision aid (PDA) was developed to educate patients on both interventions and prepare them for making the decision with their surgeon. The study objective was to evaluate the acceptability and usefulness of a PDA for informing and helping patients reach a surgical preference without increasing decisional conflict. A PDA was developed in accordance with the criteria listed by Ottawa Decision Support Framework and prospectively tested in UKA and TKA patients, who were mailed the PDAs to complete at home along with outcome measures before surgeon consultation. Of 50 patients who consented to participate, 45 patients (26 men, 19 women) used the PDA. Quantitative analysis of acceptability, decisional conflict, knowledge, and preferred surgical option was then performed. Mean patient age was 64.6 years (range, 50-80 years). Patients rated the PDA as acceptable: 84.4% indicated balanced presentation of information and 77.8% asserted that PDA helped them to make decisions between UKA and TKA. Mean knowledge score was 86.6% and total decisional conflict was 19.7 out of 100. Of 45, 33 stated a preferred option (24 UKA; 9 TKA; 12 unsure). Patients understood the majority of the benefits and risks for each surgical option without increasing decisional conflict. The decision aid for advanced medial compartment osteoarthritis is shown to be acceptable and useful for choosing between UKA and TKA. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Work and power of the knee flexor and extensor muscles in patients with osteoarthritis and after total knee arthroplasty.

    PubMed

    Bastiani, Denise; Ritzel, Cintia Helena; Bortoluzzi, Silvia Manfrin; Vaz, Marco Aurelio

    2012-01-01

    The inflammatory manifestations of knee osteoarthritis (OA) lead to muscle inhibition and hypotrophy, resulting in a reduction in total muscle work and muscle power. Total knee arthroplasty (TKA) is the most adequate surgery for the treatment of advanced OA. However, its effects on muscle functional behavior have not been well understood. To compare the total work and power of the knee flexor and extensor muscles in patients with OA (20) and in patients post-TKA (12) at two angular velocities (60º/sec and 240º/sec). An isokinetic Biodex dynamometer was used to assess muscle power and total work during isokinetic contractions. Two-way ANOVA for repeated measures was used to compare total muscle work and muscle power between the groups (SPSS software, version 13.0; significance level, P < 0.05). There was no difference between the OA and TKA groups for the total work of both knee extensors and flexors at the two angular velocities (P > 0.05). In addition, no difference was observed in the muscle power of the knee extensors and flexors (P > 0.05). Total work and power were similar in the OA and TKA groups, suggesting that TKA did not improve functional capacity, which was similar in both groups.

  16. Postoperative blood loss prevention in total knee arthroplasty.

    PubMed

    Banerjee, Samik; Kapadia, Bhaveen H; Issa, Kimona; McElroy, Mark J; Khanuja, Harpal S; Harwin, Steven F; Mont, Michael A

    2013-12-01

    Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed.

  17. Continuous infiltration of local anaesthetic following total knee arthroplasty.

    PubMed

    Ong, Johnny C A; Chin, Pak Lin; Lin, Chin Pak; Fook-Chong, Stephanie M C; Tang, Andrew; Yang, Kuang Ying; Ying, Yang Kuang; Tay, Boon Keng; Keng, Tay Boon

    2010-08-01

    To determine whether continuous infiltration of local anaesthetic can reduce the pain score and morphine use over 48 hours after total knee arthroplasty (TKA). 11 men and 43 women aged 50 to 82 years who underwent unilateral TKA for osteoarthritis were recruited. They were randomised into 3 groups. In group 1, 17 patients who acted as controls received patient-controlled analgesia (PCA) with intravenous morphine for 48 hours. In group 2, 16 patients received continuous infiltration of bupivacaine to the subcutaneous tissue and intra-articular space for 48 hours, in addition to PCA. In group 3, 21 patients received an intra-articular injection of local anaesthetic, followed by continuous infiltration of bupivacaine to the subcutaneous tissue and intraarticular space for 48 hours, in addition to PCA. For each patient, a visual analogue score (VAS) for pain was recorded postoperatively at 2, 4, 6, 12, 24, 36, and 48 hours. The total amount of morphine used was recorded at 24 and 48 hours. Over 48 hours, the VAS for pain and morphine use was significantly higher in controls than patients in groups 2 and 3. Continuous infiltration of local anaesthetic into the intra-articular space and subcutaneous tissues, in addition to PCA with intravenous morphine, provides significantly more pain relief and reduces morphine use.

  18. Relationship between Tibial Baseplate Design and Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

    PubMed Central

    Indelli, Pier Francesco; Graceffa, Angelo; Baldini, Andrea; Payne, Brielle; Pipino, Gennaro; Marcucci, Massimiliano

    2015-01-01

    This study evaluated the influence of modern tibial baseplate designs when using the anterior tibial cortex as a primary rotational landmark for the tibial baseplate in TKA. Eighty patients undergoing TKA were randomized in two groups. Group 1 included 25 females and 15 males receiving a posterior-stabilized (PS) symmetric tibial baseplate while Group 2 included 24 females and 16 males receiving a PS anatomical tibial component. Identical surgical technique, including the use of the surgical transepicondylar femoral axis (sTEA) and the anterior tibial cortex (“Curve-on-Curve”) as rotational alignment landmarks, was used. All patients underwent CT evaluation performed with the knee in full extension. Three observers independently measured the rotational alignment of the tibial component in relation to the sTEA. The rotational alignment of the symmetric baseplate showed an average external rotation of 1.3° (minimum 5°, maximum −1°): 91% of the knees showed 0 ± 3° with respect to the surgical sTEA, being internally rotated in 20%. The rotational alignment of the anatomical baseplate showed an average external rotation of 4.1° (minimum 0.4°, maximum 8.9°): only 47.5% of the knees showed 0 ± 3°, being externally rotated in 100%. The difference between the two groups was statistically significant. This study confirms the reliability of the “Curve-on-Curve” technique as an adequate rotational alignment anatomical landmark in TKA: the use of an asymmetric tibial baseplate might lead to external rotation of the tibial component when this technique is intraoperatively chosen. PMID:26491564

  19. HINGED CAST BRACE FOR PERSISTENT FLEXION CONTRACTURE FOLLOWING TOTAL KNEE REPLACEMENT

    PubMed Central

    Karam, Matthew D; Pugely, Andrew; Callaghan, John J; Shurr, Donald

    2011-01-01

    The reported incidence of persistent knee flexion contracture following total knee arthroplasty (TKA) has varied from 1-15 percent Various treatment modalities have been described in attempts to manage this often difficult problem. This paper describes a novel method of treatment by using a hinged cast brace (previously reported for treatment of femur fractures and knee contractures secondary to hemophilia and cerebral palsy) for use in patients with symptomatic knee flexion contractures. Application of this cast brace with frequent adjustment (every three to four days, initially) toward full extension can often improve knee extension, after physical therapy and other modalities such as extension-assist braces have failed. Care must be taken in the application and use of this device which utilizes frequent manipulations to reduce and maintain the knee flexion angle. We report two clinical cases in which this protocol was effectively used in decreasing symptomatic knee flexion contractures. PMID:22096423

  20. Physiotherapy Rehabilitation After Total Knee or Hip Replacement

    PubMed Central

    2005-01-01

    Executive Summary Objective The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patients To determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patients To determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Clinical Need Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person’s functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. The Therapy The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may

  1. Thrombin-Based Hemostatic Agent in Primary Total Knee Arthroplasty.

    PubMed

    Fu, Xin; Tian, Peng; Xu, Gui-Jun; Sun, Xiao-Lei; Ma, Xin-Long

    2017-02-01

    The present meta-analysis pooled the results from randomized controlled trials (RCTs) to identify and assess the efficacy and safety of thrombin-based hemostatic agent in primary total knee arthroplasty (TKA). Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5), and ScienceDirect (1966-2015.5). Relevant journals and the recommendations of expert panels were also searched by using Google search engine. RCTs assessing the efficacy and safety of thrombin-based hemostatic agent in primary TKA were included. Pooling of data was analyzed by RevMan 5.1 (The Cochrane Collaboration, Oxford, UK). A total of four RCTs met the inclusion criteria. The meta-analysis revealed significant differences in postoperative hemoglobin decline (p < 0.00001), total blood loss (p < 0.00001), drainage volume (p = 0.01), and allogenic blood transfusion (p = 0.01) between the treatment group and the control group. No significant differences were found regarding incidence of infection (p = 0.45) and deep vein thrombosis (DVT; p = 0.80) between the groups. Meta-analysis indicated that the application of thrombin-based hemostatic agent before wound closure decreased postoperative hemoglobin decline, drainage volume, total blood loss, and transfusion rate and did not increase the risk of infection, DVT, or other complications. Therefore, the reviewers believe that thrombin-based hemostatic agent is effective and safe in primary TKA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Correlation of body mass index and blood loss during total knee and total hip arthroplasty.

    PubMed

    Hrnack, Scott A; Skeen, Nick; Xu, Tom; Rosenstein, Alexander D

    2012-10-01

    Almost one-third of Americans older than 20 years are considered obese. Excessive weight has been linked to faster destruction of weight-bearing joints, which may then need to be replaced. Joint replacement surgeons disagree about an association between obesity and increased blood loss during hip or knee joint replacement. In this retrospective study, we examined the effect of body mass index (BMI), operative time (length of procedure), and anesthesia time on total blood loss during primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA). Intraoperative data from 94 primary TKAs and 78 primary THAs were reviewed, and divided into obese and nonobese groups on the basis of calculated BMI. Regression analysis was used to compare intraoperative blood loss amounts to patient characteristics. TKA and THA groups were analyzed separately. Obesity did not correlate with increased intraoperative blood loss in the TKA or THA group. However, operative time correlated with increased intraoperative blood loss. A 1-minute increase in anesthesia time resulted in total blood loss increases of 3.167 mL during TKA and 1.552 mL during THA.

  3. Apollo total knee replacements in University Malaya Medical Centre: a short-term outcome.

    PubMed

    Abbas, A A; Merican, A M; Kwan, M K; Mohamad, J A

    2006-02-01

    Total knee arthroplasty is the most preferred option for treatment of severe osteoarthritis of the knee. We report the short-term outcome of 48 total knee replacements in 31 patients utilizing the Apollo Total Knee System after an average follow-up of 48 months (range 15 to 70 months). Records of all patients who underwent TKA using Apollo Total Knee System were retrospectively reviewed. Functional outcome was evaluated using visual analogue scale for pain rating and the Oxford 12-item questionnaire. Postoperative radiographs of the replaced knees were assessed by using the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Degenerative osteoarthritis was the commonest indication for TKA. The average patient's age was 63.7 years (range, 30-77 years). The mean visual analogue scale for pre- and post-operative pain was eight and zero respectively. The mean Oxford 12-item questionnaire score pre- and post-operatively was 44.8 and 16.5 respectively. Patient satisfaction was notable in 98% of the cases with an average improvement in arc of flexion of 111 degrees. There were four failures; deep infection (one) and aseptic loosening (three) giving rise to a 94% implant survivor. The short-term results of this series is comparable with or better than a number of outcome studies of the Apollo Knee System or other implants of similar design.

  4. Knee-Extension Training with a Single-Joint Hybrid Assistive Limb during the Early Postoperative Period after Total Knee Arthroplasty in a Patient with Osteoarthritis

    PubMed Central

    Sugaya, Hisashi; Kubota, Shigeki; Onishi, Mio; Kanamori, Akihiro; Sankai, Yoshiyuki; Yamazaki, Masashi

    2016-01-01

    The knee range of motion is an important outcome of total knee arthroplasty (TKA). According to previous studies, the knee range of motion temporarily decreases for approximately 1 month after TKA due to postoperative pain and quadriceps dysfunction following surgical invasion into the knee extensor mechanism. We describe our experience with a knee-extension training program based on a single-joint hybrid assistive limb (HAL-SJ, Cyberdyne Inc., Tsukuba, Japan) during the acute recovery phase after TKA. HAL-SJ is a wearable robot suit that facilitates the voluntary control of knee joint motion. A 76-year-old man underwent HAL-SJ-based knee-extension training, which enabled him to perform knee function training during the acute phase after TKA without causing increased pain. Thus, he regained the ability to fully extend his knee postoperatively. HAL-SJ-based knee-extension training can be used as a novel post-TKA rehabilitation modality. PMID:27774330

  5. Functional ability after above-the-knee amputation for infected total knee arthroplasty.

    PubMed

    Fedorka, Catherine J; Chen, Antonia F; McGarry, William M; Parvizi, Javad; Klatt, Brian A

    2011-04-01

    Prosthetic joint infection is an uncommon but serious complication of total knee arthroplasty (TKA). Control of infection after TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA). The purpose of this study was to determine the etiology of AKA and the functional outcomes of AKA after infected TKA. We retrospectively reviewed 35 patients who underwent AKA after an infected TKA. The amputations were performed an average of 6 years (range, 21 days to 24 years) after primary TKA. There were 19 females and 16 males with a mean age of 62 years (range, 26-88 years). Patient demographic information, comorbidities, surgical treatments, cultures, and culture sensitivities were recorded. Complications and functional status, including SF-12 and activities of daily living questionnaires, after AKA were also studied. The minimum followup was 7 months (mean, 39 months; range, 7-96 months). Two patients died secondary to cardiac arrest and 13 more died during the followup period of unrelated causes. Nine patients required irrigation and débridement for nonhealing wounds after AKA and two patients had repeat AKA for bony overgrowth. Of the 14 patients fitted for prostheses, eight were functionally independent outside of the home. Patients fitted with a prosthesis had higher mean activities of daily living scores (58 versus 38) and also tended to be younger with fewer comorbidities than those who were not fitted with a prosthesis. We found low functional status in living patients with an AKA after infection with only half of the patients walking after AKA. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

  6. Intraoperative Hypothermia in Total Hip and Knee Arthroplasty.

    PubMed

    Frisch, Nicholas B; Pepper, Andrew M; Rooney, Edward; Silverton, Craig

    2017-01-01

    Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common and successful orthopedic procedures, and as their frequency continues to increase substantially, the focus on limiting perioperative complications heightens. Intraoperative normothermia is recommended to minimize additional complications, but limited evidence exists regarding the effect of hypothermia on orthopedic patients. The purpose of this retrospective study was to determine the incidence of perioperative hypothermia in the setting of TKA and THA, and to evaluate its impact on complications and outcomes. The clinical records of 2580 consecutive patients who underwent TKA or THA at a single institution between January 1, 2011, and December 31, 2013 were reviewed. After excluding patients with complex or revision procedures, a total of 2397 patients comprised the study population. Patient demographic data, surgery-specific data, postoperative complications, length of hospital stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis evaluated associations with hypothermia and the effect on complications and outcomes. The incidence of mean intraoperative hypothermia was 37%, 43.9%, and 32.6% for arthroplasty, THA, and TKA, respectively. General anesthesia was significantly associated with hypothermia (P<.001). Women and THA patients were at higher risk for hypothermia. In the arthroplasty and THA cohorts, longer operating room time and re-warmer use were associated with hypothermia (P=.010). Overall, hypothermia was associated with increased estimated blood loss, but no increase in associated transfusion was demonstrated (P=.006). Hypothermia was not associated with postoperative complications. [Orthopedics. 2017; 40(1):56-63.]. Copyright 2016, SLACK Incorporated.

  7. Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing.

    PubMed

    Yulou, Si; Yanqin, Xue; Yongjun, Xing

    2015-01-01

    To discuss the method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing. Clinical data of 80 patients from October 2013 to December 2014 was selected with a retrospective method. All patients have undergone total knee arthroplasty. Then the X-rays plain film in weight loading was measured before and after operation and osteotomy was performed accurately according to the knee joint scores and the conditions of lower limb alignments. The average angle of tibial plateau osteotomy of postoperative patients was 4.3°, and the corrective angle of soft tissue balancing was 10.7°; the postoperative patients' indicies including range of joint motion, knee joint HSS score, angle between articular surfaces, tibial angle, femoral-tibial angle and flexion contracture were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant; the postoperative patients' flexion contracture and range of joint motion were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant. The effective release of the soft tissue of the posterior joint capsule under direct vision can avoid excess osteotomy and get satisfactory knee replacement space without influencing the patients' joint recovery.

  8. Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing

    PubMed Central

    Yulou, Si; Yanqin, Xue; Yongjun, Xing

    2015-01-01

    To discuss the method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing. Clinical data of 80 patients from October 2013 to December 2014 was selected with a retrospective method. All patients have undergone total knee arthroplasty. Then the X-rays plain film in weight loading was measured before and after operation and osteotomy was performed accurately according to the knee joint scores and the conditions of lower limb alignments. The average angle of tibial plateau osteotomy of postoperative patients was 4.3°, and the corrective angle of soft tissue balancing was 10.7°; the postoperative patients’ indicies including range of joint motion, knee joint HSS score, angle between articular surfaces, tibial angle, femoral-tibial angle and flexion contracture were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant; the postoperative patients’ flexion contracture and range of joint motion were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant. The effective release of the soft tissue of the posterior joint capsule under direct vision can avoid excess osteotomy and get satisfactory knee replacement space without influencing the patients’ joint recovery. PMID:28352736

  9. Rotation flaps for coverage after total knee arthroplasty

    PubMed Central

    Pozzobon, Leonardo Rafael; Helito, Camilo Partezani; Guimarães, Tales Mollica; Gobbi, Riccardo Gomes; Pécora, José Ricardo; Camanho, Gilberto Luis

    2013-01-01

    OBJECTIVE: To evaluate the results obtained using local myocutaneous rotation flaps in cases of wound dehiscence after total knee arthroplasty. METHODS: Patients undergoing these surgical procedures were selected in the 2000-2012 period. The nine selected cases during this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius, and in one case we used advancing skin. RESULTS: Eighty nine percent of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation due to failure on treatment of infections, and one case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. CONCLUSION: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage it caused. Level of Evidence IV, Case Series. PMID:24453672

  10. Low manipulation prevalence following fast-track total knee arthroplasty.

    PubMed

    Husted, Henrik; Jørgensen, Christoffer C; Gromov, Kirill; Troelsen, Anders

    2015-02-01

    Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may have influenced the prevalence of joint stiffness and subsequent manipulation. We investigated the prevalence of manipulation following fast-track TKA and identified patients at risk of needing manipulation. 3,145 consecutive unselected elective primary unilateral TKA patients operated in 6 departments with well-defined fast-track settings were included in the study. Demographic data, prevalence, type and timing of manipulation, and preoperative and postoperative ROM were recorded prospectively, ensuring complete 1-year follow-up. 70 manipulations were performed within 1 year (2.2%) at a mean of 4 months after index surgery. Younger age and not using walking aids preoperatively were associated with a higher risk of manipulation. LOS ≤ 4 days (as opposed to a longer LOS) was not associated with an increased risk of manipulation. The prevalence of manipulation was lower or comparable to that in most published studies following more conventional pathways. Inherent patient demographics were identified as risk factors for manipulation whereas LOS ≤ 4 days was not. Thus, fast-track TKA does not result in increased risk of manipulation-despite a shorter LOS. Optimized pain treatment and early mobilization may contribute to these favorable results that support the use of fast-track.

  11. MRI diagnosis of patellar clunk syndrome following total knee arthroplasty.

    PubMed

    Heyse, Thomas J; Chong, Le Roy; Davis, Jack; Haas, Steven B; Figgie, Mark P; Potter, Hollis G

    2012-07-01

    Patellar Clunk Syndrome is a painful condition associated with a mechanical catching or clunking during active extension following total knee arthroplasty (TKA). The syndrome is caused by growth of interposing soft tissue usually at the superior pole of the patella. This interposed soft tissue cannot be visualized on plain radiographs. The aim was to ascertain if magnetic resonance imaging (MRI) would prove helpful in confirming the clinical diagnosis of patellar clunk by visualizing the interposed soft tissues adjacent to the patella and that the recognition of this tissue would be highly reproducible. MRI scans of 12 patients with clinical suspicion or related symptoms of a patellar clunk syndrome following primary TKA were retrospectively evaluated. Size of soft tissue masses proximal to the patella were determined in sagittal and axial MRI views. Largest diameters were recorded in two dimensions by two independent observers, and interobserver reliability was determined by intra-class correlation coefficients (ICC). Nine patients (75%) showed obvious MRI findings consistent with a patellar clunk lesion with high interobserver reliability (ICC values >0.75). In eight patients, this lead to operative treatment with arthroscopic debridement. MRI helps confirm the clinical diagnosis of patellar clunk. The data indicate that MRI is effective in defining the soft tissue lesion that is implicated in clinically evident patellar clunk syndrome after TKA.

  12. Cost savings of outpatient versus standard inpatient total knee arthroplasty

    PubMed Central

    Huang, Adrian; Ryu, Jae-Jin; Dervin, Geoffrey

    2017-01-01

    Background With diminishing reimbursement rates and strained public payer budgets, a high-volume inpatient procedure, such as total knee arthroplasty (TKA), is a common target for improving cost efficiencies. Methods This prospective case–control study compared the cost-minimization of same day discharge (SDD) versus inpatient TKA. We examined if and where cost savings can be realized and the magnitude of savings that can be achieved without compromising quality of care. Outcome variables, including detailed case costs, return to hospital rates and complications, were documented and compared between the first 20 SDD cases and 20 matched inpatient controls. Results In every case–control match, the SDD TKA was less costly than the inpatient procedure and yielded a median cost savings of approximately 30%. The savings came primarily from costs associated with the inpatient encounter, such as surgical ward, pharmacy and patient meal costs. At 1 year, there were no major complications and no return to hospital or readmission encounters for either group. Conclusion Our results are consistent with previously published data on the cost savings associated with short stay or outpatient TKA. We have gone further by documenting where those savings were in a matched cohort design. Furthermore, we determined where cost savings could be realized during the patient encounter and to what degree. In carefully selected patients, outpatient TKA is a feasible alternative to traditional inpatient TKA and is significantly less costly. Furthermore, it was deemed to be safe in the perioperative period. PMID:28234591

  13. Rehabilitative Guidelines after Total Knee Arthroplasty: A Review.

    PubMed

    Mistry, Jaydev B; Elmallah, Randa D K; Bhave, Anil; Chughtai, Morad; Cherian, Jeffrey Jai; McGinn, Tanner; Harwin, Steven F; Mont, Michael A

    2016-04-01

    Rehabilitation following total knee arthroplasty (TKA) continues to pose a challenge for both patients and providers. In addition, guidelines vary considerably between institutions, which often leave therapy regimens to the discretion of the provider. The lack of clear guidelines for rehabilitation may contribute to inadequate recovery of strength and range-of-motion, resulting in less optimal functional outcomes. Therefore, the aim of this review was to highlight and discuss a variety of post-TKA rehabilitative modalities currently available and to provide evidence regarding efficacy and practicality. Specifically, we assessed the role of and evidence for exercise therapy, aquatic therapy, balance training, continuous passive motion, cold therapy and compression, neuromuscular electrical stimulation, transcutaneous electrical nerve stimulation, and instrument-assisted soft-tissue therapy. Additionally, we proposed general recommendations for rehabilitation after TKA, and as we specifically described active and obese patients, we have included guidelines for these subsets as well. Our review examines the various rehabilitative modalities to offer suggestions for recovery of strength and range-of-motion after TKA, with a focus on the early incorporation of exercise therapy, balance training, aquatic therapy, cryopneumatic therapy, neuromuscular electrical stimulation, and transcutaneous electrical nerve stimulation. Dedication and commitment to rehabilitation may help patients attain and exceed their preoperative activity levels.

  14. Availability of Total Knee Arthroplasty Implants for Metal Hypersensitivity Patients

    PubMed Central

    Ajwani, Sanil Harji; Charalambous, Charalambos P.

    2016-01-01

    Purpose To provide information on the type of “hypersensitivity-friendly” components available for primary total knee arthroplasty (TKA) in the current market. Materials and Methods Implant manufactures were identified using the 2013 National Joint Registries of the United Kingdom and Sweden and contacted to obtain information about the products they offer for patients with metal hypersensitivity. Results Information on 23 TKA systems was provided by 13 implant manufacturers. Of these, 15 systems had options suitable for metal hypersensitivity patients. Two types of “hypersensitivity-friendly” components were identified: 10 implants were cobalt chrome prostheses with a “hypersensitivity-friendly” outer coating and 5 implants were made entirely from non-cobalt chrome alloys. Conclusions The results of this study suggest that several hypersensitivity TKA options exist, some of which provide the same designs and surgical techniques as the conventional implants. The information in this study can guide TKA surgeons in making informed choices about implants and identifying implants that could be examined in future controlled studies comparing outcomes between “hypersensitivity-friendly” and conventional implants. PMID:27894179

  15. Intraoperative nonpharmacotherapeutic blood management strategies in total knee arthroplasty.

    PubMed

    Banerjee, Samik; Issa, Kimona; Kapadia, Bhaveen H; Khanuja, Harpal S; Harwin, Steven F; McInerney, Vincent K; Mont, Michael A

    2013-12-01

    Substantial amounts of perioperative blood loss occur during total knee arthroplasty (TKA) that may require allogeneic transfusion in more than 30% of patients. Increased blood loss leads to poor physical functioning, increases infection risks, and prolongs hospitalization, which may eventually affect the overall clinical outcomes of TKA. In addition, allogeneic blood transfusions are associated with increased risks of transfusion reactions, immunosuppression, and a variety of immunological reactions. These concerns have led surgeons and anesthesiologists to develop various strategies to conserve blood, reduce costs, and decrease complications related to blood transfusions. Multiple nonpharmacologic intraoperative blood-saving measures have been used including acute normovolemic hemodilution, hypotensive anesthesia, tourniquets, bipolar sealants, intraoperative blood salvage systems, intramedullary femoral plugs, computer-assisted surgery, and the use of patient-specific instrumentation. However, no clear protocol exists currently to help surgeons choose the appropriate method for blood preservation. The aim of this article was to review the various nonpharmacologic intraoperative blood management strategies that have been used in TKA and to analyze their effectiveness and potential complications according to current evidence.

  16. The surgeon skill set in minimally invasive total knee arthroplasty.

    PubMed

    Rosenberg, Aaron G

    2006-07-01

    The traditional didactic approach to improving the skill set of surgeons has been shown to have minimal impact. Surgeons, like other adults, learn best by doing, by practicing what they do. and by challenging themselves to take on increasingly difficult scenarios. To be effective, surgical practice requires deconstruction of a procedure into key elements, each of which is repeated until optimal results are achieved before moving on to the next element. Given the multifactorial nature of a procedure such as minimally invasive surgery for total knee arthroplasty, surgeons need to introduce incremental changes into their operating environment to allow for realistic self-assessment during postoperative self-debriefing. One technique, visualization, can be used for virtual practice. In the future, surgical simulators may allow for true virtual practice as well as systematic recording of results. However, psychomotor skills are only one component of surgical success. Intuition and innovation are also key, but these components are more difficult to teach and to learn. The key ingredient to successful practice and ultimate self-improvement in surgery, as in other pursuits in life, is that a person be self-motivated and competitive and have a strong desire to improve coupled with appropriate practice routines that can lead to improvement.

  17. Influence of body mass index in revision total knee arthroplasty

    PubMed Central

    de Carvalho, Rogério Teixeira; Santos, Diego Benone; Chammas, Victor; Arrebola, Lucas Simões; Colombo, Mauricio Lebre; Scalizi, Caetano

    2015-01-01

    ABSTRACT OBJECTIVE : To evaluate the influence of the body mass index (BMI) on the functional assessment of patients who underwent revision total knee arthroplasty (RTKA). METHODS : Thirty patients who un-derwent RTKA between January 2008 and January 2012 were retrospectively assessed using the WOMAC questionnaire. The patients were divided into three groups according to the BMI ca-tegories defined by the World Health Organization (WHO): Group I with normal BMI (18-24.9 Kg/m2), with eight patients; Group II, overweight (BMI 25-29.9 Kg/m2), with 15 patients, and Group III obesity with BMI ≥ 30 Kg/m2, with seven patients. The post-ope-rative function scores obtained through the WOMAC questionnaire were compared with the BMI of each group. The statistical analysis between BMI and WOMAC scores was performed with the Spe-arman correlation test. RESULTS : The average functional WOMAC score for individuals in Group I was 16.7; in Group II it was 47.7; and in Group III it was 69.9, with a statistically significant differen-ce between groups I, II and III (p< 0.0001). CONCLUSION : Patients with BMI > 25 Kg/m2 had a worse functional evaluation through WOMAC scores when compared to patients with normal BMI after RTKA. Level of Evidence III, Tranversal Retrospective Study. PMID:27057139

  18. Factors affecting polyethylene wear in total knee arthroplasty.

    PubMed

    Kuster, Markus S; Stachowiak, Gwidon W

    2002-02-01

    A complication of total knee arthroplasty (TKA) is fatigue-type wear, which can destroy a tibial inlay in <10 years. This deleterious wear mechanism occurs during cyclic loading if the yield stress of polyethylene is exceeded. Because increased stress on and within the polyethylene inlay is associated with increased wear, it is important to reduce the inlay stress by either activity restrictions or conformity changes of design. All stress parameters are more sensitive to conformity changes (eg, design changes) than to load changes (eg, activity restrictions). However, the reduction of stress on and within the polyethylene through increased conformity will increase the stress at the tibial fixation interfaces. An attempt was made to solve this problem with the introduction of mobile-bearing designs. Many mobile-bearing designs exist with good long-term results. One important difference among the various designs is the amount of flexion range with full conformity between the femoral component and the tibial inlay. Although a single radius design reduces polyethylene stress throughout the flexion range, it may be disadvantageous for a revision design to intraoperatively adapt to different degrees of constraint. Aseptic loosening and osteolysis due to small abrasive and adhesive wear particles have also been reported as a cause of failure. The design and material parameters affecting polyethylene wear in TKAs, as well as the potential detrimental effects of wear particle size, are the key issues in defining the life of a TKA.

  19. Patient education and anesthesia choice for total knee arthroplasty.

    PubMed

    Elkassabany, Nabil M; Abraham, Daniel; Huang, Stephanie; Kase, Brandon; Pio, Finnah; Hume, Eric; Israelite, Craig; Liu, Jiabin

    2017-09-01

    Spinal anesthesia (SA) for Total Knee Arthroplasty (TKA) may be associated with better patients' outcomes. This study aims to assess the association between preoperative education about the advantage of SA over general anesthesia (GA) for TKA and the likelihood of patient choice of NA. Patients undergoing unilateral primary TKA were identified. Type of anesthesia (GA or SA), attendance of the (joints class), patient demographics, ASA status, anticoagulation status, and diagnosis of back problems were recoded. Regression analysis was used to assess the association between the type of anesthesia and attendance of the joints class. 1010 patients were identified to have unilateral primary TKA. 31% of patients attended the joint class. Patients who attended the joints class were more likely to receive SA when compared to those who did not attend (OR=1.7, CI: 1.2-2.5, P=0.004) after adjusting for other variables. Preoperative education about advantages of SA may be associated with an increase in patients receiving SA for TKA. Increase in patients receiving SA for TKA may improve outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Patient-specific instruments for total knee arthroplasty.

    PubMed

    Lachiewicz, Paul F; Henderson, Robert A

    2013-09-01

    The use of patient-specific instruments for total knee arthroplasty shifts computer navigation for bone landmark registration and implant positioning from the intraoperative to the preoperative setting. Each system requires preoperative MRI or CT, with specifications determined by the instrument manufacturer. The marketed advantages of patient-specific instruments include greater accuracy in coronal alignment with fewer outliers, no need for instrumentation of the intramedullary canal, reduced surgical time, lower hospital costs, and improved clinical outcomes. The few published results of these instruments suggest minimal gains obtained in hospital logistics variables and minimal evidence of improvement in either alignment or patient outcomes. Disadvantages of patient-specific instruments include increased costs for imaging and instrument fabrication as well as increased preoperative time required for surgical planning and reviewing the instrument plans, and the learning curve for the surgeon to work with the engineers and use these instruments intraoperatively. It is also necessary to have a set of standard instruments available in case the patient-specific instruments do not work properly. Additional data are required before deciding whether these instruments should be recommended.

  1. Factors Predicting the Forgotten Joint Score After Total Knee Arthroplasty.

    PubMed

    Behrend, Henrik; Zdravkovic, Vilijam; Giesinger, Johannes; Giesinger, Karlmeinrad

    2016-09-01

    We recently developed the forgotten joint score 12 (FJS-12), a tool to assess joint awareness in everyday life. It is unknown whether patient factors predicting the outcome of the FJS-12 after total knee arthroplasty (TKA) exist. Five hundred forty cases of TKA were analyzed. Objective clinical results were obtained for range of motion, stability, and alignment. Patient-reported outcome was assessed using the FJS-12. Baseline data and complications were recorded. Cluster analysis based on FJS-12, postoperative flexion, and age resulted in 3 groups: poor outcome (88 patients), good outcome (340 patients), and excellent outcome (118 patients). The characteristics of "poor" compared to "excellent" clusters were studied more closely using bivariate comparative tests and logistic regression. We could find that male patients around 63 years with a lower body mass index were most likely to be allocated to the cluster "excellent" (defined as high FJS-12 and high postoperative flexion). Preoperative extension and flexion, stability, varus/valgus alignment, surgery prior TKA, or comorbidities were not predictive for the FJS-12 at 1 year follow-up. We identified 3 preoperative patient-related factors that may predict the FJS-12 after TKA: body mass index, age, and gender. These findings can be used to guide decision-making and important preoperative discussions on expectations after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Early PROMs following total knee arthroplasty--functional outcome dependent on patella resurfacing.

    PubMed

    Baker, Paul N; Petheram, Timothy; Dowen, Daniel; Jameson, Simon S; Avery, Peter J; Reed, Mike R; Deehan, David J

    2014-02-01

    Patella resurfacing during primary total knee arthroplasty (TKA) remains controversial. Variation in published results for patella resurfacing may potentially be explained by differences in design between TKA brands. We interrogated NJR-PROMs data to ascertain whether there is an early functional benefit to resurfacing the patella, both overall and for each of the five most popular primary knee designs through use of the Oxford Knee Score. A total of 8103 resurfaced TKAs and 15,290 nonresurfaced TKAs were studied. There was a large variation in the proportion of knees undergoing patella resurfacing by brand (Nexgen=16% versus Triathlon=52%). Patellar resurfacing did not significantly influence the magnitude of improvement in overall knee function or anterior knee-specific function irrespective of TKA brand or for cruciate retaining versus sacrificing designs. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Estimating total knee replacement joint load ratios from kinematics.

    PubMed

    Fitzpatrick, Clare K; Rullkoetter, Paul J

    2014-09-22

    Accurate prediction of loads acting at the joint in total knee replacement (TKR) patients is key to developing experimental or computational simulations which evaluate implant designs under physiological loading conditions. In vivo joint loads have been measured for a small number of telemetric TKR patients, but in order to assess device performance across the entire patient population, a larger patient cohort is necessary. This study investigates the accuracy of predicting joint loads from joint kinematics. Specifically, the objective of the study was to assess the accuracy of internal-external (I-E) and anterior-posterior (A-P) joint load predictions from I-E and A-P motions under a given compressive load, and to evaluate the repeatability of joint load ratios (I-E torque to compressive force (I-E:C), and A-P force to compressive force (A-P:C)) for a range of compressive loading profiles. A tibiofemoral finite element model was developed and used to simulate deep knee bend, chair-rise and step-up activities for five patients. Root-mean-square (RMS) differences in I-E:C and A-P:C load ratios between telemetric measurements and model predictions were less than 1.10e-3 Nm/N and 0.035 N/N for all activities. I-E:C and A-P:C load ratios were consistently reproduced regardless of the compressive force profile applied (RMS differences less than 0.53e-3 Nm/N and 0.010 N/N, respectively). When error in kinematic measurement was introduced to the model, joint load predictions were forgiving to kinematic measurement error when conformity between femoral and tibial components was low. The prevalence of kinematic data, in conjunction with the analysis presented here, facilitates determining the scope of A-P and I-E joint loading ratios experienced by the TKR population. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Femoral sizing in total knee arthroplasty is rotation dependant.

    PubMed

    Koninckx, Angelique; Deltour, Arnaud; Thienpont, Emmanuel

    2014-12-01

    The mismatch between the medio-lateral (ML) and the antero-posterior (AP) size of femoral components in total knee arthroplasty (TKA) has been linked to gender, ethnicity, morphotype and height differences in patients. The hypothesis of this study was that the AP size measurement of a femoral component increases with more external rotation in posterior referencing TKA. During a 2-year period, 201 patients were included in this prospective study. The AP distance of the distal femur was measured with an AP sizer of the Vanguard (Biomet, Warsaw, US) knee system. This AP sizer allows to dial in external rotation by 1° increments and to determine the femoral size with an anterior boom. AP size was noted at 0°, 3° and 5° of external rotation and then compared for ML matching. Antero-posterior and corresponding ML sizes match perfectly for the Vanguard at 0° of external rotation and a central boom position on the anterior femoral surface. Then, the anterior boom was positioned on the antero-lateral cortex and the AP size increased a mean (SD) 1 (0.5) mm. With 3° of external rotation, the AP size increased a mean (SD) 2.3 (0.4) mm and for 5° a mean (SD) 3.8 (0.3) mm (P < 0.05). This increase in AP size resulted in ML overhang of 2.2 (1.2) mm for 3° and 4.8 (2.6) mm for 5° (P < 0.05). Antero-posterior size measurement of the distal femur is determined by the anatomy of the anterior surface with a higher antero-lateral cortex and the amount of external rotation that is dialled in during surgery. Since these parameters vary case per case, the availability of narrow components offers more surgical options to the surgeon and its importance extends beyond the gender aspect allowing different amounts of external rotation to be used without ML overhang. II.

  5. Correlations Between Functional Knee Outcomes and Health-Related Quality of Life After Total Knee Arthroplasty in an Asian Population.

    PubMed

    Thiam, Wei D; Teh, Jing-Wen D; Bin Abd Razak, Hamid Rahmatullah; Tan, Hwee-Chye A

    2016-05-01

    Current literature evaluating postoperative outcomes after total knee arthroplasty for osteoarthritis in the Asian population is sparse. We aimed to evaluate correlations between improvements in knee outcomes vs changes in generic health-related quality of life. Postoperative outcomes were collected prospectively for 369 patients and compared at a 2-year follow-up using Short-Form 36 (SF-36), Knee Society Score (KSS), and Oxford Knee Score (OKS). The Spearman correlation coefficient was used to evaluate the strength of correlation between changes in knee scores (KSS and OKS) vs changes in each domain of the SF-36 scores. All parameters achieved statistically significant improvements (P < .05) in postoperative scores at 2-year follow-up with the exception of general health (P = .221) component of SF-36. For KSS knee score, there was low correlation with bodily pain (0.32). For KSS function score, there was moderate correlation with physical functioning (0.57) and low correlation with role physical (0.31) and social functioning (0.36). For OKS, there was moderate correlation with physical functioning (0.61) and social functioning (0.54) and low correlation with role physical (0.38) and bodily pain (0.50). All other parameters of SF-36 showed little correlation (<0.3). Improvements in knee-specific outcomes (KSS and OKS) after total knee arthroplasty correlate well with improvements in physical domains of health-related quality of life (SF-36) but poorly with the mental and social health domains. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Patient perspective survey of total hip vs total knee arthroplasty surgery.

    PubMed

    de Beer, Justin; Petruccelli, Danielle; Adili, Anthony; Piccirillo, Liz; Wismer, David; Winemaker, Mitch

    2012-06-01

    A 42-item survey was developed and administered to determine patient perception of and satisfaction with total hip arthroplasty (THA) vs total knee arthroplasty (TKA). A total of 153 patients who had both primary THA and TKA for osteoarthritis with 1-year follow-up were identified. Survey response rate was 72%. Patients were more satisfied with THA meeting expectations for improvement in function and quality of life (P < .05), whereas pain relief expectations were equivalent. Most patients (70.9%) reported that TKA required more physiotherapy. One-year Oxford score and improvement in Oxford score from preoperative to 1 year were superior for THAs (P = .000). Despite equivalent pain relief, THAs trend toward higher satisfaction compared with TKAs. THA is more likely to "feel normal" with greater improvement in Oxford score. Recovery from TKA requires more physiotherapy and a longer time to achieve a satisfactory recovery status. Patients should be counseled accordingly.

  7. Research evidence for the use of preoperative exercise in patients preparing for total hip or total knee arthroplasty.

    PubMed

    Barbay, Kathryn

    2009-01-01

    Preoperative exercise/rehabilitation is currently being considered to improve outcomes for orthopaedic surgery. This article presents an evidence-based practice review of the current research literature from 1998 to 2008 to determine whether preoperative exercise alone will be beneficial to patients preparing for total knee or hip arthroplasty. Only 3 studies met the inclusion criteria of preoperative exercise as the sole intervention. Each of these studies indicated that preoperative exercise had some postoperative benefit to total knee or hip arthroplasty patients. In general, the results are inconclusive due to the lack of strong research evidence, and only a pragmatic recommendation for preoperative exercise prior to total hip or knee arthroplasty is supported. More research is needed in the area of preoperative exercise for persons preparing for total hip or knee arthroplasty.

  8. Influence of fear of movement on total knee arthroplasty outcome.

    PubMed

    Kocic, Mirjana; Stankovic, Anita; Lazovic, Milica; Dimitrijevic, Lidija; Stankovic, Ivona; Spalevic, Marija; Stojiljkovic, Predrag; Milenkovic, Marina; Stojanovic, Zorica; Nikolic, Dejan

    2015-01-01

    RiassuntoLo scopo dello studio è quello di verificare l’incidenza del timore postoperatorio ai movimenti nei pazienti sottoposti ad artroplastica totale del ginocchio (TKA) e di determinare l’associazione di questo timore con i provvedimenti da adottare. Lo studio prospettico riguarda 78 pazienti sottoposti ad TKA primaria per osteoartrite. L’incidenza di timore al movimento è stata detenninata con l’uso della Tampa Scale of Kinesiophobia (TSK). I pazienti sono stati valutati in tre fasi temporali: 2 settimane. 4 settimane e 6 mesi dopo l’intervento chirurgico. In tutte e tre le fasi sono stati valutati il dolore e l’entità della flessione, mentre l’aspetto funzionale è stato preso in considerazione soltanto sei mesi dopo l’intervento, secondo la Oxford knee score 1. Il timore al movimento è stato registrato in 17 pazienti (21,8%). Quelli con maggiore entità di timore hanno dimostrato di conseguire risultati significativamente meno buoni in termini di dolore, grado di flessione e funzionalità rispetto a quelli con limitata paura. Miglioramento del dolore e della flessione sono stati progressivamente conseguiti nel tempo in entrambi i gruppi, ma i risultati migliori vengono raggiunti nel gruppo con minore paura al movimento. Lo studio ha dimostrato che la paura postoperatoria alla motilità si associa significativamente con il dolore, l’entità della flessione e la funzionalità del ginocchio. Altri Autori haImo rilevato che il timore preoperatorio alla motilità del ginocchio fa prevedere limitazioni funzionali postoperatorie. In conclusione il timore della motilità si rileva in una significativa proporzione dei pazienti dopo TKA e si associa con gonalgia, e minore flessione e funzionalità, e dunaue questa paura rappresenta un richio di scarsi risultati dopo artroplastica totale del ginocchio.

  9. Systematic review of periprosthetic tibia fracture after total knee arthroplasties

    PubMed Central

    Ebraheim, Nabil A; Ray, Joseph R; Wandtke, Meghan E; Buchanan, Grant S; Sanford, Chris G; Liu, Jiayong

    2015-01-01

    AIM: To investigate the known incidences, treatment options, and related outcomes of periprosthetic tibia fractures after total knee arthroplasty (TKA). METHODS: A literature search was done to identify studies that fit the inclusion criteria. The database search yielded 185 results, which were further reduced by the exclusion criteria to 13 papers, totaling 157 patients that met these criteria. Incidence rates of the different types of periprosthetic tibia fractures were determined and their treatments were subsequently analyzed based on the fracture’s subclass, with patient outcomes being overall favorable. RESULTS: Of the 144 documented patients, 54 (37.5%) had a subclass C fracture, which are frequently seen in revision arthroplasties or when using cement intraoperatively. The fractures of subclasses A and B occur postoperatively. There were 90 subclass A and B fractures with incidences of 18.75% and 43.75% respectively. When broken down by type, 62 (55.36%) were type 1, 24 (21.4%) were type 2, 24 (21.4%) were type 3, and 2 (1.8%) were type 4. Furthermore, from the studies that included origin of injury, the types were further classified as having non-traumatic or traumatic origins. Type 1 had 78% (40/51) non-traumatic origin and 22% (11/51) traumatic origin. Fifteen fractures were type 2, but 5 were falls and 1 through a motor vehicle accident, giving a trauma causation of 40% (6/15). Of the 24 type 3 fractures, 12 were falls and 2 vehicular accidents, leading to a trauma causation of 58% (14/24). CONCLUSION: Type 1 fractures were the most common. Subclass A was treated with locking plates, B required a revision TKA, and C was treated intraoperatively or nonoperatively. PMID:26396942

  10. Efficient strategy for controlling postoperative hemorrhage in total knee arthroplasty.

    PubMed

    Sasanuma, Hideyuki; Sekiya, Hitoshi; Takatoku, Kenzou; Takada, Hisashi; Sugimoto, Naoya; Hoshino, Yuichi

    2011-06-01

    The objective of the present study was to compare the intraoperative use of tranexamic acid (TNA) plus intra-articular diluted-epinephrine (DEP) with preoperative autologous blood donations and transfusions in reducing an allogeneic blood transfusion (ABT) in primary unilateral total knee arthroplasty (TKA). Patients (n=133) treated with unilateral primary TKA were divided into three groups retrospectively: patients administered autologous blood transfusions were assigned to group A (n=51); patients administered preoperative injections of TNA and postoperative intra-articular injections of DEP were assigned to group B (n=42); and patients treated with the drain-clamp method in addition to injections of TNA and DEP were assigned to group C (n=40). The rate of avoidance of ABTs, postoperative blood loss, and complications (DVT/PE, skin problems) were examined. The differences among the three groups were not significant in terms of the proportion of patients requiring no ABTs (94% in group A, 93% in group B and 95% in group C, n.s.). The total blood loss calculated was 1,140±451 ml, 852±343 ml, and 850±296 ml, respectively (group B>A, group C>A, P=0.0009). The significant complications were not observed in three groups. The results of the study showed that the TNA plus DEP combination exerted a comparable effect with preoperative autologous blood transfusion in avoiding ABTs in unilateral primary TKA. Considering several problems of preoperative autologous blood donation, the use of TNA plus DEP is recommended. In addition, it is highly possible that allogeneic blood transfusions can be avoided for patients with preoperative Hb values≥10.5 using the method described in this study, and the need for preoperative autologous blood donations can be decreased.

  11. Use of tranexamic acid in total knee arthroplasty

    PubMed Central

    MARRA, FRANCESCO; ROSSO, FEDERICA; BRUZZONE, MATTEO; BONASIA, DAVIDE EDOARDO; DETTONI, FEDERICO; ROSSI, ROBERTO

    2016-01-01

    Purpose different strategies have been developed to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. Methods we enrolled all patients submitted to a primary TKA in our department between November 2014 and August 2015. They were divided into three groups corresponding to the method of TXA administration used: intravenous (IV), intra-articular (IA), and a combination of the two. Demographic data, as well as preoperative hemoglobin and platelet levels, were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions; postoperative pain was also assessed. Student’s t-test or a χ2 test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences. Results the sample comprised 34 patients: IV, 10 cases; IA, 15 cases, and combined (IV + IA), 9 cases. The average age of the patients was 71.1±6.4 years. No significant differences in the outcome measures were found between the groups, with the exception of a significantly lower maximum hemoglobin loss in the combined versus the IV group (p=0.02). There were no differences between the groups in the amount of blood in the drain or the rate of transfusions. Conclusions the data from this preliminary study, as well as data from the literature, confirm that TXA administration is safe and effective in reducing total blood loss in TKA, and no administration protocol seems to be superior to the others. Level of evidence Level II, prospective comparative study. PMID:28217656

  12. Postoperative cognitive changes after total knee arthroplasty under regional anesthesia

    PubMed Central

    Jeon, Young-Tae; Kim, Byung-Gun; Park, Young Ho; Sohn, Hye-Min; Kim, Jungeun; Kim, Seung Chan; An, Seong Soo; Kim, SangYun

    2016-01-01

    Abstract Background: The type of postoperative cognitive decline after surgery under spinal anesthesia is unknown. We investigated the type of postoperative cognitive decline after total knee arthroplasty (TKA). Neuropsychological testing was conducted and the changes in cerebrospinal fluid (CSF) biomarkers after surgery were evaluated. Methods: Fifteen patients who required bilateral TKA at a 1-week interval under spinal anesthesia were included. Neuropsychological tests were performed twice, once the day before the first operation and just before the second operation (usually 1 week after the first test) to determine cognitive decline. Validated neuropsychological tests were used to examine 4 types of cognitive decline: memory, frontal-executive, language-semantic, and others. Concentrations of CSF amyloid peptide, tau protein, and S100B were measured twice during spinal anesthesia at a 1-week interval. The patients showed poor performance in frontal-executive function (forward digit span, semantic fluency, letter-phonemic fluency, and Stroop color reading) at the second compared to the first neuropsychological assessment. Results: S100B concentration decreased significantly 1 week after the operation compared to the basal value (638 ± 178 vs 509 ± 167 pg/mL) (P = 0.019). Amyloid protein β1–42, total tau, and phosphorylated tau concentrations tended to decrease but the changes were not significant. Conclusion: Our results suggest that frontal-executive function declined 1 week after TKA under spinal anesthesia. The CSF biomarker analysis indicated that TKA under regional anesthesia might not cause neuronal damage. PMID:28033253

  13. Intraoperative evaluation of total knee replacement: kinematic assessment with a navigation system.

    PubMed

    Casino, Daniela; Zaffagnini, Stefano; Martelli, Sandra; Lopomo, Nicola; Bignozzi, Simone; Iacono, Francesco; Russo, Alessandro; Marcacci, Maurilio

    2009-04-01

    Interest in the kinematics of reconstructed knees has increased since it was shown that the alteration of knee motion could lead to abnormal wear and damage to soft tissues. We performed intraoperative kinematic measurements using a navigation system to study knee kinematics before and after posterior substituting rotating platform total knee arthroplasty (TKA). We verified intraoperatively (1) if varus/valgus (VV) laxity and anterior/posterior (AP) laxity were restored after TKA; (2) if TKA induced abnormal femoral rollback; and (3) how tibial axial rotation was influenced by TKA throughout the range of flexion. We found that TKA improved alignment in preoperative osteoarthritic varus knees which became neutral after surgery and maintained a neutral alignment in neutral knees. The VV stability at 0 degrees was restored while AP laxity at 90 degrees significantly increased after TKA. Following TKA, the femur had an abnormal anterior translation up to 60 degrees of flexion, followed by a small rollback of 12 +/- 5 mm. TKA influenced the tibia rotation pattern during flexion, but not the total amount of internal/external rotation throughout whole range of flexion, which was preserved after TKA (6 degrees +/- 5 degrees ). This study showed that the protocol proposed might be useful to adjust knee stability at time zero and that knee kinematic outcome during total knee replacement can be monitored by a navigation system.

  14. Differential knee skin temperature following total knee arthroplasty and its relationship with serum indices and outcome: A prospective study.

    PubMed

    Zeng, Yirong; Feng, Wenjun; Qi, Xinyu; Li, Jie; Chen, Jinlun; Lu, Lu; Deng, Peng; Zeng, Jianchun; Li, Feilong

    2016-10-01

    Objectives To monitor knee skin temperature changes for 12 months following total knee arthroplasty (TKA) and identify potential reasons for any differences in skin temperature and to investigate if there is a relationship between the differential temperature and clinical outcome. Methods Patients who attended for a unilateral TKA due to primary osteoarthritis between August 2012 and August 2014 were eligible for this prospective study. The skin temperature of both knees was monitored preoperatively and postoperatively using an infrared thermometer. Serum indices and Hospital for Special Surgery (HSS) knee scores were assessed. Results Thirty-nine patients were involved in the study. The skin temperature of both knees as well as the differential temperature increased following TKA. Serum haemoglobin, haematocrit and days from surgery showed inverse correlations with the differential temperature, while body mass index and American Society of Anesthesiologists scores showed positive correlations. There was a strong inverse correlation between the differential temperature and HSS. score. Conclusions Differential knee skin temperature elevation 12 months post-TKA may be a normal surgical response.

  15. The use of the knee joint-line balancer to control patella position in revision total knee arthroplasty.

    PubMed

    ten Ham, Arno M; Wymenga, Ate B; Jacobs, Wilco C H

    2005-04-01

    In revision total knee arthroplasty (TKA), control of the patellar height and the joint line is difficult. Therefore, we developed an adjustable flexion-extension spacer, the Knee Joint-line Balancer (KJB(R)). This device simulates femur component sizes, polyethylene sizes, the joint-line level, and distal femur wedges. The goal of this study is to evaluate the use of an adjustable knee spacer to control patellar height and joint-line during revision total knee surgery. The subjects of the study were the first 10 consecutive patients who had undergone revision of a primary TKA where the KJB was used. A reference group composed of the last 10 patients treated without the use of the KJB was also evaluated. The joint-line position and the patellar height were determined before and after revision TKA. The method described by Figgie et al. was used. The patellar height in the reference group averaged 7.7 mm. Seven of 10 patients had a patella baja, and two of these patients had patellar impingement. One patient needed a proximalisation of the tuberositas. The patellar height in the KJB group averaged 14.6 mm after revision, with only one patient having a patella baja. This new device, adjustable kneespacer for revision TKA ("the KJB"), seems to provide better control of the patellar position in total knee revision.

  16. In vivo six-degree-of-freedom knee-joint kinematics in overground and treadmill walking following total knee arthroplasty.

    PubMed

    Guan, Shanyuanye; Gray, Hans A; Schache, Anthony G; Feller, Julian; de Steiger, Richard; Pandy, Marcus G

    2017-08-01

    No data are available to describe six-degree-of-freedom (6-DOF) knee-joint kinematics for one complete cycle of overground walking following total knee arthroplasty (TKA). The aims of this study were firstly, to measure 6-DOF knee-joint kinematics and condylar motion for overground walking following TKA; and secondly, to determine whether such data differed between overground and treadmill gait when participants walked at the same speed during both tasks. A unique mobile biplane X-ray imaging system enabled accurate measurement of 6-DOF TKA knee kinematics during overground walking by simultaneously tracking and imaging the joint. The largest rotations occurred for flexion-extension and internal-external rotation whereas the largest translations were associated with joint distraction and anterior-posterior drawer. Strong associations were found between flexion-extension and adduction-abduction (R(2)  = 0.92), joint distraction (R(2)  = 1.00), and anterior-posterior translation (R(2)  = 0.77), providing evidence of kinematic coupling in the TKA knee. Although the measured kinematic profiles for overground walking were grossly similar to those for treadmill walking, several statistically significant differences were observed between the two conditions with respect to temporo-spatial parameters, 6-DOF knee-joint kinematics, and condylar contact locations and sliding. Thus, caution is advised when making recommendations regarding knee implant performance based on treadmill-measured knee-joint kinematic data. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1634-1643, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  17. Change in preoperative expectations in patients undergoing staged bilateral primary total knee or total hip arthroplasty.

    PubMed

    Poultsides, Lazaros A; Ghomrawi, Hassan M K; Lyman, Stephen; Aharonoff, Gina B; Mancuso, Carol A; Sculco, Thomas P

    2012-10-01

    The objective of this study was to compare preoperative expectation scores between stages in patients with bilateral total knee arthroplasty (TKA) and total hip arthroplasty (THA) using intraclass correlation coefficients (ICCs). For patients with TKA (57), ICC was 0.449, indicating fair agreement between stages; expectations did not change for 31% of patients, whereas 40% had higher and 29% had lower expectations. For patients with THA (55), ICC was 0.663, indicating moderate agreement; expectations did not change for 42% of patients, whereas 38% had higher and 20% had lower expectations. In multivariable analyses controlling for first expectation score, second expectation score was associated with better Western Ontario McMaster Universities Osteoarthritis Index stiffness score for TKA and with worse Western Ontario McMaster Universities Osteoarthritis Index function score for patients with THA. For most patients, expectations changed between staged bilateral TKA and THA, but the direction of change was not uniform.

  18. OSTEOLYSIS AROUND TOTAL KNEE ARTHOPLASTY: A REVIEW OF PATHOGENETIC MECHANISMS

    PubMed Central

    Gallo, Jiri; Goodman, Stuart B.; Konttinen, Yrjö T.; Wimmer, Markus A.; Holinka, Martin

    2014-01-01

    Aseptic loosening and other wear-related complications are one of the most frequent late reasons for revision of total knee arthroplasty (TKA). Periprosthetic osteolysis (PPOL) predates aseptic loosening in many cases indicating the clinical significance of this pathogenic mechanism. A variety of implant-, surgery-, and host-related factors have been delineated to explain the development of PPOL. These factors influence the development of PPOL due to changes in mechanical stresses within the vicinity of the prosthetic device, excessive wear of the polyethylene liner, and joint fluid pressure and flow acting on the peri-implant bone. The process of aseptic loosening is initially governed by factors such as implant/limb alignment, device fixation quality, and muscle coordination/strength. Later large numbers of wear particles detached from TKAs trigger and perpetuate particle disease, as highlighted by progressive growth of inflammatory/granulomatous tissue around the joint cavity. An increased accumulation of osteoclasts at the bone-implant interface, an impairment of osteoblast function, mechanical stresses, and an increased production of joint fluid contribute to bone resorption and subsequent loosening of the implant. In addition, hypersensitivity and adverse reactions to metal debris may contribute to aseptic TKA failure but should be determined more precisely. Patient activity level appears to be the most important factor when the long-term development of PPOL is considered. Surgical technique, implant design, and material factors are the most important preventative factors because they influence both the generation of wear debris and excessive mechanical stresses. New generations of bearing surfaces and designs for TKA should carefully address these important issues in extensive preclinical studies. Currently, there is little evidence that PPOL can be prevented with pharmacological interventions. PMID:23669623

  19. Opportunities in Total Knee Arthroplasty: Worldwide Surgeons' Perspective.

    PubMed

    Dunbar, Michael; Newman, Jared M; Khlopas, Anton; Chughtai, Morad; Martinez, Nick; Bhowmik-Stoker, Manoshi; Mont, Michael A

    2017-07-25

    This study surveyed a group of US and international orthopaedic surgeons to prioritize areas of improvement in primary total knee arthroplasty (TKA). Specifically, we assessed surgeon responses regarding the top five areas of TKA needing improvement; which were stratified by: a) US surgeons, b) international surgeons, c) US surgeons' implant-brand-loyalty, and d) surgeons' years of experience and case volume. Four hundred and eighteen surgeons who were board-certified, in practice for at least two years, spent 60% of their time in clinical practice, and performed a minimum of 25 lower extremity joint arthroplasties per year were surveyed. They chose the top five areas (among 17) needing improvement for TKA. Results were stratified by surgeons' location (US and international), implant-brand-loyalty, years of experience, and case volume. Functional outcomes was the top identified area for improvement (US 63% and international 71%), followed by brand loyalty (Company I 68%, other brand 59%, and multi-brand/no loyalty 66%), years of experience (early-career 64%, mid-career 63%, and late-career 75%) and case volume (low-volume 69%, mid-volume 60%, and high-volume 71%). Following this was costs for US surgeons (47%) and implant survivorship for international surgeons (57%). While costs were the next highest area for specific Company-loyal surgeons (57%), implant survivorship was the next highest area for the other two cohorts. Implant survivorship was the second most important area of improvement regardless of years of experience and for low- and mid-volume surgeons. Surgeons identified functional outcomes as the most important area needing improvement. Cost of implants was more important for American as compared to international surgeons.

  20. Postoperative pain treatment after total knee arthroplasty: A systematic review

    PubMed Central

    Wetterslev, Mik; Hansen, Signe Elisa; Hansen, Morten Sejer; Mathiesen, Ole; Dahl, Jørgen B.

    2017-01-01

    Introduction The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). Methods This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-based analgesic interventions after TKA. Bias was evaluated according to Cochrane methodology. Outcomes were opioid consumption (primary), pain scores at rest and during mobilization, adverse events, and length of stay. Interventions investigated in three or more trials were meta-analysed. Outcomes were evaluated using forest plots, Grading of Recommendations Assessment, Development and Evaluation (GRADE), L’Abbe Plots and trial sequential analysis. Results The included 113 trials, investigating 37 different analgesic interventions, were characterized by unclear/high risk of bias, low assay sensitivity and considerable differences in pain assessment tools, basic analgesic regimens, and reporting of adverse events. In meta-analyses single and continuous femoral nerve block (FNB), intrathecal morphine, local infiltration analgesia, intraarticular injection of local anaesthetics, non-steroidal anti-inflammatory drugs, and gabapentinoids demonstrated significant analgesic effects. The 24-hour morphine-sparing effects ranged from 4.2 mg (CI: 1.3, 7.2; intraarticular local anaesthetics), to 16.6 mg (CI: 11.2, 22; single FNB). Pain relieving effects at rest at 6 hours ranged from 4 mm (CI: -10, 2; gabapentinoids), to 19 mm (CI: 8, 31; single FNB), and at 24 hours from 3 mm (CI: -2, 8; gabapentinoids), to 16 mm (CI: 8, 23; continuous FNB). GRADE-rated quality of evidence was generally low. Conclusion A low quality of evidence, small sample sizes and heterogeneity of trial designs prohibit designation of an optimal procedure-specific analgesic regimen after TKA. PMID:28273133

  1. Clinical Analysis of Propionibacterium acnes Infection After Total Knee Arthroplasty.

    PubMed

    Nodzo, Scott R; Westrich, Geoffrey H; Henry, Michael W; Miller, Andy O

    2016-09-01

    Propionibacterium acnes is a common cause of upper extremity arthroplasty infection and usually presents in an indolent subacute fashion. It is not well described how total knee arthroplasty (TKA) patients infected with P acnes present. We retrospectively compared patients undergoing revision TKA for infection from P acnes and methicillin-sensitive Staphylococcal aureus (MSSA) in our institutional infection database. Patients were classified as having a periprosthetic joint infection based on the Musculoskeletal Infection Society criteria and were excluded if they had a polymicrobial culture. Patient demographics, preoperative laboratory values, microbiology data, and synovial fluid white blood cell (WBC) counts were analyzed. Sixteen patients with a P acnes and 30 with an MSSA TKA periprosthetic joint infection were identified. Median erythrocyte sedimentation rate was significantly higher in the MSSA group compared to the P acnes group (56.0 mm/h; interquartile range [IQR], 44.3-72.9 vs 23.0 mm/h; IQR, 18.5-52.0; respectively, P = .03) as were C-reactive protein levels (5.9 mg/dL; IQR, 3.7-26.9 vs 2.0 mg/dL; IQR, 0.5-14.0; respectively, P = .04). WBC count, synovial fluid WBC, and percentage of synovial polymorphonuclear cells were similar between groups. Mean time to culture was 8.3 ± 2.0 days in the P acnes group and 1.8 ± 0.8 days in the MSSA group. P acnes TKA infections are associated with more acute inflammatory symptoms than typically appreciated, and long hold anaerobic cultures up to 14 days are necessary to accurately identify this organism as the causative agent of TKA periprosthetic infection. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Use of Chronic Methadone Before Total Knee Arthroplasty.

    PubMed

    Chan, Ferdinand J; Schwartz, Andrew M; Wong, Jason; Chen, Cynthia; Tiwari, Bharat; Kim, Sun Jin

    2017-07-01

    A subset of patients who undergo total knee arthroplasty (TKA) are on methadone maintenance. They require more and often unpredictable quantities of opioids to function as effective painkillers. This study aims to compare the opioid requirements and the immediate postoperative course for patients on methadone maintenance with those who are not, after a TKA. A retrospective, case-control study was performed. From 2005 to 2010, 36 patients, who underwent a unilateral TKA, on chronic methadone maintenance were identified. A control group matched for age, gender, and body mass index comprised patients from the same period, who did not self-report taking methadone. Chart review and analysis of patient demographics, type of anesthesia used, preoperative methadone use, inpatient opioid use (converted to oral morphine equivalent doses), need for in-house pain management consult, length of hospital stay, and need for reoperation were performed. Patients on chronic methadone maintenance used significantly more opioids than patients not on methadone during their entire inpatient stay (P < .001). This was demonstrated by a higher median daily usage of opioids and higher patient-controlled analgesia usage. Patients on methadone maintenance had a significantly longer postoperative inpatient hospitalization (P < .001). Finally, these patients required significantly more inpatient pain management referrals (P = .025). There is a significantly higher opioid requirement, length of stay, and pain management consults in patients on methadone maintenance compared with those who are not after a TKA. These patients may benefit from a nonroutine approach to perioperative care in TKA. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Relationship between Improvements in Physical Measures and Patient Satisfaction in Rehabilitation after Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Nazzal, Mahmoud I.; Bashaireh, Khaldoon H.; Alomari, Mahmoud A.; Nazzal, Mohammad S.; Maayah, Mikhled F.; Mesmar, Mohammad

    2012-01-01

    The aim of this study was to examine patient satisfaction with rehabilitation after total knee arthroplasty (TKA). Fifty-six patients, aged 45-77 years, were enrolled in a post-TKA comprehensive therapy program focusing on knee strengthening and functional activities. The program lasted 3 months and was conducted for 1 h, twice a day, 5 days per…

  4. Technologically enhanced total knee replacement: is the juice worth the squeeze?

    PubMed

    Squire, Matthew W

    2013-09-01

    The purpose of this article is to outline the limb alignment goals for knee replacement, current surgical technologies, and evidence-based medicine principles regarding technologically advanced total knee arthroplasty (TKA). Radiologists need an understanding of the pros and cons of technologically advanced TKA. At this time, the appropriate role for TKA has not been determined.

  5. Total knee arthroplasty in a pseudoachondroplastic dwarfism patient with bilateral patellar dislocation.

    PubMed

    Oh, Kwang-Jun; Yoon, Jung-Ro; Yang, Jae-Hyuk

    2013-01-01

    Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of a 59-year-old man with underlying pseudoachondroplastic dwarfism. Advanced osteoarthritis due to bilateral neglected congenital patellar dislocation was treated with total knee arthroplasty without patella relocation surgery. Two years later, the patient had an improvement in Knee Society scores, painless function, and stability.

  6. Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Tali, Maie; Maaroos, Jaak

    2010-01-01

    The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

  7. Relationship between Improvements in Physical Measures and Patient Satisfaction in Rehabilitation after Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Nazzal, Mahmoud I.; Bashaireh, Khaldoon H.; Alomari, Mahmoud A.; Nazzal, Mohammad S.; Maayah, Mikhled F.; Mesmar, Mohammad

    2012-01-01

    The aim of this study was to examine patient satisfaction with rehabilitation after total knee arthroplasty (TKA). Fifty-six patients, aged 45-77 years, were enrolled in a post-TKA comprehensive therapy program focusing on knee strengthening and functional activities. The program lasted 3 months and was conducted for 1 h, twice a day, 5 days per…

  8. Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

    ERIC Educational Resources Information Center

    Tali, Maie; Maaroos, Jaak

    2010-01-01

    The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

  9. Predominance of synovial sensory nerve fibers in arthrofibrosis following total knee arthroplasty compared to osteoarthritis of the knee.

    PubMed

    Koeck, Franz Xaver; Schmitt, Miriam; Baier, Clemens; Stangl, Hubert; Beckmann, Johannes; Grifka, Joachim; Straub, Rainer H

    2016-02-17

    So far, there exists no golden standard for the treatment of arthrofibrosis (AF) following total knee arthroplasty (TKA). Although pain is a hallmark of AF, nociceptive nerve fibers have never been investigated in affected joint tissue. A total of 24 patients with osteoarthritis (OA) of the knee (n = 12) and post-TKA AF of the knee (n = 12) were included. Along evaluation of typical clinical signs and symptoms by using the Knee Society Clinical Rating System (KSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC index), the innervation of joint tissue was studied by semiquantitative immunofluorescence of nerve fibers. Patients with AF compared to OA had a lower KSS and lower KOOS. In all compartments (anterior, medial, and lateral recesses), the density of synovial sympathetic nerve fibers was significantly higher in OA compared to AF, which was also true for the density of sensory nerve fibers in the medial and lateral recesses. In synovial tissue of the anterior recess of patients with AF compared to OA, the density of nociceptive sensory nerve fibers was significantly higher relative to sympathetic nerve fibers. This was similarly observed in the neighboring infrapatellar fat pad of the knee. Similar as in many painful musculoskeletal diseases, this study indicates that patients with arthrofibrosis of the knee after TKA demonstrate a preponderance of profibrotic sensory nerve fibers over antifibrotic sympathetic nerve fibers. This could serve as a starting point for AF therapy with specific antifibrotic pain medication or regional anesthetic techniques.

  10. Comparison of fixed-bearing and mobile-bearing total knee arthroplasty after high tibial osteotomy.

    PubMed

    Hernigou, Philippe; Huys, Maxime; Pariat, Jacques; Roubineau, François; Flouzat Lachaniette, Charles Henri; Dubory, Arnaud

    2017-06-30

    There is no information comparing the results of fixed-bearing total knee replacement and mobile-bearing total knee replacement in the same patients previously treated by high tibial osteotomy. The purpose was therefore to compare fixed-bearing and mobile-bearing total knee replacements in patients treated with previous high tibial osteotomy. We compared the results of 57 patients with osteoarthritis who had received a fixed-bearing prosthesis after high tibial osteotomy with the results of 41 matched patients who had received a rotating platform after high tibial osteotomy. The match was made for length of follow-up period. The mean follow-up was 17 years (range, 15-20 years). The patients were assessed clinically and radiographically. The pre-operative knee scores had no statistically significant differences between the two groups. So was the case with the intra-operative releases, blood loss, thromboembolic complications and infection rates in either group. There was significant improvement in both groups of knees, and no significant difference was observed between the groups (i.e., fixed-bearing and mobile-bearing knees) for the mean Knee Society knee clinical score (95 and 92 points, respectively), or the Knee Society knee functional score (82 and 83 points, respectively) at the latest follow-up. However, the mean post-operative knee motion was higher for the fixed-bearing group (117° versus 110°). In the fixed-bearing group, one knee was revised because of periprosthetic fracture. In the rotating platform mobile-bearing group, one knee was revised because of aseptic loosening of the tibial component. The Kaplan-Meier survivorship for revision at ten years of follow-up was 95.2% for the fixed bearing prosthesis and 91.1% for the rotating platform mobile-bearing prosthesis. Although we did manage to detect significant differences mainly in clinical and radiographic results between the two groups, we found no superiority or inferiority of the mobile

  11. Biomechanical consequences of patellar component medialization in total knee arthroplasty.

    PubMed

    Anglin, Carolyn; Brimacombe, Jill M; Wilson, David R; Masri, Bassam A; Greidanus, Nelson V; Tonetti, Jérôme; Hodgson, Antony J

    2010-08-01

    The optimal amount of patellar component medialization in knee arthroplasty is unknown. We measured the impact, on patellofemoral kinematics and contact force distribution, of 0.0-, 2.5-, and 5.0-mm patellar component medialization in 7 cadaveric specimens implanted with knee arthroplasty components. The knees were flexed dynamically in a weight-bearing rig. Medialization led to lateral shift of the patellar bone, slight medial shift of the patellar component in the femoral groove, lateral tilt of the patella, reduced patellofemoral contact force in later flexion, and lateral shift of the center of pressure in early flexion. Effects on shift and tilt were proportional to the amount of medialization. As a result of this investigation, we recommend medializing the patellar component slightly-on the order of 2.5 mm. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  12. The Effect of Patellar Thickness on Intraoperative Knee Flexion and Patellar Tracking in Patients With Arthrofibrosis Undergoing Total Knee Arthroplasty.

    PubMed

    Kim, Abraham D; Shah, Vivek M; Scott, Richard D

    2016-05-01

    We evaluated the intraoperative effect of patellar thickness on intraoperative passive knee flexion and patellar tracking during total knee arthroplasty (TKA) in patients with preoperative arthrofibrosis and compared them to patients with normal preoperative range of motion (ROM) documented in a prior study. Routine posterior cruciate ligament-retaining TKA was performed in a total of 34 knees, 23 with normal ROM and 11 with arthrofibrosis, defined as ≤100° of passive knee flexion against gravity under anesthesia. Once clinical balance and congruent patellar tracking were established, custom trial patellar components thicker than the standard trial by 2-mm increments (2-8 mm) were sequentially placed and trialed. Passive flexion against gravity was recorded using digital photograph goniometry. Gross mechanics of patellofemoral tracking were visually assessed. On average, passive knee flexion decreased 2° for every 2-mm increment of patellar thickness (P < .0001), which was similar to patients with normal preoperative ROM. In addition, increased patellar thickness had no gross effect on patellar subluxation and tilt in patients with arthrofibrosis as well as those with normal ROM. Patellar thickness had a modest effect on intraoperative passive flexion and no effect on patellar tracking in patients with arthrofibrosis undergoing TKA. There was no marked difference in intraoperative flexion and patellar tracking between patients with arthrofibrosis and patients with normal preoperative ROM. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

    PubMed

    Mandzuk, Lynda L; McMillan, Diana E; Bohm, Eric R

    2015-05-01

    Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Measuring movement symmetry using tibial-mounted accelerometers for people recovering from total knee arthroplasty

    PubMed Central

    Christiansen, Cory L.; Bade, Michael J.; Paxton, Roger J.; Stevens-Lapsley, Jennifer E.

    2015-01-01

    Background The purpose of this investigation was to examine movement symmetry changes over the first 26 weeks following unilateral total knee arthroplasty in community environments using skin-mounted tibial accelerometers. Comparisons to healthy participants of similar age were also made. Methods Patients (N = 24) with unilateral knee osteoarthritis (mean (SD), 65.2 (9.2) years) scheduled to undergo total knee arthroplasty and a control group (N = 19 healthy people; mean (SD), 61.3 (9.2) years) were recruited. The total knee arthroplasty group participated in a standardized course of physical rehabilitation. Tibial acceleration data were recorded during a Stair Climb Test and 6-Minute Walk Test. Tibial acceleration data were reduced to initial peak acceleration for each step. An inter-limb absolute symmetry index of tibial initial peak acceleration values was calculated. Findings The total knee arthroplasty group had greater between limb asymmetry for tibial initial peak acceleration and initial peak acceleration absolute symmetry index values five weeks after total knee arthroplasty, during the Stair Climb Test and the 6-Minute Walk Test. Interpretation Tibial accelerometry is a potential tool for measuring movement symmetry following unilateral total knee arthroplasty in clinical and community environments. Accelerometer-based symmetry outcomes follow patterns similar to published measures of limb loading recorded in laboratory settings. PMID:25979222

  15. Same-Level Fracture of the Tibial Metal Tray and Polyethylene Insert After Total Knee Arthroplasty.

    PubMed

    Kang, Jong Yeal; Lee, Yong Seuk

    2016-07-01

    The authors report a case of failure fracture of the tibial metal tray and polyethylene insert at the same level in a 73-year-old woman 10 years after total knee arthroplasty using the AMK Total Knee System (DePuy, Warsaw, Indiana). Causes of this fracture are analyzed and discussed, with the focus on the importance of component design, position, and size. The overall aim of this case report is for orthopedic surgeons to avoid this complication in total knee arthroplasty by paying attention to these controllable factors. [Orthopedics. 2016; 39(4):e787-e789.]. Copyright 2016, SLACK Incorporated.

  16. Revision total knee arthroplasty using a custom tantalum implant in a patient following multiple failed revisions.

    PubMed

    McNamara, Colin A; Gösthe, Raúl G; Patel, Preetesh D; Sanders, Kristopher C; Huaman, Gustavo; Suarez, Juan C

    2017-03-01

    The number of revision total knee arthroplasty procedures performed annually is increasing and, subsequently, so is the number of patients presenting following a failed revision. Rerevising a total knee arthroplasty after one or more failed revision procedures presents many challenges, including diminished bone stock for prosthetic fixation. "Off the shelf" implants may not offer the best alternative for reconstruction. We present the case of a 55-year-old patient who required a rerevision total knee arthroplasty following multiple failed revisions with severe femoral and tibia bone loss. We describe a novel technique we employed to improve component fixation within the compromised bone stock.

  17. Malassezia species infection of the synovium after total knee arthroplasty surgery

    PubMed Central

    Leylabadlo, Hamed Ebrahimzadeh; Zeinalzadeh, Elham; Akbari, Najibeh Asl Rahnemaii; Kafil, Hossein Samadi

    2016-01-01

    Infection is a serious complication after implantation of total knee-prostheses. However, fungal infection is rarely found in periprosthetic joints, and in most reports, the infecting organism is a Candida species. This is a case report of infection after left knee total arthroplasty caused by Malassezia species. The patient is still undergoing antifungal therapy with voriconazole and is still being followed-up. To the authors’ knowledge, the present case is the first report of Malassezia species in a patient after total knee arthroplasty. PMID:27730027

  18. Monoblock versus modular polyethylene insert in uncemented total knee arthroplasty.

    PubMed

    Andersen, Mikkel Rathsach; Winther, Nikolaj; Lind, Thomas; SchrøDer, Henrik; Flivik, Gunnar; Petersen, Michael Mørk

    2016-12-01

    Background and purpose - Backside wear of the polyethylene insert in total knee arthroplasty (TKA) can produce clinically significant levels of polyethylene debris, which can lead to loosening of the tibial component. Loosening due to polyethylene debris could theoretically be reduced in tibial components of monoblock polyethylene design, as there is no backside wear. We investigated the effect of 2 different tibial component designs, monoblock and modular polyethylene, on migration of the tibial component in uncemented TKA. Patients and methods - In this randomized study, 53 patients (mean age 61 years), 32 in the monoblock group and 33 in the modular group, were followed for 2 years. Radiostereometric analysis (RSA) was done postoperatively after weight bearing and after 3, 6, 12, and 24 months. The primary endpoint of the study was comparison of the tibial component migration (expressed as maximum total point motion (MTPM)) of the 2 different implant designs. Results - We did not find any statistically significant difference in MTPM between the groups at 3 months (p = 0.2) or at 6 months (p = 0.1), but at 12 and 24 months of follow-up there was a significant difference in MTPM of 0.36 mm (p = 0.02) and 0.42 mm (p = 0.02) between groups, with the highest amount of migration (1.0 mm) in the modular group. The difference in continuous migration (MTPM from 12 and 24 months) between the groups was 0.096 mm (p = 0.5), and when comparing MTPM from 3-24 months, the difference between the groups was 0.23 mm (p = 0.07). Interpretation - In both study groups, we found the early migration pattern expected, with a relatively high initial amount of migration from operation to 3 months of follow-up, followed by stabilization of the implant with little migration thereafter. However, the modular implants had a statistically significantly higher degree of migration compared to the monoblock. We believe that the greater stiffness of the modular implants was the main

  19. Monoblock versus modular polyethylene insert in uncemented total knee arthroplasty

    PubMed Central

    Andersen, Mikkel Rathsach; Winther, Nikolaj; Lind, Thomas; SchrøDer, Henrik; Flivik, Gunnar; Petersen, Michael Mørk

    2016-01-01

    Background and purpose — Backside wear of the polyethylene insert in total knee arthroplasty (TKA) can produce clinically significant levels of polyethylene debris, which can lead to loosening of the tibial component. Loosening due to polyethylene debris could theoretically be reduced in tibial components of monoblock polyethylene design, as there is no backside wear. We investigated the effect of 2 different tibial component designs, monoblock and modular polyethylene, on migration of the tibial component in uncemented TKA. Patients and methods — In this randomized study, 53 patients (mean age 61 years), 32 in the monoblock group and 33 in the modular group, were followed for 2 years. Radiostereometric analysis (RSA) was done postoperatively after weight bearing and after 3, 6, 12, and 24 months. The primary endpoint of the study was comparison of the tibial component migration (expressed as maximum total point motion (MTPM)) of the 2 different implant designs. Results — We did not find any statistically significant difference in MTPM between the groups at 3 months (p = 0.2) or at 6 months (p = 0.1), but at 12 and 24 months of follow-up there was a significant difference in MTPM of 0.36 mm (p = 0.02) and 0.42 mm (p = 0.02) between groups, with the highest amount of migration (1.0 mm) in the modular group. The difference in continuous migration (MTPM from 12 and 24 months) between the groups was 0.096 mm (p = 0.5), and when comparing MTPM from 3–24 months, the difference between the groups was 0.23 mm (p = 0.07). Interpretation — In both study groups, we found the early migration pattern expected, with a relatively high initial amount of migration from operation to 3 months of follow-up, followed by stabilization of the implant with little migration thereafter. However, the modular implants had a statistically significantly higher degree of migration compared to the monoblock. We believe that the greater stiffness of the modular implants was the

  20. Long-term survival of semi-constrained total knee arthroplasty for revision surgery.

    PubMed

    Wilke, Benjamin K; Wagner, Eric R; Trousdale, Robert T

    2014-05-01

    Semi-constrained implants provide stability in the setting of soft-tissue deficiency in revision total knee arthroplasty (TKA). This study evaluated our institution's long-term survival results with a semi-constrained implant used in the revision TKA setting. 234 semi-constrained revision total knee arthroplasties were performed in 209 patients. The average follow-up was 9 years. Forty repeat revisions were performed. 5-year survival was 91% and 10-year survival was 81%. Male gender significantly increased the risk of revision. At 10 years the average range of motion, pain level, and Knee Society score improved significantly (P < 0.001). Ninety percent of patients reported an improvement in their knee. The semi-constrained implant used in revision knee arthroplasty has acceptable implant survival and functional outcomes in the long-term follow-up period.

  1. Comparison between closed suction drainage and nondrainage in total knee arthroplasty: a meta-analysis.

    PubMed

    Zhang, Qi-dong; Guo, Wan-shou; Zhang, Qian; Liu, Zhao-hui; Cheng, Li-ming; Li, Zi-rong

    2011-12-01

    From individual randomized studies, it is not clear whether a closed suction drainage should be used after total knee arthroplasty. Our meta-analysis compares the clinical outcomes of closed suction drainage with nondrainage after total knee arthroplasty in randomized controlled trials reported between January 1966 and May 2010. Fifteen eligible trials involving 1361 knee incisions (686 knees with closed suction drainage and 675 knees without drainage) satisfied the inclusion criteria for our meta-analysis. The result of the meta-analysis indicates that closed suction drainage reduces the incidence of soft tissue ecchymosis and requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference between drainage and nondrainage was observed in the incidence of infection, deep venous thrombosis, or postoperative range of motion.

  2. Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study.

    PubMed

    Steinbrück, Arnd; Schröder, Christian; Woiczinski, Matthias; Müller, Tatjana; Müller, Peter E; Jansson, Volkmar; Fottner, Andreas

    2016-08-01

    Although continuous improvements have been made, there is still a considerable amount of unsatisfied patients after total knee arthroplasty (TKA). A main reason for this high percentage is anterior knee pain, which is supposed to be provoked by post-operative increased retropatellar peak pressure. Since rotational malalignment of the implant is believed to contribute to post-operative pain, the aim of this study was to examine the influence of tibial component rotation on knee kinematics and retropatellar pressure. Eight fresh-frozen knee specimens were tested in a weight-bearing knee rig after fixed-bearing TKA under a loaded squat from 20° to 120° of flexion. To examine tibial components with different rotations, special inlays with 3° internal rotation and 3° external rotation were produced and retropatellar pressure distribution was measured with a pressure-sensitive film. The kinematics of the patella and the femorotibial joint were recorded with an ultrasonic-based motion analysis system. Retropatellar peak pressure decreased significantly from 3° internal rotation to neutral position and 3° external rotation of the tibial component (8.5 ± 2.3 vs. 8.2 ± 2.4 vs. 7.8 ± 2.5 MPa). Regarding knee kinematics femorotibial rotation and anterior-posterior translation, patella rotation and tilt were altered significantly, but relative changes remained minimal. Changing tibial rotation revealed a high in vitro influence on retropatellar peak pressure. We recommend the rotational alignment of the tibial component to the medial third of the tibial tuberosity or even more externally beyond that point to avoid anterior knee pain after TKA.

  3. Totally Endovascular Management of Popliteal Artery Occlusion and Pseudoaneurysm Formation after Total Knee Replacement.

    PubMed

    Reynolds, Anthony; Sandstrom, Anna; Jha, Pankaj K

    2017-01-01

    Injuries to the popliteal artery during total knee arthroplasty (TKA) are rare. We present a case of a 72-year-old man with popliteal artery thrombosis and a pseudoaneurysm presenting immediately after TKA. First-line management of acute limb ischemia is currently transitioning from open surgery to endovascular strategies such as catheter-directed thrombolysis or mechanical thrombectomy. Due to the rarity of acute limb ischemia and pseudoaneurysms after TKA, endovascular management is only reported in a few case studies. This case is distinctive by having both popliteal artery thrombosis and a pseudoaneurysm which were successfully managed entirely endovascular using AngioJet thrombolysis and a flexible covered stent. This case contributes to the evidence supporting endovascular management of this rare complication of TKA.

  4. Essential amino acid supplementation in patients following total knee arthroplasty

    PubMed Central

    Dreyer, Hans C.; Strycker, Lisa A.; Senesac, Hilary A.; Hocker, Austin D.; Smolkowski, Keith; Shah, Steven N.; Jewett, Brian A.

    2013-01-01

    Background. By the year 2030, 3.48 million older U.S. adults are projected to undergo total knee arthroplasty (TKA). Following this surgery, considerable muscle atrophy occurs, resulting in decreased strength and impaired functional mobility. Essential amino acids (EAAs) have been shown to attenuate muscle loss during periods of reduced activity and may be beneficial for TKA patients. Methods. We used a double-blind, placebo-controlled, randomized clinical trial with 28 older adults undergoing TKA. Patients were randomized to ingest either 20 g of EAAs (n = 16) or placebo (n = 12) twice daily between meals for 1 week before and 2 weeks after TKA. At baseline, 2 weeks, and 6 weeks after TKA, an MRI was performed to determine mid-thigh muscle and adipose tissue volume. Muscle strength and functional mobility were also measured at these times. Results. TKA patients receiving placebo exhibited greater quadriceps muscle atrophy, with a –14.3 ± 3.6% change from baseline to 2 weeks after surgery compared with –3.4 ± 3.1% for the EAA group (F = 5.16, P = 0.036) and a –18.4 ± 2.3% change from baseline to 6 weeks after surgery for placebo versus –6.2 ± 2.2% for the EAA group (F = 14.14, P = 0.001). EAAs also attenuated atrophy in the nonoperated quadriceps and in the hamstring and adductor muscles of both extremities. The EAA group performed better at 2 and 6 weeks after surgery on functional mobility tests (all P < 0.05). Change in quadriceps muscle atrophy was significantly associated with change in functional mobility (F = 5.78, P = 0.021). Conclusion. EAA treatment attenuated muscle atrophy and accelerated the return of functional mobility in older adults following TKA. Trial registration. Clinicaltrials.gov NCT00760383. Funding. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Office of the Director (OD), and the National Institutes of Health Office of Dietary Supplements (ODS), NIH grant K01HD057332, and the Medical

  5. Failure of total knee arthroplasty with or without patella resurfacing

    PubMed Central

    2011-01-01

    Background and purpose Patella resurfacing during primary total knee arthroplasty (TKA) is disputed and new prosthesis designs have been introduced without documentation of their survival. We assessed the impact on prosthesis survival of patella resurfacing and of prosthesis brand, based on data from the Norwegian Arthroplasty Register. Patients and methods 5 prosthesis brands in common use with and without patella resurfacing from 1994 through 2009 were included n = 11,887. The median follow-up times were 9 years for patella-resurfaced implants and 7 years for implants without patella resurfacing. For comparison of prosthesis brands, also brands in common use with only one of the two treatment options were included in the study population (n = 25,590). Cox regression analyses were performed with different reasons for revision as endpoints with adjustment for potential confounders. Results We observed a reduced overall risk of revision for patella resurfaced (PR) TKAs, but the statistical significance was borderline (RR = 0.84, p = 0.05). At 15 years, 92% of PR and 91% of patella non resurfaced (NR) prostheses were still unrevised. However, PR implants had a lower risk of revision due to pain alone (RR = 0.1, p < 0.001), but a higher risk of revision due to loosening of the tibial component (RR = 1.4, p = 0.03) and due to a defective polyethylene insert (RR = 3.2, p < 0.001). At 10 years, the survival for the reference NR brand AGC Universal was 93%. The NR brands Genesis I, Duracon, and Tricon (RR = 1.4–1.7) performed statistically significantly worse than NR AGC Universal, while the NR prostheses e.motion, Profix, and AGC Anatomic (RR = 0.1–0.7), and the PR prostheses NexGen and AGC Universal (RR = 0.4–0.5) performed statistically significantly better. LCS, NexGen, LCS Complete (all NR), and Tricon, Genesis I, LCS, and Kinemax (all PR) showed no differences in this respect from the reference brand. A lower risk of revision (crude) was found for TKAs

  6. Mortality following primary total knee replacement in public hospitals in Hong Kong.

    PubMed

    Lee, Q J; Mak, W P; Wong, Y C

    2016-06-01

    More than 2000 total knee replacements are performed each year in Hong Kong and more than 10 000 patients are on the waiting list. How safe is total knee replacement, however? The aims of the study were to review the mortality of primary total knee replacement in public hospitals in Hong Kong and to identify risk factors for mortality in a high-volume hospital. All primary total knee replacements performed in Hospital Authority hospitals and Yan Chai Hospital from October 2011 to September 2014 were reviewed. Case-control analysis was performed for risk factors of total all-cause mortality in total knee replacement at Yan Chai Hospital. There were 6588 patients in Hospital Authority hospitals and 1184 in Yan Chai Hospital (1095 unilateral and 89 bilateral total knee replacement). The mean follow-up time of patients in Yan Chai Hospital was 12.8 months. The mortality at 30 days, 90 days and 1 year was 0%, 0.08%, 0.34% for Yan Chai Hospital; and 0.1%, 0.2%, 0.7% for Hospital Authority hospitals, respectively. For Yan Chai Hospital, the mean operation-to-death interval was 21 months (range, 1-35 months). The mean age at death was 78 years and main causes were malignancy (50%) and pneumonia (21%). Predictors of mortality included age at surgery, American Society of Anesthesiologists class 3, and preoperative range of motion. Hospital surgery volume, preoperative co-morbidities, and postoperative deep vein thrombosis were not significant factors. Mortality after primary total knee replacement was low in public hospitals in Hong Kong. Patients of older age or poorer general well-being in terms of poor range of motion or American Society of Anesthesiologists class 3 should be in optimal health before surgery and counselled about the higher mortality rate. A citywide joint replacement registry may help monitor and analyse postoperative total knee replacement mortality specific to our locality.

  7. Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty

    PubMed Central

    Lum, Z. C.; Lombardi, A. V.; Hurst, J. M.; Morris, M. J.; Adams, J. B.; Berend, K. R.

    2016-01-01

    Aims Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts. Patients and Methods A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed. Results The mean follow-up for UKA and TKA groups was 5.4 and 5.5 years, respectively. Six TKA (3.2%) versus three UKAs (1.5%) were revised which was not significant (p = 0.269). Manipulation was more frequent after TKA (16; 8.5%) versus none in the UKA group (p < 0.001). UKA patients had higher post-operative KS function scores versus TKA patients (78 versus 66, p < 0.001) with a trend toward greater improvement, but there was no difference in ROM and KS clinical improvement (p = 0.382 and 0.420, respectively). Conclusion We found fewer manipulations, and higher functional outcomes for patients treated with medial mobile-bearing UKA compared with TKA. TKA had twice the revision rate as UKA although this did not reach statistical significance with the numbers available. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):28–33. PMID:27694513

  8. Patella position is not a determinant for anterior knee pain 10 years after balanced gap total knee arthroplasty.

    PubMed

    van Houten, Albert H; Heesterbeek, Petra J C; Wymenga, Ate B

    2016-08-01

    Incidence of anterior knee pain after total knee arthroplasty (TKA) is reported to be between 4 and 49 %. The incidence of AKP at long-term follow-up and possible determinants after cruciate cruciate-retaining TKA were investigated. A 10-year follow-up of a cohort of 55 patients (63 TKAs), who received the balanSys™ cruciate-retaining total knee system (Mathys Ltd, Bettlach, Switzerland) between 1999 and 2002, was performed. Patients had undergone the balanced gap technique, with either a fixed bearing or an AP-glide bearing. Standardised diagnostic questions regarding AKP were collected and categorised into two groups: those with and without AKP. The lateral patellar tilt, patellar displacement measurement and modified Insall-Salvati ratio were used for patella position evaluation on skyline radiographs. The Knee Society Score (KSS), the Knee Osteoarthritis Outcome Score (KOOS) and Numerical Rating Scales (NRS) for pain and satisfaction were obtained at follow-up. Sixteen patients in the study population experienced AKP. Incidence of AKP (fixed bearing 13/44; AP-glide bearing baring 3/17) was not dependent on type of insert (n.s.). There were no statistical differences in patella position and tibiofemoral contact point between the AKP group and the no AKP group (n.s.). KSS, KOOS, NRS-pain and NRS-satisfaction were significantly lower for the patients with AKP (all p < 0.05). Twenty-six percentage of the patients experienced AKP 10 years after balanced gap TKA. Postoperative patella positioning was not found to be a determinant for anterior knee pain after TKA. However, patellar displacement does not seem completely favourable. Moreover, type of bearing was not found a determinant for AKP at long-term follow-up. Lower quality prospective cohort study (<80 % follow-up, patients enrolled at different time points in disease), Level II.

  9. Assessment of reactive synovitis in rotating-platform posterior-stabilized design: a 10-year prospective matched-pair MRI study.

    PubMed

    Meftah, Morteza; Potter, Hollis G; Gold, Stephanie; Ranawat, Anil S; Ranawat, Amar S; Ranawat, Chitranjan S

    2013-10-01

    This is the first long-term (mean 11.6 years), prospective, matched-pair study (based on age, gender, BMI and UCLA scores) using MAVRIC (multi-acquisition variable-resonance image combination) magnetic resonance imaging to analyze reactive synovitis and osteolysis between rotating-platform posterior-stabilized (RP-PS), fixed-bearing metal-back (FB-MB), and all-polyethylene tibial (APT) in active patients (24 total, 8 in each group, mean age of 64 years, mean UCLA of 8.5) with identical femoral component and polyethylene. Reactive synovitis was observed in 6 RP-PS (75%), all 8 FB-MB (100%), and 6 APT (75%). There was a significant difference between the RP-PS and FB-MB knees in volumetric synovitis (P=0.023). Osteolysis with bone loss more than 4mm was seen in 3 FB-MB, 2 APT and none for RP-PS. These were not statistically significant.

  10. Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement.

    PubMed

    Jerosch, Joerg; Aldawoudy, Akram M

    2007-01-01

    The purpose of this study was to document the effect of arthroscopic management in patients with knee stiffness after total knee replacement. We present a case series study, in which 32 patients have been treated for moderate arthrofibrosis of the knee after total knee replacement, with the same regimen. We have excluded all cases of stiffness, because of infection, mechanical mal-alignment, loosening of the implants and other obvious reasons of stiffness of the knee, rather than pure arthrofibrosis. All patients first underwent a trial of conservative treatment before going for arthroscopic management. A pain catheter for femoral nerve block was inserted just before anesthesia for post-operative pain management. Arthroscopic arthrolysis of the intra-articular pathology was performed in a standardized technique with release of all fibrous bands in the suprapatellar pouch, reestablishing the medial and lateral gutter, release of the patella, resection of the remaining meniscal tissue or an anterior cyclops, if needed. Intensive physiotherapy and continuous passive motion were to start immediately post-operatively. All the patients were available for the follow up and they were evaluated using the knee society rating system. A total of 25 of the 32 procedures resulted in an improvement of the patients knee score. All the knees operated upon had intra-articular fibrous bands, hypertrophic synovitis and peri-patellar adhesions. A total of eight patients suffered from an anterior cyclops lesion and six patients showed pseudomenicus. In 19 cases a medial and lateral relapse of the patella was performed; only 5 patients got an isolated lateral release. The mean knee flexion was 119 degrees (100-130) at the end of arthroscopy and was 97 degrees (75-115) at the last follow up. The eight patients with extension lags decreased from 27 degrees (10 degrees-35 degrees) pre-operatively to 4 degrees (0-10) at time of follow up. The average knee society ratings increased from 70

  11. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty: A Cross-Sectional Study

    PubMed Central

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt; Kehlet, Henrik; Jakobsen, Thomas Linding

    2014-01-01

    Background Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA. Objective To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. Design Cross-sectional study. Setting Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013. Participants Seventeen patients, no more than 3 weeks after their TKA. Main outcome measures: In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0–10). Results Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001). Resting knee pain 60 seconds after the final repetition (2.7±2.4 points) was not different from that recorded before strength training (2.7±1.8 points, P = 0.88). Conclusion Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived. Trial Registration

  12. [The application of electroacupuncture to postoperative rehabilitation of total knee replacement].

    PubMed

    Chen, Gang; Gu, Rui-Xin; Xu, Dan-Dan

    2012-04-01

    To explore the effect of electroacupuncture therapy for postoperative rehabilitation of total knee replacement of knee osteoarthritis. Seventy cases of total knee replacement of knee osteoarthritis were randomly divided into an acupuncture-rehabilitation group and a rehabilitation group, thirty five cases in each group. In acupuncture-rehabilitation group, routine rehabilitation therapy combined with electroacupuncture therapy was applied. The acupoints selection was mainly based on pathological location; Xuehai (SP 10), Liangqiu (ST 34), Dubi (ST 35), Neixiyan (EX-LE 4) and Yanglingquan (GB 34), etc. were selected. In rehabilitation group, routine rehabilitation therapy was applied. The functions of affected knee in both groups were evaluated by artificial total knee replacement scale of the New York Hospital for Special Surgery (HSS), range of motion (ROM) of affected knee, Visual Analogue Scale (VAS) of pain and Manual Muscle Test (MMT) before, and 2, 6 and 12 weeks after surgery. HSS scores in acupuncture-rehabilitation group were markedly higher than those in rehabilitation group in 2, 6 and 12 weeks after surgery (P < 0.05, P < 0.01); VAS scores in acupuncture-rehabilitation group were markedly lower than those in rehabilitation group (P < 0.05, P < 0.01); ROM and MMT in acupuncture-rehabilitation group were little superior to those in rehabilitation group, however, there was no significant difference (all P > 0.05). Rehabilitation therapy combined with electroacupuncture can obviously restrain the pain during rehabilitation process for total knee replacement patients, improve the endurance capacity of rehabilitation training and motivation, and obviously promote the recovery of total knee joint function.

  13. Extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty.

    PubMed

    Okamoto, Shigetoshi; Okazaki, Ken; Mitsuyasu, Hiroaki; Matsuda, Shuichi; Mizu-Uchi, Hideki; Hamai, Satoshi; Tashiro, Yasutaka; Iwamoto, Yukihide

    2014-12-01

    In total knee arthroplasty (TKA), a high soft-tissue tension in extension at the time of operation would cause a post-operative flexion contracture. However, how tight the extension gap should be during surgery to avoid a post-operative flexion contracture remains unclear. The hypothesis is that some laxity in the intraoperative extension gap is necessary to avoid the post-operative flexion contracture. A posterior-stabilized TKA was performed for 75 osteoarthritic knees with a varus deformity. The intraoperative extension gap was measured using a tensor device that provides the gap length and the angle between the femoral component and the tibial cut surface. The medial component gap was defined as the gap calculated by subtracting the selected thickness of the tibial component, including the polyethylene liner, from the extension gap at the medial side. Then, the patients were divided into three groups according to the medial component gap, and post-operative extension angle measured 1 year after the surgery was compared between each groups. One year post-operatively, a flexion contracture of more than 5° was found in 0/34 patients when the medial component gap was more than 1 mm, in 2/26 (8%) patients when the gap was between 0 and 1 mm, and in 3/15 (20%) patients when the gap was <0 mm. Three factors were associated significantly with the post-operative extension angle: age, preoperative extension angle, and medial component gap. The intraoperative extension gap is related to the post-operative extension angle. Surgeons should leave more than 1-mm laxity after the implantation to avoid the post-operative flexion contracture. As a clinical relevance, this study clarified the optimal extension gap to avoid the post-operative flexion contracture. Prospective comparative study, Level II.

  14. Navigation-based tibial rotation at 90° of flexion is associated with better range of motion in navigated total knee arthroplasty.

    PubMed

    Ishida, Kazunari; Shibanuma, Nao; Matsumoto, Tomoyuki; Sasaki, Hiroshi; Takayama, Koji; Hiroshima, Yuji; Kuroda, Ryosuke; Kurosaka, Masahiro

    2016-08-01

    In clinical practice, people with better femorotibial rotation in the flexed position often achieve a favourable postoperative maximum flexion angle (MFA). However, no objective data have been reported to support this clinical observation. In the present study, we aimed to investigate the correlation between the amount of intraoperative rotation and the pre- and postoperative flexion angles. Fifty-five patients with varus osteoarthritis undergoing computer-assisted posterior-stabilized total knee arthroplasty (TKA) were enrolled. After registration, rotational stress was applied towards the knee joint, and the rotational angles were recorded by using a navigation system at maximum extension and 90° of flexion. After implantation, rotational stress was applied for a second time, and the angles were recorded once more. The MFA was measured before surgery and 1 month after surgery, and the correlation between the amount of femorotibial rotation during surgery and the MFA was statistically evaluated. Although the amount of tibial rotation at maximum extension was not correlated with the MFA, the amount of tibial rotation at 90° of flexion after registration was positively correlated with the pre- and postoperative MFA (both p < 0.005). However, no significant relationship was observed between the amount of tibial rotation after implantation and the postoperative MFA (n.s.). The results showed that better femorotibial rotation at 90° of flexion is associated with a favourable postoperative MFA, suggesting that the flexibility of the surrounding soft tissues is an important factor for obtaining a better MFA, which has important clinical relevance. Hence, further evaluation of navigation-based kinematics during TKA may provide useful information on MFA. Diagnostic studies, development of diagnostic criteria in a consecutive series of patients, and a universally applied "gold" standard, Level II.

  15. Biomechanical comparison of extensile exposures in total knee arthroplasty.

    PubMed

    Wall, Simon J; Rose, David M; Khanuja, Harpal S; Sutter, Edward G; Knight, Trevor A; Belkoff, Stephen M; Mears, Simon C

    2010-06-09

    The "banana peel" exposure is a novel technique for knee joint exposure that consists of partially peeling the patellar tendon off the tibia, leaving the extensor mechanism intact distally and laterally. Although good clinical results have been reported with this technique with no disruption of the extensor mechanism, concerns exist that it could cause extensor lag, quadriceps weakness, or patellar tendon rupture. We compared the banana peel exposure repair to tibial tubercle osteotomy repair, which we chose as our benchmark procedure because much is known about its associated healing and rehabilitation protocols. In our study of 16 paired, fresh-frozen human knee specimens, the 2 techniques were used alternately for the right and left knees. To measure acute strength, 10 pairs were tested. The patella was clamped and pulled superiorly at 25 mm/min until failure. For cyclical testing (6 pairs), the knee was extended from 90 degrees of flexion to 0 degrees for 2000 cycles at 0.25 Hz while we monitored the distance between the inferior pole of the patella and the tibial diaphysis using a passive optical kinematic measuring system. Mean failure strengths of the banana peel and osteotomy groups were 2642+/-1104 N and 2123+/-562 N, respectively, suggesting that the banana peel repair is not weaker than the osteotomy repair. Neither group had a significant increase (via paired Student t test, P>.05) in the distance between the inferior pole of the patella and the tibial diaphysis, suggesting that neither exposure would result in extensor lag. Copyright 2010, SLACK Incorporated.

  16. Severe Bilateral Fixed Flexion Deformity-Simultaneous or Staged Total Knee Arthroplasty?

    PubMed

    Lee, Wu Chean; Kwan, Yu Heng; Yeo, Seng Jin

    2016-01-01

    Outcomes of 29 simultaneous (SimBTKA) and 38 staged bilateral total knee arthroplasty (StaBTKA) subjects with severe (≥16°) bilateral fixed flexion deformity (FFD) were retrospectively investigated. SimBTKA patients were significantly younger (63 ± 8 vs 68 ± 7, P > .01). At 2 years, SimBTKA subjects had significantly better residual FFD (2.5° ± 5.1° vs 5.4° ± 6.6°, P = .02) and Knee Society function score (75.7 ± 25.7 vs 69.3 ± 24.1, P = .02). However, Knee Society knee scores, Oxford Knee Scores, and Short Form-36 scores were similar. These suggest no large clinical advantage of SimBTKA over StaBTKA. We feel that severe bilateral FFD is not an absolute indication for SimBTKA.

  17. Total knee arthroplasty after lower extremity amputation: a review of 13 cases.

    PubMed

    Amanatullah, Derek F; Trousdale, Robert T; Sierra, Rafael J

    2014-08-01

    Below knee amputation protects the ipsilateral knee from osteoarthritis and overloads the contralateral knee predisposing it to symptomatic osteoarthritis. We retrospectively reviewed 13 primary total knee arthroplasty (TKAs) in 12 patients with a prior lower extremity amputation. Twelve TKAs were performed on the contralateral side of the amputated limb while only one TKA was performed on the ipsilateral side. The average clinical follow-up was 6.8 ± 4.8 years. Knee Society Scores improved from 30.4 ± 11.8 to 88.5 ± 4.2 after TKA with a prior contralateral amputation. Three (23.1%) patients with TKA after contralateral amputation had aseptic loosening of the tibial component. Patients experience clinically significant improvement with TKA after lower extremity amputation. Augmentation of tibial fixation with a stem may be advisable during TKA after contralateral amputation.

  18. The natural history of a newly developed flexion contracture following primary total knee arthroplasty.

    PubMed

    Anania, Andres; Abdel, Matthew P; Lee, Yuo-yu; Lyman, Stephen; González Della Valle, Alejandro

    2013-10-01

    We investigated the incidence, natural history, and functional consequences of a newly developed flexion contracture after total knee arthroplasty (TKA). Forty patients with full knee extension preoperatively who developed a postoperative flexion contracture were match-paired 1:2 with 80 patients who had full extension. The incidence of a newly developed flexion contracture, ROM, and Knee Society scores (KSS) at six weeks, four months, and one year were analysed. The incidence of a new flexion contracture at six weeks was 14%, but diminished to 5% and 0.3% at four months and one year, respectively. One year after surgery, there was no difference in the KSS (p = 0.5). This study showed that the majority of patients who developed a new flexion contracture after TKA have full knee extension one year postoperatively. Moreover, knee extension and KSS at one year are equivalent to those patients who did not developed a flexion contracture.

  19. Acute Metallosis Following Total Knee Replacement – A Case Report

    PubMed Central

    Klontz, Karl C.; Smith, William I; Jonathan C., Klontz

    2014-01-01

    Introduction: Metallosis involving the knee joint most often results from metal-on-metal contact late in the life of a failing implant following polyethylene wear. We report a case of acute metallosis following knee arthroplasty in a previously healthy 59-year old male. Case Report: In June 2011, the patient underwent left knee arthroplasty for severe osteoarthritis with necrosis and bone edema in the medial femoral condyle and tibial plateau. Nine months later, because of persistent pain and swelling in the joint, revision arthroplasty was undertaken along with partial synovectomy. Examination revealed pristine prosthetic implants in the absence of loose fragments of bone or glue. Synovial pathology exhibited marked chronic inflammation and hyperplasia with extensive finely granular foreign material resembling metallic debris. Laboratory analysis of synovium revealed a predominance of iron, the principal component of the saw blades. Conclusion: We hypothesize the patient experienced acute metallosis resulting from deposition of metallic fragments from three saw blades used during arthroplasty. We believe the increased density of the patient’s bone that required use of multiple blades may have resulted, in part, from heavy lifting the patient partook in during the two years preceding arthroplasty. PMID:27298939

  20. Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty.

    PubMed

    Bonutti, Peter M; Marulanda, German A; McGrath, Mike S; Mont, Michael A; Zywiel, Michael G

    2010-02-01

    Arthrofibrosis is a relatively common complication after total knee arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory knee stiffness after total knee arthroplasty. Twenty-five patients who had knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3-16 weeks), the median increase in range of motion was 25 degrees (range, 8-82 degrees). The median gain in knee active flexion was 19 degrees (range, 5-80 degrees). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after total knee arthroplasty.

  1. Comparison of pain perception between open and minimally invasive surgery in total knee arthroplasty

    PubMed Central

    Moretti, Biagio; Vitale, Elsa; Esposito, Antonio; Colella, Antonio; Cassano, Maria; Notarnicola, Angela

    2010-01-01

    Total knee arthroplasty (TKA) was a well-established procedure that had shown excellent long-term results in terms of reduced pain and increased mobility. Pain was one of the most important outcome measures that contributed to patient dissatisfaction after TKA. After a computerized search of the Medline and Embase databases, we considered articles from January 1st, 1997 to October 31st, 2009 that underlined the impact on patient pain perception of either standard open total knee arthroplasty or minimally invasive total knee arthroplasty. We included articles that used the visual analog scale (VAS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), Knee Score, Hospital for Special Surgery Score (HSS), Oxford Knee Score (OKS) as postoperative pain indicators, and we included studies with a minimum follow-up period of two months. We excluded studies that monitored only functional postoperative knee activities. It was shown that TKA with the open technique was a better treatment for knees with a positive effect on pain and function than the minimally invasive technique. PMID:21042568

  2. Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture.

    PubMed

    Yan, Denglu; Yang, Jing; Pei, Fuxing

    2013-11-15

    This study aims to explore the technique of soft tissue balance and joint tension maintenance in total knee arthroplasty (TKA) for the rheumatoid arthritis (RA) patients with flexion contracture of the knee. This retrospective study reviewed flexion contracture deformity of RA patients who underwent primary TKA and ligament and soft tissue balancing. Based on the flexion contracture deformity, the remaining 76 patients available for analysis were divided into two groups, i.e., severe flexion group (SF) and moderate flexion group (MF). There were no intraoperative complications in this study. All patients had improved Knee Society Rating System scores and range of motion. The flexion contracture was completely corrected in MF and SF patients. There were no cases of patellar dislocation, but three cases had mild mediolateral instability in severe flexion group. Four knees (two knees in SF versus two knees in MF) had transient peroneal nerve palsy but recovered after conservative therapy. TKA can be performed successfully in the RA knees with severe flexion contracture. It is very important in TKA to maintain the joint stability in the condition of severe flexion contracture deformity of the RA knee.

  3. Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture

    PubMed Central

    2013-01-01

    Background This study aims to explore the technique of soft tissue balance and joint tension maintenance in total knee arthroplasty (TKA) for the rheumatoid arthritis (RA) patients with flexion contracture of the knee. Methods This retrospective study reviewed flexion contracture deformity of RA patients who underwent primary TKA and ligament and soft tissue balancing. Based on the flexion contracture deformity, the remaining 76 patients available for analysis were divided into two groups, i.e., severe flexion group (SF) and moderate flexion group (MF). Results There were no intraoperative complications in this study. All patients had improved Knee Society Rating System scores and range of motion. The flexion contracture was completely corrected in MF and SF patients. There were no cases of patellar dislocation, but three cases had mild mediolateral instability in severe flexion group. Four knees (two knees in SF versus two knees in MF) had transient peroneal nerve palsy but recovered after conservative therapy. Conclusions TKA can be performed successfully in the RA knees with severe flexion contracture. It is very important in TKA to maintain the joint stability in the condition of severe flexion contracture deformity of the RA knee. PMID:24229435

  4. [Clinical factors and findings in knee arthroscopy of patients with knee arthrosis candidates for conversion to total replacement].

    PubMed

    Figueroa, D; Calvo, R; Villalón, I; Tuca, M J; Vaisman, A; Valdés, M

    2013-01-01

    To identify those clinical characteristic and arthroscopic findings in patients with knee arthrosis that are associated with worsening of the disease and subsequent total knee arthroplasty (TKA). A retrospective, descriptive study was conducted on 78 consecutive patients (88 knees) who underwent knee arthroscopy for arthrosis. The study included 44 women and 34 men, with a mean age of 58.9 years (range: 37-78 years). After a mean follow-up of 50.4 months (range: 12-96 months), those patients who progressed towards TKA were identified. A logistic regression model was applied to recognise the factors associated with deterioration of the arthrosis, with consequent progression towards a TKA. Twenty-four out of the 88 knees progressed towards a TKA (27.3%) within a mean time of 13.5 months after arthroscopy (range: 13-29 months). The clinical characteristics that showed a significant association with poor progression of the arthrosis were: female gender (0.02) and Ahlbäck 2 (P=.04). Arthroscopic finding that proved significant correlation with worsening of the arthrosis towards TKA were: meniscal tears of the posterior horn (P=.02), meniscectomies above 60% (P=.03), and 2nd degree chondral lesions in loading areas of the medial femoral condyle (P=.02). The variables associated with a greater chance of progressing towards a TKA after a knee arthroscopy due to arthrosis in this study were, female gender, grade 2 radiographic arthrosis, posterior horn meniscal lesions, meniscectomies over 60%, and chondral lesions in loading area of the medial femoral condyle. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  5. Bi-cruciate stabilized total knee arthroplasty can reduce the risk of knee instability associated with posterior tibial slope.

    PubMed

    Hada, Masaru; Mizu-Uchi, Hideki; Okazaki, Ken; Kaneko, Takao; Murakami, Koji; Ma, Yuan; Hamai, Satoshi; Nakashima, Yasuharu

    2017-09-22

    The purpose of this study was to evaluate the relationship between posterior tibial slope and knee kinematics in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA), which has not been previously reported. This computer simulation study evaluated Journey 2 BCS components (Smith & Nephew, Inc., Memphis, TN, USA) implanted in a female patient to simulate weight-bearing stair climbing. Knee kinematics, patellofemoral contact forces, and quadriceps forces during stair climbing (from 86° to 6° of flexion) were computed in the simulation. Six different posterior tibial slope angles (0°-10°) were simulated to evaluate the effect of posterior tibial slope on knee kinematics and forces. At 65° of knee flexion, no anterior sliding of the tibial component occurred if the posterior tibial slope was less than 10°. Anterior contact between the anterior aspect of the tibial post- and the femoral component was observed if the posterior tibial slope was 6° or more. An increase of 10° in posterior tibial slope (relative to 0°) led to a 4.8% decrease in maximum patellofemoral contact force and a 1.2% decrease in maximum quadriceps force. BCS TKA has a wide acceptable range of posterior tibial slope for avoiding knee instability if the posterior tibial slope is less than 10°. Surgeons should prioritize avoiding adverse effects over trying to achieve positive effects such as decreasing patellofemoral contact force and quadriceps force by increasing posterior tibial slope. Our study helps surgeons determine the optimal posterior tibial slope during surgery with BCS TKA; posterior tibial slope should not exceed 10° in routine clinical practice.

  6. Transepicondylar axes for femoral component rotation might produce flexion asymmetry during total knee arthroplasty in knees with proximal tibia vara.

    PubMed

    Park, Il Seok; Ong, Alvin; Nam, Chang Hyun; Ahn, Nong Kyum; Ahn, Hye Sun; Lee, Su Chan; Jung, Kwang Am

    2014-03-01

    Adequate rotation of the femoral component in total knee arthroplasty is mandatory for prevention of numerous adverse sequelae. Therefore, we investigate whether there is the distal femoral deformity in knees with tibia vara. The purpose of this study was to evaluate the reliability of the transepicondylar axis as a rotational landmark in knees with tibia vara. We retrospectively reviewed and selected 101 osteoarthritic knees with proximal tibia vara and 150 osteoarthritic knees without tibia vara for inclusion in this study. The transepicondylar axis (TEA), anteroposterior (AP) axis and posterior condylar (PC) line were measured using the axial image from magnetic resonance imaging axial images. We compared the external rotation angle of the TEA relative to the PC line between groups in order to investigate the presence of distal femoral anatomical adaptation in the tibia vara group. The TEA in the tibia vara group had 6.1º of external rotation relative to the PC line, which was not significantly different from the 6.0º of external rotation in the non-tibia vara group. The line perpendicular to the AP axis in the tibia vara group had 6.1º of external rotation relative to the PC line, which was not significantly different from the 5.4º of external rotation in the non-tibia vara group. Distal femoral geometry was unaffected by the tibia vara deformity. The use of transepicondylar axes in determining femoral rotation may produce flexion asymmetry in knees with tibia vara. Level III. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Subchondral Bone Marrow Edema Had Greater Effect on Postoperative Pain After Medial Unicompartmental Knee Arthroplasty Than Total Knee Arthroplasty.

    PubMed

    Jacobs, Cale A; Christensen, Christian P; Karthikeyan, Tharun

    2016-02-01

    Although the relationship between pain and bone marrow edema (BME) in the osteoarthritic knee has been established, little is known about the effect of preoperative BME on postoperative outcomes after knee arthroplasty or if the influence of BME on postoperative outcomes differs between medial unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The purpose of this study was to compare pain, patient satisfaction, and revision rates between medial UKA and TKA patients with and without magnetic resonance imaging evidence of BME in the proximal tibia. We identified 71 patients (72 knees) from our prospective outcomes database with magnetic resonance images taken before undergoing either medial UKA or TKA and recorded the absence or presence of tibial BME. We then compared preoperative and postoperative Knee Society pain scores, patient satisfaction, and revisions between groups of UKA and TKA patients with or without preoperative tibial BME. Pain scores for UKA patients with BME were worse both before and after surgery, whereas TKA patients with BME demonstrated greater postoperative improvements in pain scores when compared to TKA patients without BME. Similarly, significantly fewer UKA patients with BME were satisfied with their procedure than those without BME (8/11, 73% vs 17/17, 100%; P = .05), but BME did not affect patient satisfaction after TKA. Preoperative BME did not influence TKA outcomes; however, pain scores for UKA patients with BME were worse both before and after surgery and fewer UKA patients with preoperative tibial BME were satisfied with their surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Cost-benefit comparison of the Oxford Knee score and the American Knee Society score in measuring outcome of total knee arthroplasty.

    PubMed

    Medalla, Greg Anthony; Moonot, Pradeep; Peel, Tamlyn; Kalairajah, Yegappan; Field, Richard E

    2009-06-01

    The American Knee Society score (AKSS) and the Oxford Knee score (OKS) are validated outcome measures for evaluation of total knee arthroplasties (TKAs). We investigated whether patient self-assessment using the OKS offers a viable alternative to clinical review using the AKSS. Preoperative, 2-year, 5-year, and 10-year postoperative OKS and AKSS were reviewed from TKA patients. The scores were analyzed using the Pearson correlation. There was good correlation of OKS and AKSS at 2 years. This implies that patient self-assessment is a viable screening tool to identify which patients require clinical review, at 2 years, after TKA. However, the moderate correlation at 5 and 10 years indicates that clinical evaluation remains necessary at these time points.

  9. Calcaneal stress fracture: an adverse event following total hip and total knee arthroplasty: a report of five cases.

    PubMed

    Miki, Takaaki; Miki, Takahito; Nishiyama, Akihiro

    2014-01-15

    Stress fractures have been reported to occur in the pubis, femoral neck, proximal part of the tibia, and fabella during the postoperative period following total knee or total hip arthroplasty. However, to our knowledge, calcaneal stress fractures after total hip or total knee arthroplasty have not been reported in the English-language literature. Most orthopaedic surgeons are not familiar with calcaneal stress fractures that may occur in elderly patients after a total knee or total hip arthroplasty. We retrospectively reviewed the clinical features, imaging findings, and bone mineral content of the proximal part of the femur and the distal end of the radius in five patients who had a calcaneal stress fracture after a total knee or total hip arthroplasty. All patients were women with a mean age of 76.8 years. All fractures occurred in the calcaneus on the same side as the arthroplasty. The fracture appeared at a mean of 10.2 weeks postoperatively. All patients reported heel pain on walking. Swelling and local heat were found in four and three patients, respectively. Pain was elicited by squeezing the calcaneus in all patients. Early radiographs had normal findings in two patients, and an irregular sclerotic line appeared later in the radiographs of all patients. All fractures were treated conservatively. Four fractures healed uneventfully, but one fracture displaced. All patients had osteoporosis. Calcaneal stress fractures during the postoperative period following total knee or total hip arthroplasty may not be as rare as previously thought. Because clinical symptoms of the fracture appear insidiously and radiographic findings are absent or subtle in the early stage, a high index of suspicion is needed for orthopaedic surgeons to make the correct diagnosis. Magnetic resonance imaging or repeated radiographs may be necessary to make the correct diagnosis when no abnormality is apparent on the initial radiograph.

  10. Short and mid term results of revision total knee arthroplasty with Global Modular Replacement System.

    PubMed

    Marczak, Dariusz; Kowalczewski, Jacek; Czubak, Jarosław; Okoń, Tomasz; Synder, Marek; Sibiński, Marcin

    2017-01-01

    The original knee megaprostheses with fixed or rotating hinge articulation were custom made and only used for reconstruction of the knee following distal femoral or proximal tibial tumor resections. The aim of the study was to analyze the short- and mid-term results of revision total knee arthroplasty with Global Modular Replacement System (GMRS) used in difficult situations not amenable to reconstruction with standard total knee replacement implants. Nine patients (9 knees) were treated with this comprehensive modular implant system, with a mean age of 73.7 years (range 56-83 years) and a mean followup of 5 years (range 3-8 years). Two patients were treated for distal femoral nonunion, five for distal femur periprosthetic fracture and two for periprosthetic joint infection. The mean Knee Society Score: Knee and functional scores were 77.9 and 40 points, respectively. All demonstrated full extension and flexion was at least 90°. Recurrence of infection was present in one patient. No signs of loosening, dislocation, or implant failure were observed. Based on our small series of patients that represent severe cases, GMRS provides relatively good mid-term functional results, pain relief, and good implant survivorship with a low complication rate. This salvage procedure allows elderly, infirm patients to regain early ambulatory ability.

  11. Total knee arthroplasty following tibial plateau fracture: a matched cohort study.

    PubMed

    Scott, C E H; Davidson, E; MacDonald, D J; White, T O; Keating, J F

    2015-04-01

    Radiological evidence of post-traumatic osteoarthritis (PTOA) after fracture of the tibial plateau is common but end-stage arthritis which requires total knee arthroplasty is much rarer. The aim of this study was to examine the indications for, and outcomes of, total knee arthroplasty after fracture of the tibial plateau and to compare this with an age and gender-matched cohort of TKAs carried out for primary osteoarthritis. Between 1997 and 2011, 31 consecutive patients (23 women, eight men) with a mean age of 65 years (40 to 89) underwent TKA at a mean of 24 months (2 to 124) after a fracture of the tibial plateau. Of these, 24 had undergone ORIF and seven had been treated non-operatively. Patients were assessed pre-operatively and at 6, 12 and > 60 months using the Short Form-12, Oxford Knee Score and a patient satisfaction score. Patients with instability or nonunion needed total knee arthroplasty earlier (14 and 13.3 months post-injury) than those with intra-articular malunion (50 months, p < 0.001). Primary cruciate-retaining implants were used in 27 (87%) patients. Complication rates were higher in the PTOA cohort and included wound complications (13% vs 1% p = 0.014) and persistent stiffness (10% vs 0%, p = 0.014). Two (6%) PTOA patients required revision total knee arthroplasty at 57 and 114 months. The mean Oxford knee score was worse pre-operatively in the cohort with primary osteoarthritis (18 vs 30, p < 0.001) but there were no significant differences in post-operative Oxford knee score or patient satisfaction (primary osteoarthritis 86%, PTOA 78%, p = 0.437). Total knee arthroplasty undertaken after fracture of the tibial plateau has a higher rate of complications than that undertaken for primary osteoarthritis, but patient-reported outcomes and satisfaction are comparable. Cite this article: Bone Joint J 2015;97-B:532-8.

  12. Functional Outcomes of a New Mobile-Bearing Ultra-Congruent TKA System: Comparison With the Posterior Stabilized System.

    PubMed

    Machhindra, Morey Vivek; Kang, Jong Yeal; Kang, Yeon Gwi; Chowdhry, Madhav; Kim, Tae Kyun

    2015-12-01

    We determined whether a new mobile-bearing ultra-congruent (UC) TKA system provides better functional outcomes than an established posterior-stabilized (PS) prosthesis. The functional outcomes (motion arc, AKS scores, WOMAC Index, and SForm-36 scores evaluated at 1 and 2 years postoperatively), satisfaction and incidences of adverse events were compared between the knees implanted with mobile-bearing UC prosthesis (n=103) and the mobile-bearing PS prosthesis (n=99). At 2 years, mobile-bearing UC TKAs showed similar functional outcomes and satisfaction, but smaller motion arc compared to mobile-bearing PS TKAs (126° vs. 131°). There were no differences in the incidence of adverse events. Mobile-bearing UC prosthesis can be considered a safe and viable alternative to the PS design, with an expectation of smaller postoperative maximum flexion.

  13. Role of Patellofemoral Offset in Total Knee Arthroplasty: A Randomized Trial.

    PubMed

    Stryker, Louis S; Odum, Susan M; Springer, Bryan D; Fehring, Thomas K

    2017-01-01

    Total knee arthroplasty occasionally does not meet expectations. This randomized clinical trial assessed the effect of restoration of the native patellofemoral height on clinical outcomes. Group I underwent standard patellar bone resection; group II underwent modified patellar bone resection that adjusted the amount of anterior condylar bone removed and the anterior flange thickness. There were no differences in anterior knee pain, Western Ontario and McMaster Universities Arthritis Index scores, or Knee Injury and Osteoarthritis Outcome Score scores. Patellofemoral compartment height restoration versus patellar height alone does not appear to significantly reduce pain or improve function.

  14. The influence of postoperative coronal alignment on revision surgery in total knee arthroplasty.

    PubMed

    Morgan, Samer S; Bonshahi, A; Pradhan, N; Gregory, A; Gambhir, A; Porter, M L

    2008-10-01

    This study examines the association between postoperative coronal tibiofemoral alignment and revision surgery in knee arthroplasty. We retrospectively reviewed the case notes and post-operative long-leg radiographs of 197 Kinemax knee arthroplasty with mean follow-up of 9 years (SD 2.2). They were divided into three groups: neutral, valgus and varus. Revision or decision to revise was used as a hard endpoint. There was no statistical difference among the three groups (p=0.78). We conclude that aseptic failure of a total knee is multifactorial. Coronal tibio-femoral alignment may not be as important a cause of failure as has been previously thought.

  15. The use of focal knee joint cryotherapy to improve functional outcomes after total knee arthroplasty: review article.

    PubMed

    Ewell, Melvin; Griffin, Christopher; Hull, Jason

    2014-08-01

    The purpose of this study was to review and synthesize available evidence on the effect of focal knee joint cryotherapy on quadriceps arthrogenic muscle inhibition and to discuss the implications of the findings regarding the use of this modality for patients after a total knee arthroplasty. An electronic literature search that targeted peer reviewed journals was completed by using the PubMed, CINAHL, ScienceDirect, and OvidSP databases. An article was included when it was determined that the article was relevant to the topic of focal knee joint cryotherapy and its effect on quadriceps muscle function. There were 6 studies that met the inclusion criteria. Of the reviewed studies, effect sizes for quadriceps activation ranged from very small to large. Five of the 6 studies observed medium to large effects. Effect sizes for quadriceps torque and force production ranged from no effect to a large effect. Two of the 5 studies with outcome measurements related to quadriceps torque or force production observed medium and large effects. Analysis of this evidence suggests that focal joint cooling of the knee shows the potential to improve quadriceps activation as well as quadriceps torque and force production in patients with arthrogenic muscle inhibition. Arthrogenic muscle inhibition of the quadriceps is an impairment commonly observed in patients after a total knee arthroplasty. Analysis of the evidence uncovered in this review suggests that this patient population may be positively impacted by the use of this modality to improve quadriceps activation as well as quadriceps torque and force production.

  16. MEDIUM-TERM ASSESSMENT OF TOTAL KNEE ARTHROPLASTY WITH IMPLANT MADE IN BRAZIL

    PubMed Central

    Barretto, João Maurício; Malta, Márcio; e Albuquerque, Rodrigo Pires; de Assis, Daniel Pinho; Campos, André Siqueira

    2015-01-01

    Objective: This study assessed 47 patients who underwent total knee arthroplasty (TKA) with implants manufactured in Brazil, with a mean follow-up of five years. Methods: This was a retrospective study at Santa Casa de Misericordia Hospital in Rio de Janeiro, from January 1993 to December 2002. The sample comprised 47 patients (44 females and three males) who underwent TKA, totaling 58 knees. The patients’ ages ranged from 46 to 83 years. A diagnosis of osteoarthritis or rheumatic disease was confirmed in all the patients. Results: In this investigation, all the patients underwent cemented TKA with preservation of the posterior cruciate ligament. The length of follow-up ranged from 5 to 17 years. The functional assessment criterion used was the one of the Hospital for Special Surgery (HSS), and this yielded an average of 87 points after the operation. The radiographic criterion used was the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. We had three cases with a radiolucent line without implant loosening, which were asymptomatic from a clinical standpoint. Conclusion: The total knee arthroplasty procedures using an implant made in Brazil were performed by a trained and experienced team. To date, over the clinical follow-up on these patients with knee osteoarthritis or rheumatoid arthritis, the results have been seen to be satisfactory. PMID:27027051

  17. Repeat Manipulation Under Anesthesia For Persistent Stiffness After Total Knee Arthroplasty Achieves Functional Range of Motion.

    PubMed

    Ferrel, Jason R; Davis, Richard L; Agha, Obiajulu A J C; Politi, Joel R

    2015-05-01

    Poor range of motion may decrease a patient's ability to participate in activities of daily living after total knee arthroplasty. Manipulation under anesthesia has been shown to improve range of motion; however, some patients have persistent stiffness even after manipulation. The goal of this study was to evaluate the outcomes and complications of patients who underwent a second manipulation under anesthesia for persistent stiffness after total knee arthroplasty. The review of surgical records of two joint arthroplasty surgeons identified 226 knees in 210 patients who underwent a manipulation under anesthesia for poor range of motion after total knee arthroplasty. Of these patients, 16 patients underwent a second manipulation under anesthesia. For patients undergoing two manipulations under anesthesia procedures, at latest follow up (mean 539 days), mean extension improved from 10.50° to 2.50° (p=0.001) and mean flexion improved from 87.50° to 112.69° (p=0.001) respectively. SF-12 scores were available for 12 of 16 knees with a mean score of 34.42. Two of 16 patients (12.5%) experienced a complication. Three of 16 (18.8%) patients who underwent a second manipulation required a revision arthroplasty procedure. In conclusion, a second manipulation under anesthesia can achieve functional range of motion that is sustained after total knee arthroplasty.

  18. Total knee arthroplasty with computer-assisted navigation more closely replicates normal knee biomechanics than conventional surgery.

    PubMed

    McClelland, Jodie A; Webster, Kate E; Ramteke, Alankar A; Feller, Julian A

    2017-06-01

    Computer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated. This study compared knee biomechanics during level walking of 121 participants: 39 with conventional TKA, 42 with computer-assisted navigation TKA and 40 unimpaired control participants. Standing lower-limb alignment was significantly closer to ideal in participants with navigation TKA. During gait, when differences in walking speed were accounted for, participants with conventional TKA had less knee flexion during stance and swing than controls (P<0.01), but there were no differences between participants with navigation TKA and controls for the same variables. Both groups of participants with TKA had lower knee adduction moments than controls (P<0.01). In summary, there were fewer differences in the biomechanics of computer-assisted navigation TKA patients compared to controls than for patients with conventional TKA. Computer-assisted navigation TKA may restore biomechanics during walking that are closer to normal than conventional TKA. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty.

    PubMed

    Thienpont, Emmanuel

    2015-12-01

    Metal allergy in total knee arthroplasty (TKA) is still a controversial topic. Oxinium, ceramic or titanium niobium nitride (TiNbN) coated implants are available for some knee systems. The hypothesis of this study was that the use of TiNbN-coated components would not lead to inferior results compared to conventional implants and that none of the allergic patients receiving TiNbN-coated implants would require revision for metal allergy. This study was a retrospective, 2 to 1 matched pairs study with 40 titanium niobium nitride-coated TKA compared with 80 conventional cobalt chrome implants. No demographic differences between these groups were observed. The mean follow-up for this study was 2 years. No differences in clinical, radiological, or patient-reported outcome measurements were observed between the two groups. No patients have been revised at this short- to medium-term outcome evaluation. Metal allergy leading to contact or systemic dermatitis is especially linked to chrome and cobalt allergy. Nickel allergy because of knee implants rarely gives cutaneous symptoms, but could potentially lead to peri-prosthetic osteolysis and loosening. The use of titanium niobium nitride implants in case of a positive history of metal allergy could avoid this devastating complication. The use of titanium niobium nitride-coated implants for primary knee osteoarthritis shows similar clinical and radiological outcomes as conventional TKA without revision for loosening at short- to medium-term follow-up. Level of evidence Level IV study.

  20. Alpine Skiing With total knee ArthroPlasty (ASWAP): physical activity, knee function, pain, exertion, and well-being.

    PubMed

    Würth, S; Finkenzeller, T; Pötzelsberger, B; Müller, E; Amesberger, G

    2015-08-01

    This study focused on the psychological and quality of life aspects of resuming alpine skiing practice after total knee arthroplasty (TKA) in elderly skilled skiers. Two data pools were used in order to analyze psychological states: (a) at the beginning, at the end, and 8 weeks after a 12-week skiing intervention; and (b) concerning diurnal variations of states (i.e., skiing days compared with everyday life during intervention and retention phase). In particular, effects of skiing on amount of physical activity and perceived exertion, perceived pain and knee function, and subjective well-being were analyzed using a control group design. Results reveal that the skiing intervention substantially increases the amount of physical activity by the intervention group (122.30 ± 32.38 min/day), compared with the control group (75.14 ± 21.27 min/day) [F (2, 32) = 8.22, P < 0.01, η(2)  = 0.34)]. Additionally, the analyses of psychological states demonstrated that skiing goes along with enhanced well-being and no significant impact on perceived pain, exertion or knee function. In sum, alpine skiing can be recommended for older persons with TKA with respect to well-being, perceived pain and knee function, and perceived exertion.

  1. A case for one-stage revision in infected total knee arthroplasty?

    PubMed

    Parkinson, Richard W; Kay, Peter R; Rawal, Arvind

    2011-01-01

    Infection in total knee replacement is a rare but devastating complication. The current literature tends to support a two-stage revision as definitive treatment of established deep infection. Despite the fact that single stage revision is a well recognised treatment for the infected hip replacement, it has not gained the same level of support in the knee. This article reviews the literature of two-stage and single stage revision and reports the senior author's experience with the latter.

  2. A comparison of subvastus and midvastus approaches in minimally invasive total knee arthroplasty.

    PubMed

    Bonutti, Peter M; Zywiel, Michael G; Ulrich, Slif D; Stroh, D Alex; Seyler, Thorsten M; Mont, Michael A

    2010-03-01

    The mini-subvastus and the mini-midvastus approaches are among the most common alternatives to the medial parapatellar approach for total knee arthroplasty. The purpose of this study was to compare the early clinical outcomes of these two approaches. In this prospective, randomized study of fifty-one patients who underwent bilateral total knee arthroplasty, the mini-subvastus approach was used in one knee and the mini-midvastus approach, in the contralateral knee. There were forty-two women and nine men who had a mean age of seventy years at the time of the index arthroplasties, and they were followed for two years postoperatively. Clinical outcome was assessed and compared with use of the Knee Society pain and function scores, the straight-leg-raising test, range of motion, and isokinetic strength testing. Operating time and blood loss for each approach were also compared. In addition, patients were surveyed concerning which knee they preferred. Comparisons of postoperative Knee Society scores between both approaches at the time of the two-year follow-up did not yield a significant difference in outcome. Isokinetic strength testing at twelve weeks postoperatively revealed no significant differences in muscle strength, with a mean extensor peak torque-to-body weight ratio of 0.14 Nm/kg for both groups. No significant difference was found with respect to total blood loss, straight-leg-raising test, range of motion, or patient preference. There was no clinically relevant difference in operative times between the two approaches. The minimally invasive subvastus and midvastus approaches for total knee arthroplasty were both associated with excellent short-term clinical results. Some surgeons believe that the subvastus approach completely avoids damage to the quadriceps mechanism and therefore would be associated with improved muscle function. This prospective series did not identify a substantive difference between the two approaches. We believe that the decision

  3. The management of extensor mechanism complications in total knee arthroplasty. AAOS exhibit selection.

    PubMed

    Nam, Denis; Abdel, Matthew P; Cross, Michael B; LaMont, Lauren E; Reinhardt, Keith R; McArthur, Benjamin A; Mayman, David J; Hanssen, Arlen D; Sculco, Thomas P

    2014-03-19

    Complications involving the knee extensor mechanism and patellofemoral joint occur in 1% to 12% of patients following total knee arthroplasty and have major negative effects on patient outcomes and satisfaction. The surgeon must be aware of intraoperative, postoperative, and patient-related factors that can increase the rate of these problems. This review focuses on six of the most commonly encountered problems: patellar tendon disruption, quadriceps tendon rupture, patellar crepitus and soft-tissue impingement, periprosthetic patellar fracture, patellofemoral instability, and osteonecrosis of the patella. The goals of this report are to (1) review the relevant anatomy of the knee extensor mechanism, (2) present risk factors that may lead to extensor mechanism complications, (3) provide a diagnostic and treatment algorithm for each of the aforementioned problems, and (4) review the specific surgical techniques of Achilles tendon allograft reconstruction and synthetic mesh augmentation. Extensor mechanism disorders following total knee arthroplasty remain difficult to manage effectively. Although various surgical techniques have been used, the results in patients with a prior total knee arthroplasty are inferior to the results in the young adult without such a prior procedure. Surgical attempts at restoration of the knee extensor mechanism are usually warranted; however, the outcomes of treatment of these complications are often poor, and management of patient expectations is important.

  4. A comparative analysis between fixed bearing total knee arthroplasty (PFC Sigma) and rotating platform total knee arthroplasty (PFC-RP) with minimum 3-year follow-up.

    PubMed

    Jawed, Akram; Kumar, Vijay; Malhotra, R; Yadav, C S; Bhan, S

    2012-06-01

    Since the introduction of mobile bearing total knee designs nearly 30 years back, many studies have been done to evaluate its long-term result. Comparison with fixed bearing designs has been done in the past, but the studies were confounded by variables such as disease, surgeon, bone quality, pain tolerance, etc. We attempt to eliminate these variables in this study. A total of 50 patients who had bilateral arthritis of the knee with similar deformity and pre-operative range of motion on both sides agreed to have one knee replaced with mobile bearing total knee design (PFC-RP) and the other with a fixed bearing design (PFC Sigma) were prospectively evaluated. Comparative analysis of both the designs was done at a mean follow-up of 40 months, minimizing patient, surgeon and observer related bias. Clinical and radiographic outcome, survival and complication rates were compared. At a mean follow-up of 40 months (range 36-47 months), no benefit of mobile bearing (PFC-RP) over fixed bearing design (PFC Sigma) could be demonstrated with respect to Knee Society scores, pain scores, range of flexion, subject preference or patello-femoral complication rates. Radiographs showed no difference in prosthetic alignment. No patient required a revision surgery till last follow-up. Our study demonstrated no advantage of the mobile-bearing arthroplasty over fixed bearing arthroplasty with regard to clinical results at short-term follow-up. However, longer follow-up is necessary to confirm whether these results are sustained.

  5. Iodine-impregnated incision drape and bacterial recolonization in simulated total knee arthroplasty.

    PubMed

    Milandt, Nikolaj; Nymark, Tine; Jørn Kolmos, Hans; Emmeluth, Claus; Overgaard, Søren

    2016-08-01

    Background and purpose - Iodine-impregnated incision drapes (IIIDs) are used to prevent surgical site infection (SSI). However, there is some evidence to suggest a potential increase in SSI risk as a result of IIID use, possibly from promotion of skin recolon