CLINICAL AND RADIOLOGICAL RESULTS OF TOTAL KNEE REPLACEMENT USING PATIENT-SPECIFIC POSITIONING GUIDES WITH AT LEAST 5 YEARS OF FOLLOW-UP

2020 ◽  
pp. 2050020
Author(s):  
Xabier Foruria ◽  
Jesús Moreta ◽  
Carlos Jaramillo ◽  
Ane Anton ◽  
Isidoro Calvo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Knee Score ◽  
Conventional Instrumentation ◽  
Total Knee ◽  
The Mean ◽  
Clinical And Radiological Results ◽  
Coronal Malalignment

Objective: Patient-specific positioning guides have been designed to improve precision in total knee arthroplasty. The aim of this study is to evaluate the medium-term clinical and radiological outcomes with magnetic resonance imaging-based patient-specific positioning guides. Material and methods: We retrospectively reviewed patients from two centers treated with total knee arthroplasty performed with patient-specific positioning guides. We enrolled patients operated on between January 2011 and December 2013, with a minimum follow-up of 5 years. Preoperative and postoperative hip knee angle (HKA) and position of each component in the coronal plane were assessed. Overall malalignment was defined as an outlier of more than [Formula: see text] from the neutral mechanical axis and specific malalignment as when any component showed more than [Formula: see text] of deviation. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee Score. Results: This study included 68 patients with a mean age of 72 years. The mean postoperative alignment (HKA) was [Formula: see text] and 26.5% of patients showed coronal malalignment [Formula: see text]. Regarding femoral components, 19.1% showed specific malalignment [Formula: see text], while 11.7% of tibial components were classified as outliers. The mean HSS Knee Score at final follow up was 89.2. Patients whose implants were mechanically aligned did not obtain better functional outcomes ([Formula: see text]). Conclusion: In our series, the use of patient-specific positioning guides resulted in a range of mechanical malalignment, similar to conventional instrumentation results reported in the literature.

Routine Histopathological Analysis of the Synovium in Patients with Primary Total Knee Arthroplasty

2020 ◽  
Vol 34 (01) ◽  
pp. 115-120
Author(s):  
Ali Utkan ◽  
Emrah Caliskan ◽  
Batuhan Gencer ◽  
Bulent Ozkurt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Primary Total Knee Arthroplasty ◽  
Histopathological Analysis ◽  
Knee Score ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

AbstractAlthough there are numerous studies about routine histopathological analysis during arthroplasty surgeries, most of them showed that new diagnoses have rarely been obtained as a result. The aim of this study was to evaluate the efficacy of routine pathological analyses of synovia resected during primary total knee arthroplasty in patients with osteoarthritis and its relevance in the treatment process. Of the 47 included patients who were followed up prospectively, 26 patients had clinical and histopathological concordant diagnoses and 21 patients had discrepant diagnoses. Oxford knee score and visual analogue score were performed for all the patients. Kallgren-Lawrence score was used for radiological analyses. The Mann-Whitney U test was used to examine the differences between the abnormally distributed variables. Mean age was 65.9 ± 4.3 years (range, 50–89 years) and mean follow-up time was 19 ± 7.8 months (range, 6–39 months). Grade IV gonarthrosis was found to be statistically lower in the discrepant group (p = 0.046). The mean preoperative Oxford knee score was 16.8 ± 2.3 (range, 2–23) and the mean postoperative Oxford knee score was 44.6 ± 1.8 (range, 27–48; p = 0.016). Postoperative Oxford knee scores and VAS were significantly increased in both the concordant and discrepant groups (p = 0.026 and p = 0.035, p = 0.019 and p = 0.039, respectively). Resection and histopathologic analyses of the hypertrophied and inflamed synovium encountered during primary arthroplasty procedure should be performed. This examination not only could provide crucial information that may influence the postoperative follow-up guidelines but also could help us to expand our knowledge and awareness of rare diseases that might yield osteoarthritis. The level of evidence for the study is level II.

The results of knee arthrodesis with dedicated modular intramedullary nail as a limb salvage procedure in infection complications of knee arthroplasty

2020 ◽  
Vol 86 (2) ◽  
pp. 33-38
Author(s):  
Marcin Para ◽  
◽  
Paweł Bartosz ◽  
Maciej Kogut ◽  
Gracjan Suchodolski ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Intramedullary Nail ◽  
Oxford Knee Score ◽  
Knee Score ◽  
Knee Arthrodesis ◽  
Bone Contact ◽  
Total Knee ◽  
The Mean

Introduction. Complications after arthroplasty often result in irreversible disability. In some cases, for the extremity to be salvaged, permanent knee joint arthrodesis is a last-chance procedure. Modular implant design simplifies surgical technique and knee arthrodesis without bone-on-bone contact, immediately provides full weight bearing and restores limb length and alignment. Puropose. The aim of this article was to perform a clinical evaluation of patients after knee arthrodesis with a dedicated modular intramedullary nail without bone-on-bone contact after a failed infected total knee arthroplasty. Methods. Between 2017 and 2021, 17 patients were treated with knee arthrodesis with a modular nail after a septic complication of total knee arthroplasty. Clinical evaluation of 15 patients was obtained during a follow-up visit, including: the pain severity using the Visual Analog Scale (VAS), physical function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score, gait independence, and the shortening of the affected limb in relation to the other one. Results. The mean follow-up duration was 1.4 years. The group included 11 women and 4 men with an average of 69.3 (57–84) years. All nails were cemented. There was one recurrence of infection. The mean VAS pain score was 2.73, also 4 patients felt no pain at all. The average functional score on the WOMAC scale was 36.4 (14–60) and for the Oxford Knee Score was 26.5 (15–41). Each patient achieved an independent gait. All patients reported the necessity of use of crutches outside home. The average limb shortening was 2.05 cm (0.5–3.0). In addition, 14 of the 15 patients positively evaluated the procedure results and if they had to, they would again decide on this form of treatment. During follow-up, no complication or problems with implants used were observed. Conclusions. Knee arthrodesis with modular nail offers an acceptable functional result and gives a chance of salvaging a limb in complex septic complications of TKA.

Manipulation under anaesthesia after primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 126-130
Author(s):  
Brian P. Chalmers ◽  
Enrique Goytizolo ◽  
Mithun D. Mishu ◽  
Geoffrey H. Westrich
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Pain Scores ◽  
Neuraxial Anaesthesia ◽  
Manipulation Under Anaesthesia ◽  
Total Knee ◽  
The Mean ◽  
Sedation Group

Aims Manipulation under anaesthesia (MUA) remains an effective intervention to address restricted range of motion (ROM) after total knee arthroplasty (TKA) and occurs in 2% to 3% of primary TKAs at our institution. Since there are few data on the outcomes of MUA with different anaesthetic methods, we sought to compare the outcomes of patients undergoing MUA with intravenous (IV) sedation and neuraxial anaesthesia. Methods We identified 548 MUAs after primary TKA (136 IV sedation, 412 neuraxial anaesthesia plus IV sedation) from March 2016 to July 2019. The mean age of this cohort was 62 years (35 to 88) with a mean body mass index of 31 kg/m2 (18 to 49). The mean time from primary TKA to MUA was 10.2 weeks (6.2 to 24.3). Pre-MUA ROM was similar between groups; overall mean pre-MUA extension was 4.2° (p = 0.452) and mean pre-MUA flexion was 77° (p = 0.372). We compared orthopaedic complications, visual analogue scale (VAS) pain scores, length of stay (LOS), and immediate and three-month follow-up knee ROM between these groups. Results Following MUA, patients with IV sedation had higher mean VAS pain scores of 5.2 (SD 1.8) compared to 4.1 (SD = 1.5) in the neuraxial group (p < 0.001). The mean LOS was shorter in patients that received IV sedation (9.5 hours (4 to 31)) compared to neuraxial anaesthesia (11.9 hours (4 to 51)) (p = 0.009), but an unexpected overnight stay was similar in each group (8.6%). Immediate-post MUA ROM was 1° to 121° in the IV sedation group and 0.9° to 123° in the neuraxial group (p = 0.313). Three-month follow-up ROM was 2° to 108° in the IV sedation group and 1.9° to 110° in the neuraxial anaesthesia group (p = 0.325) with a mean loss of 13° (ranging from 5° gain to 60° loss), in both groups by three months. No patients in either group sustained a complication. Conclusion IV sedation alone and neuraxial anaesthesia are both effective anaesthetic methods for MUA after primary TKA. Surgeons and anaesthetists should offer these anaesthetic techniques to match patient-specific needs as the orthopaedic outcomes are similar. Also, patients should be counselled that ROM following MUA may decrease over time. Cite this article: Bone Joint J 2021;103-B(6 Supple A):126–130.

scholarly journals FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 807.3-807
Author(s):  
I. Moriyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Osteoarthritis Of The Knee ◽  
Patellar Resurfacing ◽  
Criterion A ◽  
Total Knee ◽  
The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

scholarly journals The application of Patient specific Instrument （PSI ）in total knee arthroplasty with valgus knee

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Wang Yuehui ◽  
Zou Shiping ◽  
Cao Liangliang ◽  
Chen Wenzhong
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Valgus Knee ◽  
Specific Instrument ◽  
Guide Plate ◽  
Before And After ◽  
Total Knee ◽  
Surgery Department

Introduction: To invest the auxiliary role of Patient specific Instrument(PSI) used as osteotomy guide plate in total knee arthroplasty(TKA) with valgus knee. Hypotheses: PSI osteotomy guide plate is applicable for total knee arthroplasty with valgus knee. Methods: A retrospective analysis was performed on 21 patients with valgus knee, including 5 males and 16 females, who underwent TKA in joint surgery department I of ZhengZhou Orthopaedic Hospital from March 2016 to February 2018. All the operations were performed with the assistance of PSI, and the radiographic and clinical evaluations including femoral tibial joint ectropion angle(FTA) before and after operation, range of motion(ROM) and the Hospital for Special Surgery (HSS) knee score were reviewed, and surgical complications were recorded. Results: All the 21 patients werefollowed up for 10 ˜ 26 months (mean 16 months).All the incisions healed by first intention. The FTA was reduced significantly to 6.3 °±1.2° after operation from 17.6 ° + 5.7 °(P < 0.05), the ROM was improved significantly from preoperative 71.3° ±5.8° to postoperative 102.4°±7.5° (P < 0.05), the HSS score at the last follow-up was improved from 38.2±5.7 to 87.5-3.5(P < 0.05). During the follow-up, no complications such as infection, loosening, sinking and valgus were observed. Conclusion: Providing accurate osteotomy, effective correction of the force line, simple operation and satisfactory clinical effect, the PSI osteotomy guide plate is applicable for total knee arthroplasty with valgus knee.

Should We Resect Hoffa's Fat Pad during Total Knee Replacement?

2017 ◽  
Vol 30 (09) ◽  
pp. 894-897 ◽  
Author(s):  
Alun Yewlett ◽  
Ryan Trickett ◽  
Mark Forster ◽  
Adel Ghandour ◽  
Hannah Sellars
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Fat Pad ◽  
Hoffa’S Fat Pad ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean ◽  
The Difference ◽  
The One

AbstractResection of Hoffa's fat pad during total knee arthroplasty is sometimes performed to improve access and view. Opponents of this technique argue that sacrificing the fat pad potentially compromises blood supply to the patellar tendon and it can subsequently shorten. Our objective was to identify any difference in the Insall-Salvati ratio of knees undergoing total knee arthroplasty between a cohort that had Hoffa's fat pad preserved and the one that had Hoffa's fat pad completely excised. The total knee arthroplasties by two surgeons at our institution were reviewed over a 3-year period. Surgeon A routinely preserves the fat pad and surgeon B routinely excises the fat pad. Radiographs preoperatively, immediately postoperatively, and at a minimum of 1-year follow up were analyzed for the Insall-Salvati ratio. A total of 161 knees were reviewed, 65 in the preserved group and 96 in the excised group with a mean age of 67 and 70 years, respectively. The mean preoperative Insall-Salvati ratio for the preserved group was 1.12 (±0.145) and excised group 1.16 (±0.168) (p = 0.094). The mean immediate postoperative Insall-Salvati ratio for the preserved group was 1.10 (±0.154) and for excised group 1.18 (±0.194). The difference in Insall-Salvati ratio from preoperative to the immediate postoperative period in the preserved group compared with the excised group demonstrated a significant difference (p = 0.010). However, the change of Insall-Salvati ratio at 1 year did not significantly differ between the groups (p = 0.059). There does not appear to be any difference in the Insall-Salvati ratios of both groups at 1 year's follow up; therefore, this study radiologically at least supports the use of either technique.

scholarly journals Reconstruction for Massive Proximal Tibial Bone Defects Using Patient-customized Three-dimensional-printed Metaphyseal Cones in Revision Total Knee Arthroplasty

2020 ◽  
Author(s):  
Yang Li ◽  
Xinguang Wang ◽  
Hua Tian
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Bone Defects ◽  
Revision Total Knee Arthroplasty ◽  
3D Printed ◽  
Total Knee ◽  
The Mean ◽  
Highly Porous

Abstract Background: The reconstruction of massive bone defects is one of the main challenges in revision total knee arthroplasty (RTKA). Although several methods are available, each of them has its prominent shortcomings. The purpose of this study is to review the clinical outcomes of RTKA with massive proximal tibial bone defects using patient-customized three-dimensional (3D)-printed highly porous metaphyseal cones.Methods: We retrospectively reviewed seven RTKAs with Anderson Orthopaedic Research Institute (AORI) type III tibial defects using patient-customized 3D-printed highly porous metaphyseal cones, which have been performed at a single institution between 2016 and 2018. Results: The mean age at diagnosis of the patients was 68 years old (61-77). The mean length of follow-up was 25.3 months (19-36). At the latest follow-up, no aseptic loosening or prosthetic joint infection has been determined. The mean HSS increased from 49 (39-63) to 78 (70-83) (P<0.01); the mean WOMAC increased from 59 (46-73) to 26 (12-38) (P<0.01). All patients obtained the range of motion and mechanical alignment improvement postoperatively.Conclusion: The patient-customized 3D-printed metaphyseal cone could be a promising technique in addressing severe tibial defects in RTKA. Our study shows encouraging short-term clinical and radiological outcomes with no aseptic loosening, periprosthetic infection, or fracture. Nevertheless, further follow-up and the expansion of sample size are needed to demonstrate the advantage of this innovative technique fully.

scholarly journals Natural course of Baker’s cysts in a total knee arthroplasty population

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0028
Author(s):  
Hagen Hommel ◽  
Sebastian Kopf
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Natural Course ◽  
Cyst Size ◽  
Baker’S Cyst ◽  
Baker's Cyst ◽  
Adjacent Structures ◽  
Total Knee ◽  
The Mean

Aims and Objectives: Baker’s cysts are known to be a source of discomfort and pain due to pressure on adjacent structures. They are not uncommon in patients eligible for total knee arthroplasty (TKA). Since there is a paucity of medium-term studies that assess the natural course of Baker’s cyst following TKA, in this study we report the one- and five-year outcomes of patients to elucidate the state of their Baker’s cyst following TKA. Materials and Methods: In this prospective case series, 102 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker’s cyst. Sonography was performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at one and five years after TKA. Symptoms potentially attributable to the Baker’s cyst were recorded at each assessment. In addition, the five-year assessment included a sonographic assessment of the anterior aspect of the knee to identify joint effusion. Results: Ninety-one patients were available for the five-year assessment (with an 89% follow-up rate). After one and five years, Baker’s cyst was still present in 87 (85%) and 30 (33%) patients, respectively. Of those patients who retained a Baker’s cyst at one-year follow up, 31 patients (36%) had sustained popliteal symptoms. Of those patients who continued to have a Baker’s cyst at five years, 17 patients (56.7%) were still symptomatic. The probability of entering remission was dependent on the size of the Baker’s cyst at baseline (odds ratio, 1.41; p = 0.025). The mean preoperative cyst size was 14.5 cm2. At one and five years postoperatively, the mean cyst size was 10.6 cm2 and 9.9 cm2, respectively. At five years, no association between cyst size and popliteal symptoms was found. Conclusion: Five years after TKA, the majority of the Baker’s cysts that were present at baseline had gone into remission. The probability of going into remission was dependent on the size of the Baker’s cyst at baseline.

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