scholarly journals New Technologies in Knee Arthroplasty: Current Concepts

2020 ◽  
Vol 10 (1) ◽  
pp. 47
Author(s):  
Cécile Batailler ◽  
John Swan ◽  
Elliot Sappey Marinier ◽  
Elvire Servien ◽  
Sébastien Lustig
Keyword(s):  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Surgical Planning ◽  
New Technologies ◽  
Survival Rates ◽  
Patient Specific ◽  
Good Survival ◽  
Implant Positioning ◽  
3D Surgical Planning ◽  
Total Knee

Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. Despite good survival rates, up to 20% of TKA patients remain dissatisfied. Recently, promising new technologies have been developed in knee arthroplasty, and could improve the functional outcomes. The aim of this paper was to present some new technologies in TKA, their current concepts, their advantages, and limitations. The patient-specific instrumentations can allow an improvement of implant positioning and limb alignment, but no difference is found for functional outcomes. The customized implants are conceived to reproduce the native knee anatomy and to reproduce its biomechanics. The sensors have to aim to give objective data on ligaments balancing during TKA. Few studies are published on the results at mid-term of these two devices currently. The accelerometers are smart tools developed to improve the TKA alignment. Their benefits remain yet controversial. The robotic-assisted systems allow an accurate and reproducible bone preparation due to a robotic interface, with a 3D surgical planning, based on preoperative 3D imaging or not. This promising system, nevertheless, has some limits. The new technologies in TKA are very attractive and have constantly evolved. Nevertheless, some limitations persist and could be improved by artificial intelligence and predictive modeling.

Functional Outcomes and Accuracy of Patient-Specific Instruments for Total Knee Arthroplasty

2018 ◽  
Vol 25 (5) ◽  
pp. 470-475 ◽  
Author(s):  
Andrea H. Stone ◽  
Udai S. Sibia ◽  
James H. MacDonald
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Patient Specific ◽  
Consecutive Series ◽  
Coronal Alignment ◽  
Patient Specific Instrumentation ◽  
Estimated Blood Loss ◽  
Patient Specific Instruments ◽  
Total Knee

Background. Patient-specific instruments (PSIs) were developed to improve mechanical axis alignment for patients undergoing total knee arthroplasty (TKA) as neutral alignment (180°) is a predictor of long-term success. This study examines alignment accuracy and functional outcomes of PSI as compared with standard instruments (SIs). Methods. We retrospectively reviewed a consecutive series of TKA procedures using PSI. A total of 85 PSI procedures were identified, and these were compared with a matched cohort of 85 TKAs using SI. Intraoperative decision-making, estimated blood loss, efficiency, Knee Society Scores, and postoperative radiographs were evaluated. Results. One hundred and seventy patients with comparable patient demographics were reviewed. Eighty-one percent of the PSI procedures were within target (180 ± 3°) mechanical alignment, while the SI group had 70% of cases within the target plane ( P = .132). Mean target alignment (2.0° PSI vs 2.2° SI, P = .477) was similar between groups. Twenty-seven percent of patients in the PSI group had surgeon-directed intraoperative recuts to improve the perceived coronal alignment. The change in hematocrit was reduced in the PSI group (8.89 vs 7.21, P = .000). Procedure time and total operating room time were equivalent. Knee Society Scores did not differ between groups at 6 months or at 1 year. Conclusion. Patient-specific instrumentation decreased change in hematocrit, though coronal alignment and efficiency were equivalent between groups. Surgeons must evaluate cuts intraoperatively to confirm alignment. Functional outcomes are equivalent for PSI and SI groups.

scholarly journals Current concepts for aligning knee implants: patient-specific or systematic?

2018 ◽  
Vol 3 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Charles Rivière ◽  
Stefan Lazic ◽  
Oliver Boughton ◽  
Yann Wiart ◽  
Loic Vïllet ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Anatomical Variation ◽  
Patient Specific ◽  
Kinematic Alignment ◽  
Additional Advantage ◽  
Prosthetic Knee ◽  
Total Knee ◽  
Alternative Techniques ◽  
Anatomical Alignment

Mechanical or anatomical alignment techniques create a supposedly ‘biomechanically friendly’ but often functionally limited prosthetic knee. Alternative techniques for alignment in total knee arthroplasty (TKA) aim at being more anatomical and patient-specific, aiming to improve functional outcomes after TKA. The kinematic alignment (KA) technique for TKA has shown good early clinical outcomes. Its role in extreme anatomical variation remains to be defined. The restricted KA technique for TKA might be a reasonable option for patients with extreme anatomical variation. While unicompartmental knee arthroplasty (UKA) has many advantages over TKA, the revision rate remains higher compared with TKA. One major explanation is the relative ease with which a UKA can be converted to a TKA, compared with revising a TKA. This can be considered as an additional advantage of UKA. Another reason is that surgeons favour revising a UKA to a TKA in cases of degeneration of the other femorotibial compartment rather than performing a relatively simple re-operation of the knee by doing an additional UKA (staged bi-UKA).Cite this article: EFORT Open Rev 2018;3:1–6. DOI: 10.1302/2058-5241.3.170021

scholarly journals Robotic technology in total knee arthroplasty: a systematic review

2019 ◽  
Vol 4 (10) ◽  
pp. 611-617 ◽  
Author(s):  
Babar Kayani ◽  
Sujith Konan ◽  
Atif Ayuob ◽  
Elliot Onochie ◽  
Talal Al-Jabri ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Learning Curves ◽  
Robotic Technology ◽  
Soft Tissue Envelope ◽  
Implant Positioning ◽  
Total Knee

Robotic total knee arthroplasty (TKA) improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment compared to conventional jig-based TKA. Robotic TKA does not have a learning curve effect for achieving the planned implant positioning. The learning curve for achieving operative times comparable to conventional jig-based TKA is 7–20 robotic TKA cases. Cadaveric studies have shown robotic TKA is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKA. Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA. Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs. Further higher quality studies are required to compare differences in conventional TKA versus robotic TKA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:611-617. DOI: 10.1302/2058-5241.4.190022

scholarly journals The evolution of patellofemoral prosthetic design in total knee arthroplasty: how far have we come?

2019 ◽  
Vol 4 (8) ◽  
pp. 503-512 ◽  
Author(s):  
Mark Anthony Roussot ◽  
Fares Sami Haddad
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
New Technologies ◽  
Cost Effective ◽  
Implant Positioning ◽  
Cost Effective Treatment ◽  
Total Knee ◽  
Alternative Approaches ◽  
End Stage ◽  
Further Development

Total knee arthroplasty (TKA) has evolved into a successful, cost-effective treatment for end-stage knee arthrosis. The patellofemoral articulation in TKA has largely been ignored during its development despite being an important determinant of outcome. New technologies still need further development to incorporate the patella in TKA surgical planning and operative technique. Alternative approaches to alignment in TKA will have a secondary impact on patellofemoral mechanics and possibly future implant designs. Technologies that assist with precise implant positioning may alter our understanding and overall practice of TKA. Cite this article: EFORT Open Rev 2019;4:503-512. DOI: 10.1302/2058-5241.4.180094

Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

2020 ◽  
Author(s):  
Stephen Thomas ◽  
Ankur Patel ◽  
Corey Patrick ◽  
Gary Delhougne
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Hospital Cost ◽  
Readmission Rate ◽  
Hospital Costs ◽  
Patient Specific ◽  
P Value ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Total Knee

AbstractDespite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

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