S. Di Paolo, S. Fratini, A. Meena, S. Bignozzi, G. M. Marcheggiani Muccioli, S. Zaffagnini
The purpose of the present study was to associate the intraoperative kinematics acquired with a computer navigation system with long-term clinical outcomes and survivorship in patients undergoing TKA to investigate the role of constraint in patients’ satisfaction.A surgical navigation system was used to verify bone resections, gaps, and implant positioning during TKA. Kinematic examination, i.e. varus-valgus at full-extended knee (VV0), varus-valgus at 30° of flexion (VV30), anterior/posterior displacement at 90° of flexion (AP90), passive range of motion (ROM) were performed. Long-term clinical assessment interviews were performed. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to investigate patients’ clinical and functional status.Out of 165 patients, 120 met the inclusion criteria. The average follow-up time was 7.7±2.8 years. 7 patients had undergone revision surgery and were considered as a surgical failure with an overall survival rate of 94.2%, while the survival rate at 6, 8, 10 years was 98.8%, 97.4%, 93.6%, respectively. Clinical failure (KOOS score <70) was detected in 11 (9.2%), 10 (8.3%), 21 (17.5%), 39 (32.5%), 113 (94.2%) patients for the Symptoms, Pain, ADL, QoL, and Sport sub-scores, respectively. A statistically significant difference was found in KOOS-QoL between patients with and without clinical failure for the VV0 test (ES=0.58, p=0.022), with lower laxity for patients with score<70.Over-constraint kinematics during TKA surgery leads to worse clinical outcomes at long-term follow-up. Surgeons should be aware of the intraoperative ligament balancing and avoid over-constraint, especially in PS TKA designs.
{"title":"Over Constraint Varus Valgus Laxity Leads to Worse Clinical Outcomes at Long Term Follow Up in Total Knee Arthroplasty: Intraoperative Assessment through Surgical Navigation System","authors":"S. Di Paolo, S. Fratini, A. Meena, S. Bignozzi, G. M. Marcheggiani Muccioli, S. Zaffagnini","doi":"10.29007/tz3f","DOIUrl":"https://doi.org/10.29007/tz3f","url":null,"abstract":"The purpose of the present study was to associate the intraoperative kinematics acquired with a computer navigation system with long-term clinical outcomes and survivorship in patients undergoing TKA to investigate the role of constraint in patients’ satisfaction.A surgical navigation system was used to verify bone resections, gaps, and implant positioning during TKA. Kinematic examination, i.e. varus-valgus at full-extended knee (VV0), varus-valgus at 30° of flexion (VV30), anterior/posterior displacement at 90° of flexion (AP90), passive range of motion (ROM) were performed. Long-term clinical assessment interviews were performed. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to investigate patients’ clinical and functional status.Out of 165 patients, 120 met the inclusion criteria. The average follow-up time was 7.7±2.8 years. 7 patients had undergone revision surgery and were considered as a surgical failure with an overall survival rate of 94.2%, while the survival rate at 6, 8, 10 years was 98.8%, 97.4%, 93.6%, respectively. Clinical failure (KOOS score <70) was detected in 11 (9.2%), 10 (8.3%), 21 (17.5%), 39 (32.5%), 113 (94.2%) patients for the Symptoms, Pain, ADL, QoL, and Sport sub-scores, respectively. A statistically significant difference was found in KOOS-QoL between patients with and without clinical failure for the VV0 test (ES=0.58, p=0.022), with lower laxity for patients with score<70.Over-constraint kinematics during TKA surgery leads to worse clinical outcomes at long-term follow-up. Surgeons should be aware of the intraoperative ligament balancing and avoid over-constraint, especially in PS TKA designs.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127172337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A key goal of all TKA alignment strategies is to achieve joint balance. This study aims to compare the alignments achieved by preoperatively planning to a novel distracted joint gap protocol to common alignment strategies as well as to the alignment of a healthy non-arthritic population.A retrospective study comprised of 145 knees was performed. A long-leg supine CT scan, weightbearing AP knee X-ray and two distracted knee X-rays (one each in extension and flexion, making use of an ankle weight to open the joint) were taken pre-operatively. This imaging was used to perform segmentation, landmarking and 3D-to-2D registration. The medial and lateral joint gaps were determined in extension and flexion.The mean weightbearing, KA planned and distracted joint planned HKA were 4.7° (±5.9°) varus, 0.3° (±3.2°) varus, and 2.2° (±3.5°) varus. This compares to a healthy adult HKA of 1.3° (±2.3°) varus. A patient level comparison between the planned KA and distracted joint HKA found that the coronal angles of the two alignments are within 3° of each other for 64% patients, within 3-5° for 26% of patients and greater than 5° for the remaining 10% of patients.Of those compared, the planned distracted HKA was the closest to the constitutional varus HKA of a healthy population. Patient level analysis highlighted the fundamental differences between the planned KA and joint distracted alignments. By considering both hard and soft tissue, the planned joint distracted alignment allows for a more holistic foundation for pre-operative surgical planning for a given patient.
{"title":"Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning","authors":"David W. Liu, Ishaan Jagota, J. Twiggs, B. Miles","doi":"10.29007/xfj7","DOIUrl":"https://doi.org/10.29007/xfj7","url":null,"abstract":"A key goal of all TKA alignment strategies is to achieve joint balance. This study aims to compare the alignments achieved by preoperatively planning to a novel distracted joint gap protocol to common alignment strategies as well as to the alignment of a healthy non-arthritic population.A retrospective study comprised of 145 knees was performed. A long-leg supine CT scan, weightbearing AP knee X-ray and two distracted knee X-rays (one each in extension and flexion, making use of an ankle weight to open the joint) were taken pre-operatively. This imaging was used to perform segmentation, landmarking and 3D-to-2D registration. The medial and lateral joint gaps were determined in extension and flexion.The mean weightbearing, KA planned and distracted joint planned HKA were 4.7° (±5.9°) varus, 0.3° (±3.2°) varus, and 2.2° (±3.5°) varus. This compares to a healthy adult HKA of 1.3° (±2.3°) varus. A patient level comparison between the planned KA and distracted joint HKA found that the coronal angles of the two alignments are within 3° of each other for 64% patients, within 3-5° for 26% of patients and greater than 5° for the remaining 10% of patients.Of those compared, the planned distracted HKA was the closest to the constitutional varus HKA of a healthy population. Patient level analysis highlighted the fundamental differences between the planned KA and joint distracted alignments. By considering both hard and soft tissue, the planned joint distracted alignment allows for a more holistic foundation for pre-operative surgical planning for a given patient.","PeriodicalId":385854,"journal":{"name":"EPiC Series in Health Sciences","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127544370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：