Justin T Butler, Samuel D Stegelmann, Trent Davis, Amy Singleton, Hunter Ostlie, Richard Miller, Kirk Davis
Acquired idiopathic stiffness (AIS) following total knee arthroplasty (TKA) often requires manipulation under anesthesia (MUA). Robotic-assisted TKA (RA-TKA) systems provide gap balance templates for objective correlation with the rate of AIS. The purpose of this study was to assess intraoperative balancing parameters that were associated with MUA utilizing an "anatomical" implant design.We performed a retrospective chart review of 265 imageless RA-TKA procedures performed by R.M. and K.D. between 2018 and 2020. The primary outcome for AIS or clinically significant "arthrofibrosis" was MUA. Patient intraoperative gap planning data were examined for association.The rate of MUA was 8.7% (23/265), which was performed at a mean follow-up time of 75.9 ± 32.2 days. The lateral to medial gap difference in extension was significantly less in patients requiring MUA (odds ratio [OR] = 0.86, 95% confidence interval [CI], 0.75-0.99) (p = 0.034). Significantly less preoperative varus mechanical axis was associated with knees requiring MUA (1.83° vs. 4.04°, OR = 1.09, 95% CI, 1.00-1.19). Decreased templated mechanical axis correction was associated with MUA (2.09° vs. 4.75°, p < 0.0001).A tighter lateral-to-medial gap in extension, less preoperative varus, and smaller templated mechanical axis corrections were associated with increased rates of MUA.
{"title":"The Influence of Preimplant Balancing on Manipulation under Anesthesia Rates following Imageless Robotic-Assisted Total Knee Arthroplasty.","authors":"Justin T Butler, Samuel D Stegelmann, Trent Davis, Amy Singleton, Hunter Ostlie, Richard Miller, Kirk Davis","doi":"10.1055/a-2410-2668","DOIUrl":"10.1055/a-2410-2668","url":null,"abstract":"<p><p>Acquired idiopathic stiffness (AIS) following total knee arthroplasty (TKA) often requires manipulation under anesthesia (MUA). Robotic-assisted TKA (RA-TKA) systems provide gap balance templates for objective correlation with the rate of AIS. The purpose of this study was to assess intraoperative balancing parameters that were associated with MUA utilizing an \"anatomical\" implant design.We performed a retrospective chart review of 265 imageless RA-TKA procedures performed by R.M. and K.D. between 2018 and 2020. The primary outcome for AIS or clinically significant \"arthrofibrosis\" was MUA. Patient intraoperative gap planning data were examined for association.The rate of MUA was 8.7% (23/265), which was performed at a mean follow-up time of 75.9 ± 32.2 days. The lateral to medial gap difference in extension was significantly less in patients requiring MUA (odds ratio [OR] = 0.86, 95% confidence interval [CI], 0.75-0.99) (<i>p</i> = 0.034). Significantly less preoperative varus mechanical axis was associated with knees requiring MUA (1.83° vs. 4.04°, OR = 1.09, 95% CI, 1.00-1.19). Decreased templated mechanical axis correction was associated with MUA (2.09° vs. 4.75°, <i>p</i> < 0.0001).A tighter lateral-to-medial gap in extension, less preoperative varus, and smaller templated mechanical axis corrections were associated with increased rates of MUA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To compare the outcomes of tibial tubercle osteotomy (TTO) and trochleoplasty for the treatment of patellar instability associated with trochlear dysplasia Methods: This was a systematic review of the literature including published articles that describe either trochleoplasty or TTO in addition to medial patellofemoral ligament reconstruction for the surgical treatment of patellar instability associated with trochleoplasty. Main outcomes assessed were Kujala and international knee documentation committee (IKDC) scores, in addition to recurrent instability and complications. Outcome measures reported were provided in a table format and a subjective analysis was performed.
Results: Ten studies were included with a total of 362 knees including 132 in the trochleoplasty group and 230 in the TTO group. Mean follow up ranged from 27.6 to 61.3 months. At the final follow up, both Kujala and IKDC scores improved significantly in all studies that reported both preoperative and postoperative scores in both groups. There was a total of 3 instability events in the trochleoplasty group as opposed to 21 in the TTO group.
Conclusion: Both procedures, trochleoplasty and TTO may provide satisfactory functional improvement in patients with patellar instability associated with trochlear dysplasia. However, trochleoplasty may be a better option to minimize the risk of recurrent instability.
{"title":"Outcomes of Trochleoplasty vs Tibial Tubercle Osteotomy for Treatment of Patellar Instability Associated with Trochlear Dysplasia; A Systematic Review and Meta-analysis.","authors":"Yehia H Bedeir, Ehsan Akram Deghidy","doi":"10.1055/a-2430-0192","DOIUrl":"https://doi.org/10.1055/a-2430-0192","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the outcomes of tibial tubercle osteotomy (TTO) and trochleoplasty for the treatment of patellar instability associated with trochlear dysplasia Methods: This was a systematic review of the literature including published articles that describe either trochleoplasty or TTO in addition to medial patellofemoral ligament reconstruction for the surgical treatment of patellar instability associated with trochleoplasty. Main outcomes assessed were Kujala and international knee documentation committee (IKDC) scores, in addition to recurrent instability and complications. Outcome measures reported were provided in a table format and a subjective analysis was performed.</p><p><strong>Results: </strong>Ten studies were included with a total of 362 knees including 132 in the trochleoplasty group and 230 in the TTO group. Mean follow up ranged from 27.6 to 61.3 months. At the final follow up, both Kujala and IKDC scores improved significantly in all studies that reported both preoperative and postoperative scores in both groups. There was a total of 3 instability events in the trochleoplasty group as opposed to 21 in the TTO group.</p><p><strong>Conclusion: </strong>Both procedures, trochleoplasty and TTO may provide satisfactory functional improvement in patients with patellar instability associated with trochlear dysplasia. However, trochleoplasty may be a better option to minimize the risk of recurrent instability.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In most previous studies investigating return to preinjury level of sport (RTPS) after anterior cruciate ligament reconstruction (ACLR), whether patients continue aiming for RTPS not only before but also after ACLR was unclear because environmental and social factors were not considered. Herein, we aimed to evaluate factors associated with RTPS among athletes who desired to achieve RTPS even after ACLR, excluding patients who no longer desire this goal owing to environmental and social factors. Ninety-two patients who underwent primary double-bundle ACLR with a minimum 2-year follow-up and desired to achieve RTPS before surgery were retrospectively enrolled. Twelve (13%) patients who no longer desired to achieve RTPS after ACLR owing to environmental and social factors were excluded. Sixty-nine patients were included in the final cohort. At the final follow-up, the patients were split into two groups: those who achieved (R group) or did not achieve (N group) RTPS based on patient self-assessment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores were also determined. The anterior tibial translation in the Lachman test and acceleration and external rotational angular velocity (ERAV) in the pivot shift test were measured at the hardware removal operation. Significant differences were observed for preinjury level of sports between the groups (p < 0.05). The rate of RTPS in competitive athletes was lower than that in recreational athletes (20/46: 43% vs. 16/22: 73%; p =.037). Lysholm score, KOOS symptom, pain, and quality of life showed higher values in the R group than in the N group (p < 0.050). Acceleration was significantly lower in the R group than in the N group (p = 0.028). Competitive level of sports is a risk factor for failure to achieve RTPS. The postoperative functional outcomes in the group that achieved RTPS showed more favorable results. These results provide important information to enable the surgeons to consider the appropriate surgical plan for competitive athletes who desire to achieve RTPS after ACLR.
{"title":"Factors Associated with Return to Sport After Anterior Cruciate Ligament Reconstruction: A Focus on Athletes Who Desire Preinjury Level of Sport.","authors":"Yusuke Kawanishi, Makoto Kobayashi, Sanshiro Yasuma, Hiroaki Fukushima, Jiro Kato, Atsunori Murase, Tetsuya Takenaga, Masahito Yoshida, Gen Kuroyanagi, Yohei Kawaguchi, Hideki Murakami, Masahiro Nozaki","doi":"10.1055/a-2333-1490","DOIUrl":"10.1055/a-2333-1490","url":null,"abstract":"<p><p>In most previous studies investigating return to preinjury level of sport (RTPS) after anterior cruciate ligament reconstruction (ACLR), whether patients continue aiming for RTPS not only before but also after ACLR was unclear because environmental and social factors were not considered. Herein, we aimed to evaluate factors associated with RTPS among athletes who desired to achieve RTPS even after ACLR, excluding patients who no longer desire this goal owing to environmental and social factors. Ninety-two patients who underwent primary double-bundle ACLR with a minimum 2-year follow-up and desired to achieve RTPS before surgery were retrospectively enrolled. Twelve (13%) patients who no longer desired to achieve RTPS after ACLR owing to environmental and social factors were excluded. Sixty-nine patients were included in the final cohort. At the final follow-up, the patients were split into two groups: those who achieved (R group) or did not achieve (N group) RTPS based on patient self-assessment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores were also determined. The anterior tibial translation in the Lachman test and acceleration and external rotational angular velocity (ERAV) in the pivot shift test were measured at the hardware removal operation. Significant differences were observed for preinjury level of sports between the groups (<i>p</i> < 0.05). The rate of RTPS in competitive athletes was lower than that in recreational athletes (20/46: 43% vs. 16/22: 73%; <i>p</i> =.037). Lysholm score, KOOS symptom, pain, and quality of life showed higher values in the R group than in the N group (<i>p</i> < 0.050). Acceleration was significantly lower in the R group than in the N group (<i>p</i> = 0.028). Competitive level of sports is a risk factor for failure to achieve RTPS. The postoperative functional outcomes in the group that achieved RTPS showed more favorable results. These results provide important information to enable the surgeons to consider the appropriate surgical plan for competitive athletes who desire to achieve RTPS after ACLR.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Han Zhang, Xiao Ma, GuanHong Chen, Ze Wang, Zhen Shang, Tianrui Wang, Tengbo Yu, Yongtao Zhang
Rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) face infection risk. The study evaluates vancomycin-loaded calcium sulfate bone as infection prevention. Patients with RA treated with TKA who had their femoral canal filled using either vancomycin-loaded calcium sulfate bone (experimental group [n = 35]) or the patient's own excised autologous bone (control group [n = 30]) at the Qingdao University Affiliated Hospital, Qingdao, China from January 1, 2017, to March 1, 2023, were retrospectively enrolled in this study. An experienced surgeon used midvastus approach. Surgeries included disinfection, antibiotics, and femoral filling. The age, gender, body mass index (BMI), comorbidities, and intraoperative details were extracted from the patient's medical records. Preoperation and postoperation markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]), pain scale (Visual Analog Scale [VAS]), infection rate, and Knee Society Score (KSS) were collected. Groups matched in age, gender, and BMI. No preoperative inflammatory marker differences were observed. However, compared to the control group, the postoperative inflammatory markers were significantly lower in the experimental group at 1-week postsurgery (CRP: 40.80 ± 23.17 vs. 60.80 ± 43.12 mg/L, p = 0.021; ESR: 72.06 ± 17.52 vs. 83.87 ± 21.52 mm/h, p = 0.012) and at 1-month postsurgery (CRP: 15.63 ± 6.56 vs. 21.17 ± 13.16 mg/L, p = 0.032; ESR: 25.25 ± 20.44 vs. 38.40 ± 25.26 mm/h, p = 0.024). There were no significant differences in the VAS (2.79 ± 0.90 vs. 2.70 ± 0.84 score, p = 0.689) and KSS (64.31 ± 17.88 vs. 66.57 ± 12.36) at 1-month postsurgery. Experimental group: zero infections; control group: only one infection. Administering vancomycin and calcium sulfate during TKA in RA patients reduces postoperative inflammation, but does not significantly affect infection risk; further research may be necessary for validation.
{"title":"Inflammatory Marker Changes Following Total Knee Arthroplasty for Rheumatoid Arthritis with Vancomycin-loaded Calcium Sulfate Bone Filling.","authors":"Han Zhang, Xiao Ma, GuanHong Chen, Ze Wang, Zhen Shang, Tianrui Wang, Tengbo Yu, Yongtao Zhang","doi":"10.1055/s-0044-1790243","DOIUrl":"https://doi.org/10.1055/s-0044-1790243","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) face infection risk. The study evaluates vancomycin-loaded calcium sulfate bone as infection prevention. Patients with RA treated with TKA who had their femoral canal filled using either vancomycin-loaded calcium sulfate bone (experimental group [<i>n</i> = 35]) or the patient's own excised autologous bone (control group [<i>n</i> = 30]) at the Qingdao University Affiliated Hospital, Qingdao, China from January 1, 2017, to March 1, 2023, were retrospectively enrolled in this study. An experienced surgeon used midvastus approach. Surgeries included disinfection, antibiotics, and femoral filling. The age, gender, body mass index (BMI), comorbidities, and intraoperative details were extracted from the patient's medical records. Preoperation and postoperation markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]), pain scale (Visual Analog Scale [VAS]), infection rate, and Knee Society Score (KSS) were collected. Groups matched in age, gender, and BMI. No preoperative inflammatory marker differences were observed. However, compared to the control group, the postoperative inflammatory markers were significantly lower in the experimental group at 1-week postsurgery (CRP: 40.80 ± 23.17 vs. 60.80 ± 43.12 mg/L, <i>p</i> = 0.021; ESR: 72.06 ± 17.52 vs. 83.87 ± 21.52 mm/h, <i>p</i> = 0.012) and at 1-month postsurgery (CRP: 15.63 ± 6.56 vs. 21.17 ± 13.16 mg/L, <i>p</i> = 0.032; ESR: 25.25 ± 20.44 vs. 38.40 ± 25.26 mm/h, <i>p</i> = 0.024). There were no significant differences in the VAS (2.79 ± 0.90 vs. 2.70 ± 0.84 score, <i>p</i> = 0.689) and KSS (64.31 ± 17.88 vs. 66.57 ± 12.36) at 1-month postsurgery. Experimental group: zero infections; control group: only one infection. Administering vancomycin and calcium sulfate during TKA in RA patients reduces postoperative inflammation, but does not significantly affect infection risk; further research may be necessary for validation.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander J Nedopil, Anand Singh Dhaliwal, Antonio Klasan, Stephen M Howell, Maury L Hull
When performing caliper-verified kinematically aligned total knee arthroplasty (KA TKA) in the osteoarthritic (OA) knee with valgus deformity, an elongated medial collateral ligament (MCL) could result in a valgus setting of the tibial component. The present study analyzed KA TKA in patients with valgus deformities (i.e., tibiofemoral angle > 10 degrees of valgus) and determined (1) the occurrence of radiographic MCL elongation, (2) the incidence of lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) release and the use of constrained components, and (3) whether the 1-year Forgotten Joint Score (FJS), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and Likert satisfaction score were comparable to KA TKAs for OA deformities ≤10 degrees of valgus. One hundred and two consecutive patients who underwent KA TKA by a single surgeon were analyzed radiographically and clinically at a minimum follow-up of 1 year. Radiographic MCL elongation was identified by a greater than 1 degree of valgus orientation of the tibial component relative to the OA tibial joint line. Twenty-six patients had a radiographic anatomic tibiofemoral angle greater than 10 degrees of valgus (range of OA deformity: 11-23 degrees of valgus). Seventy-six had an OA deformity ≤10 degrees of valgus (10-degree valgus to -14-degree varus). No patient had MCL elongation or a ligament release, or required constrained components. The median FJS of 78, OKS of 42, and KOOS JR of 76, and the 85% satisfaction rate of the patients with greater than 10 degrees of OA valgus deformity were not significantly different from those with ≤10 degrees of OA valgus deformity (p ≥ 0.17). Because MCL elongation was not detected in OA deformities up to 23 degrees of valgus, the risk of under-correcting the valgus deformity leading to instability and poor outcome scores is low when performing KA TKA using primary components without releasing the LCL and/or PCL. LEVEL OF EVIDENCE:: IV.
目的:在对伴有外翻畸形的骨关节炎(OA)膝关节进行卡尺验证的运动学配准全膝关节置换术(KA TKA)时,内侧副韧带(MCL)的拉长可能会导致胫骨组件的外翻设置。本研究分析了膝关节外翻畸形患者的 KA TKA(即、2)外侧副韧带(LCL)和后交叉韧带(PCL)松解的发生率以及受限组件的使用情况、3)对于髋关节外翻≤10°的OA畸形,一年的 "遗忘关节评分"(FJS)、"牛津膝关节评分"(OKS)、"膝关节损伤和骨关节炎关节置换术结果评分"(KOOS JR)和Likert满意度评分是否与KA TKAs相当。方法:对由一名外科医生实施 KA TKA 的 112 名连续患者进行了至少 1 年的放射学和临床随访分析。胫骨组件相对于OA胫骨关节线的外翻方向大于1°,即可确定MCL的影像学伸长:26名患者的胫股关节放射解剖角度大于10°外翻(OA畸形范围为11°至23°外翻)。76名患者的OA畸形≤10°外翻(10°外翻至-14°内翻)。没有患者出现 MCL 拉长、韧带松解或需要约束组件。OA外翻畸形大于10°的患者的FJS中位数为78,OKS中位数为42,KOOS JR中位数为76,满意率为85%,与OA外翻畸形小于10°的患者相比无显著差异(P≥0.17):由于在外翻23°以下的OA畸形中未检测到MCL伸长,因此在不释放LCL和/或PCL的情况下使用主组件进行KA TKA手术时,外翻畸形矫正不足导致不稳定和不良结果评分的风险很低。
{"title":"No Radiographic Evidence of Medial Collateral Ligament Elongation in Valgus Osteoarthritic Knees Enables Treatment with Kinematically Aligned Total Knee Arthroplasty.","authors":"Alexander J Nedopil, Anand Singh Dhaliwal, Antonio Klasan, Stephen M Howell, Maury L Hull","doi":"10.1055/a-2395-6831","DOIUrl":"10.1055/a-2395-6831","url":null,"abstract":"<p><p>When performing caliper-verified kinematically aligned total knee arthroplasty (KA TKA) in the osteoarthritic (OA) knee with valgus deformity, an elongated medial collateral ligament (MCL) could result in a valgus setting of the tibial component. The present study analyzed KA TKA in patients with valgus deformities (i.e., tibiofemoral angle > 10 degrees of valgus) and determined (1) the occurrence of radiographic MCL elongation, (2) the incidence of lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) release and the use of constrained components, and (3) whether the 1-year Forgotten Joint Score (FJS), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and Likert satisfaction score were comparable to KA TKAs for OA deformities ≤10 degrees of valgus. One hundred and two consecutive patients who underwent KA TKA by a single surgeon were analyzed radiographically and clinically at a minimum follow-up of 1 year. Radiographic MCL elongation was identified by a greater than 1 degree of valgus orientation of the tibial component relative to the OA tibial joint line. Twenty-six patients had a radiographic anatomic tibiofemoral angle greater than 10 degrees of valgus (range of OA deformity: 11-23 degrees of valgus). Seventy-six had an OA deformity ≤10 degrees of valgus (10-degree valgus to -14-degree varus). No patient had MCL elongation or a ligament release, or required constrained components. The median FJS of 78, OKS of 42, and KOOS JR of 76, and the 85% satisfaction rate of the patients with greater than 10 degrees of OA valgus deformity were not significantly different from those with ≤10 degrees of OA valgus deformity (<i>p</i> ≥ 0.17). Because MCL elongation was not detected in OA deformities up to 23 degrees of valgus, the risk of under-correcting the valgus deformity leading to instability and poor outcome scores is low when performing KA TKA using primary components without releasing the LCL and/or PCL. LEVEL OF EVIDENCE:: IV.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hamza Raja, Luke Wesemann, Michael A Charters, Wayne Trevor North
Introduction: Robotic-assisted devices help provide precise component positioning in conversion of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). A few studies offer surgical techniques for CT-based robotic-assisted conversion of UKA to TKA, however no studies to date detail this procedure utilizing a non-CT based robotic assisted device. This paper introduces a novel technique employing a non-CT based robotic assisted device (ROSA® Knee System, Zimmer Biomet, Warsaw, IN) for converting UKA to TKA with a focus on its efficacy in gap balancing.
Case: We present three patients (ages 46 to 66) who were evaluated for conversion of UKA to TKA for aseptic loosening, stress fracture, and progressive osteoarthritis. Each patient underwent robotic-assisted conversion to TKA. Postoperative assessments at 6 months revealed improved pain, function, and radiographic stability.
Technique: Preoperative planning included biplanar long leg radiographs to determine the anatomic and mechanical axis of the leg. After arthrotomy with a standard medial parapatellar approach, infrared reflectors were pinned into the femur and tibia, followed by topographical mapping of the knee with the UKA in-situ. The intraoperative software was utilized to evaluate flexion and extension balancing and plan bony resections. Then, the robotic arm guided placement of the femoral and tibial guide pins and the UKA components were removed. After bony resection of the distal femur and proximal tibia, the intraoperative software was used to reassess the extension gap, and plan posterior condylar resection to have the flexion gap match the extension gap.
Conclusion: The use of a non-CT based robotic assisted device in conversion of UKA to TKA is a novel technique and a good option for surgeons familiar with robotic-assisted arthroplasty, resulting in excellent outcomes at 6 months.
{"title":"The Conversion of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty with Non-CT Based Robotic Assistance: A Novel Surgical Technique and Case Series.","authors":"Hamza Raja, Luke Wesemann, Michael A Charters, Wayne Trevor North","doi":"10.1055/a-2421-5496","DOIUrl":"https://doi.org/10.1055/a-2421-5496","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted devices help provide precise component positioning in conversion of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). A few studies offer surgical techniques for CT-based robotic-assisted conversion of UKA to TKA, however no studies to date detail this procedure utilizing a non-CT based robotic assisted device. This paper introduces a novel technique employing a non-CT based robotic assisted device (ROSA® Knee System, Zimmer Biomet, Warsaw, IN) for converting UKA to TKA with a focus on its efficacy in gap balancing.</p><p><strong>Case: </strong>We present three patients (ages 46 to 66) who were evaluated for conversion of UKA to TKA for aseptic loosening, stress fracture, and progressive osteoarthritis. Each patient underwent robotic-assisted conversion to TKA. Postoperative assessments at 6 months revealed improved pain, function, and radiographic stability.</p><p><strong>Technique: </strong>Preoperative planning included biplanar long leg radiographs to determine the anatomic and mechanical axis of the leg. After arthrotomy with a standard medial parapatellar approach, infrared reflectors were pinned into the femur and tibia, followed by topographical mapping of the knee with the UKA in-situ. The intraoperative software was utilized to evaluate flexion and extension balancing and plan bony resections. Then, the robotic arm guided placement of the femoral and tibial guide pins and the UKA components were removed. After bony resection of the distal femur and proximal tibia, the intraoperative software was used to reassess the extension gap, and plan posterior condylar resection to have the flexion gap match the extension gap.</p><p><strong>Conclusion: </strong>The use of a non-CT based robotic assisted device in conversion of UKA to TKA is a novel technique and a good option for surgeons familiar with robotic-assisted arthroplasty, resulting in excellent outcomes at 6 months.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leo Cooper, Brewer Owen, Tatsuya Soeno, Stephen Wahl, Benjamin Stronach, Lowry Barnes, Simon C Mears, Jeffrey Stambough
Introduction: There is continued debate about the efficacy and indications for patellar resurfacing in total knee arthroplasty (TKA), especially with the emergence of patella-friendly designs. This study aimed to compare the postoperative outcomes in patients undergoing TKA with or without patellar resurfacing using the same implant design.
Method: This is a retrospective cohort study of patients who underwent TKA including those with patellar resurfacing (PR group) and those without (NPR group). Demographic data included age, gender, side of surgery, operative time, and BMI. Outcomes included preoperative, 2-week, 6-week, and 1-year postoperative Knee Injury and Osteoarthritis Outcome Score and Joint Replacement (KOOS, JR) values along with knee range of motion (ROM). Postoperative complications were recorded. The power analysis with a large effect size indicated that a minimum sample size of 54 was required for the student t-test and 34 for the paired t-test.
Result: A total of 90 medial pivot (MP) TKA were included in this study. There were 30 knees in the PR group and 60 in the NPR group. There was no significant difference between the groups for all demographic data, preoperative and postoperative ROM, and KOOS, JR values at all time points (p>0.05 for all variables). The KOOS, JR significantly improved in the NPR groups at 2-week, 6-week, and 1-year postoperatively when compared to the preoperative score and at 6-week and 1-year postoperatively in the PR group (p<0.01). No revisions related to the patellofemoral joint were observed in patients initially undergoing patellar resurfacing. One patient in the NPR group required secondary patellar resurfacing.
Conclusion: The patella-friendly MP TKA yielded favorable postoperative outcomes, with or without patellar resurfacing. Improvements in KOOS, JR were observed earlier in the NPR group when compared to the PR group, suggesting that patellar resurfacing may not always be necessary for modern TKA designs.
导言:关于全膝关节置换术(TKA)中髌骨重置的疗效和适应症一直存在争议,尤其是随着髌骨友好型设计的出现。本研究旨在比较接受全膝关节置换术(TKA)的患者在使用相同植入物设计的情况下进行髌骨复位或不进行髌骨复位的术后效果:这是一项回顾性队列研究,研究对象为接受 TKA 的患者,包括使用髌骨复位的患者(PR 组)和未使用髌骨复位的患者(NPR 组)。人口统计学数据包括年龄、性别、手术侧、手术时间和体重指数。结果包括术前、术后两周、六周和一年的膝关节损伤与骨关节炎结果评分和关节置换(KOOS,JR)值以及膝关节活动范围(ROM)。记录了术后并发症。大效应规模的功率分析表明,学生 t 检验和配对 t 检验分别需要最少 54 个和 34 个样本量:本研究共纳入了 90 例内侧支点(MP)TKA。PR组有30个膝关节,NPR组有60个膝关节。在所有人口统计学数据、术前和术后 ROM 以及 KOOS、JR 值的所有时间点上,两组间均无明显差异(所有变量的 P 均大于 0.05)。与术前评分相比,NPR组在术后2周、6周和1年的KOOS、JR值均有明显改善,而PR组在术后6周和1年的KOOS、JR值均有明显改善(P结论:无论是否进行髌骨复位,髌骨友好型 MP TKA 术后效果都很好。与 PR 组相比,NPR 组的 KOOS 和 JR 改善得更早,这表明现代 TKA 设计并不一定需要髌骨重置。
{"title":"Early Improvement in Postoperative Clinical Outcomes without Patellar Resurfacing in Patella-friendly Design of Medial Pivot TKA.","authors":"Leo Cooper, Brewer Owen, Tatsuya Soeno, Stephen Wahl, Benjamin Stronach, Lowry Barnes, Simon C Mears, Jeffrey Stambough","doi":"10.1055/a-2421-5572","DOIUrl":"https://doi.org/10.1055/a-2421-5572","url":null,"abstract":"<p><strong>Introduction: </strong>There is continued debate about the efficacy and indications for patellar resurfacing in total knee arthroplasty (TKA), especially with the emergence of patella-friendly designs. This study aimed to compare the postoperative outcomes in patients undergoing TKA with or without patellar resurfacing using the same implant design.</p><p><strong>Method: </strong>This is a retrospective cohort study of patients who underwent TKA including those with patellar resurfacing (PR group) and those without (NPR group). Demographic data included age, gender, side of surgery, operative time, and BMI. Outcomes included preoperative, 2-week, 6-week, and 1-year postoperative Knee Injury and Osteoarthritis Outcome Score and Joint Replacement (KOOS, JR) values along with knee range of motion (ROM). Postoperative complications were recorded. The power analysis with a large effect size indicated that a minimum sample size of 54 was required for the student t-test and 34 for the paired t-test.</p><p><strong>Result: </strong>A total of 90 medial pivot (MP) TKA were included in this study. There were 30 knees in the PR group and 60 in the NPR group. There was no significant difference between the groups for all demographic data, preoperative and postoperative ROM, and KOOS, JR values at all time points (p>0.05 for all variables). The KOOS, JR significantly improved in the NPR groups at 2-week, 6-week, and 1-year postoperatively when compared to the preoperative score and at 6-week and 1-year postoperatively in the PR group (p<0.01). No revisions related to the patellofemoral joint were observed in patients initially undergoing patellar resurfacing. One patient in the NPR group required secondary patellar resurfacing.</p><p><strong>Conclusion: </strong>The patella-friendly MP TKA yielded favorable postoperative outcomes, with or without patellar resurfacing. Improvements in KOOS, JR were observed earlier in the NPR group when compared to the PR group, suggesting that patellar resurfacing may not always be necessary for modern TKA designs.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The current literature lacks data regarding perioperative complications after medial patellofemoral ligament reconstruction (MPFLr). The objective of this study was to identify the incidence and predictors of adverse events in the first 90 days after MPFLr. Patients undergoing primary MPFLr between January 1, 2010, and December 31, 2019, were included. Predictors of readmission for any reason were identified using a multivariable logistic regression analysis. A total of 140 MPFL reconstructions were included in the final analysis. Of these, 17 patients (12.1%) were admitted in the first 90 days after MPFL reconstruction. The most common reason for readmission was pain (7/140, 5%) followed by cellulitis (5/140, 3.5%). The only major complication was pulmonary embolism experienced by one patient (1/140, 0.7%). Univariate logistic regression analysis demonstrated that patients who ever smoked were 4.5 times (p=0.005) more likely to be readmitted in the first 90-days. Although additional soft tissue procedures increased the readmission rated by 21% (p=0.810) and additional chondral procedure increased by 35%(p=0.568), the multivariable analysis didn't reveal a significant difference. Surgeons can use this information to counsel patients on what to expect following MPFL reconstruction.
{"title":"Incidence of early adverse events following medial patellofemoral ligament reconstruction.","authors":"Sercan Yalçın, Karington Seals, Lutul Farrow","doi":"10.1055/a-2421-5391","DOIUrl":"https://doi.org/10.1055/a-2421-5391","url":null,"abstract":"<p><p>The current literature lacks data regarding perioperative complications after medial patellofemoral ligament reconstruction (MPFLr). The objective of this study was to identify the incidence and predictors of adverse events in the first 90 days after MPFLr. Patients undergoing primary MPFLr between January 1, 2010, and December 31, 2019, were included. Predictors of readmission for any reason were identified using a multivariable logistic regression analysis. A total of 140 MPFL reconstructions were included in the final analysis. Of these, 17 patients (12.1%) were admitted in the first 90 days after MPFL reconstruction. The most common reason for readmission was pain (7/140, 5%) followed by cellulitis (5/140, 3.5%). The only major complication was pulmonary embolism experienced by one patient (1/140, 0.7%). Univariate logistic regression analysis demonstrated that patients who ever smoked were 4.5 times (p=0.005) more likely to be readmitted in the first 90-days. Although additional soft tissue procedures increased the readmission rated by 21% (p=0.810) and additional chondral procedure increased by 35%(p=0.568), the multivariable analysis didn't reveal a significant difference. Surgeons can use this information to counsel patients on what to expect following MPFL reconstruction.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
George N Guild, Mary J McConnell, Farideh Najafi, Brandon H Naylor, Charles A DeCook, Thomas L Bradbury
This study aimed to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons (n = 9) with either PCL preservation (n = 264) or sacrifice (n = 134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90-day complications, and patient-reported outcomes were recorded for each patient. There were no differences in preoperative baseline function or patient-reported outcome measures, Charlson Comorbidity Index, or American Society of Anesthesiologists class among patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12-week postoperative Knee Injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group (p < 0.05). Yet, no complications within the 90-day period were associated with PCL status and other patient-reported outcomes. This study comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores, and complication rates, which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared with the PCL-preserving at early follow-up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications.
简介:本研究旨在比较一家专门从事髋关节和膝关节置换术的门诊手术中心(ASC)在全膝关节置换术(TKA)中使用内侧同形(MC)聚乙烯插入物保留后交叉韧带(PCL)和切除后交叉韧带(PCL)的结果和并发症发生率:在2023年5月至2023年10月期间进行了一项回顾性研究,分析了398名患者,这些患者在一家独立的ASC接受了初级MC TKA手术,由高产量的关节置换外科医生(人数=9)实施,并保留了PCL(人数=264)或牺牲了PCL(人数=134)。患者按时间顺序2:1配对。记录每位患者的人口统计学特征、基线功能、90天并发症和患者报告结果:结果:各组患者的术前基线功能、患者报告的结果指标(PROMs)、夏尔森综合指数(COI)或美国麻醉医师协会(ASA)等级均无差异。PCL 保留组和 PCL 牺牲组的术后 12 周膝关节损伤和骨关节炎结果(KOOS,JR.具体而言,PCL-舍弃组中达到 KOOS, JR. 评分最小临床意义差异(MCID)的患者人数较多(p结论:PCL-舍弃组中达到 KOOS, JR. 评分最小临床意义差异(MCID)的患者人数较多(p结论):该手稿比较了保留 PCL 和牺牲 PCL 的 MC TKAs 的疗效,结果表明这两种技术都是可行的选择,具有相似的功能疗效、疼痛评分和并发症发生率,在 ASC 环境中可能有好处。在早期随访中,与保留 PCL 组相比,牺牲 PCL 组在 KOOS、JR.未来的研究应采用前瞻性的随机设计来进一步验证这些发现并探索其长期影响。
{"title":"Posterior Cruciate Ligament Preservation versus Posterior Cruciate Ligament Sacrifice: Comparing Patient Outcomes in Medial Congruent Total Knee Arthroplasty.","authors":"George N Guild, Mary J McConnell, Farideh Najafi, Brandon H Naylor, Charles A DeCook, Thomas L Bradbury","doi":"10.1055/a-2379-6488","DOIUrl":"10.1055/a-2379-6488","url":null,"abstract":"<p><p>This study aimed to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons (<i>n</i> = 9) with either PCL preservation (<i>n</i> = 264) or sacrifice (<i>n</i> = 134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90-day complications, and patient-reported outcomes were recorded for each patient. There were no differences in preoperative baseline function or patient-reported outcome measures, Charlson Comorbidity Index, or American Society of Anesthesiologists class among patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12-week postoperative Knee Injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group (<i>p</i> < 0.05). Yet, no complications within the 90-day period were associated with PCL status and other patient-reported outcomes. This study comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores, and complication rates, which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared with the PCL-preserving at early follow-up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew F Gong, Logan E Finger, Christina Letter, Soheyla Amirian, Bambang Parmanto, Michael O'Malley, Brian A Klatt, Ahmad P Tafti, Johannes F Plate
Knee range of motion (ROM) is an important indicator of knee function. Outside the clinical setting, patients may not be able to accurately assess knee ROM, which may impair recovery following trauma or surgery. This study aims to validate a smartphone mobile application developed to measure knee ROM compared to visual and goniometer ROM measurements. A knee ROM Android mobile application was developed to measure knee ROM. Patients ≥ 18 years old presenting to an orthopaedic clinic with native knee complaints were approached to participate. Knee ROM was measured bilaterally by an arthroplasty-trained surgeon using (1) vision, (2) goniometer, and (3) the mobile application. Measurements were compared in flexion and extension using a one-way analysis of variance with post hoc Tukey test (alpha = 0.05). Eighty-four knee ROM measurements (40 left, 44 right) were obtained in 47 patients. Median Kellgren-Lawrence grade from available radiographs was grade 3. In flexion, mobile application (117.6 ± 14.7 degrees) measurements were not significantly different from visual (116.1 ± 13.6 degrees) or goniometer (116.2 ± 13.6 degrees) measurements. In extension, mobile application (4.8 ± 7.3 degrees) measurements were significantly different from visual (1.9 ± 4.1 degrees) measurements on post hoc analysis (p < 0.01), while no differences were present compared to goniometer (3.1 ± 5.8 degrees) measurements. Our study found that a mobile application for evaluating knee ROM was noninferior to goniometer-based measurements performed by an arthroplasty-trained surgeon. Future studies will investigate this application's utility in (1) remote patient care, (2) accelerating recovery during rehabilitation, (3) detecting early postoperative complications including arthrofibrosis, and (4) adding additional functionalities to the application to provide more detail-oriented descriptive analyses of patient knee function.
{"title":"Development and Validation of a Mobile Phone Application for Measuring Knee Range of Motion.","authors":"Matthew F Gong, Logan E Finger, Christina Letter, Soheyla Amirian, Bambang Parmanto, Michael O'Malley, Brian A Klatt, Ahmad P Tafti, Johannes F Plate","doi":"10.1055/a-2388-0812","DOIUrl":"10.1055/a-2388-0812","url":null,"abstract":"<p><p>Knee range of motion (ROM) is an important indicator of knee function. Outside the clinical setting, patients may not be able to accurately assess knee ROM, which may impair recovery following trauma or surgery. This study aims to validate a smartphone mobile application developed to measure knee ROM compared to visual and goniometer ROM measurements. A knee ROM Android mobile application was developed to measure knee ROM. Patients ≥ 18 years old presenting to an orthopaedic clinic with native knee complaints were approached to participate. Knee ROM was measured bilaterally by an arthroplasty-trained surgeon using (1) vision, (2) goniometer, and (3) the mobile application. Measurements were compared in flexion and extension using a one-way analysis of variance with post hoc Tukey test (alpha = 0.05). Eighty-four knee ROM measurements (40 left, 44 right) were obtained in 47 patients. Median Kellgren-Lawrence grade from available radiographs was grade 3. In flexion, mobile application (117.6 ± 14.7 degrees) measurements were not significantly different from visual (116.1 ± 13.6 degrees) or goniometer (116.2 ± 13.6 degrees) measurements. In extension, mobile application (4.8 ± 7.3 degrees) measurements were significantly different from visual (1.9 ± 4.1 degrees) measurements on post hoc analysis (<i>p</i> < 0.01), while no differences were present compared to goniometer (3.1 ± 5.8 degrees) measurements. Our study found that a mobile application for evaluating knee ROM was noninferior to goniometer-based measurements performed by an arthroplasty-trained surgeon. Future studies will investigate this application's utility in (1) remote patient care, (2) accelerating recovery during rehabilitation, (3) detecting early postoperative complications including arthrofibrosis, and (4) adding additional functionalities to the application to provide more detail-oriented descriptive analyses of patient knee function.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}