Aims. The liner design is a key determinant of the
Aims. Mid-level
Constrained implants with intra-medullary fixation are expedient for complex TKA.
Introduction. The interaction between the mobile components of total elbow replacements (TER) provides additional
Introduction. Studies have shown that increased implant conformity in total knee arthroplasty (TKA) has been linked to increased
Background. The
Introduction. Pre-clinical assessment of total knee replacements (TKR) can provide useful information about the
Summary Statement. The
Introduction. Total knee arthroplasty (TKA) prostheses are semi-constrained artificial joints. Femorotibial
Introduction. Total knee arthroplasty (TKA) prostheses are semi-constrained artificial joints. A well-functioning TKA prosthesis should be designed with a good balance between stability and mobility, meaning the femorotibial
Summary Statement. Femorotibial
Purpose. Although classic teaching holds that the least amount of
Introduction. Revision for instability has supplanted revision for aseptic loosening and revision for osteolysis since the advent of improved polyethylene inserts with changes in both sterilization techniques and cross-linking. Having the ability to judiciously choose a higher level of
The goals of total knee arthroplasty (TKA) are to relieve pain, restore function, and provide a stable joint. In regard to types of implants, the workhorses are posterior cruciate retaining (CR), posterior stabilised (PS), and posterior stabilised constrained (PSC) designs. However, the continuum of
Introduction. We wished to quantify the influence of
Introduction. Modern implant systems offer a variety of options to address the posterior cruciate ligament (PCL) and afford stability in primary total knee arthroplasty (TKA). One system has three bearing options for cruciate retaining (CR) TKA: standard CR bearing (CR-S) with 3° posterior slope and no posterior lip; CR lipped bearing (CR-L) with no slope and small posterior lip, and deep-dished anterior stabilized bearing (CR-AS) with large anterior build-up to compensates for deficient or lax PCL. We previously reported on 1940 patients (2449 CR-TKA) at early follow-up comparing these three CR bearings and found CR-AS bearings had greater improvement in ROM and lower rate of manipulation despite their use in patients with greater preoperative deformity and lower ROM. The purpose of this study was to review a broader series by a single surgeon-designer with minimum 2-year follow-up to determine if there were differences between bearing types in terms of clinical outcomes and survival. Methods. From 2003 to 2014, 3348 patients (4500 knees) underwent primary CR-TKA and were available for review with minimum 2-year follow-up. An algorithmic approach to
The Acrobot®, an active
Total knee arthroplasty (TKA) is a major orthopaedic
intervention. The length of a patient's stay has been progressively
reduced with the introduction of enhanced recovery protocols: day-case
surgery has become the ultimate challenge. This narrative review shows the potential limitations of day-case
TKA. These
INTRODUCTION. The specific factors affecting wear of the ultrahigh molecular weight polyethylene (UHMWPE) tibial component of total knee replacements (TKR) are poorly understood. One recent study demonstrated that lower conforming inserts produced less wear in knee simulators. The purpose of this study is to investigate the effect of insert conformity and design on articular surface wear of postmortem retrieved UHMWPE tibial inserts. METHODS. Nineteen NexGen cruciate-retaining (NexGen CR) and twenty-five NexGen posterior-stabilized (NexGen PS) (Zimmer) UHWMPE tibial inserts were retrieved at postmortem from fifteen and eighteen patients respectively. Articular surfaces were scanned at 100×100μm using a coordinate measuring machine (SmartScope, OGP Inc.). Autonomous mathematical reconstruction of the original surface was used to calculate volume loss and linear penetration maps of the medial and lateral plateaus. Wear rates for the medial, lateral and total articular surface were calculated as the slope of the linear regression line of volume loss against implantation time. Volume loss due to creep was estimated as the regression intercept. Student t-tests were used to check for significant. RESULTS. The NexGen CR and NexGen PS patient groups were approximately the same age at time of implantation (mean±SD: 72.1±9.9 and 68.7±8.8 years respectively, p=0.260) and implantation times were not significantly different (8.7±3.1 and 9.1±3.7 years, p=0.670). Both groups showed high variability in wear scars. No significant difference in wear rates on the total surface (mean±SE: 11.89±5.01 mm. 3. /year vs. 11.09±4.18 mm. 3. /year, p=0.905). However, NexGen CR components showed significantly higher volume loss due to creep than NexGen PS components (70.22±47.07 mm. 3. vs. 31.30±41.15 mm. 3. , p=0.007). These results were reflected on the medial and lateral sides, with no significant differences in wear rates on the medial side (p=0.856) or lateral side (p=0.633) and higher volume losses due to creep associated with the NexGen CR components. While NexGen CR and NexGen PS showed a near equal mean percentage of volume loss on the medial side (CR: 52.4±11.7%, PS: 52.5±11.6%), a paired t-test showed that NexGen PS components showed a higher volume loss on the medial side (p=0.056), NexGen CR components did not (p=0.404). DISCUSSION. The combination of higher conformity and more kinematic
Introduction: Active Robots have been shown to be effective at performing arthroplasty, but some hesitation has been felt by the surgical world. The lack of human interface in the procedure has been one of the stumbling blocks towards wider acceptance. The Acrobot has been developed, at Imperial College London, in collaboration with University College London to allow the surgeon to perform the surgery himself, but with active