Total knee arthroplasty (TKA) may provoke ankle symptoms. The aim of this study was to validate the impact of the preoperative mechanical tibiofemoral angle (mTFA), the talar tilt (TT) on ankle symptoms after TKA, and assess changes in the range of motion (ROM) of the subtalar joint, foot posture, and ankle laxity. Patients who underwent TKA from September 2020 to September 2021 were prospectively included. Inclusion criteria were primary end-stage osteoarthritis (Kellgren-Lawrence stage IV) of the knee. Exclusion criteria were missed follow-up visit, post-traumatic pathologies of the foot, and neurological disorders. Radiological angles measured included the mTFA, hindfoot alignment view angle, and TT. The Foot Function Index (FFI) score was assessed. Gait analyses were conducted to measure mediolateral changes of the gait line and ankle laxity was tested using an ankle arthrometer. All parameters were acquired one week pre- and three months postoperatively.Aims
Methods
This study compared the cobalt and chromium serum ion concentration of patients treated with two different metal-on-metal (MoM) hinged total knee arthroplasty (TKA) systems, as well as a titanium nitride (TiN)-coated variant. A total of 63 patients (65 implants) were treated using either a MoM-coated (n = 29) or TiN-coated (n = 7) hinged TKA (GenuX mobile bearing, MUTARS; Implantcast, Germany) versus the BPKS (Brehm, Germany) hinged TKA (n = 27), in which the weight placed on the MoM hinge is diffused through a polyethylene (PE) inlay, reducing the direct load on the MoM hinge. Serum cobalt and chromium ion concentrations were assessed after minimum follow-up of 12 months, as well as functional outcome and quality of life.Aims
Methods
The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck. Long-leg standing radiographs of patients undergoing realignment surgery around the knee were used. The hip-knee-ankle angle (HKA) and the vertical orientation of the femoral neck in relation to the floor were measured, prior to surgery and after osteotomy-site-union. Linear regression was performed to determine the influence of knee alignment on the vertical orientation of the femoral neck.Aims
Methods
Eight-plates are used to correct varus-valgus deformity (VVD) or limb-length discrepancy (LLD) in children and adolescents. It was reported that these implants might create a bony deformity within the knee joint by change of the roof angle (RA) after epiphysiodesis of the proximal tibia following a radiological assessment limited to anteroposterior (AP) radiographs. The aim of this study was to analyze the RA, complemented with lateral knee radiographs, with focus on the tibial slope (TS) and the degree of deformity correction. A retrospective, single-centre study was conducted. The treatment group (n = 64 knees in 44 patients) was subclassified according to the implant location in two groups: 1) medial hemiepiphysiodesis; and 2) lateral hemiepiphysiodesis. A third control group consisted of 25 untreated knees. The limb axes and RA were measured on long standing AP leg radiographs. Lateral radiographs of 40 knees were available for TS analysis. The mean age of the patients was 10.6 years (4 to 15) in the treatment group and 8.4 years (4 to 14) in the control group. Implants were removed after a mean 1.2 years (0.5 to 3).Aims
Methods
Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “knee”, and “surgery”. The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies.Aims
Materials and Methods
Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty for patients who require treatment of single-compartment osteoarthritis, especially for young patients. To satisfy this requirement, new patient-specific prosthetic designs have been introduced. The patient-specific UKA is designed on the basis of data from preoperative medical images. In general, knee implant design with increased conformity has been developed to provide lower contact stress and reduced wear on the tibial insert compared with flat knee designs. The different tibiofemoral conformity may provide designers the opportunity to address both wear and kinematic design goals simultaneously. The aim of this study was to evaluate wear prediction with respect to tibiofemoral conformity design in patient-specific UKA under gait loading conditions by using a previously validated computational wear method. Three designs with different conformities were developed with the same femoral component: a flat design normally used in fixed-bearing UKA, a tibia plateau anatomy mimetic (AM) design, and an increased conforming design. We investigated the kinematics, contact stress, contact area, wear rate, and volumetric wear of the three different tibial insert designs.Objectives
Methods
Introduction. Recent studies have challenged the concept that a single ‘correct’ alignment to standardised anatomical references is the primary driver of TKA performance with regards to patient satisfaction outcomes. Patient specific variations in musculoskeletal anatomy are one explanation for this. Virtual simulated environments such as rigid body modelling allow for the impact of component alignment and variable patient specific musculoskeletal anatomy to be studied simultaneously. This study aims to determine if the output kinematics derived from consideration of both postoperative component alignment and patient specific musculoskeletal modelling has predictive potential of Patient Reported Outcomes. Method. Landmarking of key anatomical points and 3D registration of implants was performed on 96 segmented post-operative CT scans of TKAs. Both femoral and tibia implant components were registered. Acadaver rig validated platform for generating patient specific rigid body musculoskeletal models was used to assess the resultant motions and contact forces through a 0 to 140 degree deep knee bend cycle. Resultant kinematics were segmented and tested for differentiation with and correlation to a 12 month postoperative Knee injury and Osteoarthritis Outcome Score (KOOS). Results. Significant negative correlations (p<0.05) were found between the postoperative KOOS symptoms score and the rollback occurring in midflexion, quadriceps force in mid flexion, patella shear force and patella tilt at 90 degrees of flexion. A significant positive correlation was found between lateral shit of the patella through flexion and the symptoms score. (p<0.05) When segmenting those KOOS scores performing in the lowest 20% of patients, both rollback and the three patella measurements have statistically significantly different means (t test, p<0.05). There were other trends present that are discernible but do not have linear correlations, as they are cross-dependant on other kinematic factors or are not linear in nature. When segmenting the varus/valgus angular change into those with a varus angular change from extension to full flexion between 0 and 4 degrees (long
Purpose. Use of theguide angle method using intramedullary guide angle for distal femoral cutting in total knee arthroplasty may cause error when rotation of the femur occurs or the insertion point of the intramedullary guide is incorrectly positioned in preoperative radiography. On the other hand, use of the measured cutting method, in which resection of distal femoral condyles is performed according to predicted measured thickness in a preoperative radiograph can allow for correction of these errors intraoperatively. Therefore, we compared these two distal femoral bone cutting methods for restoration of accurate coronal alignment. Methods. Between 2010 and 2012, 47 patients (70 knees) underwent total knee arthroplasty for treatment of osteoarthritis with varus deformity and flexion contracture less than 10 degrees. Bone resection depending on distal femur resection thickness measured before the operation was performed in 38 cases (Group I). Distal femoral cutting using the guide angle was performed in 32 cases (Group II). Radiographic evaluation, including mean value of lower
The radiologic and clinical results of High Tibial Osteotomies (HTO) strongly rely on the accuracy of correction, and inadequate intraoperative measurements of the
The alignment of prostheses components has a major impact on the longevity of total knee protheses as it significantly influences the biomechanics and thus also the load distribution in the knee joint. Knee joint loads depend on three factors: (1) geometrical conditions such as bone geometry and implant position/orientation, (2) passive structures such as ligaments and tendons as well as passive mechanical properties of muscles, and (3) active structures that are muscles. The complex correlation between implant position and clinical outcome of TKA and later in vivo joint loading after TKA has been investigated since 1977. These investigations predominantly focused on component alignment relative to the mechanical
INTRODUCTION. Computer-aided systems have been developed recently in order to improve the precision of implantation of a total knee replacement (TKR). Several authors demonstrated that the accuracy of implantation of TKR was higher with the help of a navigation system in comparison to the conventional, manual technique. Theoretically, the clinical results and the survival rates should be improved. Our team was one of the first all over the world which decided to use routinely a navigation system for TKR. Prostheses designed with a mobile bearing polyethylene component allow an increased congruence between femoral and tibial gliding surface, and should decrease the risk of long-term polyethylene wear. We designed a prosthetic system with one of the highest congruence on the current market. These prostheses might be technically more demanding than more conventional designs, and involve specific complications like bearing luxation. Navigation systems might be helpful in this was as well. In the present study, we wanted to test clinically the theoretic advantages of these three specific points of our system (navigated implantation, mobile bearing and increased congruence) with a five-year clinical and radiological follow-up. MATERIAL AND METHODS. 128 patients were operated on at our Department with this TKR system between 2000, and were contacted for a five-year clinical and radiological follow-up. The clinical and functional results were evaluated according to the Knee Society Scoring System (KSS). The subjective results were analyzed with the Oxford Knee Score. The accuracy of implantation was assessed on post-operative long leg antero-posterior and lateral X-rays. The survival rate after 5 years was calculated according to the Kaplan-Meier technique. RESULTS. The mean clinical score was 87 points (maximum of 100 points). The mean pain score was 43 points (maximum of 50 points). The mean flexion angle was 118°, and 33% oft he patients were able to reach 130° of knee flexion or more. The mean functional score was 70 points (maximum of 100). The mean Oxford Score was 23 points (best score = 12 points, worst score = 60 points). An optimal correction of the coronal
Revision total knee replacement (TKR) is a challenging procedure, especially because most of the standard bony and ligamentous landmarks used during primary TKR are lost due to the index implantation. One might also assume that the conventional instruments, which rely on visual or anatomical alignments or intra-or extramedullary rods, are associated with significant higher variation of the
Correct positioning and alignment of components during primary total knee replacement (TKR) is widely accepted to be an important predictor of patient satisfaction and implant durability. This retrospective study reports the effect of the post-operative mechanical axis of the lower limb in the coronal plane on implant survival following primary TKR. A total of 501 TKRs in 396 patients were divided into an aligned group with a neutral mechanical axis (± 3°) and a malaligned group where the mechanical axis deviated from neutral by >
3°. At 15 years’ follow-up, 33 of 458 (7.2%) TKRs were revised for aseptic loosening. Kaplan-Meier survival analysis showed a weak tendency towards improved survival with restoration of a neutral mechanical axis, but this did not reach statistical significance (p = 0.47). We found that the relationship between survival of a primary TKR and mechanical axis alignment is weaker than that described in a number of previous reports.
We conducted a retrospective study to investigate the effect of femoral bowing on the placement of components in total knee replacement (TKR), with regard to its effect on reestablishing the correct mechanical axis, as we hypothesised that computer-assisted total knee replacement (CAS-TKR) would produce more accurate alignment than conventional TKR. Between January 2006 and December 2009, 212 patients (306 knees) underwent TKR. The conventional TKR was compared with CAS-TKR for accuracy of placement of the components and post-operative alignment, as determined by five radiological measurements. There were significant differences in the reconstructed mechanical axes between the bowed and the non-bowed group after conventional TKR (176.2° ( For patients with significant femoral bowing, the reconstructed mechanical axes were significantly closer to normal in the CAS group than in the conventional group (179.2° (
Computer based navigation system improved the accuracy of limb and component alignment and decreased the incidence of outliers. The majority of previous studies were based on the infrared navigation system. We evaluate the availability and accuracy of the electromagnectic(EM) navigation system in total knee arthroplasty. From July 2006 to January 2007, 40 patients (50 TKAs) with osteoarthritis were participated in this study. AxiEM(Medtronics) was used and Nexgen CR(26 cases), and Nexgen CR flex(24 cases) were used. We analyzed the failure mode of navigation (7 cases), operation time and radiologic results (limb and component alignment). Total registration time was 4 minutes 45 seconds in average (Range: 3 minutes 45 seconds – 6 minutes 55 seconds). Failures in clinical applications resulted from non-recognition of EM tracker or paddle by metallic interference in 4 cases and from informational changes during surgery by fixation loss or loosening of the tracker in 3 cases. Radiologically, the mechanical axis changed from −11.2±7.21 (Range: −25.8~3.1) to 1.0±1.25(Range: −2.1~4.0) and 1 case of outlier occurred (valgus 4°). Component alignment is measured as followed: 89.3±1.6° of Theta angle, 89.9±1.5° of Beta angle, 1.8±2.5° of Gamma angle, 86.1±2.9 of Delta angle°. There were no complications related to the EM navigation. The EM navigation system helped to achieve accurate alignment of component and lower
Revision total knee replacement (TKR) is a challenging procedure, especially because most of the standard bony and ligamentous landmarks used during primary TKR are lost due to the index implantation. However, as for primary TKR, restoration of the joint line, adequate limb axis correction and ligamentous stability are considered critical for the short- and long- term outcome of revision TKR. There is no available data about the range of tolerable leg alignment after revision TKR. However, it is logical to assume that the same range than after primary TKR might be accepted, that is ± 3° off the neutral alignment. One might also assume that the conventional instruments, which rely on visual or anatomical alignments or intra- or extra-medullary rods, are associated with significant higher variation of the
Revision TKR is a challenging procedure, especially because most of the standard bony and ligamentous landmarks are lost due to the primary implantation. However, as for primary TKR, restoration of the joint line, adequate limb axis correction and ligamentous stability are considered critical for the short- and long-term outcome of revision TKR. There is no available data about the range of tolerable leg alignment after revision TKR. However, it is logical to assume that the same range than after primary TKR might be accepted, that is ± 3° off the neutral alignment. One might also assume that the conventional instruments, which rely on visual or anatomical alignments or intra- or extramedullary rods, are associated with significant higher variation of the
Long term successful results of high tibial osteotomy (HTO) strongly depend on the degree of correction, and inadequate intraoperative measurements of the
Computer based navigation system improved the accuracy of limb and component alignment and decreased the incidence of outliers. The majority of previous studies were based on the infrared navigation system. We evaluate the availability and accuracy of the electromagnectic(EM) navigation system in total knee arthroplasty. From July 2006 to January 2007, 40 patients (50 TKAs) with osteoarthritis were participated in this study. AxiEM(Medtronics) was used and Nexgen CR(26 cases), and Nexgen CR flex(24 cases) were used. We analyzed the failure mode of navigation (7 cases), operation time and radiologic results (limb and component alignment). Total registration time was 4 minutes 45 seconds in average (Range : 3 minutes 45 seconds ~ 6 minutes 55 seconds). Failures in clinical applications resulted from non-recognition of EM tracker or paddle by metallic interference in 4 cases and from informational changes during surgery by fixation loss or loosening of the tracker in 3 cases. Radiologically, the mechanical axis changed from −11.2±7.21 (Range : −25.8~3.1) to 1.0±1.25(Range : −2.1~4.0) and 1 case of outlier occurred (valgus 4°). Component alignment is measured as followed: 89.3±1.6° of Theta angle, 89.9±1.5° of Beta angle, 1.8±2.5° of Gamma angle, 86.1±2.9 of Delta angle°. There were no complications related to the EM navigation. The EM navigation system helped to achieve accurate alignment of component and lower