The patellar clunk syndrome describes painful catching, grinding or jumping of the patella when the knee moves from a flexed to an extended position after total knee replacement (TKR). The
The Bisurface knee prosthesis (BP) has a
We present a prospective study of patients with tuberculosis of the dorsal, dorsolumbar and lumbar spine after combined anterior (radical debridement and anterior fusion) and posterior (instrumentation and fusion) surgery. The object was to study the progress of interbody union, the extent of correction of the kyphosis and its maintenance with early mobilisation, and the incidence of graft and implant-related problems. The American Spinal Injury Association (ASIA) score was used to assess the neurological status. The mean preoperative vertebral loss was highest (0.96) in the dorsal spine. The maximum correction of the kyphosis in the dorsolumbar spine was 17.8°. Loss of correction was maximal in the lumbosacral spine at 13.7°. All patients had firm anterior fusion at a mean of five months. The incidence of infection was 3.9% and of graft-related problems 6.5%. We conclude that adjuvant
Abstract. Introduction. Total knee replacement (TKR) in patients with skeletal dysplasia is technically challenging surgery due to deformity, joint contracture, and associated co-morbidities. The aim of this study is to follow up patients with skeletal dysplasia following a TKR. Methodology. We retrospectively reviewed 22 patients with skeletal dysplasia who underwent 31 TKRs at our institution between 2006 and 2022. Clinical notes, operative records and radiographic data were reviewed. Results. Achondroplasia was the most common skeletal dysplasia (8), followed by Chondrodysplasia punctata (7) and Spondyloepiphyseal dysplasia (5). There were fourteen men and eight women with mean age of 51 years (28 to 73). The average height of patients was 1.4 metres (1.16–1.75) and the mean weight was 64.8 Kg (34.3–100). The mean follow up duration was 68.32 months (1–161). Three patients died during follow up. Custom implants were required in twelve patients (38.71%). Custom jigs were utilised in six patients and two patients underwent robotic assisted surgery. Hinged TKR was used in seventeen patients (54.84%),
Numerous papers present in-vivo knee kinematics data following total knee arthroplasty (TKA) from fluoroscopic testing. Comparing data is challenging given the large number of factors that potentially affect the reported kinematics. This paper aims at understanding the effect of following three different factors: implant geometry, performed activity and analysis method. A total of 30 patients who underwent TKA were included in this study. This group was subdivided in three equal groups: each group receiving a different type of
Total knee replacement (TKR) design aims to restore normal kinematics with emphasis on flexion range. The survivorship of a TKR is dependent on the kinematics in six-degrees-of-freedom (6-DoF). Stepping up, such as stair ascent is a kinematically demanding activity after TKR. The debate about design choice has not yet been informed by 6-DoF in vivo kinematics. This prospective randomised controlled trial (RCT) compared kneeling kinematics in three TKR designs. 68 participants were randomised to receive either cruciate retaining (CR-FB), rotating platform (CR-RP) or
Stand-alone anterior lumbar interbody fusion (ALIF) provides the opportunity to avoid supplemental posterior fixation. This may reduce morbidity and complication rate, which is of special interest in patients with reduced bone mineral density (BMD). This study aims to assess immediate biomechanical stability and radiographic outcome of a stand-alone ALIF device with integrated screws in specimens of low BMD. Eight human cadaveric spines (L4-sacrum) were instrumented with SynFix-LR™ (DePuy Synthes) at L5/S1. Quantitative computed tomography was used to measure BMD of L5 in AMIRA. Threshold values proposed by the American Society of Radiology 80 and 120 mg CaHa/mL were used to differentiate between Osteoporosis, Osteopenia, and normal BMD. Segmental lordosis, anterior and posterior disc height were analysed on pre- and postoperative radiographs (Fig 1). Specimens were tested intact and following instrumentation using a flexibility protocol consisting of three loading cycles to ±7.5 Nm in flexion-extension, lateral bending, and axial rotation. The ranges of motion (ROM) of the index level were assessed using an optoelectronic system. BMD ranged 58–181mg CaHA/mL. Comparison of pre- and postoperative radiographs revealed significant increase of L5/S1 segmental lordosis (mean 14.6°, SD 5.1, p < 0.001) and anterior disc height (mean 5.8mm, SD 1.8, p < 0.001), but not posterior disc height. ROM of 6 specimens was reduced compared to the intact state. Two specimens showed destructive failure in extension. Mean decrease was most distinct in axial rotation up to 83% followed by flexion-extension. ALIF device with integrated screws at L5/S1 significantly increases segmental lordosis and anterior disc height without correlation to BMD. Primary stability in the immediate postoperative situation is mostly warranted in axial rotation. The risk of failure might be increased in extension for some patients with reduced lumbar BMD, therefore additional
Constrained implants with intra-medullary fixation are expedient for complex TKA. Constraint is associated with loosening, but can correction of deformity mitigate risk of loosening?. Primary TKA's with a non-linked constrained prosthesis from 2010-2018 were identified. Indications were ligamentous instability or intra-medullary fixation to bypass stress risers. All included fully cemented 30mm stem extensions on tibia and femur. If soft tissue stability was achieved, a
Most studies comparing medial pivot to the
Aims. Modern total knee arthroplasty (TKA) prostheses are designed to restore near normal kinematics including high flexion. Kneeling is a high flexion, kinematically demanding activity after TKA. The debate about design choice has not yet been informed by six-degrees-of-freedom in vivo kinematics. This prospective randomized clinical trial compared kneeling kinematics in three TKA designs. Methods. In total, 68 patients were randomized to either a
Background. The purpose of this study was to evaluate the clinical and radiographic outcomes of the rotating-platform, posterior-stabilized PFC Sigma at fifteen-year follow-up. Methods. Between January 2000 and November 2001, two hundred consecutive patients underwent TKA with a rotating-platform,
Introduction and Objective. Gait variability is the amplitude of the fluctuations in the time series with respect to the mean of kinematic (e.g., joint angles) or kinetic (e.g., joint moments) measurements. Although gait variability increases with normal ageing or pathological mechanisms, such as knee osteoarthritis (OA). The purpose was to determine if a patient who underwent a total knee arthroplasty (TKA) can reduce gait variability. Materials and Methods. Twenty-five patients awaiting TKA were randomly assigned to receive either medial pivot (MP, m=7/f=6, age=62.4±6.2 years) or
Aims. To compare patients undergoing total knee arthroplasty (TKA) with ≤ 80° range of movement (ROM) operated with a 2 mm increase in the flexion gap with matched non-stiff patients with at least 100° of preoperative ROM and balanced flexion and extension gaps. Methods. In a retrospective cohort study, 98 TKAs (91 patients) with a preoperative ROM of ≤ 80° were examined. Mean follow-up time was 53 months (24 to 112). All TKAs in stiff knees were performed with a 2 mm increased flexion gap. Data were compared to a matched control group of 98 TKAs (86 patients) with a mean follow-up of 43 months (24 to 89). Knees in the control group had a preoperative ROM of at least 100° and balanced flexion and extension gaps. In all stiff and non-stiff knees
Purpose. The success of total knee replacement (TKR) surgery can be attributed to improvements in TKR design, instrumentation, and surgical technique. Over a decade ago oxidized zirconium (OxZr) femoral components were introduced as an alternative bearing surface to cobalt-chromium (CoCr), based on strong in-vitro evidence, to improve the longevity of TKR implants. Early reports have demonstrated the clinical success of this material however no long-term comparative studies have demonstrated the superiority of OxZr implants compared to a more traditional CoCr implant. This study aims to compare long-term survivorship and outcomes in OxZr and CoCr femoral components in a single total knee design. Methods. We reviewed our institutional database to identify all patients whom underwent a TKA with a
Knee flexion is often decreased in severe arthritis causing pain, and functional limitations in lifestyles and occupations. Newer knee replacement designs offer the possibility of greater knee motion. The objective of our study was to compare the clinical outcomes, in particular the range of motion, in patients treated with a total knee arthroplasty using either a standard
The purpose of this study was to evaluate the effect of decreasing tibial slope on extention gap during
Introduction. Increasingly young and active patients are concerned about revision arthroplasty forcing the manufacturers to think about revision prostheses that fit to this population while meeting the indications and fitting with bone losses and ligament deficiencies. One of those industrials claims that its system allows the surgeon to rise the constraint from a
Object. Although single-radius designs have theoretical advantages in some aspects, there has been a paucity of evaluation studies. The purpose of this study was to compare 10-year clinical, radiological, survivorship outcomes of single radius and multi radius
Abstract. Objectives. Patella resurfacing in primary total knee arthroplasty (TKA) remains a contentious issue. Australian rates of patellar resurfacing are 66.6%, significantly higher compared to UK rates of 8–15% and Swedish rates of 2%. Resurfacing has gained popularity in Australia since registry data has shown decreased revision rates with no increase in patellar component related complications. We present for discussion an analysis of 113,694 total knee arthroplasties using commonly implanted prostheses in the UK. Methods. We included all TKA's since the Australian register's conception on 01/09/1999 for a primary diagnosis of osteoarthritis involving the use of either the Triathlon or Duracon implant with and without patellar components. The primary outcome of the study was time to revision for Triathlon's resurfaced and non-resurfaced prosthesis compared to the Duracon's equivalent data. We also analysed the reasons for revision between the 4 groups, type of revision and complication rates. We then compared minimally stabilised and
Introduction. Robotics have been applied to total knee arthroplasty (TKA) to improve surgical precision in component placement and joint function restoration. The purpose of this study was to evaluate prosthetic component alignment in robotic arm-assisted (RA)-TKA performed with functional alignment and intraoperative fine-tuning, aiming for symmetric medial and lateral gaps in flexion/extension. It was hypothesized that functionally aligned RA-TKA the femoral and tibial cuts would be performed in line with the preoperative joint line orientation. Methods. Between September 2018 and January 2020, 81 RA cruciate retaining (CR) and
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),
Introduction. Femoral periprosthetic fractures above TKA are commonly treated with retrograde intramedullary nailing (IMN). This study determined if TKA design and liner type affect the minimum knee flexion required for retrograde nailing through a TKA. Methods. Twelve cadaveric specimens were prepared for six single radius (SR) TKAs and six asymmetric medial pivot (MP) TKAs. Trials with 9mm polyethylene liners were tested with cruciate retaining (CR), cruciate substituting (CS) and
Background:. We studied the effect of posterior condylar offset on maximum knee flexion after a
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),
Purpose. Two-stage re-implantation after infection of Total Knee Arthroplasty (TKA), remains the gold standard to which other forms of treatment should be compared. The primary purpose of this study was to determine the rates of failure and functional outcome of two stage revision TKA for treatment of infection comparing cemented
Background:. The safety implications of achieving high flexion after TKA and the use of high flexion prostheses remain issues of concern. It is possible that different designs have different clinical and radiological results and complications, such as, early aseptic loosening. However, little information is available on the clinical results of TKAs performed using single-radius, high-flex
Aims: In this study, data from previously published survival analysis life tables of primary total condylar type TKRs has been combined to enable comparison of different design features. In particular, does
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),
Objectives: The purpose of this study was to assess the effect of different types of
Introduction. Our objective is to describe early and midterm results with the use of a new knee prosthesis as an articulating spacer in planned two-stage management for infected total knee arthroplasty. As a second objective, we compared outcomes between the group with a retained first stage and those with a completed 2-stage revision. Methods. Forty-seven patients (48 knees) from January 2012 and November 2017 underwent a 2-stage exchange with an articulating spacer with new implants was used for a chronic knee periprosthetic joint infection with a mean follow-up of 3.7 years (2–6.5 years). The most frequently identified infecting organism was MSSA (31%), MRSA (21%) or MRSE (20%). At the first stage, a new PS femoral component and a new all-polyethylene
Bicruciate ligament retaining total knee arthroplasty preserves all of the ligaments of the knee while still addressing the ligament balance and the flexion-extension gaps. The concept of cruciate ligament preservation is not new and both Townley and Cartier designed prostheses in the late 1980s that did preserve all of the ligaments. Their results were quite acceptable for that time in knee replacement surgery but the
Purpose. The purpose of this study was to compare intercompartmental loads and the proportion of knees with unbalanced loads after tensiometer-assisted balancing (TAB) between cruciate retaining (CR) and
The most recent Australian registry has a database of 547,407 knee arthroplasties, having added over 52,000 in 2016. Total knee arthroplasties (TKA) comprise 83.8%, revisions (RevTKA) 8.1% and “partials of all types” 8.1%. Since 2003, the percent of TKA has increased from 76.7%, RevTKA has stayed stable and partial replacements have declined from 14.5%. In the last year, however, TKA declined slightly. There is a slightly higher percentage of women (56.1%) undergoing TKA and this has remained very stable since 2003. Revision rates are slightly higher for men. Percentages of the youngest (<55) and oldest (>85) are small and stable. The 75–84 year olds have declined as 55–74 year olds have increased. This represents a gradual shift to earlier TKA surgery. More patella are resurfaced and this is a gradual trend with a cross over in 2010 when half were resurfaced. Computer navigation is progressively more popular and now accounts for almost 30% of cases. Cement fixation is also increasing and accounts for about 65% of cases. Crosslinked polyethylene is gradually replacing non crosslinked and in 2014 was used in 50% of cases. Revisions are performed most commonly for loosening and infection. Revision rates correlate directly with age. Loosening is the most common indication for revision in both genders, but males have a distinctly higher revision rate due to infection. Revision rates are slightly higher in all forms of mobile bearing than fixed bearing. Minimally constrained (cruciate retaining) devices are used in the majority of TKAs.
Introduction: Anterior lumbar interbody fusion (ALIF) with
We hypothesised that an independent Notch Trial is essential on the same lines as other Component Trials-Femoral, Tibial and Patellar - in
The study was conducted to review the outcome in cases of anterior expandable interbody cages inserted through a posterior only approach. Cases selected were the anterior cage insertion and
Objective: This study investigates whether the sequence of anterior and posterior procedure has any effect on the lordosis, disc height and stability in combined A-P fusion of the lumbar spine. Design: A biomechanical study on cadaver lumbar spine. Materials and Methods: Twelve motion segments (between L2–L5) from four cadaver lumbar spines were studied. Anterior and
Summary. The 80% porous structure of trabecular metal allows for bone ingrowth in more than 90% of the available surface. The Nexgen LPS Uncemented Knee using a trabecular metal tibial component has performed well at minimum of 5 years’ follow-up. Introduction. Total Knee Arthroplasty prostheses most frequently used in today's practice have cemented components. These have shown excellent clinical results. The fixation can however weaken with time, and cement debris within the articulation can lead to accelerated wear. Cementless implants are less commonly used, but some have also shown good long-term clinical results. The potential advantages of cementless implants are retention of bone stock, less chance of third-body wear due to the absence of cement, shorter operative time, and easier treatment of periprosthetic fractures. The
The purpose of this study was to examine the influence of weight-bearing on the measurement of in vivo wear of total knee replacements using model-based RSA at 1 and 2 years following surgery. Model-based RSA radiographs were collected for 106 patients who underwent primary TKR at a single institution. Supine RSA radiographs were obtained post-operatively and at 6-, 12-, and 24-months. Standing (weight-bearing) RSA radiographs were obtained at 12-months (n=45) and 24-months (n=48). All patients received the same knee design with a fixed, conventional PE insert of either a cruciate retaining or
PURPOSE. Total knee arthroplasty (TKA) is a successful technique for treating painful osteoarthritic knees. However, the patients' satisfaction is not still comparable with total hip arthroplasty. Basically, the conditions with operated joints were anterior cruciate ligament (ACL) deficient knees, thus, the abnormal kinematics is one of the main reason for the patients' incomplete satisfaction. Bi-cruciate stabilized (BCS) TKA was established to reproduce both ACL and posterior cruciate ligament (PCL) function and expected to improve the abnormal kinematics. However, there were few reports to evaluate intraoperative kinematics in BCS TKA using navigation system. Hence, the aim in this study is to reveal the intraoperative kinematics in BCS TKA and compare the kinematics with conventional
First generation condylar knee replacements suffered from 2 prominent observations: Difficulty in stair climbing and Limited range of motion. Improved understanding of knee kinematics, the importance of femoral rollback, and enhanced stability in flexion led to 2 differing schools of thought: posterior cruciate ligament retention or posterior cruciate substitution. The advantages of posterior cruciate substitution include predictable CAM-post engagement leading to rollback, predictable ROM, stability during stair climbing, ease of knee balancing regardless of degree of angular deformity, and avoidance of issues such as PCL tightness / laxity at time of index procedure, as well as late ligament disruption leading to late instability. Evolution has shown that human appendages that no longer served a purpose, slowly shrivel up. As we have seen with the appendix, the coccyx, and the erector pili muscles, these vestigial organs no longer are necessary for daily function and are destined for obsolescence. I submit: the PCL in knee arthroplasty IS THE VESTIGIAL ORGAN: not the
Purpose: Retrograde nailing is emerging among methods proposed or stabilisation of femoral fractures above total knee arthroplasties (TKA). Material and methods. Between June 1994 and may 2000, 12 fractures above TKA were treated by retrograde nailing. These fractures occurred 43 months (4–51) after implantation of the TKA in three men and women aged 74 years (43–88). The fracture was situated just above the prosthetic trochlea in ten, and distant from the implant in two. The posterior cruciate ligament was preserved in six TKA and six were
Introduction. Numerous fluoroscopic studies have been conducted to investigate kinematic variabilities of total knee arthroplasty (TKA). In those studies, subjects having a
Purpose:
PURPOSE: To record our experience in surgical treatment of thoracic spine fractures with
Eighteen porous coated
Introduction. Instability, loosening, and patellofemoral pain belong to the main causes for revision of total knee arthroplasty (TKA). Currently, the diagnostic pathway requires various diagnostic techniques such as x-rays, CT or SPECT-CT to reveal the original cause for the failed knee prosthesis, but increase radiation exposure and fail to show soft-tissue structures around TKA. There is a growing demand for a diagnostic tool that is able to simultaneously visualize soft tissue structures, bone, and TKA without radiation exposure. MRI is capable of visualising all the structures in the knee although it is still disturbed by susceptibility artefacts caused by the metal implant. Low-field MRI (0.25T) results in less metal artefacts and offers the ability to visualize the knee in weight-bearing condition. Therefore, the aim of this study is to investigate the possibilities of low field MRI to image, the patellofemoral joint and the prosthesis to evaluate the knee joint in patients with and without complaints after TKA. Method. Ten patients, eight satisfied and two unsatisfied with their primary TKA, (NexGen
The survivorship method of analysis has been used to compare the failure rate and overall success of 1,430 cemented primary total knee arthroplasties performed at The Hospital for Special Surgery over a 15-year period. There were 224 total condylar prostheses with a polyethylene tibia, 289 of the
This study presents the results of 1188 original and innovative
Background. In this study, we assessed implant survivorship, patient satisfaction, and patient-reported functional outcomes at two years for patients implanted with a customized,
Purpose. The purpose of this study was to examine the influence of weight-bearing on the measurement of in vivo wear of total knee replacements using model-based RSA at 1 and 2 years following surgery. Methods. Model-based RSA radiographs were collected for 106 patients who underwent primary TKR at a single institution. Supine RSA radiographs were obtained post-operatively and at 6-, 12-, and 24-months. Standing (weight-bearing) RSA radiographs were obtained at 12-months (n=45) and 24-months (n=48). All patients received the same knee design with a fixed, conventional PE insert of either a cruciate retaining or
Introduction. Special high-flexion prosthetic designs show a small increase in postoperative flexion compared to standard designs and some papers show increased anterior knee pain with these prosthesis. However, no randomised controlled trails have been published which investigate difference in postoperative complaints of anterior knee pain. To assess difference in passive and active postoperative flexion and anterior knee pain we performed a randomized clinical trial including the two extremes of knee arthroplasty designs, being a high flex
Introduction. Maintaining posterior stability in total knee arthroplasty (TKA) may be achieved by using a
Easier patient positioning and less extensive soft tissue dissection have spurred a trend for anterior instrumentation and fusion for C-spine fracture/ dislocations. We present group of forty-six patients treated over an eighteen month period with an anterior approach. There were no permanent approach related complications, infections, hardware failures or graft displacements. One patient had worsened post-operative neurological findings. One patient required additional
The aim of this study was to compare the migration of the femoral component, five years postoperatively, between patients with a highly cross-linked polyethylene (HXLPE) insert and those with a conventional polyethylene (PE) insert in an uncemented Triathlon fixed insert cruciate-retaining total knee arthroplasty (TKA). Secondary aims included clinical outcomes and patient-reported outcome measures (PROMs). We have previously reported the migration and outcome of the tibial components in these patients. A double-blinded randomized controlled trial was conducted including 96 TKAs. The migration of the femoral component was measured with radiostereometry (RSA) at three and six months and one, two, and five years postoperatively. PROMs were collected preoperatively and at all periods of follow-up.Aims
Methods
The purpose of this study was to assess mid-term survivorship following primary total knee arthroplasty (TKA) with Optetrak Logic components and identify the most common revision indications at a single institution. We identified a retrospective cohort of 7,941 Optetrak primary TKAs performed from January 2010 to December 2018. We reviewed the intraoperative findings of 369 TKAs that required revision TKA from January 2010 to December 2021 and the details of the revision implants used. Kaplan-Meier analysis was used to determine survivorship. Cox regression analysis was used to examine the impact of patient variables and year of implantation on survival time.Aims
Methods
Objectives: The aim of this study was to examine the influence of different prosthesis designs (Deep-Dish (DD) vs.
Aims. The introduction of a novel design of total knee arthroplasty (TKA) must achieve outcomes at least as good as existing designs. A novel design of TKA with a reducing radius of the femoral component and a modified cam-post articulation has been released and requires assessment of the fixation to bone. Radiostereometric analysis (RSA) of the components within the first two postoperative years has been shown to be predictive of medium- to long-term fixation. The aim of this study was to assess the stability of the tibial component of this system during this period of time using RSA. Patients and Methods. A cohort of 30 patients underwent primary, cemented TKA using the novel
Debate has raged over whether a cruciate retaining
(CR) or a
Purpose Of Study. The in vivo evaluation of patellofemoral contact pressures in a
Gram-negative infections are associated with comorbid patients, but outcomes are less well understood. This study reviewed diagnosis, management, and treatment for a cohort treated in a tertiary spinal centre. A retrospective review was performed of all gram-negative spinal infections (n = 32; median age 71 years; interquartile range 60 to 78), excluding surgical site infections, at a single centre between 2015 to 2020 with two- to six-year follow-up. Information regarding organism identification, antibiotic regime, and treatment outcomes (including clinical, radiological, and biochemical) were collected from clinical notes.Aims
Methods
The aim of this study was to perform a systematic review and bias evaluation of the current literature to create an overview of risk factors for re-revision following revision total knee arthroplasty (rTKA). A systematic search of MEDLINE and Embase was completed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The studies were required to include a population of index rTKAs. Primary or secondary outcomes had to be re-revision. The association between preoperative factors and the effect on the risk for re-revision was also required to be reported by the studies.Aims
Methods
The mid-term results of kinematic alignment (KA) for total knee arthroplasty (TKA) using image derived instrumentation (IDI) have not been reported in detail, and questions remain regarding ligamentous stability and revisions. This paper aims to address the following: 1) what is the distribution of alignment of KA TKAs using IDI; 2) is a TKA alignment category associated with increased risk of failure or poor patient outcomes; 3) does extending limb alignment lead to changes in soft-tissue laxity; and 4) what is the five-year survivorship and outcomes of KA TKA using IDI? A prospective, multicentre, trial enrolled 100 patients undergoing KA TKA using IDI, with follow-up to five years. Alignment measures were conducted pre- and postoperatively to assess constitutional alignment and final implant position. Patient-reported outcome measures (PROMs) of pain and function were also included. The Australian Orthopaedic Association National Joint Arthroplasty Registry was used to assess survivorship.Aims
Methods
The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised knee. Topics covered will include: (1) Exposure in the multiply operated knee (when to use quad snip, tibial tubercle osteotomy, other techniques); (2) Implant removal: Tips for removing stemmed implants; (3) Management of bone loss in multiply operated knees (metal cones/sleeves vs. structural allograft vs. particulate graft); (4) Level of constraint (when to use
First generation condylar knee replacements suffered from two prominent observations: 1) Difficulty in stair climbing, 2) Limited range of motion (ROM). Improved understanding of knee kinematics, the importance of femoral rollback, and enhanced stability in flexion led to 2 differing schools of thought: Posterior Cruciate ligament retention vs. Posterior Cruciate substitution. The advantages of posterior cruciate substitution include predictable cam-post engagement leading to rollback, predictable ROM, stability during stair climbing, ease of knee balancing regardless of degree of angular deformity, and avoidance of issues such as PCL tightness / laxity at time of index procedure, as well as late ligament disruption leading to late instability. Evolution has shown that human appendages that no longer served a purpose, slowly shrivel up. As we have seen with the appendix, the coccyx, and the erector pili muscles, these vestigial organs no longer are necessary for daily function and are destined for obsolescence. I submit: the PCL in knee arthroplasty IS THE VESTIGIAL ORGAN: not the
Introduction. Inability to reproduce 6-degrees of freedom (6DOF) kinematics, abnormal “paradoxical” anterior femoral translation and loss of normal medial pivot rotation are challenges associated with contemporary posterior cruciate retaining and
Introduction: Recent knee prosthesis designs postulate to allow more flexion of the knee without increasing the contact stress on the polyethylene inlay. The study’s purpose was to compare the tibiofemoral contact stress of four different inlay types of a new “high flexion knee prosthesis system under dynamic, physiologic loading conditions in an in vitro test. Thereby, the cruciate retaining and
Background. Patient satisfaction after total knee arthroplasty (TKA) has been lower than after a similar procedure, total hip arthroplasty. Poor subjective outcomes after TKA may be partially explained by abnormal kinematics patterns after TKA. The purpose of this study was to analyse rotational kinematics patterns in knees that had undergone
Flexion instability is a well-defined, though often difficult to diagnose, type of TKA instability. It may also complicate
INTRODUCTION. This study is to determine the response of CRP after TKR surgery, both unilateral and simultaneous bilateral TKR. According to the previously published literature from North America and Europe CRP value peaks on the 1. st. and 2. nd. post-operative day and then gradually comes down to normal by 6–8 weeks post-operatively. AIM. To determine the trend of CRP in Indian patients undergoing TKR, both unilateral and simultaneous bilateral TKR. To see whether it follows the trend in North American and European population and to determine whether there is a difference in the CPR pattern in unilateral versus simultaneous bilateral TKR patients. MATERIAL & METHODS. Twenty six patients were included in this study. 13 patients each had unilateral TKR and simultaneous bilateral TKR. All the patients were operated by a single surgeon and assistant. Patients who had Rheumatoid arthritis and post operative adverse events like urinary tract infection were excluded from this study. All 26 patients were female patients and the mean age in the unilateral group was 67 years and in the simultaneous bilateral TKR group was 73 years. CRP levels were measured pre- operatively on 2. nd. day and 8 weeks. TKR was performed in a standard fashion. Both the groups received standard pre and post operative antibiotic prophylaxis. All patients received a
Introduction. When introducing new joint replacement designs, it is difficult to predict with any certainty the clinical performance of the new designs. Using roentgen stereophotogrammetric analysis (RSA) to evaluate the first two years of follow-up can serve as a predictor of late mechanical loosening for hip and knee prostheses. This prospectively randomized study was designed to evaluate the clinical performance of the Triathlon total knee system and compare the results between the two versions;
Past work in our laboratory identified the generalized effects of TKA on muscle balance, showing a significant change in relative moment generating potential balance favoring flexion and external rotation relative to the normal (intact) knee (for both PCL sparing and
Many patients who undergo a total knee arthroplasty (TKA) wish to return to a more active lifestyle. The implant must be able to restore adequate muscle strength and function. However, this may not be a reality for some patients as quadriceps and hamstrings muscle activity may remain impaired following surgery. The purpose of this study was to compare muscle activity between patients implanted with a medial pivot (MP) or
Introduction. Aseptic loosening of total knee replacements is a leading cause for revision. It is known that micromotion has an influence on the loosening of cemented implants though it is not yet well understood what the effect of repeated physiological loading has on the micromotion between implants and cement mantle. This study aims to investigate effect of physiological loading on the stability of tibial implants previously subjected to simulated intra-operative lipid/marrow infiltration. Methods. Three commercially available fixed bearing tibial implant designs were investigated in this study: ATTUNE. ®. , PFC SIGMA. ®. CoCr, ATTUNE. ®. S+. The implant designs were first prepared using a LMI implantation process. Following the method described by Maag et al tibial implants were cemented in a bone analog with 2 mL of bone marrow in the distal cavity and an additional reservoir of lipid adjacent to the posterior edge of the implant. The samples were subjected to intra- operative range of motion (ROM)/stability evaluation using an AMTI VIVO simulator, then a hyperextension activity until 15 minutes of cement cure time, and finally 3 additional ROM/stability evaluations were performed. Implant specific physiological loading was determined using telemetric tibial implant data from Orthoload and applying it to a validated FE lower limb model developed by the University of Denver. Two high demand activities were selected for the loading section of this study: step down (SD) and deep knee bend (DKB). Using the above model, 6 degree of freedom kinetics and kinematics for each activity was determined for each
It is unknown whether gap laxities measured in robotic arm-assisted total knee arthroplasty (TKA) correlate to load sensor measurements. The aim of this study was to determine whether symmetry of the maximum medial and lateral gaps in extension and flexion was predictive of knee balance in extension and flexion respectively using different maximum thresholds of intercompartmental load difference (ICLD) to define balance. A prospective cohort study of 165 patients undergoing functionally-aligned TKA was performed (176 TKAs). With trial components in situ, medial and lateral extension and flexion gaps were measured using robotic navigation while applying valgus and varus forces. The ICLD between medial and lateral compartments was measured in extension and flexion with the load sensor. The null hypothesis was that stressed gap symmetry would not correlate directly with sensor-defined soft tissue balance.Aims
Methods
Injury to the spinal cord and kyphosis are the two most feared complications of tuberculosis of the spine. Since tuberculosis affects principally the vertebral bodies, anterior decompression is usually recommended. Concomitant posterior instrumentation is indicated to neutralise gross instability from panvertebral disease, to protect the anterior bone graft, to prevent graft-related complications after anterior decompression in long-segment disease and to correct a kyphosis. Two-stage surgery is usually performed in these cases. We present 38 consecutive patients with tuberculosis of the spine for whom anterior decompression, posterior instrumentation, with or without correction of the kyphus, and anterior and posterior fusion was performed in a single stage through an anterolateral extrapleural approach. Their mean age was 20.4 years (2.0 to 57.0). The indications for surgery were panvertebral disease, neurological deficit and severe kyphosis. The patients were operated on in the left lateral position using a ‘T’-shaped incision sited at the apex of kyphosis or lesion. Three ribs were removed in 34 patients and two in four and anterior decompression of the spinal cord was carried out. The posterior vertebral column was shortened to correct the kyphus, if necessary, and was stabilised by a Hartshill rectangle and sublaminar wires. Anterior and posterior bone grafting was performed. The mean number of vertebral bodies affected was 3.24 (2.0 to 9.0). The mean pre-operative kyphosis in patients operated on for correction of the kyphus was 49.08° (30° to 72°) and there was a mean correction of 25° (6° to 42°). All except one patient with a neural deficit recovered complete motor and sensory function. The mean intra-operative blood loss was 1175 ml (800 to 2600), and the mean duration of surgery 3.5 hours (2.7 to 5.0). Wound healing was uneventful in 33 of 38 patients. The mean follow-up was 33 months (11 to 74). None of the patients required intensive care. The extrapleural anterolateral approach provides simultaneous exposure of the anterior and posterior aspects of the spine, thereby allowing decompression of the spinal cord,
Purpose: We hypothesised that independent Notch Trial is essential on same lines as other Component Trials – Femoral, Tibial and Patellar – in
In severe destructive spinal infections, with neurological deficit, progressive deformity or uncontrolled sepsis, the mainstay of treatment is surgical debridement with anterior and
Purpose of the study: Several authors have focused attention on the kinematics of total knee arthroplasty. In vitro studies have shown the influence of prosthetic kinematics on wear of the tibial insert. In vivo, investigations are limited for this important parameter. We propose computer algorithm which gives a linear assessment of femur penetration into the tibial insert. The purpose of this work was to test this measurement by radiostereometric analysis (RSA) on pre-worn prosthesis models. Material and methods: A resin plateau was manufactured with four Triatlhon
Purpose: The range of motion after TKA depends on many patient, surgical technique, and implant factors. Recently, high-flexion designs have been introduced as a means of ensuring or gaining flexion after TKA. We therefore evaluated factors affecting postoperative flexion to determine whether implant design influences long-term flexion. Method: We prospectively collected data on patients receiving a primary Genesis II total knee replacement with a minimum of 1-year followup (mean, 5.4 years; range, 1–13 years). We recorded pre – and postoperative outcome measures, patient demographics, and implant design (cruciate retaining [CR, n = 160],
Purpose of the study: The purpose of this retrospective study was to present the outcomes observed with the Cedior total knee arthroplasty (TKA), and in particular an embedded patellar implant fixed without cement and cemented titanium backed base plate with a press fit stem. Material and methods: From January 1993 to December 1996, 155 TKA were implanted in 143 patients for degenerative disease of the knee joint. At last follow-up, 55 patients had died, 28 were lost to follow-up 14 were contacted by phone, and 46 were reviewed clinically. Mean age was 62 years (62–80), BMI: 29.9 (22.6–38.2). Mean follow-up was 12 years (10–13).
Study Aim. Femoral components used in total knee arthroplasty (TKA) are primarily designed on the basis of kinematics and ease of fixation. This study considers the stress-strain environment in the distal femur due to different implant internal geometry variations (based on current industry standards) using finite element (FE) analyses. Both two and three dimensional models are considered for a range of physiological loading scenarios – from full extension to deep flexion. Issues associated with micro-motion at the bone-implant interface are also considered. Materials and methods. Two (plane strain) and three dimensional finite element analyses were conducted to examine implant micro-motions and stability. The simple 2D models were used to examine the influence of anterior-posterior (AP) flange angle on implant stability. AP slopes of 3°, 7° and 11° were considered with contact between bone and implant interfaces being modeled using the standard coulomb friction model. The direction and region of loading was based on loading experienced at full extension, 90° flexion and 135° flexion. Three main model variations were created for the 3D analyses, the first model represented an intact distal femur, the second a primary implanted distal femur and the third a distal femur implanted with a
Purpose of the study: We analysed the clinical and radiographic outcomes of 113 cemented total knee arthroplasties (TKA) with resurfaced patella implanted in 83 patients with rheumatoid arthritis who were reviewed 1 to 12 years after implantation. Mean follow-up was 5.86 years. All implants were
Purpose: The literature regarding the outcome of total knee arthroplasty following distal femoral varus osteotomy is limited. The largest published series to date of eleven such patients suggested that medio-lateral constrained implants are commonly required as ligament balancing is difficult. This study presents mid-term outcomes of patients treated with total knee arthroplasty following distal femoral varus osteotomy at a single center. Method: Twenty-two consecutive distal femoral varus osteotomies (21 patients) converted to total knee arthroplasties were reviewed at a mean follow-up of five years (range, two to 14 years). The mean duration between osteotomy and conversion to arthroplasty was 12 years (range, three to 21 years). In 14 patients (15 knees) the underlying etiology for the femoral osteotomy was primary knee osteoarthritis with valgus deformity, while in seven patients the procedure was performed to unload a fresh osteochondral allograft of either the lateral tibia (five patients) or femur (two patients). It is the authors’ routine to use
Introduction. Mobile-bearing TKRs allow some axial rotation and may provide a more natural patellar movement. The aim was to compare patellar kinematics among the normal knee, fixed-bearing and mobile-bearing TKR. Methods. Optical computer navigation (Brainlab) was used to track the position of the femur, tibia and patella in 9 whole lower extremities (5 fresh cadavers) in the natural knee, in the same knee with the trial components of a
We analysed the clinical and radiographic results after total knee arthroplasty in the valgus knee. Thirty six knees in 27 patients with a valgus alignment of more than 10 degrees of femorotibial angle underwent TKA. The average followup period was 7 years(range 1 to 14 years). Eighteen knees were implanted with a cruciate retaining prosthesis, 17 knees with a
The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised knee. Topics covered will include: (1) Exposure in the multiply operated knee (when to use quad snip, tibial tubercle osteotomy, other techniques); (2) Level of constraint (when to use
Introduction. Increased long-term survival of TKA is becoming more important. Several studies have confirmed that optimal positioning and alignment of prosthetic components is crucial for the best long-term results. Therefore, the purpose of the current study was to compare the postoperative alignment and sizing of femoral prosthesis among patients performed by 3 different navigation systems. Methods. Twenty patients who underwent primary TKA (E. motion; B. Braun Aesculap, Tuttlingen, Germany) using a CT-free navigation system (OrthoPilot v 4.2) by modified gap technique were enrolled in this study. The results of this study group were retrospectively compared with those in a control group of 20 matched-paired
In patients with previous patellectomy the optimal constrained implant is not well understood. Previous outcome studies have shown contradictory results. There interpretation is limited by small number of patients, included primary and revision implants or involved a heterogeneous group of different constraint implants. We performed retrospective match controlled analysis of a
The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised knee. Topics covered will include: (1) Exposure in the multiply operated knee (when to use quad snip, tibial tubercle osteotomy, other techniques); (2) Implant removal: Tips for removing stemmed implants; (3) Management of bone loss in multiply operated knees (metal cones/sleeves vs. structural allograft vs. particulate graft); (4) Level of constraint (when to use
There exists a variety of options for a medial compartment knee with osteoarthritis, specifically a unicompartmental knee, high tibial osteotomy, and total knee arthroplasty. This surgeon prefers a rotating platform
Hypothesis: 1. Increased wear results from modularity. 2. Modification of the patello-femoral articulation will decrease patellar fractures. Materials &
Methods: A prospective comparison of 100 consecutive Non-modular Insall Burstein Posterior Stabilized (IBPS) knee prostheses (1986–1989) with 100 consecutive modular IBPS II knee replacements (1989–1990). No patient was lost. Results: IBI: Nine re-operations of which 6 were complete revisions: two for sepsis, one for tibial loosening, one for patellar wear and two for undiagnosed pain. Of seven patellar fractures, five required surgery. IBII: Nineteen re-operations of which six were complete revisions: two for sepsis, one for tibial loosening from catastrophic osteolysis, two for instability and one for stiffness. There were no revisions for patellar complications. Of 12 non-revision re-operations, two were for patellar fractures, three for dislocation of the
Introduction The aim of this study was to examine the flexion stability of
Introduction: Mobile bearing TKA systems have drawn great attention as an alternative solution for the limitations of fixed bearing designs. Recently rotating platform
We have reviewed our experience in managing 11 patients who sustained an indirect sternal fracture in combination with an upper thoracic spinal injury between 2003 and 2006. These fractures have previously been described as ‘associated’ fractures, but since the upper thorax is an anatomical entity composed of the upper thoracic spine, ribs and sternum joined together, we feel that the term ‘fractures of the upper transthoracic cage’ is a better description. These injuries are a challenge because they are unusual and easily overlooked. They require a systematic clinical and radiological examination to identify both lesions. This high-energy trauma gives severe devastating concomitant injuries and CT with contrast and reconstruction is essential after resuscitation to confirm the presence of all the lesions. The injury level occurs principally at T4–T5 and at the manubriosternal joint. These unstable fractures need early
The Genesis II total knee prosthesis was a successor to the Genesis I TKR in which three degrees of external rotation was built into the femoral component to improve patellofemoral tracking and eliminate rotational incongruity. The midterm (minimum five year) results of three hundred and forty-three Genesis II cemented components were reviewed in three hundred and twenty-four patients. Kaplan-Meier survivorship was 98% at a mean 7.6 years. The focus of this study was to analyze the minimum five- year results of patients receiving either a cruciate-retaining,
Introduction. The aim of this study was to evaluate the effects of posterior tibial slope (PTS) and posterior condylar offset (PCO) on patient-reported pain and function one year after TKA. Methods. A total of 500 patients from 11 clinics in 6 countries were enrolled into a prospective, multicenter study. All patients were indicated for primary TKA for OA and received components from a single manufacturer. All liners were made from vitamin-E stabilized, highly crosslinked (95 kGy) polyethylene; 54.7% were
Introduction. Clinical observations suggest mid-flexion instability may occur more commonly with rotating platform (RP) total knee arthroplasty (TKA), including increased revision rates and patient-reported instability and pain. We propose that increased gap laxity leads to liftoff of the lateral femoral condyle with decreased conformity between the femoral component and polyethylene (PE) insert surface leading to PE subluxation or dislocation. The objectives of this study were to define “at risk” loading conditions that predispose patients to PE insert subluxation or spinout, and to quantify the margin of error for flexion/extension gap laxity in preventing these adverse events under physiologic loading conditions. Methods. Biomechanical testing was performed on six fresh frozen cadaveric knees implanted with a