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The Bone & Joint Journal
Vol. 103-B, Issue 6 Supple A | Pages 145 - 149
1 Jun 2021
Crawford DA Passias BJ Adams JB Berend KR Lombardi AV

Aims

A limited number of investigations with conflicting results have described perivascular lymphocytic infiltration (PVLI) in the setting of total knee arthroplasty (TKA). The purpose of this study was to determine if PVLI found in TKAs at the time of aseptic revision surgery was associated with worse clinical outcomes and survivorship.

Methods

A retrospective review was conducted on 617 patients who underwent aseptic TKA revision who had histological analysis for PVLI at the time of surgery. Clinical and radiological data were obtained pre- and postoperatively, six weeks postoperatively, and then every year thereafter.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 63 - 63
1 Oct 2019
Berend KR Crawford DA Adams JB Lombardi AV
Full Access

Introduction

Patients are often cautioned against a high level of activity following knee arthroplasty. The purpose of this study is to report on implant survivorship and outcomes of high activity patients compared to low activity patients after TKA.

Methods

We identified 1611 patients (2038 knees) who underwent TKA with 5-year minimum follow-up. Patients were divided in two groups: Low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥ 6). Pre-and postoperative ROM, Knee Society scores, complications and reoperations were evaluated.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_12 | Pages 35 - 35
1 Oct 2018
Lombardi AV Berend KR Adams JB Mallory NT
Full Access

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 constraint was employed, choosing the least amount necessary to afford stability. Bearings used were 3883 CR-S (86%), 256 CR-L (6%), and 361 CR-AS (8%). CR-S bearings were used in patients with less preoperative tibiofemoral deformity (p=0.0316), less flexion contracture (p<0.0001), and better ROM (p<0.0001), but more mediolateral instability (p<0.0001) than CR-AS bearings.


The Bone & Joint Journal
Vol. 98-B, Issue 10_Supple_B | Pages 3 - 10
1 Oct 2016
Hamilton TW Pandit HG Lombardi AV Adams JB Oosthuizen CR Clavé A Dodd CAF Berend KR Murray DW

Aims

An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre.

Patients and Methods

Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature.


The Bone & Joint Journal
Vol. 98-B, Issue 10_Supple_B | Pages 28 - 33
1 Oct 2016
Lum ZC Lombardi AV Hurst JM Morris MJ Adams JB Berend KR

Aims

Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts.

Patients and Methods

A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed.


The Bone & Joint Journal
Vol. 96-B, Issue 11_Supple_A | Pages 101 - 104
1 Nov 2014
Lombardi Jr AV Berend KR Adams JB

Previous studies of failure mechanisms leading to revision total knee replacement (TKR) performed between 1986 and 2000 determined that many failed early, with a disproportionate amount accounted for by infection and implant-associated factors including wear, loosening and instability. Since then, efforts have been made to improve implant performance and instruct surgeons in best practice. Recently our centre participated in a multi-centre evaluation of 844 revision TKRs from 2010 to 2011. The purpose was to report a detailed analysis of failure mechanisms over time and to see if failure modes have changed over the past 10 to 15 years. Aseptic loosening was the predominant mechanism of failure (31.2%), followed by instability (18.7%), infection (16.2%), polyethylene wear (10.0%), arthrofibrosis (6.9%) and malalignment (6.6%). The mean time to failure was 5.9 years (ten days to 31 years), 35.3% of all revisions occurred at less than two years, and 60.2% in the first five years. With improvements in implant and polyethylene manufacture, polyethylene wear is no longer a leading cause of failure. Early mechanisms of failure are primarily technical errors. In addition to improving implant longevity, industry and surgeons must work together to decrease these technical errors. All reports on failure of TKR contain patients with unexplained pain who not infrequently have unmet expectations. Surgeons must work to achieve realistic patient expectations pre-operatively, and therefore, improve patient satisfaction post-operatively.

Cite this article: Bone Joint J 2014;96-B(11 Suppl A):101–4.


The Bone & Joint Journal
Vol. 95-B, Issue 11_Supple_A | Pages 129 - 132
1 Nov 2013
Berend KR Lombardi Jr AV Adams JB

Debate has raged over whether a cruciate retaining (CR) or a posterior stabilised (PS) total knee replacement (TKR) provides a better range of movement (ROM) for patients. Various sub-sets of CR design are frequently lumped together when comparing outcomes. Additionally, multiple factors have been proven to influence the rate of manipulation under anaesthetic (MUA) following TKR. The purpose of this study was to determine whether different CR bearing insert designs provide better ROM or different MUA rates. All primary TKRs performed by two surgeons between March 2006 and March 2009 were reviewed and 2449 CR-TKRs were identified. The same CR femoral component, instrumentation, and tibial base plate were consistently used. In 1334 TKRs a CR tibial insert with 3° posterior slope and no posterior lip was used (CR-S). In 803 there was an insert with no slope and a small posterior lip (CR-L) and in 312 knees the posterior cruciate ligament (PCL) was either resected or lax and a deep-dish, anterior stabilised insert was used (CR-AS). More CR-AS inserts were used in patients with less pre-operative ROM and greater pre-operative tibiofemoral deformity and flexion contracture (p < 0.05). The mean improvement in ROM was highest for the CR-AS inserts (5.9° (-40° to 55°) vs CR-S 3.1° (-45° to 70°) vs CR-L 3.0° (-45° to 65°); p = 0.004). There was a significantly higher MUA rate with the CR-S and CR-L inserts than CR-AS (Pearson rank 6.51; p = 0.04). Despite sacrificing or not substituting for the PCL, ROM improvement was highest, and the MUA rate was lowest in TKRs with a deep-dish, anterior-stabilised insert. Substitution for the posterior cruciate ligament (PCL) in the form of a PS design may not be necessary even when the PCL is deficient.

Cite this article: Bone Joint J 2013;95-B, Supple A:129–32.