Aims. To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period. Methods. This is a retrospective study of 166 (154 patients) consecutive cemented,
Summary Statement. Wear of total knee replacement (TKR) is a clinical concern. This study demonstrated low-conformity moderately cross-linked-polyethylene
Purpose of the study. Assessing medium term outcome of medial Uni compartmental replacement and whether there is a difference in outcome between mobile and
Aim: This study investigated the difference in proximal tibial cortical strain distribution using a fixed or mobile bearing design for TKA. Methods: Eight fresh frozen human cadaver tibias were used. The strain magnitude and distribution on the anterior cortex of the proximal tibia during axial and rotational loading of the knee were measured with a quantitative full-field strain measurement technique (Electronic Speckle Pattern Interferometry). First, strain distributions of the intact knee were acquired. Subsequently, strain distributions after implementation of conventional and mobile bearing PCL retaining total knee implants (Scorpio®) were measured. Results: Under each loading condition, the minimum principal strain was greater in magnitude as compared to the maximum principal strain. Under 1′500 N axial loading, the resulting minimum principal strain magnitude and orientation was nearly identical between the mobile bearing configuration (500 ± 287 με), and the
Introduction Movement between the polyethylene insert and the metal tibial tray in modular
This study investigated the difference in proximal tibial cortical strain distribution using a fixed or mobile bearing design for TKA. Eight fresh frozen human cadaver tibias were used. The strain magnitude and distribution on the anterior cortex of the proximal tibia during axial and rotational loading of the knee were measured with a quantitative full-field strain measurement technique (Electronic Speckle Pattern Interferometry). First, strain distributions of the intact knee were acquired. Subsequently, strain distributions after implantation of conventional and mobile bearing PCL retaining total knee implants (Scorpio®) were measured. Under each loading condition, the minimum principal strain was greater in magnitude as compared to the maximum principal strain. Under 1,500 N axial loading, the resulting minimum principal strain magnitude and orientation was nearly identical between the mobile bearing configuration(500 ± 287m;e;), and the
The purpose of this study was to compare the clinical and radiological results of the PFC flex mobile bearing design with those of the LPS flex
Introduction and Aims:
Abstract. Introduction. Medial fix bearing unicompartmental knee replacement (UKR) designs are consider safe and effective implants with many registries data and big cohort series showing excellent survivorship and clinical outcome comparable to that reported for the most expensive and surgically challenging medial UKR mobile bearing designs. However, whether all polyethylene tibial components (all-poly) provided comparable results to metal-backed modular components during medial fix bearing UKR remains unclear. There have been previous suggestions that all-poly tibia UKR implants might show unacceptable higher rates of early failure due to tibial component early loosening especially in high body max index (BMI) patients. This study aims to find out the short and long-term survival rate of all-poly tibia UKR and its relationship with implant thickness and patient demographics including sex, age, ASA and BMI. Material and Methods. we present the results of a series of 388 medial
Purpose of Study:
BACKGROUND:. Implant wear continues to be a limitation of total knee replacement (TKR). Wear simulator studies are a valuable screening tool in new implant development. The purpose of this study was to determine the ability of micro-CT to prospectively measure wear in TKR implants during a wear simulator trial. METHODS:. Three identical cruciate-retaining,
The outcome and survivorship of osteotomy for medial compartment osteoarthritis are closely correlated to the changes in the weight bearing axis. Questions remain over the optimal correction when undertaking medial unicompartmental knee replacement (UKR). Prospective data was collected on 50 patients (30F:20M) undergoing
Background: The osteolysis in revision total knee arthroplasty was observed. The purpose of this study was to compare the prevalence and characteristics of osteolysis recognized in revision total knee arthroplasties between the failed mobile
Introduction. Wear debris induced osteolysis and loosening continue to be causes of clinical failure in total knee replacement (TKR). Laboratory simulation aims to predict the wear of TKR bearings under specific loading and motion conditions. However, the conditions applied may have significant influence on the study outcomes (1). The aim of this study was to examine the influence of femoral setup and kinematic inputs on the wear of a conventional polyethylene
We report the short term follow up of nineteen consecutive PFC sigma unicompartmental knee replacements carried out in our institution with minimum one year follow up. The PFC Sigma medial unicompartmental knee replacement is a
Purpose. Prospective randomized intervention trial to determine whether patients undergoing rotating platform total knee arthroplasty have better clinical outcomes at two years when compared to patients receiving
Introduction: In vivo fluoroscopic studies have shown considerable differences in kinematics between different designs of knee prostheses and compared to the natural knee. Most noticeably, lift off of the femoral condyles from the tibial insert has been observed in many patients (. Dennis et al, 2003. ). The aim of this study was to simulate lateral femoral condylar lift off in vitro and to compare the wear of
Purpose of Study:
Introduction and Aims A randomised controlled trial (RCT) and a multi-centre unilateral cohort study were performed as part of the stepwise introduction of a new mobile bearing knee. The aim was to ensure that outcome for the new device was at least as good as that for an established
Introduction. Total knee arthroplasty (TKA) is a well-established procedure associated with excellent clinical results. We have previously reported that intraoperative knee kinematics correlate with the clinical outcome in mobile bearing TKA. In addition, the intraoperative knee kinematics pattern does not correlate with the degree of preoperative knee deformity in mobile bearing TKA. However, the relationship among preoperative knee deformity, intraoperative kinematics and clinical outcome in
Introduction: Mobile bearing TKRs may allow some axial rotation and also compensate for a slight tibiofemoral rotational mismatch. This is thought to provide better kinematics and a more natural patellar movement. This theoretical advantage has not been verified in clinical studies for the tibiofemoral kinematics. However, little is known about the patellofemoral kinematics of mobile bearing TKRs. The aim was to compare patellar kinematics among the anatomic knee,
The Profix knee replacement arthroplasty manufactured by Smith and Nephew has been in use for the past five years however there are few published outcome data for this prosthesis. The purpose of this study was to provide clinical outcome data for a cohort of patients with a Profix TKR at a minimum 3 years follow up. There were 65 joint replacements in 58 patients all performed by or under the direct supervision of one of two senior consultant Orthopaedic surgeons. There were 34 right and 31 left knees replaced in 31 male and 27 female patients. Mean age of the patients was 69 years (51–84 years) and mean body mass 89Kg (45–140Kg). The femoral component was uncemented in 49 knees and cemented in 16 knees. The tibial component was cemented in all 65 cases. There were 53 mobile bearing polyethylene inserts and 12
Between 1995 and 1998, eighty revision total knee arthroplasties were done for the primary reason of advanced polyethylene wear. The primary arthroplasties prosthesis that failed included thirty-four mobile bearing knees and forty-six
Introduction. Unidirectional mobile bearing knees (RP) were developed to optimise the tibio-femoral articulation in an effort to enhance function and reduce polyethylene wear. The self aligning bearing should also benefit the patello-femoral joint further improving outcome. This study was designed to assess whether these potential benefits are realised in the clinical setting. Methods. A total of 352 patients undergoing a PS PFC Sigma TKR were randomly allocated to receive either a Mobile Bearing (176 knees) or a
Introduction. Unidirectional mobile bearing knees (RP) were developed to optimise the tibio-femoral articulation in an effort to enhance function and reduce polyethylene wear. The self-aligning bearing should also benefit the patello-femoral joint further improving outcome. This study was designed to assess whether these potential benefits are realised in the clinical setting. Methods. A total of 352 patients undergoing a PS PFC Sigma TKR were randomly allocated to receive either a Mobile Bearing (176 knees) or a
Medial unicompartmental replacement (UKR) has been shown to have superior functional results to total knee replacement (TKR) in appropriately selected patients, and this has been associated with a resurgence of interest in the procedure. This may relate to evidence showing that the kinematic profile of UKR is similar to the normal knee, in comparison to TKR, which has abnormal kinematics. Concerns remain over the survivorship of UKR and work has suggested the anterior cruciate ligament (ACL) may become dysfunctional over time. Cruciate mechanism dysfunction would produce poor kinematics and instability providing a potential mechanism of failure for the UKR. Aim: To test the hypothesis that the sagittal plane kinematics (and cruciate mechanism) of a
Purpose: There are numerous papers from specialist arthroplasty centres outlining results of total knee arthroplasties but little information from outside these major centres. We carried out a review of a
Background. Wear and fatigue damage to polyethylene components remain major factors leading to complications after total knee and unicompartmental arthroplasty. A number of wear simulations have been reported using mechanical test equipment as well as computer models. Computational models of knee wear have generally not replicated experimental wear under diverse conditions. This is partly because of the complexity of quantifying the effect of cross-shear at the articular interface and partly because the results of pin-on-disk experiments cannot be extrapolated to total knee arthroplasty wear. Our premise is that diverse experimental knee wear simulation studies are needed to generate validated computational models. We combined five experimental wear simulation studies to develop and validate a finite-element model that accurately predicted polyethylene wear in high and low crosslinked polyethylene, mobile and
Purpose: As part of the step-wise introduction of a meniscal-bearing total knee replacement (Oxford TMK) we needed to know, before proceeding to longer term studies, whether its early clinical results were at least as good as those of an established
Purpose: In this ongoing trial we are analysing the performance of both a
Recently mobile-bearing total knee arthroplasty (TKA) has become more popular. However, the advantages of mobile bearing (MB) PS TKA still remain unclear especially from a kinematic point of view. The objective of this study was to investigate the difference and advantage in kinematics of mobile baring PS TKA compared with
Introduction and Aims: The study was designed to compare the early results, prospectively, of the fixed-bearing Zimmer NexGen cruciate retaining (CR) and the Zimmer NexGen mobile-bearing knee (MBK) knee arthroplasty. The study was designed to determine whether differences exist in the clinical outcomes between patients receiving different types of bearings. Method: Patients were randomly assigned to receiving either fixed or mobile bearings. Patients were blinded but not assessors to the type of arthroplasty. The study commenced in June 2000. By November 2002, 69 and 70 patients had been recruited into the CR and MBK groups respectively. Consultants were present in 92% of operations and the rest were performed by a senior registrar. The major indication was osteoarthritis (64 CR: 65 MBK). The surgical approach was medial parapatellar in 65 CR and 63 MBK the rest were subvastus, patella resurfacing was not routinely employed. Pre-operative, intra-operative and post-operative data was collated. Results: The body mass index was 32 ± 7 CR and 32 ± 6 MBK. The average age was 67 ± 8 CR and 67 ± 8 MBK. Pain in the contralateral knee was present in 79.7% CR and 74.3% MBK group. Minimum post-operative follow-up was one year. There was no significant difference in the pre-operative and post-operative fixed flexion contracture, 4.3 ± 5.4 to 1.0 ± 2.9 CR and 6.2 ± 6.9 to 0.9 ± 2.8. The mean flexion pre-operatively and post-operatively between the two groups was not significantly different 108 ± 19 to 105 ± 16 CR and 107 ± 15 to 102 ± 13. Patello-femoral joint symptoms diminished from 67% to 12% CR and from 69% to 21% in the MBK group. The dependence on walking aids diminished from 50.7% to 16.7% CR and 51.4% to 26.9% MBK. At one year, nine percent and 21% were dissatisfied in the CR and MBK groups respectively. In the CR group, two revisions had been performed, one for infection and the other for arthrolysis and poly exchange. Two revisions had been carried out in the MBK group, one for extreme ‘clunking’ and the other for arthrolysis with poly exchange. Conclusions: The one-year results suggest that the levels of dissatisfaction and patello-femoral problems are significantly greater in the mobile bearing group as opposed the
Purpose. Total knee arthroplasty (TKA) is the preferred treatment for those with end stage osteoarthritis (OA) and severe functional limitations. With the demographic transition in society, TKA is being offered to a younger patient population. Younger patients are generally more active requiring an increased range of motion, and place greater physiological demands on the prosthesis than typical older patients. The mobile bearing (MB) total knee prosthesis has theoretically been designed to meet these demands. We conducted a meta-analysis and systematic review of randomized controlled trials comparing outcomes of MB and
Clinical experience has shown the needs for high flexion. The aim of this study was to evaluate the clinical and radiological results of a
Summary. We report a large study of 331 patients at two years post operation who were prospectively randomised to receive either a rotating platform or a
Introduction: Total knee arthroplasty (TKA) has become a successful clinical treatment for patients in regard to relief of pain, correction of deformity and restoration of function with promising long term behaviour [Pradhan et al. 2006]. In TKA the generation of polyethylene wear debris is mainly affected by the factors design of the articulating bearing, contact stresses, kinematics, implant material and surface finish [McEwen et al. 2005]. The objective of our study was to evaluate the in vitro wear behaviour of
Introduction There are only a limited number of long term studies of total knee arthroplasty but none with a minimum 15 year survivorship of a modular
Recently mobile-bearing total knee arthroplasty (TKA) has become more popular. However, the advantages of mobile bearing (MB) PS TKA still remain unclear especially from a kinematic point of view. The objective of this study was to investigate the difference and advantage in kinematics of mobile baring PS TKA compared with
Introduction: The aim of this study was to compare the clinical, radiological and functional outcome results of the Scorpio PS TKA prosthesis with either a mobile (MB) or
To evaluate prospectively the mid-term results of the Zimmer Unicondylar Knee arthoplasty (UKA). Between 2005 and 2012, 187 unicompartmental knee arthroplasties (UKA) were performed by a single surgeon using a fixed-bearing prosthesis (Zimmer). 37 cases were excluded as either were lost to follow-up or had less than six months follow-up. The study included 150 UKAs. Deformity, if present, was correctable. Patellofemoral joint (PFJ) disease was not considered as an absolute contraindication. The average patient age at the time of surgery was 66 years (range 42–88 years); 78 of which were male. Mean follow-up time was 3.6 years (range 7–81 months). Mean Body Mass Index (BMI) was 29 (range 21–41). Clinical and conventional radiological evaluations were carried out at six months, one, two and five years postoperatively. 147 cases were medial compartment replacement and three were lateral. 86 patients had grade III OA and 64 had grade IV (Kellgren and Lawrence). 113 patients had an element of PFJ disease. The mean Knee Society knee and function scores had an improvement from 55 and 54 points pre-operatively to 95 and 94 points respectively at time of most recent evaluation. The average flexion improved from 116 degrees pre-operatively to 127 degrees. Two cases were revised, one due to progression of osteoarthritis in the lateral compartment of the knee and the other was due to arthrofibrosis. The Zimmer unicompartmental knee arthroplasty provided excellent pain relief and restoration of function in carefully selected patients. However, long-term studies are necessary to investigate the survival rate for this prothesis.
This randomized controlled double-blind study included to date 14 patients: the gait signatures of four patients with mobile-bearing were compared to the gait signatures of nine patients with fixed-bearing pre-operatively and post-operatively at 6 weeks, 3 months and 6 months. Each participant was asked to perform two walking trials of 30m long at his/her preferred speed and to complete a EQ-5D questionnaire, a WOMAC and Knee Society Score (KSS). Lower limbs rotations were measured by four miniature angular rate sensors mounted respectively, on each shank and thigh. A new method for a portable system for gait analysis has been developed with very encouraging results regarding the objective outcome of total knee arthroplasty using mobile- and fixed-bearings.
Conventional fixed-bearing (FB) knee prostheses have been proved clinically successful. Rotating platform, mobile-bearing (MB) total knee replacements (TKR) have been developed to improve knee kinematics, lower contact stresses on the polyethylene tibial component, minimize constraint, and allow implant self-alignment. The purpose of this study was to characterize and compare the functional outcome of FB- and MB- TKR during gait and deep knee bends, using a motion analysis system. Two groups of five patients with a unilateral FB TKR (PFC) or MB TKR (LCS) underwent a gait analysis study. The normal contralateral limb was used as a control to compare data in the stance phase of gait. Demographic, clinical, and radiographic data were equivalent in the 2 groups. Both MB and FB TKRs gave good functional results in spite of different design rationales. No statistically significant difference was demonstrated between the two groups. However, gait and knee function after TKR was abnormal even though the patients were asymptomatic. A flexional pattern for flex-ion-extension moments at the knee during level walking was present in both types of TKR. Differences in rotational moments between the two groups were observed, with a higher internal rotational moment in the PFC group (PFC, 0.14 Nm/kg; LCS, 0.09 Nm/kg; p=0.094). A stressful weightbearing activity, such as deep knee bends, amplified the functional differences between the different prosthetic designs, indicating that knee kinematics are activity-dependent. Kinetic and kinematic differences noted between the 2 groups reflect different patterns of joint surface motion and loading, with postulated effects on long term failure of the implants through wear, mechanical failure, and loosening. Gait analysis using external skin markers has a limited role in the characterization of the joint surface motion of the prosthetic knee during ambulatory activities because of errors and assumptions inherent in the technique. However, it provides scope for the study of kinetic parameters acting on different knee prostheses during gait.
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. 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 posterior stabilised fixed-bearing TKR (FB) (Sigma PFC, Depuy) and a posterior stabilised mobile-bearing TKR (MB) (Sigma RP Stabilised). The patellae were not resurfaced. Values: mean+/−one standard deviation. Statistical analysis: two tailed paired Student's T-test.Introduction
Methods
The choice of the ideal outcome measure to assess total joint replacement remains a complex issue. However, gait analysis provides objective and quantifying evidences of treatment evaluation. Significant methodological advances are currently made in gait analysis laboratories and ambulatory gait devices are now available. The goal of this study was to provide gait parameters as a new objective method to assess total knee arthroplasty outcome between patients with fixed- and mobile-bearing, using an ambulatory device with minimal sensor configuration.
There is conflicting evidence about the merits of using mobile bearings at total knee replacement (TKR), partly because most randomised controlled trials (RCTs) have not been adequately powered. A pragmatic multicentre RCT involving 116 surgeons in 34 UK centres was begun in 1999. Within a partial factorial design, 539 patients were randomly allocated to mobile or fixed bearings. The primary outcome measure was the Oxford Knee Score (OKS); secondary measures included SF-12, EQ-5D, costs, cost-effectiveness and need for further surgery.Introduction
Methods
There is conflicting evidence about the merits
of mobile bearings in total knee replacement, partly because most randomised
controlled trials (RCTs) have not been adequately powered. We report
the results of a multicentre RCT of mobile versus fixed
bearings. This was part of the knee arthroplasty trial (KAT), where
539 patients were randomly allocated to mobile or fixed bearings
and analysed on an intention-to-treat basis. The primary outcome measure
was the Oxford Knee Score (OKS) plus secondary measures including
Short Form-12, EuroQol EQ-5D, costs, cost-effectiveness and need
for further surgery. There was no significant difference between the groups pre-operatively:
mean OKS was 17.18 (. sd. 7.60) in the mobile-bearing group
and 16.49 (. sd. 7.40) in the fixed-bearing group. At five
years mean OKS was 33.19 (. sd. 16.68) and 33.65 (. sd. 9.68),
respectively. There was no significant difference between trial
groups in OKS at five years (-1.12 (95% confidence interval -2.77
to 0.52) or any of the other outcome measures. Furthermore, there
was no significant difference in the proportion of patients with
knee-related re-operations or in total costs. In this appropriately powered RCT, over the first five years
after total knee replacement functional outcomes, re-operation rates
and healthcare costs appear to be the same irrespective of whether
a mobile or
Introduction. Backside wear of polyethylene (PE) inlays in fixed-bearing total knee replacement (TKR) generates high number of wear debris, but is poorly studied in modern plants with improved locking mechanisms. Aim of study. Retrieval analysis of PE inlays from contemporary
This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.Aims
Methods