BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the nativ...BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.展开更多
AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly,...AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly, the reliability and correspondence between the size of said measurement and the actual implant utilized was determined. Secondly, the existing correlation between the intra- and interobserver determinations with the intraclass correlation coefficient was analyzed. RESULTS: An overall correspondence of 54%, improving up to 92% when the measured size admitted a difference of one size, was found. Good intra- and interobserver reliability with an intraclass correlation coefficient greater than 0.90(P < 0.001) was also discovered. CONCLUSION: Agreement between the preoperative measurement with standardized acetate templates and the prosthetic size implanted can be considered satisfactory. We thus conclude it is a reproducible technique.展开更多
Background:Accurate evaluation of the plain radiography of lower limb is critical for preoperative planning of total knee arthroplasty (TKA). We aimed to investigate the effect of femoral lateral bowing and rotatio...Background:Accurate evaluation of the plain radiography of lower limb is critical for preoperative planning of total knee arthroplasty (TKA). We aimed to investigate the effect of femoral lateral bowing and rotation on the radiographic measurements of distal femoral condyle resection thickness (DRT) and the distal femoral resection valgus angle (FVA). Methods: We analyzed 246 three-dimensional femoral models generated from computed tomography images of 123 patients, acquiring projected contours in seven positions – 20° and 10° internal rotation; 0° rotation; 10°, 20°, 30°, and 40° external rotation – for each model. Medial and lateral condyle DRTs, femoral shaft lateral bowing angle (FBA), and distal FVA were determined for each position. Linear mixed effect model was used to determine the effect of degree of femur rotation on repeated measurements of DRT or FVA. Results: FBA significantly affected the FVA and DRT (Pearson's R = 0.767 and -0.408, respectively; P 〈 0.000). Samples were divided into three groups according to the FBA measured in neutral position: FBA 〈0°: DRT 3.75 ± 1.30 mm, FVA 4.53° ± 1.27°; FBA 〉0° but 〈3°: DRT 3.39 ± 1.31 mm, FVA 5.92° ± 1.31°; FBA 〉3°: DRT 2.22 ± 1.31 mm, FVA 7.37° ± 1.31°. From simulated 20° internal rotation to 40° external rotation in each femoral model, the average variation ranges of radiographically measured DRT, FVA, and FBA were 0.50 ± 0.28 mm, 2.93° ± 0.96°, and 10.33° ± 1.90°, respectively, with no significant differences among the FBA groups. The degree of femoral rotation significantly affected the FVA (F = 62.148, P 〈 0.000), whereas there was no effect on condyle resection thickness (F = 0.4705, P = 0.494). Conclusions: Axial femoral rotation has less effect on radiographic measurements of differences in the DRT than on those of the distal FVA.展开更多
BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for whic...BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.展开更多
Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a v...Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a validated inertial measurement unit(IMU)method for capturing knee RoM was deployed assessing postoperative RoM both in and outside of the clinical setting.The study's objectives were to evaluate the feasibility of continuously capturing knee RoM pre-/post-op via IMUs,dividing data into PT/non-PT portions of each day,and comparing PT/non-PT metrics.We hypothesized IMU-based clinical knee RoM would differ from IMU-based knee RoM captured outside clinical settings.10 patients(3 M,69±13 years)completed informed consent documents following ethics board approval.A validated IMU method captured long duration(8–12 h/day,~50 days)knee RoM pre-/post-op.Post-op metrics were subdivided(PT versus non-PT).Clinical RoM and patient reported outcome measures were also captured.Compliance and clinical disruption were evaluated.ANOVA compared post-op PT and non-PT means and change scores.Maximum flexion during PT was less than outside PT.PT stance/swing RoM and activity level were greater than outside PT.No temporal variable differences were found PT versus non-PT.IMU RoM measurements capture richer information than clinical measures.Maximum PT flexion was likely less than non-PT due to the exercises completed(i.e.high passive RoM vs.low RoM gait).PT gait flexion likely exceed non-PT because of‘white coat effects’wherein patients are closely monitored clinically.This implies data captured clinically represents optimum performance whereas data captured non-clinically represents realistic performance.展开更多
Coronal plane alignment in total knee arthroplasty(TKA)is an important predictor of clinical outcomes including patient satisfaction and device longevity.Radiography and computer assisted navigation are the two primar...Coronal plane alignment in total knee arthroplasty(TKA)is an important predictor of clinical outcomes including patient satisfaction and device longevity.Radiography and computer assisted navigation are the two primary technologies currently available to surgeons for intraoperative assessment of alignment;however,neither is particularly well-suited for use in this increasingly high volume procedure.Herein we propose a novel gyroscopebased instrument for intraoperative validation of tibia coronal plane alignment,and provide initial analytical and experimental performance assessments.The gyroscope-based alignment estimate is derived from simplified joint geometry and verified experimentally using a custom tibial trial insert containing a consumer-grade inertial measurement unit(IMU).Average accuracy of the gyroscope-based tibia coronal angle estimate was found to be within1in mechanical leg jig and cadaver testing.These results indicate that the proposed gyroscope-based method shows promise for low cost,accurate intraoperative validation of limb alignment in TKA patients.Integrating IMU technology into the TKA surgical workflow via low-cost instrumentation will enable surgeons to easily validate implant alignment in real time,thereby reducing cost,operating room time,and future revision burden.展开更多
Background:Despite the advent of innovative knee prosthesis design,a consistent first-option knee implant design in total knee arthroplasty(TKA)remained unsettled.This study aimed to compare the clinical effects among...Background:Despite the advent of innovative knee prosthesis design,a consistent first-option knee implant design in total knee arthroplasty(TKA)remained unsettled.This study aimed to compare the clinical effects among posterior-stabilized(PS),cruciate-retaining(CR),bi-cruciate substituting(BCS),and bi-cruciate retaining designs for primary TKA.Methods:Electronic databases were systematically searched to identify eligible randomized controlled trials(RCTs)and cohort studies from inception up to July 30,2021.The primary outcomes were the range of knee motion(ROM),and the secondary outcomes were the patient-reported outcome measures(PROMs)and complication and revision rates.Confidence in evidence was assessed using Confidence in Network Meta-Analysis.The Bayesian network meta-analysis was performed for synthesis.Results:A total of 15 RCTs and 18 cohort studies involving 3520 knees were included.The heterogeneity and inconsistency were acceptable.There was a significant difference in ROM at the early follow-up when PS was compared with CR(mean difference[MD]=3.17,95%confidence interval[CI]0.07,7.18)and BCS was compared with CR(MD=9.69,95%CI 2.18,17.51).But at the long-term follow-up,there was no significant difference in ROM in any one knee implant compared with the others.No significant increase was found in the PROMs and complication and revision rates at the final follow-up time.Conclusions:At early follow-up after TKA,PS and BCS knee implants significantly outperform the CR knee implant in ROM.But in the long run,the available evidence suggests different knee prostheses could make no difference in clinical outcomes after TKA with extended follow-up.展开更多
文摘BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit rate.There were three(1.2%)hospital readmissions within 90 d postoperatively.With a mean time to latest follow-up of 3.3 years,four patients(1.6%)required revision,two for arthrofibrosis,one for aseptic femoral loosening,and one for peri-prosthetic joint infection.There were significant improvements in KOOS JR,PROMIS Pain Intensity,PROMIS Pain Interference,PROMIS Mobility,and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores.CONCLUSION The evaluated implant is an effective,novel design offering excellent outcomes and low complication rates.At a mean follow up of 3.3 years,four patients required revisions,three aseptic and one septic,resulting in an overall implant survival rate of 98.4%and an aseptic survival rate of 98.8%.The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.
文摘AIM: To investigate the correlation between preoperative measurement in total knee arthroplasty and the prosthetic size implanted. METHODS: A prospective double-blind study of 50 arthroplasties was performed. Firstly, the reliability and correspondence between the size of said measurement and the actual implant utilized was determined. Secondly, the existing correlation between the intra- and interobserver determinations with the intraclass correlation coefficient was analyzed. RESULTS: An overall correspondence of 54%, improving up to 92% when the measured size admitted a difference of one size, was found. Good intra- and interobserver reliability with an intraclass correlation coefficient greater than 0.90(P < 0.001) was also discovered. CONCLUSION: Agreement between the preoperative measurement with standardized acetate templates and the prosthetic size implanted can be considered satisfactory. We thus conclude it is a reproducible technique.
文摘Background:Accurate evaluation of the plain radiography of lower limb is critical for preoperative planning of total knee arthroplasty (TKA). We aimed to investigate the effect of femoral lateral bowing and rotation on the radiographic measurements of distal femoral condyle resection thickness (DRT) and the distal femoral resection valgus angle (FVA). Methods: We analyzed 246 three-dimensional femoral models generated from computed tomography images of 123 patients, acquiring projected contours in seven positions – 20° and 10° internal rotation; 0° rotation; 10°, 20°, 30°, and 40° external rotation – for each model. Medial and lateral condyle DRTs, femoral shaft lateral bowing angle (FBA), and distal FVA were determined for each position. Linear mixed effect model was used to determine the effect of degree of femur rotation on repeated measurements of DRT or FVA. Results: FBA significantly affected the FVA and DRT (Pearson's R = 0.767 and -0.408, respectively; P 〈 0.000). Samples were divided into three groups according to the FBA measured in neutral position: FBA 〈0°: DRT 3.75 ± 1.30 mm, FVA 4.53° ± 1.27°; FBA 〉0° but 〈3°: DRT 3.39 ± 1.31 mm, FVA 5.92° ± 1.31°; FBA 〉3°: DRT 2.22 ± 1.31 mm, FVA 7.37° ± 1.31°. From simulated 20° internal rotation to 40° external rotation in each femoral model, the average variation ranges of radiographically measured DRT, FVA, and FBA were 0.50 ± 0.28 mm, 2.93° ± 0.96°, and 10.33° ± 1.90°, respectively, with no significant differences among the FBA groups. The degree of femoral rotation significantly affected the FVA (F = 62.148, P 〈 0.000), whereas there was no effect on condyle resection thickness (F = 0.4705, P = 0.494). Conclusions: Axial femoral rotation has less effect on radiographic measurements of differences in the DRT than on those of the distal FVA.
文摘BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.
基金This was work supported by the National Center for Advancing Translational Sciences of the National Institutes of Health[UL1TR001086].
文摘Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a validated inertial measurement unit(IMU)method for capturing knee RoM was deployed assessing postoperative RoM both in and outside of the clinical setting.The study's objectives were to evaluate the feasibility of continuously capturing knee RoM pre-/post-op via IMUs,dividing data into PT/non-PT portions of each day,and comparing PT/non-PT metrics.We hypothesized IMU-based clinical knee RoM would differ from IMU-based knee RoM captured outside clinical settings.10 patients(3 M,69±13 years)completed informed consent documents following ethics board approval.A validated IMU method captured long duration(8–12 h/day,~50 days)knee RoM pre-/post-op.Post-op metrics were subdivided(PT versus non-PT).Clinical RoM and patient reported outcome measures were also captured.Compliance and clinical disruption were evaluated.ANOVA compared post-op PT and non-PT means and change scores.Maximum flexion during PT was less than outside PT.PT stance/swing RoM and activity level were greater than outside PT.No temporal variable differences were found PT versus non-PT.IMU RoM measurements capture richer information than clinical measures.Maximum PT flexion was likely less than non-PT due to the exercises completed(i.e.high passive RoM vs.low RoM gait).PT gait flexion likely exceed non-PT because of‘white coat effects’wherein patients are closely monitored clinically.This implies data captured clinically represents optimum performance whereas data captured non-clinically represents realistic performance.
基金This work was supported by OrthoSensor,Inc.,Dania Beach,FL[grant number 20151001].
文摘Coronal plane alignment in total knee arthroplasty(TKA)is an important predictor of clinical outcomes including patient satisfaction and device longevity.Radiography and computer assisted navigation are the two primary technologies currently available to surgeons for intraoperative assessment of alignment;however,neither is particularly well-suited for use in this increasingly high volume procedure.Herein we propose a novel gyroscopebased instrument for intraoperative validation of tibia coronal plane alignment,and provide initial analytical and experimental performance assessments.The gyroscope-based alignment estimate is derived from simplified joint geometry and verified experimentally using a custom tibial trial insert containing a consumer-grade inertial measurement unit(IMU).Average accuracy of the gyroscope-based tibia coronal angle estimate was found to be within1in mechanical leg jig and cadaver testing.These results indicate that the proposed gyroscope-based method shows promise for low cost,accurate intraoperative validation of limb alignment in TKA patients.Integrating IMU technology into the TKA surgical workflow via low-cost instrumentation will enable surgeons to easily validate implant alignment in real time,thereby reducing cost,operating room time,and future revision burden.
基金National Natural Science Foundation of China(No.81974347)Postdoctoral Science Foundation of China(No.2021M702351)Medical Science and Technology Program of Health Commission of Sichuan Province of China(No.21PJ040)
文摘Background:Despite the advent of innovative knee prosthesis design,a consistent first-option knee implant design in total knee arthroplasty(TKA)remained unsettled.This study aimed to compare the clinical effects among posterior-stabilized(PS),cruciate-retaining(CR),bi-cruciate substituting(BCS),and bi-cruciate retaining designs for primary TKA.Methods:Electronic databases were systematically searched to identify eligible randomized controlled trials(RCTs)and cohort studies from inception up to July 30,2021.The primary outcomes were the range of knee motion(ROM),and the secondary outcomes were the patient-reported outcome measures(PROMs)and complication and revision rates.Confidence in evidence was assessed using Confidence in Network Meta-Analysis.The Bayesian network meta-analysis was performed for synthesis.Results:A total of 15 RCTs and 18 cohort studies involving 3520 knees were included.The heterogeneity and inconsistency were acceptable.There was a significant difference in ROM at the early follow-up when PS was compared with CR(mean difference[MD]=3.17,95%confidence interval[CI]0.07,7.18)and BCS was compared with CR(MD=9.69,95%CI 2.18,17.51).But at the long-term follow-up,there was no significant difference in ROM in any one knee implant compared with the others.No significant increase was found in the PROMs and complication and revision rates at the final follow-up time.Conclusions:At early follow-up after TKA,PS and BCS knee implants significantly outperform the CR knee implant in ROM.But in the long run,the available evidence suggests different knee prostheses could make no difference in clinical outcomes after TKA with extended follow-up.