The octogenarian total knee arthroplasty

Sixty-five patients aged > 80 years were compared to 65 patients aged between 60 and 70 years to assess total knee arthroplasty (TKA) outcome using the octogenarian postoperative Knee Society knee and function scores. Knee Society knee scores showed excellent outcomes with no statistically significant difference in the younger cohort (preoperative score, P = .7156; 5-year score, P = -.0677). Knee Society function scores also showed good outcomes with no statistically significant difference between the groups (preoperative score, P = .1147; 5-year score, P = .1348). Average length of stay increased by 3 days for octogenarians. Octogenarians had more pre-existing medical conditions and suffered more postoperative confusion. All but 1 patient rated the result as good/excellent. Patients maintained their independence for approximately 3.5 years before requiring more social input. With careful preoperative planning and counseling, TKA is recommended for the octogenarian.     

Short-term differences in anterior knee pain and clinical outcomes between rotating and fixed platform posterior stabilized total knee arthroplasty with a new femoral component design

AIM To compare rotating versus fixed-bearing Press-Fit Condylar(PFC) Sigma posterior stabilized(PS) total knee arthroplasty(TKA) with the new "J curve"femoral design in terms of clinical outcomes and anterior knee pain.METHODS We retrospectively analyzed 39 patients who underwent primary total knee replacement surgery for knee osteoarthritis using the PFC Sigma PS TKA with either fixed(FP group, 20 cases) or rotating platform(RP group, 19 cases) treated between 2009 and 2013 by the same surgeon. The two groups were homogeneous for age, gender, weight, American Society of Anesthesiologists status, preoperative clinical and functional scores, and prosthetic alignment at two years after surgery. We analyzed clinical outcomes score at two years follow-up using Knee Society Score(KSS), Knee Injury and Osteoarthritis Outcome Score(KOOS),Knee Performance Score, Short Form(SF) 36, and anterior knee pain assessed by the Hospital for Special Surgery(HSS) patellar score.RESULTS No differences were found in KSS, Knee Performance Score, and SF-36 outcome scores. A statistically significant difference was found in the HSS Patella score objective(FP: 22.36; RP: 28.75; P 0.05), HSS Patella score total(FP: 73.68; RP:86.50; P 0.05), and KOOS symptoms(FP: 73.49; RP: 86.44; P 0.05).CONCLUSION Rotating platform in PFC Sigma PS TKA appears to reduce the short-term incidence of anterior knee pain compared to the fixed platform.     

Functional Outcome of Total Knee Arthroplasty After Periprosthetic Distal Femoral Fracture

A prospective matched cohort study was performed to compare functional outcomes between 28 patients with periprosthetic femoral fractures and 28 with primary total knee arthroplasties (TKA). The mean follow-up was 6.7 years (range, 5–9). Radiographic osteopenia was a predisposing factor, but not notching, body mass index, or preinjury knee scores or motion. At last follow-up, the Knee Society scores, knee motion, Womac, and SF-12 were significantly lower in the fracture group, and were significantly decreased compared to the preinjury status. We found that periprosthetic distal femoral fracture after TKA worsens functional outcomes at the medium term, but arthroplasty complication and survival rates were similar in both groups.     

Influence of limb alignment and prosthetic orientation on patient-reported clinical outcomes in total knee arthroplasty

BackgroundThe relationship between postoperative limb alignment and clinical outcomes in primary total knee arthroplasty (TKA) is well reported, but the instruments used to evaluate clinical outcomes of TKA are mainly scoring systems from the physician's viewpoint, not patient-reported outcomes. The purpose of this study was to investigate retrospectively the relationship between postoperative limb alignment and patient-reported clinical outcomes using the 2011 Knee Society Knee Scoring System (2011 KSS).MethodsThe present study included 155 knees of patients (median age, 74 years) who underwent primary TKA for varus osteoarthritis, with a mean follow-up period of 46 months. The subjects were divided into three groups based on postoperative limb alignment and femoral and tibial component positioning angle (varus, neutral, and valgus). The 2011 KSS scores were compared among the groups.ResultsFor limb alignment, the postoperative objective knee indicator score was significantly lower in the valgus group than in the varus and neutral groups, whereas no significant differences were observed in any subjective categories of the 2011 KSS. However, for the femoral component angle, functional activity scores were significantly lower in the valgus group than in the varus and neutral groups.ConclusionsThe subjective patient-reported score was not affected by the postoperative limb alignment. However, the valgus femoral component angle resulted in lower subjective functional scores. For clinical relevance, postoperative valgus positioning of femoral component should be avoided from patient-reported functional aspects during TKA.     

Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty

A total of 208 patients were enrolled in a multicenter, prospective randomized, institutional review board-approved study that compared preoperative surgical plan to postoperative 2-dimensional radiographic alignment measured by a blinded reviewer for primary total knee arthroplasty (TKA) implanted using computer-assisted surgery (CAS) compared with conventional TKA instrumentation. The results demonstrated a statistically significant improvement in the coronal tibial component alignment (P < .03) and failed to demonstrate a statistically significant improvement in the mechanical axis, femoral coronal/sagittal, and tibial sagittal alignment. Knee Society Score knee and function scores and 6-minute walk test were equivalent between the 2 treatment groups at all postoperative intervals. There was a statistically significant increase in the skin-skin time (P < .0001) and the time until first bone cut (P < .0001) for the CAS knees compared with those implanted with conventional instrumentation. The use of CAS in this randomized clinical trial conducted at high-volume centers did not offer a clinically meaningful improvement in postoperative alignment, clinical, functional, or safety outcomes compared with conventional TKA.     

股骨远端解剖的性别差异对全膝关节置换术后临床疗效的影响

目的 探讨股骨远端解剖的性别差异对全膝关节置换术后临床疗效的影响.方法 2003年3月至2006年10月,对213例(294膝)骨关节炎患者采用固定平台高屈曲后稳定型假体行全膝关节置换术治疗,男87例(118膝),女126例(176膝);年龄55～70岁,平均64.4岁.患膝均无膝反张;伸直受限＜10°,膝内翻或膝外翻＜10°,KSS内外侧稳定性评分≥10分,双膝关节屈曲度均≥110°,双侧股四头肌肌力4+～5级,体重指数＜30 kg/m2.对患者术前、术后2年的KSS评分,股骨远端前后径校正后的股骨前、后髁偏距以及术前、术中、术后2年的膝关节屈曲度进行比较.结果 术前男、女患者的KSS各项评分、膝关节屈曲度,术后膝关节屈曲度、KSS稳定性评分、行走功能的改善值差异均无统计学意义;而男性患者术后KSS疼痛评分,上、下楼功能,术中膝关节屈曲度的改善值均高于女性.两组校正后的股骨后髁偏距均有所减小,女性的减小程度显著高于男性[女性(-5.23±3.02)mm,男性(-1.38±2.04)mm],前髁偏距减小程度相同[女性(-2.39±2.72)mm,男性(-2.97±2.81)mm].校正后的后髁偏距改变值与术后KSS疼痛评分、爬楼功能及术中膝关节屈曲度的改善值均呈正向相关.结论 中国男性全膝关节置换术后疗效优于女性,股骨假体设计应考虑不同性别间的解剖差异.     

股骨远端解剖的性别差异对全膝关节置换术后临床疗效的影响

目的 探讨股骨远端解剖的性别差异对全膝关节置换术后临床疗效的影响.方法 2003年3月至2006年10月,对213例(294膝)骨关节炎患者采用固定平台高屈曲后稳定型假体行全膝关节置换术治疗,男87例(118膝),女126例(176膝);年龄55～70岁,平均64.4岁.患膝均无膝反张;伸直受限＜10°,膝内翻或膝外翻＜10°,KSS内外侧稳定性评分≥10分,双膝关节屈曲度均≥110°,双侧股四头肌肌力4+～5级,体重指数＜30 kg/m2.对患者术前、术后2年的KSS评分,股骨远端前后径校正后的股骨前、后髁偏距以及术前、术中、术后2年的膝关节屈曲度进行比较.结果 术前男、女患者的KSS各项评分、膝关节屈曲度,术后膝关节屈曲度、KSS稳定性评分、行走功能的改善值差异均无统计学意义;而男性患者术后KSS疼痛评分,上、下楼功能,术中膝关节屈曲度的改善值均高于女性.两组校正后的股骨后髁偏距均有所减小,女性的减小程度显著高于男性[女性(-5.23±3.02)mm,男性(-1.38±2.04)mm],前髁偏距减小程度相同[女性(-2.39±2.72)mm,男性(-2.97±2.81)mm].校正后的后髁偏距改变值与术后KSS疼痛评分、爬楼功能及术中膝关节屈曲度的改善值均呈正向相关.结论 中国男性全膝关节置换术后疗效优于女性,股骨假体设计应考虑不同性别间的解剖差异.     

The effect of a 12 week prehabilitation program on pain and function for patients undergoing total knee arthroplasty: A prospective controlled study

BackgroundThe concept of preparing the body before a stressful event, such as surgery, has been termed “prehabilitation” (preoperative physiotherapy and exercise programs). Prehabilitation programs for people awaiting total knee arthroplasty (TKA) have positive effects on patients health status and may also lead to better postoperative outcomes.AimThe purpose of this study was to examine effect of a prehabilitation program on knee pain, functional ability among patients with knee osteoarthritis after TKA surgery.Study DesignA Prospective Controlled Study.Patients and MethodsSubjects enrolled in this prospective controlled study who referred to our Orthopedics and Traumatology outpatient clinic between 2014 April–2015 May, had severe OA with pain not responsive to conservative treatment and scheduled for unilateral TKA. Subjects were assigned to a control or prehabilitation group. Patients of prehabilitation group were recruited from the orthopaedic waiting lists for primary unilateral TKA. Partipicants in the prehabilitation group were prescribed a training program that consisted of education and home-based exercise 12 weeks before the operation. After the TKA, all subjects partipicated in the same postoperative rehabilitation protocol. Evaluations were made before the surgery, with follow-up assessments at 3 and 6 months after surgery. Knee pain was assessed by the use of a 10-cm Visual Analog Scale (VAS) and function assesed by Knee injury and Osteoarthritis Outcome Score (KOOS) scale.ResultsA statistically significant improvement was observed in the values of VAS and all subsclaes of KOOS in both groups at third and sixth month compared to baseline. The intergroup comparison of the improvement (pre-post scores at sixth month) did not show any statistically significant diffeferences in VAS and KOOS scores.ConclusionOur results show that prehabilitation before TKA is not superior to surgical treatment alone but about 20% of the patients changed their operation decision. So it is important to be able to postpone this process especially in the early period.     

Influence of stability on range of motion after cruciate-retaining TKA

BACKGROUND: A loosely balanced total knee arthroplasty (TKA) is reported to produce a good postoperative range of motion (ROM), but too much laxity is thought to be the cause of persistent pain and worsened functionality. METHODS: The anteroposterior and mediolateral laxity values were measured to evaluate the influence of stability after cruciate-retaining (CR) TKA on ROM and the modified Knee Society score at 4-8 years after the operation. Twenty-one knees in 15 patients with an average age of 68 years who had undergone a CR TKA for osteoarthrosis were examined. The mean preoperative and postoperative ROM was 124 degrees and 112 degrees, respectively. The mean anteroposterior and mediolateral laxity values were 9.7 mm and 10.6 degrees, respectively. RESULTS: No correlation was found between the postoperative ROM and laxity or between the modified Knee Society score and laxity. A loosely balanced TKA did not produce a good postoperative ROM. No parameters suggested that lax knees showed a higher pain score and lower functional score than stable knees.     

Long-Term Functional Outcomes and Quality of Life at Minimum 10-Year Follow-Up After Fixed-Bearing Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty for Isolated Medial Compartment Osteoarthritis

BackgroundThe aim of this study is to compare the long-term functional outcome and quality of life between total knee arthroplasty (TKA) and fixed-bearing unicompartmental knee arthroplasty (UKA) for the treatment of isolated medial compartment osteoarthritis.MethodsBetween 2000 and 2008, a total of 218 patients underwent primary UKA at our tertiary hospital. A TKA group was matched through 1:1 propensity score matching and adjusted for age, gender, body mass index, preoperative knee flexion, and function scores. All patients had medial compartment osteoarthritis. The patients were assessed with the range of motion, Knee Society Knee Score and Knee Society Function Score, Oxford Knee Score, Short Form-36 physical component score (PCS) and mental component score preoperatively, at 6 months, 2 years, and 10 years. Patients’ satisfaction, expectation fulfillment, and minimal clinically important difference were analyzed.ResultsThere were no differences in baseline characteristics between groups after propensity score matching (P > .05). UKA had greater knee flexion at all time points. Although the Knee Society Function Score was superior in UKA by 5.5, 3, and 4.3 points at 6 months, 2 years, and 10 years, respectively (P < .001), these differences did not exceed the minimal clinically important difference (Knee Society Knee Score 6.1). There were no significant differences in the Oxford Knee Score and Short Form-36 physical component score/mental component score. At 10 years, similar proportions of UKA and TKA were satisfied (90.8% vs 89.9%, P = .44) and had expectation fulfillment (89.4% vs 88.5%, P = .46). Between 2 and 10 years, all function scores deteriorated significantly for both groups (P < .01).ConclusionUKA and TKA are excellent treatment modalities for isolated medial compartment osteoarthritis, with similar functional outcomes, quality of life, and satisfaction at 10 years.     

The Clinical Outcome of Patellofemoral Arthroplasty vs Total Knee Arthroplasty in Patients Younger Than 55 Years

BackgroundPatellofemoral osteoarthritis affects 10% of patients older than 40 years and is commonly treated by patellofemoral joint arthroplasty (PFA) or a total knee arthroplasty (TKA). PFA is a more conservative approach with documented faster recovery. No study to date has compared both approaches with respect to patient-reported outcome measures in patients younger than 60 years.MethodsA retrospective case-matched cohort based on age, sex, body mass index, and side of 23 PFAs (in 19 patients) operated on by 2 surgeons and of 23 TKAs (23 patients) operated on by 6 surgeons was included in the study. All patients were younger than 55 years and operated on between March 2010 and September 2015. The Western Ontario and McMaster Osteoarthritic Index, Knee injury and Osteoarthritis Outcome scores, Tegner, and University of California, Los Angeles activity scores were compared between preoperative and minimum 2-year postoperative timepoints between groups.ResultsTKA and PFA were comparable on all patient-reported outcome measures at minimum 2-year follow-up; however, PFA patients exhibited statistically significantly larger improvement between 1 year postoperative and 2 years postoperative timepoints (P < .05). All patients improved between preoperative and postoperative timepoints (P < .05).ConclusionAlthough TKA performed better with respect to functional outcomes at the 1-year mark, at 2-year follow-up, PFA and TKA performed equally well. Our results allow us to conclude that in younger patients with isolated patellofemoral osteoarthritis who desire a more conservative, kinematic-preserving approach, PFA continues to be a practical treatment option yielding early outcomes that compare favorably with TKA.     

Change in Body Mass Index After Total Knee Arthroplasty and Its Influence on Functional Outcome

Background

There is often an assumption by patients that weight loss will occur once their knee pain is relieved by total knee arthroplasty (TKA). This study aims to evaluate (1) the change in patients' body mass index (BMI) after TKA; (2) if postoperative change in BMI influences functional outcome and survival rate of TKA; and (3) the predictive factors associated with change in BMI.

Mid-term results of total knee arthroplasty after high tibial osteotomy

Background The outcome of total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is still controversial. In order to determine if osteotomy has any effect on this outcome we performed a medium-term review of a cohort of patients with knee osteoarthritis. Materials and methods Thirty-two patients (38 knees), who were treated with a HTO before the TKA during the last 8 years, were compared with a matched group who underwent primary TKA. The knees were evaluated preoperatively and postoperatively according to the scoring systems of the Knee Society and Hospital for Special Surgery (HSS). The anteroposterior tibiofemoral alignment, the Insall–Salvati patellar position ratio, range-of-motion and the location of the lateral joint line, were also recorded. The patients were reviewed with a mean follow-up of 4.5 years after TKA. Results The preoperative and postoperative knee scores had no statistically significant differences between the two groups. So was the case with the intraoperative releases, blood loss, thromboembolic or neurologic complications and infection rates in either group. Access to perform the arthroplasty was reportedly more difficult and took an average of 25 min longer. A significant difference (p < 0.05) was detected in terms of impingement of the tibial stem on the lateral tibial cortex, patellar subluxation and patella baja between the two groups but this did not have any influence on the outcome of the prosthesis. Knee alignment and stability so as range of motion (ROM) measurements were also found with no statistical significance. Conclusion Although we did manage to detect statistically significant differences mainly in radiographic results between the two groups, this situation did not appear to influence the clinical outcome of the patients, however. The fact that most of the patients had good or excellent results at an average follow-up of 4.5 years suggests that HTO does not have a significant negative effect on later TKA.     

A Prospective Randomized Study of Bicompartmental vs. Total Knee Arthroplasty with Functional Testing and Short Term Outcome

The purpose of this study was to compare 50 bicompartmental knee arthroplasty (BKA) and total knee arthroplasty (TKA) cases, particularly in restoring knee function. Patients were between 30 and 65 years old, with a BMI under 35, and had osteoarthritis in the medial and patellofemoral compartments. Knee Society scores, Oxford questionnaires, radiographs, and functional tests were performed preoperatively, and at 1, 4, 12, and 24 months postoperatively. Functional testing included gait analysis, stair climbing, lunging, and sit-to-stand analysis. Both groups achieved equivalent Knee Society scores (2 year mean 93.6 vs. 92.6, P = 0.43) and Oxford scores (2-year mean 43 vs. 41, P = 0.35). Functional testing showed significant improvement. Two years postoperatively the BKA and TKA groups achieved equivalent results in clinical scores and functional testing.     

Primary total knee arthroplasty in patients receiving workers' compensation benefits.

OBJECTIVE: To determine the influence of Ontario Workplace Safety and Insurance Board (WSIB) benefits on short-term clinical outcomes of primary unilateral total knee arthroplasty (TKA). METHODS: In a retrospective matched-cohort study at a single tertiary-care arthroplasty centre in Ontario, we compared a study cohort of 38 successive primary TKA patients receiving WSIB benefits from 1998 to 2002 to 38 controls, a matched cohort of non-WSIB patients, comparing Oxford Knee Score and Knee Society Score (both clinical and functional components) as well as flexion and pain variables, preoperatively and at postoperative intervals of 6 weeks, 6 months and 1 year. At least 1 year after their surgery, all patients were asked to complete a non-validated patient satisfaction survey. The number of clinic visits related to the operation was also compared, by means of Ontario Hospital Insurance Plan billing codes for each individual. RESULTS: Preoperative measurements showed the 2 groups to be similar. At follow-up, WSIB patients had significantly higher pain scores, poorer self-perceived functional outcomes and a lower range of knee flexion than the control group. WSIB patients also required more postoperative clinic visits and were more reluctant to answer questions about functional outcome. CONCLUSIONS: Short-term outcomes of primary TKA in patients receiving WSIB benefits are inferior to those of non-WSIB patients. WSIB patients are seen more frequently for postoperative follow-up, which we would attribute to the persistence of subjective complaints after TKA.     

On the outcome of computer-assisted total knee replacement

A number of studies have reported a significant improvement of the postoperative alignment, when computer-navigated total knee arthroplasty (TKA) was compared with conventional techniques. However, no studies are available on the functional and patient-relevant outcomes after computer-assisted knee replacement. In a prospective, randomized trial comparing 27 computer-assisted TKAs with 25 conventional implantations, the Knee Society Score was used to assess functional status, and the WOMAC questionnaire was used to record the disease-specific, patient-relevant outcome. At a twelve-month follow-up no significant difference was detected between the two patient groups in either the scores or the number of complications and range of postoperative knee flexion. The results are in agreement with those reported in other studies on the effect of conventional TKA. With the patient group of this size it can be concluded that computer-navigated TKA gives short-term resuits comparable with those achieved by conventional methods of implantation.