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1.
Effect of femoral component position on biomechanical outcomes of unicompartmental knee arthroplasty
Kyoung-Tak Kang Juhyun Son Yong-Gon Koh Oh-Ryong Kwon Sae Kwang Kwon Yong Jun Lee Kwan Kyu Park 《The Knee》2018,25(3):491-498
Background
The positions of unicompartmental femoral components do not always follow the neutral center of the medial distal femoral condyle. The biomechanical effect of the center of the distal femoral condyle has not yet been evaluated, and the optimal femoral position in unicompartmental knee arthroplasty (UKA) is yet to be biomechanically justified. The purpose of this study was to evaluate, using finite element analysis, the effect of the center of the distal femoral component on the biomechanical outcomes of UKA with respect to the contact stresses in the polyethylene (PE) insert and articular cartilage.Methods
Five models in which the centers of the distal femoral components were translated by three millimeters and five millimeters to the medial and lateral sides, respectively, from the neutral position were modeled and analyzed in a gait loading condition.Results
The contact stresses on the PE insert increased as the center of the femoral component translated to the lateral side and, in contrast, the contact stresses decreased as it translated to the medial side. For the articular cartilage the contact stresses increased and decreased as the center of the femoral component translated to the medial and lateral sides.Conclusion
This study implied that the best position for the femoral component in UKA could be the center of the distal femoral condyle. Femoral component position could be one of the sensitive factors that influenced the contact stresses on the PE insert and articular cartilage, and the postoperative significance of the femoral component position in UKA. 相似文献2.
Background
The anterior part of the distal femur in trochlear dysplasia has been well investigated; however, to date, posterior morphological characteristics have not been well studied. This study aimed to evaluate whether the posterior femoral condyle in patients with trochlear dysplasia differs from those without trochlear dysplasia.Methods
Computed tomography scans of 75 knees with trochlear dysplasia and 55 knees with normal anatomy of the patellofemoral joint were analyzed retrospectively. Three observers assessed the width, length, and height of the posterior condyle between the two groups. The intra-class correlation coefficient was used to evaluate inter-observer reliability. The independent Student's t-test was used to assess the statistical significance of the qualitative variables.Results
There was excellent inter-observer reliability (intra-class correlation coefficient 0.91–0.99) for all of the quantitative measurements. There were significant differences between trochlear dysplastic and normal knees. The trochlear dysplasia group had a larger medial posterior condyle and smaller lateral posterior condyle than the control group. Furthermore, proportion of the posterior condyle in the distal femur markedly differed between the two groups: in the trochlear dysplasia group, the medial posterior condyle accounted for a bigger proportion, while the lateral posterior condyle accounted for a smaller proportion.Conclusion
Patients with trochlear dysplasia have different posterior femoral condyles compared with those without trochlear dysplasia. Patients with this condition have bigger medial posterior condyles and smaller lateral posterior condyles. A greater amount of attention needs to be paid to this abnormality. 相似文献3.
Harshvardhan Chawla Jelle P. van der List Alexander B. Christ Maximiliano R. Sobrero Hendrik A. Zuiderbaan Andrew D. Pearle 《The Knee》2017,24(2):179-190
Background
Utilization of unicompartmental knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) as alternatives to total knee arthroplasty (TKA) for unicompartmental knee osteoarthritis (OA) has increased. However, no single resource consolidates survivorship data between TKA and partial resurfacing options for each variant of unicompartmental OA. This meta-analysis compared survivorship between TKA and medial UKA (MUKA), lateral UKA (LUKA) and PFA using annual revision rate as a standardized metric.Methods
A systematic literature search was performed for studies quantifying TKA, MUKA, LUKA and/or PFA implant survivorship. Studies were classified by evidence level and assessed for bias using the MINORS and PEDro instruments. Annual revision rates were calculated for each arthroplasty procedure as percentages/observed component-year, based on a Poisson-normal model with random effects using the R-statistical software package.Results
One hundred and twenty-four studies (113 cohort and 11 registry-based studies) met inclusion/exclusion criteria, providing data for 374,934 arthroplasties and 14,991 revisions. The overall evidence level was low, with 96.7% of studies classified as level III–IV. Annual revision rates were lowest for TKA (0.49%, CI 0.41 to 0.58), followed by MUKA (1.07%, CI 0.87 to 1.31), LUKA (1.13%, CI 0.69 to 1.83) and PFA (1.75%, CI 1.19 to 2.57). No difference was detected between revision rates for MUKA and LUKA (p = 0.222).Conclusions
Revisions of MUKA, LUKA and PFA occur at an annual rate of 2.18, 2.31 and 3.57-fold that of TKA, respectively. These estimates may be used to inform clinical decision-making, guide patient expectations and evaluate the cost-effectiveness of total versus partial knee replacement in the setting of unicompartmental OA. 相似文献4.
Background
osteochondritis dissecans (OCD) is an ancient disease with few well-described cases in paleopathological records. Here, we report a very rare case of OCD on both lateral femoral condyles and on the lateral condyle of the right tibia in an early medieval human skeleton.Methods
macroscopic examination of the bone vestiges of a young male unearthed from a 6th–8th Lombard cemetery in the northeast Italy was perform.Results
We observed a circular crater-like depression with well-defined smooth margins and exposure of the trabecular bone on both lateral femoral condyles and in the lateral condyle of the right tibia. The left tibia was fragmented and the lateral condyle was lacking. Findings are consistent with the diagnosis of multifocal juvenile osteochondritis dissecans of the knee.Conclusion
Research in past and modern skeletal remains can contribute to define the nature and distribution of OCD. 相似文献5.
Murat Bozkurt Serhan Unlu Nurdan Cay Nihal Apaydin Metin Dogan 《Surgical and radiologic anatomy : SRA》2014,36(8):741-746
Background
The anatomic and the kinematical relationships between the femur and the tibia have been previously examined in both normal and diseased knees. However, less attention has been directed to the effect of these relationships on the meniscal diseases. Therefore, we aimed to investigate the impact of femorotibial incongruence on both lateral and medial meniscal tears.Materials and methods
A total of 100 images obtained from MRI of 100 patients (39 males and 61 females) were included in the study. Diameters of the medial and the lateral femoral condyles, thicknesses of the menisci, and diameters of the medial and the lateral tibial articular surfaces were measured.Results
The medial meniscus tear was detected in 40 (40 %) patients. However, no lateral meniscus tear was found. Significant relationships were found between the diameters of the posterior medial femoral condyle and the medial tibial superior articular surface and between the diameters of the posterior lateral femoral condyle and the lateral tibial superior articular surface. The mean values for the diameter of the medial condyle of the femur, the lateral condyle of the femur, the medial superior articular surface of the tibia, and the lateral superior articular surface of the tibia were found to be significantly higher in cases with meniscus tear compared to cases without meniscus tear. However, no significant difference was present regarding the thicknesses of the medial and the lateral menisci. A positive relationship between the diameter of the posterior medial femoral condyle and the tibial medial superior articular surface was found in cases with (n = 40) (r 2 = 0.208, p = 0.003) and without tear (n = 60) (r 2 = 0.182, p = 0.001). In addition, a significant positive relationship was found between the diameter of the posterior medial femoral condyle and the medial tibial superior articular surface in cases with and without tear.Conclusion
The impact of femorotibial incongruence on the medial meniscus tear is important for the understanding of the lesions. 相似文献6.
Bernd Friesenbichler Julia F. Item-Glatthorn Vanessa Wellauer Fabian von Knoch Nicola C. Casartelli Nicola A. Maffiuletti 《The Knee》2018,25(4):638-643
Background
There are many uncertainties about the advantages and disadvantages of using unicompartmental (UKA) versus total knee arthroplasty (TKA) to treat patients with knee osteoarthritis. It is important to have sufficient early postoperative quadriceps strength for long-term, self-reported and gait-related outcomes after knee arthroplasty, but very limited comparative data exist regarding UKA and TKA patients.Methods
This study assessed isometric quadriceps strength, spatio-temporal gait parameters (walking speed, step length, single-limb support phase) and self-reported outcomes (pain, function, stiffness) in 18 TKA and 18 UKA patients six months after surgery, as well as in 18 healthy controls.Results
Quadriceps strength of TKA, but not of UKA patients, was lower than that of controls (P?<?0.05). UKA patients demonstrated better gait function in terms of a longer single-limb support phase than TKA patients (P?<?0.01), which agreed with better self-reported pain (P?<?0.05), function (P?<?0.01) and stiffness (P?<?0.05) scores compared to TKA patients.Conclusions
Six months after surgery, UKA patients showed better short-term quadriceps strength and gait function compared to TKA patients, together with less self-reported knee pain and stiffness. Patients eligible for UKA may experience less functional impairments compared to those who require TKA. 相似文献7.
Background
The main objective of the study was to determine if excessive body weight and meniscal destabilization cause knee articular cartilage damage and changes in meniscal histology indicative of knee osteoarthritis (OA).Methods
Forty female Lewis rats were randomly assigned to regular diet sham surgery, regular diet medial meniscus destabilization (DMM) surgery, high-fat diet sham surgery, or high-fat diet DMM surgery. Surgical intervention occurred four weeks after diet initiation. Rats were sacrificed four weeks post-surgery. Progression of OA was evaluated in femoral condyles and tibial plateaus using the Osteoarthritis Research Society International (OARSI) scoring system by two blinded scorers. Ossification of menisci was evaluated with digitized histological slides using a grid.Results
DMM surgery had greater OARSI scores than sham surgery for all knee surfaces in both diet groups (all P?<?0.004). The high-fat diet sham surgery group had greater OARSI scores than the regular diet sham surgery group on all knee surfaces (all P?<?0.02). Histological evaluation showed the lateral meniscus had more bone than the medial meniscus, but there was no relationship between diet or surgery groups and amount of bone in the meniscus.Conclusions
Results suggested excessive body weight may contribute to spontaneous onset of OA and emphasized the importance of preventative care in those at risk of developing OA. 相似文献8.
Xuesong Dai Jinghua Fang Lifeng Jiang Yan Xiong Miaofeng Zhang Sunan Zhu 《The Knee》2018,25(3):434-444
Background
Medial unicompartmental knee arthroplasty (UKA) using Oxford mobile-bearing prosthesis is performed in the treatment of medial compartmental arthritis of the knee. However, little is known about the stress distributions for mobile-bearing UKA on the medial tibial plateau.Methods
In this study, the stresses on the coronal plane were calculated in a three-dimensional model of the proximal tibia. The features of the stress distribution were investigated when the tibial tray was placed in 15°, 10°, six degrees, and three degrees varus, neutral (0°), and in three degrees, six degrees, 10°, and 15° valgus on the coronal plane of the medial plateau.Results
The peak von Mises stress was found on the cortex below the medial plateau while the stresses of cortical bone increased gradually as the inclination of the tibial tray was changed from varus to valgus. The amount of peak stress was almost the same as that in the normal knee model when the tibial tray was placed in six degrees valgus and consistently lower in varus inclination than in the normal knee model. Conversely, the peak stress of soft bone was found at the bottom of the slot.Conclusions
This study demonstrates that the inclination of the tibial component affects stress distribution in the proximal tibia after UKA. Slight varus inclination of the mobile-bearing tibial component is acceptable as it lowers the peak stress on the medial cortex. Additionally, placing the tibial tray in slight varus avoids a rise in stress between the tip of the keel and the medial tibial cortex. 相似文献9.
Andrew R. Hopkins Andrew M. New Ferdinando Rodriguez-y-Baena Mark Taylor 《Medical engineering & physics》2010,32(1):14-21
Concerns over accelerated damage to the untreated compartment of the knee following unicompartmental knee arthroplasty (UKA), as well as the relatively poor success rates observed for lateral as opposed to the medial arthroplasty, remain issues for attention. Finite element analysis (FEA) was used to assess changes to the kinematics and potential for cartilage damage across the knee joint in response to the implantation of the Oxford Mobile Bearing UKA. FE models of lateral and medial compartment arthroplasty were developed, in addition to a healthy natural knee model, to gauge changes incurred through the arthroplasty. Varus–valgus misalignments were introduced to the femoral components to simulate surgical inaccuracy or over-correction. Boundary conditions from the Stanmore knee simulator during the stance phase of level gait were used. AP translations of the tibia in the medial UKA models were comparable to the behaviour of the natural knee models (±0.6 mm deviation from pre-operative motion). Following lateral UKA, 4.1 mm additional posterior translation of the tibia was recorded than predicted for the natural knee. IE rotations of the medial UKA models were less consistent with the pre-operative knee model than the lateral UKA models (7.7° vs. 3.6° deviation). Varus misalignment of the femoral prosthesis was more influential than valgus for medial UKA kinematics, whereas in lateral UKA, a valgus misalignment of the femoral prosthesis was most influential on the kinematics. Resection of the cartilage in the medial compartment reduced the overall risk of progressive OA in the knee, whereas removing the cartilage from the lateral compartment, and in particular introducing a valgus femoral misalignment, increased the overall risk of progressive OA in the knee. Based on these results, under the conditions tested herein, both medial and lateral UKA can be said to induce kinematics of the knee which could be considered broadly comparable to those of the natural knee, and that even a 10° varus–valgus misalignment of the femoral component may not induce highly irregular kinematics. However, elevated posterior translation of the tibia in lateral UKA and large excursions of the insert may explain the higher incidence of bearing dislocation observed in some clinical studies. 相似文献
10.
Background
This work aimed to evaluate the changes in the femoral posterior condylar offset (PCO) and tibial slope after posterior cruciate ligament (PCL)-substituting total knee arthroplasty (TKA), and to address the presence of any interactive effect between the two on knee flexion.Methods
Fifty-two PCL-substituting TKAs were performed using a posterior referencing system. Three-dimensional reconstructed computed tomographic (CT) images were used to evaluate PCO and tibial slope before and after arthroplasty. Range of motion and clinical scores were evaluated at a mean of 3.1 years postoperatively. Multivariate linear model with interaction terms was used to evaluate and compare the relationships among changes in PCO, tibial slope, and postoperative knee flexion angles.Results
The degree of change in PCO was greater in the lateral condyle than in the medial condyle (3.1 ± 2.5 mm and ? 0.5 ± 2.8 mm, respectively). Postoperative medial and lateral tibial slopes were 1.4° ± 1.8 and 1.4° ± 2.0, respectively. The mean degree of postoperative knee flexion was 125°. Analysis with interaction terms and covariate adjustment demonstrated that medial PCO and tibial slope were significantly related to knee flexion with interactive effect (P = 0.011). In cases with < 3° posterior tibial slope, the postoperative PCO was positively correlated to the degree of knee flexion angle. However, in cases with > 3° tibial slope, PCO was negatively correlated to knee flexion.Conclusion
Medial femoral PCO and tibial slope showed interactive effect on knee flexion after PCL-substituting TKAs. Reconstitution of the proper PCO and avoiding excessive tibial slope may be necessary. 相似文献11.
Optimization of sagittal and coronal planes with robotic-assisted unicompartmental knee arthroplasty
Michael A. Gaudiani Benedict U. Nwachukwu Jayesh V. Baviskar Mrinal Sharma Anil S. Ranawat 《The Knee》2017,24(4):837-843
Background
One of the anatomic goals of total knee arthroplasty (TKA) is optimizing in the coronal and sagittal plane. Accurate alignments of both planes have been correlated to functional outcome and range of motion. There is a paucity of evidence on the accuracy of unicompartmental knee arthroplasty (UKA) in balancing biplanar knee alignment – specifically sagittal plane alignment. Because robotic assisted UKA has an advantage of more accurately manipulating sagittal plane for optimal alignment and kinematics based on pre-operative and intraoperative CT planning we assessed the accuracy.Methods
We reviewed the clinical and radiographic information of 94 robotic assisted UKA surgeries for balancing of sagittal and coronal knee anatomy using radiographic parameters, such as posterior condylar offset ratio (PCOR), posterior tibial slope (PTS), femoral-tibial angle, and joint line.Results
In the sagittal plane, we found no significant difference between pre and postoperative PCOR values. As planned, PTS was significantly lower after UKA compared to the native knee (4.91° vs 2.28°; p < 0.0001). In the coronal plane, there was no significant difference in the joint line however pre and post-operative mechanical axis were significantly different (5.43°± 2.58 of varus vs. 2.76°± 2.14 of varus; p < 0.0001).Conclusion
This study attempts to quantify sagittal and coronal plane alignment after robotic assisted UKA. More attention should be paid to the role of sagittal plane alignment after UKA. We believe modifying posterior tibial slope, while maintaining PCOR is fundamental in achieving native kinematics and optimizing range of motion in the sagittal plane. This may be best-accomplished using robotic techniques for UKA. 相似文献12.
Jelle P. van der List Dana L. Sheng Laura J. Kleeblad Harshvardhan Chawla Andrew D. Pearle 《The Knee》2017,24(3):497-507
Background
Aseptic loosening is a common failure mode in cemented unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This led to the development of cementless designs but the historical outcomes were poor. Recent developments in cementless designs have improved outcomes, but the current status is unknown. Therefore, a systematic review was performed to assess recent outcomes of cementless knee arthroplasty.Methods
A search was performed using PubMed, Embase and Cochrane systems and national registries for studies reporting outcomes since 2005. Fifty-two cohort studies and four registries reported survivorship, failure modes or functional outcomes of cementless UKA and TKA.Results
Nine level I studies, six level II studies, three level III studies, 34 level IV studies and four registries were included. Three hundred eighteen failures in 10,309 cementless TKA procedures and 62 failures in 2218 cementless UKA procedures resulted in extrapolated five-year, 10-year and 15-year survivorship of cementless TKAs of 97.7%, 95.4% and 93.0%, respectively, and cementless UKA of 96.4%, 92.9% and 89.3%, respectively. Aseptic loosening was more common in cementless TKA (25%) when compared to UKA (13%). Functional outcomes of cementless TKA and UKA were excellent with 84.3% and 84.5% of the maximum possible scores, respectively.Conclusions
This systematic review showed that good to excellent extrapolated survivorship and functional outcomes are seen following modern cementless UKA and TKA, with a low incidence of aseptic loosening following cementless UKA.Level of evidence
Level IV. 相似文献13.
Andrew D. Pearle Jelle P. van der List Lily Lee Thomas M. Coon Todd A. Borus Martin W. Roche 《The Knee》2017,24(2):419-428
Background
Successful clinical outcomes following unicompartmental knee arthroplasty (UKA) depend on lower limb alignment, soft tissue balance and component positioning, which can be difficult to control using manual instrumentation. Although robotic-assisted surgery more reliably controls these surgical factors, studies assessing outcomes of robotic-assisted UKA are lacking. Therefore, a prospective multicenter study was performed to assess outcomes of robotic-assisted UKA.Methods
A total of 1007 consecutive patients (1135 knees) underwent robotic-assisted medial UKA surgery from six surgeons at separate institutions between March 2009 and December 2011. All patients received a fixed-bearing metal-backed onlay implant as tibial component. Each patient was contacted at minimum two-year follow-up and asked a series of five questions to determine survivorship and patient satisfaction. Worst-case scenario analysis was performed whereby all patients were considered as revision when they declined participation in the study.Results
Data was collected for 797 patients (909 knees) with average follow-up of 29.6 months (range: 22–52 months). At 2.5-years of follow-up, 11 knees were reported as revised, which resulted in a survivorship of 98.8%. Thirty-five patients declined participation in the study yielding a worst-case survivorship of 96.0%. Of all patients without revision, 92% was either very satisfied or satisfied with their knee function.Conclusion
In this multicenter study, robotic-assisted UKA was found to have high survivorship and satisfaction rate at short-term follow-up. Prospective comparison studies with longer follow-up are necessary in order to compare survivorship and satisfaction rates of robotic-assisted UKA to conventional UKA and total knee arthroplasty. 相似文献14.
J.B. Seeger J.P. Schikschneit C. Schuld R. Rupp M. Rickert A. Jahnke G.S. Maier M. Clarius 《The Knee》2018,25(3):392-397
Background
Unicompartmental knee arthroplasty (UKA) is an effective treatment for patients with medial osteoarthritis of the knee joint. Instrumented gait analysis provides an objective measure to quantify and qualify postoperative changes of gait. The purpose of this study was to evaluate standardized instrumented gait analysis for functional recovery and gait as an outcome of mobile-bearing UKA in patients with medial osteoarthritis of the knee.Methods
Twenty-one patients with isolated medial osteoarthritis of the knee joint received mobile-bearing UKA. They were examined by a gait analysis before surgery and after an average follow-up time of seven months. Gait analysis was performed on a treadmill with six infrared-cameras to identify changes of gait characteristics (e.g., velocity, stride time, stride length, knee adduction and hip abduction).Results
Mean velocity (chosen by individuals) increased from 0.61 to 0.76 m/s and further significant advancements, particularly in the knee adduction and the hip abduction were detected. Time and length of strides improved significantly as well as the clinical scores American Knee Society Score (AKSS), Oxford-12, Hannover Functional Ability Questionnaire for Osteoarthritis (FFbH-OA) Score and Devane Score.Conclusion
Mobile-bearing UKA can restore physiological axis of the leg and improve gait and function of the knee joint. The combination of instrumented gait analysis with clinical scores constitutes an eligible measuring instrument to quantify and qualify changes in patients' gait patterns. 相似文献15.
Background
Anterior cruciate ligament (ACL) tears increase the risk of developing knee osteoarthritis. This risk increases further with concurrent meniscus injury. The role of bone changes during knee osteoarthritis development are not well-understood, but may be important to its etiology.Purpose
To explore the effects of ACL tears on bone mineral density (BMD) and bone microarchitecture at five years post-op and their relationship to meniscal pathology, using high-resolution peripheral quantitative computed tomography (HR-pQCT).Methods
Twenty-eight participants with unilateral ACL reconstructions five years prior and no evidence of clinical or radiographic osteoarthritis were recruited. All participants represented one of three meniscus statuses: meniscus intact, meniscus repair, or meniscectomy. BMD and bone microarchitecture of the subchondral bone plate and adjacent trabecular bone were assessed using HR-pQCT, and percent-differences between the injured and contralateral knee were determined.Results
Subchondral bone plate thickness in the lateral femoral condyle was higher in the reconstructed knee (9.0%, p?=?0.002), driven by the meniscus repair and meniscectomy groups (15.2% to 15.4%, p?<?0.05).Trabecular BMD was lower in the reconstructed knee in the medial femoral condyle (? 4.8% to ? 7.6%, p?<?0.05), driven by all meniscus statuses. In the lateral compartments, few differences in trabecular bone were found. However, accounting for meniscus status, the meniscus intact group had lower trabecular BMD throughout both femur and tibia.Conclusions
Five years post-op, reconstructed knees demonstrated detectable differences in BMD and bone microarchitecture, despite having normal radiographs. Meniscus damage affected primarily the lateral compartment, warranting further investigation to determine if these changes relate to osteoarthritis development. 相似文献16.
Yuan-Kai Hsu Shi-Yuan Sheu Chia-Yih Wang Ming-Hsi Chuang Pei-Chun Chung Yu-Siang Luo Jun-Jie Huang Fumihito Ohashi Hideo Akiyoshi Tzong-Fu Kuo 《The Knee》2018,25(6):1181-1191
Background
This study aimed to investigate the efficacy of adipose-derived mesenchymal stem cells (ADSCs), platelet-rich fibrin releasates (PRFr), and chondrocyte transplantation in rabbit acute osteochondral defects.Methods
Thirty rabbits were randomly assigned to five groups: untreated controls; ADSCs alone; PRFr alone; PRFr?+?ADSCs; and PRFr?+?chondrocytes. The critical size osteochondral defects in right knee femoral condyles were injected intra-articularly according to the groups, as listed. The experimental rabbits received treatments once a week for two weeks postoperatively. All evaluations were conducted for 14?weeks following surgery, and the regenerated cartilages were assessed by gross inspection and histological examination.Results
There were no complications encountered in any of the rabbits. The size of the defect decreased and the volume of repaired cartilage increased in the medial femoral condyles of the PRFr?+?ADSCs group. Relative to the ADSCs or PRFr group, histological examination demonstrated that the PRFr?+?ADSCs group had thicker hyaline cartilage-specific extracellular matrix. Grading scores revealed that PRFr?+?ADSCs injection had better matrix, cell distribution, and surface indices than other groups (P?<?0.05). However, the histological scores reported for PRFr?+?chondrocytes on cartilage repair were similar to those of PRFr, and there were no significant between-group differences.Conclusions
These findings showed that intra-articular injections of PRFr?+?ADSCs into the knee can reduce cartilage defects by regenerating hyaline-like cartilage without complications. This approach may provide an alternative method for functional reconstruction of acute osteochondral defects with an unlimited source of cells and releasates. 相似文献17.
Yasushi Oshima Norishige Iizawa Tatsunori Kataoka Tokifumi Majima Shinro Takai 《The Knee》2018,25(1):195-202
Background
Femoral rotational alignment is considered an essential factor for total knee arthroplasty because malrotation of femoral components results in poor outcomes. To obtain proper alignment, we developed a superimposable computed tomography (CT) scan-based template to intraoperatively determine the accurate surgical epicondylar axis (SEA), and evaluated the effectiveness of this CT template.Methods
In the experimental group (n = 55), three serial slices of CT images, including medial and lateral epicondyles, were merged into a single image, and SEA was overlaid. SEA was traced onto an image of an assumed distal femoral resection level; this combined image was then printed out onto a transparent film as a CT template. Following a distal femoral resection in TKA, SEA was duplicated onto the femoral surface. Thereafter, the posterior condyle was resected parallel to this SEA. In the control group (n = 53), posterior condyles were resected at three degrees of the external rotation from the posterior condylar line (PCL).A posterior condylar angle (PCA) between PCL of the femoral component and SEA was postoperatively evaluated. Positive values indicated external rotation of the femoral component from the SEA.Results
In the experimental group, PCA was 0.01° ± 1.61°, and three cases were considered as outliers (greater than three degrees or less than ?3 degrees). Conversely, in the control group, PCA was 0.10° ± 2.4°, and 12 cases were considered as outliers. Consequently, dispersion of PCA data was significantly smaller in the experimental group (P = 0.004).Conclusions
The CT template accurately determined intraoperative SEA. 相似文献18.
Manabu Kawata Yusuke Sasabuchi Hiroshi Inui Shuji Taketomi Hiroki Matsui Kiyohide Fushimi Hirotaka Chikuda Hideo Yasunaga Sakae Tanaka 《The Knee》2017,24(5):1198-1205
Background
Various nationwide studies have reported differing annual trends in utilization of knee arthroplasty and tibial osteotomy. Using the Diagnosis Procedure Combination database in Japan, the present series examined annual trends and demographics in total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and tibial osteotomy.Methods
All patients were identified who underwent TKA, UKA or tibial osteotomy for osteoarthritis, osteonecrosis or rheumatoid arthritis of the knee between July 2007 and March 2015.Results
A total of 170,433 cases of TKA, 13,209 cases of UKA and 8760 cases of tibial osteotomy were identified. The proportion of patients undergoing UKA rose from 4.0% in 2007 to 8.1% in 2014 (P < 0.001), and that of tibial osteotomy from 2.6% in 2007 to 5.5% in 2014 (P < 0.001); the proportion undergoing TKA fell from 93.4% in 2007 to 86.3% in 2014 (P < 0.001). Between 2007 and 2014 the proportions of patients with osteonecrosis who underwent UKA and tibial osteotomy increased from 34.7% and 11.6% to 38.6% and 16.2%, respectively (P = 0.001 for UKA and P = 0.004 for tibial osteotomy). The proportions of patients with osteonecrosis undergoing UKA or tibial osteotomy were significantly greater than those with other diagnoses (P < 0.001 for both).Conclusions
The popularity of UKA and tibial osteotomy in Japan increased during the period 2007–2014 at the expense of TKA. The proportions of UKA and tibial osteotomy in patients with osteonecrosis also increased, and were larger than those in patients with other causative diseases. 相似文献19.
Won Sik Choy Kwang Won Lee Ha Yong Kim Kap Jung Kim Young Sub Chun Dae Suk Yang 《The Knee》2017,24(4):829-836
Background
Because Asian populations have different lifestyles, such as squatting and sitting on the floor, from those of Western populations, it is possible that the clinical results and survival rate of unicompartmental knee arthroplasty (UKA) for Asian patients may be different. This study described outcomes of mobile bearing medial UKA for Korean patients.Methods
A total of the 164 knees treated with mobile bearing UKAs in 147 patients (14 males and 133 females) were reviewed. The mean follow-up period was 12.1 years (range 10.1–14).Results
The clinical outcomes, such as the Hospital for Special Surgery Knee score, the Oxford Knee Score and the Knee Society rating system, showed statistically significant improvement from pre-operative to final follow-up (P < 0.05). A total of 26 UKAs (15.8%) required revision; the most common reason was bearing dislocation. The 95% confidence interval of survival rate at 12 years was 84.1%, with revision for any reason as the end point.Conclusions
Minimally invasive mobile bearing UKA in Asian patients who required high degrees of knee flexion showed rapid recovery and good clinical outcome. However, they also showed relatively high rates of bearing dislocation and aseptic loosening. Therefore, mobile bearing UKA should only be performed in patients whose lifestyle involves high flexions after carefully considering these risks and benefits. 相似文献20.
This study describes the soft X-ray examinations of 24 lateral tibial plateaus obtained during total knee arthroplasty for varus osteoarthritis. The average thickness of the articular cartilage was 3.5 min and ranged from 2.1 to 5.0. We considered that 21 out of the 24 lateral tibial plateaus had well preserved articular cartilage. Within the well preserved articular cartilage, bony protuberances of various sizes were found in five cases. All lateral tibial plateaus except one showed osteophyte formation. We considered that 12 of the 24 lateral tibial plateaus had large osteophytes. Ten of these 12 lateral tibial plateaus had well preserved articular cartilage. Large osteophyte formation may not necessarily be a contra-indication of high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA). Cases with a bony protuberance may not be suitable for HTO or UKA, because the overlying articular cartilage is thin and inadequate for supporting load. 相似文献