Automated Virtual Placement and Evaluation of Tibial Components for Knee Arthroplasty

2011 ◽  
Author(s):  
Yifei Dai ◽  
Mary S. S. Wentorf ◽  
Jeffrey E. Bischoff
Keyword(s):  
Knee Arthroplasty ◽  
Rotational Alignment ◽  
Implant Design ◽  
Rotational Axis ◽  
Rotational Malalignment ◽  
Tibial Tray ◽  
Key Factor ◽  
Total Knee ◽  
The Impact ◽  
Good Coverage

The ability of tibial tray component shapes to appropriately fit boney geometry is an important aspect of implant design in total knee arthroplasty. Overhang of components in the knee has been associated with soft tissue damage and joint pain [1,2]. Good coverage establishes stability through adequate cortical bone support of the tray component, and reduces the likelihood of loosening and subsidence [3–5], and therefore serves as a key factor in component fixation, especially in those that rely on biological growth into porous component backings such as Trabecular Metal™ Material. More importantly, rotational malalignment of the tibial tray can disrupt the natural kinematics and implant longevity [6]. Previous studies investigated coverage of multiple tibial trays on digitized bone resection contours [1,7]. However the methodology for rotational alignment during implantation was not identified. Although rotational alignment has been investigated in numerous studies, most of the studies were carried out by either investigating the impact of malalignment [6], or assessing different definitions of the tibia rotational axis [8]. No correlation between the size of the rotational alignment window and the amount of coverage has been shown.

The Effect of Implant Design on Sagittal Plane Stability: A Randomized Trial of Medial- versus Posterior-Stabilized Total Knee Arthroplasty

2019 ◽  
Vol 33 (05) ◽  
pp. 452-458 ◽  
Author(s):  
Adam I. Edelstein ◽  
Surabhi Bhatt ◽  
Josh Wright-Chisem ◽  
Ryan Sullivan ◽  
Matt Beal ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Sagittal Plane ◽  
Oxford Knee Score ◽  
Implant Design ◽  
Posterior Stabilized ◽  
Patient Reported ◽  
Total Knee ◽  
The Impact

AbstractUp to 20% of total knee arthroplasty (TKA) patients report dissatisfaction with their outcome, especially with weight-bearing in flexion (WBiF) activities. Sagittal plane instability may contribute to dissatisfaction following TKA. We assessed the impact of implant design on TKA sagittal plane stability and clinical satisfaction. We randomized patients to receive one of two TKA implant designs: medial-stabilized (MS) or posterior-stabilized (PS). Sagittal stability was assessed using a KT-1000 arthrometer. Patient-reported outcome measures, including a custom bank of questions targeting patient satisfaction (0–100%) with WBiF activities, were administered to patients 2 years following surgery. The final analysis included 50 patients (25 MS, 25 PS). The MS group had greater sagittal plane stability than the PS group at 30-degree flexion (5.6 ± 1.9 vs. 10.2 ± 2.7 mm; p < 0.0001) but not at 90-degree flexion (4.1 ± 2 vs. 5.3 ± 3 mm; p = 0.14). Range of motion was not different (111.3 ± 10.4 vs. 114.7 ± 10.7 degrees; p = 0.31). There were no differences in the PROMIS (Patient-Reported Outcomes Measurement Information System) score, Oxford Knee Score, Knee Society Score, Forgotten Joint Score, or Veterans Rand. The MS group had no difference in satisfaction for WBiF activities versus non-WBiF activities (80.5 ± 18 vs. 88.3% ± 16.4%; p = 0.13), whereas the PS group had significantly worse satisfaction for WBiF versus non-WBiF activities (71.6 ± 24.6 vs. 87.8% ± 16.6%; p = 0.019). An MS prosthetic design was more stable in the sagittal plane in midflexion compared with a PS design. There was no difference in patient-reported outcomes, although custom survey data suggest improved satisfaction with MS design during WBiF activities.

Comparison of patient-reported outcomes based on implant brand in total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 48-54 ◽  
Author(s):  
C. A. Kahlenberg ◽  
S. Lyman ◽  
A. D. Joseph ◽  
Y-F. Chiu ◽  
D. E. Padgett
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Smoking Status ◽  
Short Form ◽  
Implant Design ◽  
Patient Reported ◽  
Total Knee ◽  
Healthcare Administrators ◽  
The Impact

AimsThe outcomes of total knee arthroplasty (TKA) depend on many factors. The impact of implant design on patient-reported outcomes is unknown. Our goal was to evaluate the patient-reported outcomes and satisfaction after primary TKA in patients with osteoarthritis undergoing primary TKA using five different brands of posterior-stabilized implant.Patients and MethodsUsing our institutional registry, we identified 4135 patients who underwent TKA using one of the five most common brands of implant. These included Biomet Vanguard (Zimmer Biomet, Warsaw, Indiana) in 211 patients, DePuy/Johnson & Johnson Sigma (DePuy Synthes, Raynham, Massachusetts) in 222, Exactech Optetrak Logic (Exactech, Gainesville, Florida) in 1508, Smith & Nephew Genesis II (Smith & Nephew, London, United Kingdom) in 1415, and Zimmer NexGen (Zimmer Biomet) in 779 patients. Patients were evaluated preoperatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS), and 12-Item Short-Form Health Survey questionnaire (SF-12). Demographics including age, body mass index, Charlson Comorbidity Index, American Society of Anethesiologists status, sex, and smoking status were collected. Postoperatively, two-year KOOS, LEAS, SF-12, and satisfaction scores were compared between groups.ResultsOutcomes were available for 4069 patients (98%) at two years postoperatively. In multiple regression analysis, which separately compared each implant group with the aggregate of all others, there were no clinically significant differences in the change of KOOS score from baseline to two-year follow-up between any of the groups. More than 80% of patients in each group were satisfied at this time in all domains. In a multivariate regression model, patients in the NexGen group were the most likely to be satisfied (odds ratio (OR) 1.63; p = 0.006) and Optetrak Logic patients were the least likely to be satisfied (OR 0.60; p < 0.001).ConclusionTKA provides improvement in function and satisfaction regardless of the type of implant. We could not demonstrate superiority of one design above others across these groups of implants, and any price premium for one above the other systems may not be justified. Healthcare administrators may find these similarities in outcomes helpful when negotiating purchasing contracts. Cite this article: Bone Joint J 2019;101-B(7 Supple C):48–54

The Adjustment of the Rotational Alignment of the Distal End of the Extramedullary Guide to the Anteroposterior Axis of the Proximal Tibia in Total Knee Arthroplasty

2021 ◽  
Author(s):  
Hideki Mizu-uchi ◽  
Hidehiko Kido ◽  
Tomonao Chikama ◽  
Kenta Kamo ◽  
Satoshi Kido ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Proximal Tibia ◽  
Rotational Alignment ◽  
Coronal Alignment ◽  
Ideal Position ◽  
Total Knee ◽  
Alignment Guide ◽  
The Ideal

AbstractThe optimal placement within 3 degrees in coronal alignment was reportedly achieved in only 60 to 80% of patients when using an extramedullary alignment guide for the tibial side in total knee arthroplasty (TKA). This probably occurs because the extramedullary alignment guide is easily affected by the position of the ankle joint which is difficult to define by tibial torsion. Rotational direction of distal end of the extramedullary guide should be aligned to the anteroposterior (AP) axis of the proximal tibia to acquire optimal coronal alignment in the computer simulation studies; however, its efficacy has not been proven in a clinical setting. The distal end of the guide can be overly displaced from the ideal position when using a conventional guide system despite the alignment of the AP axis to the proximal tibia. This study investigated the effect of displacement of the distal end of extramedullary guide relative to the tibial coronal alignment while adjusting the rotational alignment of the distal end to the AP axis of the proximal tibia in TKA. A total of 50 TKAs performed in 50 varus osteoarthritic knees using an image-free navigation system were included in this study. The rotational alignment of the proximal side of the guide was adjusted to the AP axis of the proximal tibia. The position of the distal end of the guide was aligned to the center of the ankle joint as viewed from the proximal AP axis (ideal position) and as determined by the navigation system. The tibial intraoperative coronal alignments were recorded as the distal end was moved from the ideal position at 3-mm intervals. The intraoperative alignments were 0.5, 0.9, and 1.4 degrees in valgus alignment with 3-, 6-, and 9-mm medial displacements, respectively. The intraoperative alignments were 0.7, 1.2, and 1.7 degrees in varus alignment with 3-, 6-, and 9-mm lateral displacements, respectively. In conclusion, the acceptable tibial coronal alignment (within 2 degrees from the optimal alignment) can be achieved, although some displacement of the distal end from the ideal position can occur after the rotational alignment of the distal end of the guide is adjusted to the AP axis of the proximal tibia.

scholarly journals Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
K Giesinger ◽  
JM Giesinger ◽  
DF Hamilton ◽  
J Rechsteiner ◽  
A Ladurner
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Pain Relief ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Normal Weight ◽  
World Health ◽  
Obese Patients ◽  
Total Knee ◽  
The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

The Impact of Gastric Bypass Surgery Compared to Total Knee Arthroplasty on Knee Symptoms

2018 ◽  
Vol 04 (02) ◽  
Author(s):  
Hafiz Kassam ◽  
Allan Okrainec ◽  
Timothy Jackson ◽  
Michael G Zyweil ◽  
Anthony V Perruccio ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Gastric Bypass ◽  
Knee Arthroplasty ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Total Knee ◽  
The Impact

Bone ingrowth in total knee arthroplasty: The impact of HA-coatings and the relation with mechanical stability

1998 ◽  
Vol 31 ◽  
pp. 26
Author(s):  
L. Labey ◽  
H. Van Campenhout ◽  
J. Vander Sloten ◽  
R. Van Audekercke ◽  
G. Van der Perre ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Stability ◽  
Bone Ingrowth ◽  
Total Knee ◽  
The Impact

Femoral Anterior Tangent Line of the Osteoarthritic Knee for Determining Rotational Alignment of the Femoral Component in Total Knee Arthroplasty

2011 ◽  
Vol 26 (2) ◽  
pp. 268-273 ◽  
Author(s):  
Hiroki Watanabe ◽  
Ryuichi Gejo ◽  
Yoshikazu Matsuda ◽  
Ichiro Tatsumi ◽  
Kazuo Hirakawa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Rotational Alignment ◽  
Tangent Line ◽  
Osteoarthritic Knee ◽  
Total Knee

Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements

The Knee ◽  
2021 ◽  
Vol 31 ◽  
pp. 64-76
Author(s):  
Takao Kaneko ◽  
Tadashi Igarashi ◽  
Kazutaka Takada ◽  
Shu Yoshizawa ◽  
Hiroyasu Ikegami ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Rotational Alignment ◽  
Robotic Assisted ◽  
Total Knee
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