scholarly journals Accuracy of Implant Placement Utilizing Customized Patient Instrumentation in Total Knee Arthroplasty

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
William D. Bugbee ◽  
Hideki Mizu-uchi ◽  
Shantanu Patil ◽  
Darryl D'Lima
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Computer Aided Design ◽  
Sagittal Plane ◽  
Coronal Plane ◽  
Absolute Difference ◽  
Mean Absolute Difference ◽  
Implant Placement ◽  
Total Knee ◽  
The Mean

Customized patient instrumentation (CPI) combines preoperative planning with customized cutting jigs to position and align implants during total knee arthroplasty (TKA). We compared postoperative implant alignment of patients undergoing surgery with CPI to traditional TKA instrumentation for accuracy of implant placement. Twenty-five consecutive TKAs using CPI were analyzed. Preoperative CT scans of the lower extremities were segmented using a computer program. Limb alignment and mechanical axis were computed. Virtual implantation of computer-aided design models was done. Postoperative coronal and sagittal view radiographs were obtained. Using 3D image-matching software, relative positions of femoral and tibial implants were determined. Twenty-five TKAs implanted using traditional instrumentation were also analyzed. For CPI, difference in alignment from the preoperative plan was calculated. In the CPI group, the mean absolute difference between the planned and actual femoral placements was 0.67° in the coronal plane and 1.2° in the sagittal plane. For tibial alignment, the mean absolute difference was 0.9° in the coronal plane and 1.3° in the sagittal plane. For traditional instrumentation, difference from ideal placement for the femur was 1.5° in the coronal plane and 2.3° in the sagittal plane. For the tibia, the difference was 1.8° in the coronal plane. CPI achieved accurate implant positioning and was superior to traditional TKA instrumentation.

CT Validation of Intraoperative Implant Position and Knee Alignment as Determined by the MAKO Total Knee Arthroplasty System

2020 ◽  
Author(s):  
James D. Sires ◽  
Christopher J. Wilson
Keyword(s):  
Total Knee Arthroplasty ◽  
Tibial Component ◽  
Sagittal Plane ◽  
Absolute Difference ◽  
Limb Alignment ◽  
Component Alignment ◽  
Mean Absolute Difference ◽  
Robotic Assisted ◽  
Ct Protocol ◽  
Total Knee

AbstractRobotic-assisted technology in total knee arthroplasty (TKA) aims to increase implantation accuracy, with real-time data being used to estimate intraoperative component alignment. Postoperatively, Perth computed tomography (CT) protocol is a valid measurement technique in determining both femoral and tibial component alignments. The aim of this study was to evaluate the accuracy of intraoperative component alignment by robotic-assisted TKA through CT validation. A total of 33 patients underwent TKA using the MAKO robotic-assisted TKA system. Intraoperative measurements of both femoral and tibial component placements, as well as limb alignment as determined by the MAKO software were recorded. Independent postoperative Perth CT protocol was obtained (n = 29) and compared with intraoperative values. Mean absolute difference between intraoperative and postoperative measurements for the femoral component were 1.17 degrees (1.10) in the coronal plane, 1.79 degrees (1.12) in the sagittal plane, and 1.90 degrees (1.88) in the transverse plane. Mean absolute difference between intraoperative and postoperative measurements for the tibial component were 1.03 degrees (0.76) in the coronal plane and 1.78 degrees (1.20) in the sagittal plane. Mean absolute difference of limb alignment was 1.29 degrees (1.25), with 93.10% of measurements ≤3 degrees of postoperative CT measurements. Overall, intraoperatively measured component alignment as estimated by the MAKO robotic-assisted TKA system is comparable to CT-based measurements.

How Does Robotic-Arm Assisted Technology Influence Total Knee Arthroplasty Implant Placement for Surgeons in Fellowship Training?

2020 ◽  
Author(s):  
Laura Y. Scholl ◽  
Emily L. Hampp ◽  
Kevin M. de Souza ◽  
Ta-Cheng Chang ◽  
Matthew Deren ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Sagittal Plane ◽  
Fellowship Training ◽  
Coronal Plane ◽  
Robotic Arm ◽  
Teaching Hospitals ◽  
Implant Position ◽  
Accuracy And Precision ◽  
Total Knee

AbstractImplant malalignment during total knee arthroplasty (TKA) may lead to suboptimal postoperative outcomes. Accuracy studies are typically performed with experienced surgeons; however, it is important to study less experienced surgeons when considering teaching hospitals where younger surgeons operate. Therefore, this study assessed whether robotic-arm assisted TKA (RATKA) allowed for more accurate and precise implant position to plan when compared with manual techniques when the surgery is performed by in-training orthopaedic surgical fellows. Two surgeons, currently in their fellowship training and having minimal RATKA experience, performed a total of six manual TKA (MTKA) and six RATKAs on paired cadaver knees. Computed tomography scans were obtained for each knee pre- and postoperatively. These scans were analyzed using a custom autosegmentation and autoregistration process to compare postoperative implant position with the preoperative planned position. Mean system errors and standard deviations were compared between RATKA and MTKA for the femoral component for sagittal, coronal, and axial planes and for the tibial component in the sagittal and coronal planes. A 2-Variance testing was performed using an α = 0.05. Although not statistically significant, RATKA was found to have greater accuracy and precision to plan than MTKA for: femoral axial plane (1.1° ± 1.1° vs. 1.6° ± 1.3°), coronal plane (0.9° ± 0.7° vs. 2.2° ± 1.0°), femoral sagittal plane (1.5° ± 1.3° vs. 3.1° ± 2.1°), tibial coronal plane (0.9° ± 0.5° vs. 1.9° ± 1.3°), and tibial sagittal plane (1.7° ± 2.6° vs. 4.7° ± 4.1°). There were no statistical differences between surgical groups or between the two surgeons performing the cases. With limited RATKA experience, fellows showed increased accuracy and precision to plan for femoral and tibial implant positions. Furthermore, these results were comparable to what has been reported for an experienced surgeon performing RATKA.

scholarly journals FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 807.3-807
Author(s):  
I. Moriyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Osteoarthritis Of The Knee ◽  
Patellar Resurfacing ◽  
Criterion A ◽  
Total Knee ◽  
The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

scholarly journals Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Sanjay Bhalchandra Londhe ◽  
Ravi Vinod Shah ◽  
Amit Pankaj Doshi ◽  
Shubhankar Sanjay Londhe ◽  
Kavita Subhedar ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Forgotten Joint Score ◽  
Group A ◽  
Manipulation Under Anaesthesia ◽  
Total Knee ◽  
The Mean ◽  
Group B ◽  
Discharge From Hospital

Abstract The aim of this retrospective cohort study was to compare home physiotherapy with or without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty. Methods A total of 900 patients (including 810 females and 90 males) who had undergone total knee arthroplasty were divided into group A (n = 300) and group B (n = 600). Patients in group A had home physiotherapy on their own after discharge from hospital. The physiotherapist did not visit them at home. Patients in group B received home physiotherapy under supervision of physiotherapist for 6 weeks after discharge from hospital. Patients’ age, range of motion of the knee, and forgotten joint score-12 were assessed. A p < 0.05 was considered statistically significant. Results In group A, the mean age was 69.1 ± 14.3 years (range: 58 to 82 years); in group B, the mean age was 66.5 ± 15.7 years (range: 56 to 83 years) (p > 0.05). Preoperatively, the mean range of motion of the knee in group A and B was 95.8° ± 18.1° and 95.4° ± 17.8°, respectively (p > 0.05). The mean forgotten joint score-12 of group A and B were 11.90 ± 11.3 and 11.72 ± 12.1 (p > 0.05), respectively. Six weeks after total knee arthroplasty, the mean ROM of the knee in group A and B was 109.7° ± 22.3° and 121° ± 21.5°, respectively (p < 0.05). The mean postoperative forgotten joint score-12 of the group A and B was 24.5 ± 16.4 and 25.6 ± 17.4, respectively (p > 0.05). The rate of manipulation under anaesthesia was 3% in group A and 0.2% in group B (p < 0.05). Conclusion After total knee arthroplasty, frequent physiotherapist’s instruction helps the patients improve knee exercises and therefore decrease the risk of revision surgery. The home physiotherapy under supervision of physiotherapist lowers the rate of manipulation under anaesthesia. Level of evidence Therapeutic study, Level IIa.

scholarly journals Effect of Posterior Tibial Slope Change on Postoperative Range of Motion and Clinical Outcomes after Posterior Cruciate-Substituting Total Knee Arthroplasty

2021 ◽  
Author(s):  
O-Sung Lee ◽  
Jangyun Lee ◽  
Myung Chul Lee ◽  
Hyuk-Soo Han
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Correlation Coefficient ◽  
Knee Arthroplasty ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Clinical Scores ◽  
Total Knee ◽  
The Mean

AbstractThe posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the preoperative and postoperative PTS, ROM, visual analog scale pain scale, Western Ontario and McMaster University Index (WOMAC), Hospital for Special Surgery Knee Score, Knee Society Score, and Forgotten Joint Score (FJS). The association of the absolute change in PTS with ROM and clinical scores was analyzed using correlation analysis and multiple regression analysis. As a result, the mean PTS and mean ROM changed from 9.6 ±  3.4 and 120.1 ±  15.4 degrees preoperatively to 2.0 ±  1.3 and 128.4 ±  9.3 degrees postoperatively, and the mean PTS change was 7.6 ±  3.5 degrees. The PTS change had no statistically significant association with the postoperative ROM and clinical scoring systems, although it did have a weak positive correlation with WOMAC function, No 10 (difficulty in rising from sitting) (correlation coefficient = 0.342, p = 0.041), and moderate positive correlation with the FJS, No. 6 (awareness when climbing stairs) (correlation coefficient = 0.470, p = 0.001). The authors concluded that the amount of change in PTS did not affect the postoperative ROM and clinical scores, although proximal tibial resection with a constant target of PTS resulted in individually different changes in the PTS after PS TKA,

scholarly journals Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Goki Kamei ◽  
Shigeki Ishibashi ◽  
Koki Yoshioka ◽  
Satoru Sakurai ◽  
Hiroyuki Inoue ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Gap Size ◽  
Flexion Gap ◽  
Gap Technique ◽  
Joint Gap ◽  
Total Knee ◽  
The Mean

Abstract Background In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap. Methods This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component. Results The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°). Conclusions In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.

scholarly journals Why knees move like they do: A simulation of the effect of varying distal femoral and proximal tibial anatomy on coronal kinematic curve morphology

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0016
Author(s):  
Peter McEwen
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Proximal Tibia ◽  
Coronal Plane ◽  
Curve Shape ◽  
Femoral Rotation ◽  
Full Extension ◽  
Reciprocal Effect ◽  
Maximal Deviation ◽  
Total Knee

Objective: Computer assisted total knee arthroplasty (CA TKA) platforms can provide detailed kinematic data that is presented in various forms including a coronal plane graphic that maps the flexion arc from full extension to deep flexion. Graphics obtained from normal tibiofemoral articulations reveal varied and complex kinematic patterns that have yet to be explained. An understanding of what drives curve variation would allow prediction of how a preoperative curve would be altered by total knee arthroplasty. Implant position could then be tailored to maintain a desirable curve or avoid an undesirable one. Methods: An articulated lower limb saw bone with a stable hip pivot was obtained. Adjustable osteotomies were created so that femoral torsion, femoral varus-valgus and tibial varus-valgus could be altered independently. The saw bone limb was registered with a CA TKA navigation system using the posterior condyles as a rotational axis. Axial and coronal plane morphology of the distal femur and coronal plane morphology of the proximal tibia were systematically altered and a kinematic curve obtained for each morphologic combination. Femoral rotational position was varied from 100 of internal torsion to 100 of external torsion in 20 increments. Similarly, femoral coronal position was varied from 20 of varus to 60 of valgus and tibial coronal position was varied from 5.50 of varus to 10 of valgus. Curves were obtained by manually flexing the joint through a full range of motion with the femoral condyles in contact with proximal tibia at all times. Results: Varying femoral rotation has no effect in full extension but drives the curve away from neutral as the knee flexes. Maximal deviation is seen at around 900 of flexion. Internal torsion drives the curve into valgus as the knee flexes and external torsion has a reciprocal effect. Varying femoral varus-valgus causes maximal deviation from neutral in full extension. Femoral varus drives the curve from varus in extension towards valgus as the knee flexes with the effect peaking in maximal flexion. Femoral valgus has a reciprocal effect. Varying tibial varus-valgus has no effect on curve shape but does move the curve either side of neutral. Complex (parabolic) curves are caused by large rotations or the opposing effects of femoral varus-valgus and femoral rotation. The modal human anatomy of slight femoral internal rotation, slight femoral valgus and slight tibial varus produces a straight neutral curve. Conclusion: Kinematic curve shape is driven by distal femoral anatomy. The typical changes made to distal femoral articular anatomy in TKA by externally rotating a neutrally orientated femoral component will bring many native curves towards neutral. Externally rotating when the preoperative curve begins neutral and drives into varus as the knee flexes will drive the curve harder into varus. Conversely, kinematic femoral placement will reconstitute the premorbid curve morphology. Which outcome is preferable has yet to be determined.

Costs of unicompartmental compared with total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 23-31
Author(s):  
Robert A. Burnett III ◽  
JaeWon Yang ◽  
P. Maxwell Courtney ◽  
E. Bailey Terhune ◽  
Charles P. Hannon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Healthcare Costs ◽  
Cost Savings ◽  
Vein Thrombosis ◽  
Total Knee ◽  
The Mean ◽  
One Year ◽  
Surgery Rates

Aims The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts. Results Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425). Conclusion Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23–31.

Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee

2019 ◽  
Vol 101-B (11) ◽  
pp. 1356-1361 ◽  
Author(s):  
Brian P. Chalmers ◽  
Kapil G. Mehrotra ◽  
Rafael J. Sierra ◽  
Mark W. Pagnano ◽  
Michael J. Taunton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Cox Regression Analysis ◽  
Primary Tkas ◽  
Total Knee ◽  
The Mean

Aims Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. Patients and Methods In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. Results Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. Conclusion Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356–1361.

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