scholarly journals Improving Pre-Operative Flexion in Primary TKA: A Surgical Technique Emphasizing Knee Flexion with 5-Year Follow-Up

2014 ◽  
Vol 4 (2) ◽  
pp. 29-36
Author(s):  
Edward McPherson, MD FACS ◽  
Denise Portugal, MD ◽  
Matthew Dipane, BA ◽  
Sherif Sherif, MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Surgical Technique ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Primary Total Knee Arthroplasty ◽  
Implant Design ◽  
Consecutive Series ◽  
High Flexion ◽  
Total Knee

This study prospectively reviews a consecutive series of 228 primary total knee arthroplasty (TKA) procedures utilizing a technique to optimize knee flexion.  The main features include: (1)the use of a “patellar friendly” femoral component and reduced thickness patellar components, (2) patient individualized adjustment of the femoral component rotation set strictly to the anterior-posterior femoral axis, (3)a rigorous flexion compartment debridement to remove non-essential posterior femoral bone with a Z-osteotome, and (4)incorporation of a rapid recovery protocol with features to promote knee flexion.Results were categorized into three groups: low pre-op flexion (90 degrees and below), regular pre-op flexion (91-125 degrees), and high pre-op flexion (126 degrees and above).  Average flexion in the low flexion group improved by 20 degrees at 6 weeks, 28 degrees at 3 months, 31 degrees at 1 year, and 30 degrees at 5 years.  In the regular flexion group, average flexion improved by 2 degrees at 6 weeks, 10 degrees at 3 months, 12 degrees at 1 year, and 13 degrees at 5 years.  Finally, in the high flexion group, average flexion decreased by 7 degrees at 6 weeks, regained preoperative levels at 3 months, and increased by 3 degrees at 1 year and 4 degrees at 5 years.In summary, a technique that emphasizes patellofemoral kinematics can consistently improve flexion in TKA in short and long-term follow-up.Keywords: Total knee arthroplasty, range of motion, high flexion, surgical technique, implant design, AP AxisLevel of Evidence:  AAOS Therapeutic Study Level III

Isolated Liner Revision for Total Knee Arthroplasty Instability: A Road That Should Remain Less Taken

2020 ◽  
Author(s):  
Jason D. Tegethoff ◽  
Rafael Walker-Santiago ◽  
William M. Ralston ◽  
James A. Keeney
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
P Value ◽  
Surgical Morbidity ◽  
Exact Test ◽  
Total Knee ◽  
Component Revision

AbstractIsolated polyethylene liner exchange (IPLE) is infrequently selected as a treatment approach for patients with primary total knee arthroplasty (TKA) prosthetic joint instability. Potential advantages of less immediate surgical morbidity, faster recovery, and lower procedural cost need to be measured against reoperation and re-revision risk. Few published studies have directly compared IPLE with combined tibial and femoral component revision to treat patients with primary TKA instability. After obtaining institutional review board (IRB) approval, we performed a retrospective comparison of 20 patients treated with IPLE and 126 patients treated with tibial and femoral component revisions at a single institution between 2011 and 2018. Patient demographic characteristics, medical comorbidities, time to initial revision TKA, and reoperation (90 days, <2 years, and >2 years) were assessed using paired Student's t-test or Fisher's exact test with a p-value <0.01 used to determine significance. Patients undergoing IPLE were more likely to undergo reoperation (60.0 vs. 17.5%, p = 0.001), component revision surgery (45.0 vs. 8.7%, p = 0.002), and component revision within 2 years (30.0 vs. 1.6%, p < 0.0001). Differences in 90-day reoperation (p = 0.14) and revision >2 years (p = 0.19) were not significant. Reoperation for instability (30.0 vs. 4.0%, p < 0.001) and infection (20.0 vs. 1.6%, p < 0.01) were both higher in the IPLE group. IPLE does not provide consistent benefits for patients undergoing TKA revision for instability. Considerations for lower immediate postoperative morbidity and cost need to be carefully measured against long-term consequences of reoperation, delayed component revision, and increased long-term costs of multiple surgical procedures. This is a level III, case–control study.

Modern femoral component design in total knee arthroplasty shows a lower patellar contact force during knee flexion compared with its predecessor

The Knee ◽  
2021 ◽  
Vol 30 ◽  
pp. 1-8
Author(s):  
Naoki Nakano ◽  
Yuichi Kuroda ◽  
Toshihisa Maeda ◽  
Koji Takayama ◽  
Shingo Hashimoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Contact Force ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Component Design ◽  
Total Knee

scholarly journals Knee Flexion after Total Knee Arthroplasty

2007 ◽  
Vol 15 (2) ◽  
pp. 149-153 ◽  
Author(s):  
PH Li ◽  
YC Wong ◽  
YL Wai
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Female Gender ◽  
Implant Design ◽  
Functional Score ◽  
Middle Range ◽  
Postoperative Flexion ◽  
Total Knee ◽  
Flexion And Extension

Purpose. To identify factors related to knee flexion after total knee arthroplasty in a Chinese population. Methods. Records of 242 total knee arthroplasties were retrospectively reviewed. The parameters evaluated were age, gender, diagnosis, preoperative knee flexion and extension, preoperative flexion arc, tibiofemoral angle, Knee Society knee score and functional score, and implant design. Results. Advanced age, female gender, and good preoperative flexion and flexion arc were related to better postoperative flexion. Postoperative flexion tended to migrate to the middle range despite different ranges of preoperative flexion. Preoperative tibiofemoral malalignment had no significant effect on postoperative flexion. Conclusion. Contemporary designs of posterior stabilised prostheses with right and left femoral components were superior to older designs.

scholarly journals Fatigue failure of the femoral component of a total knee arthroplasty: a case report and review of the literature

2020 ◽  
Author(s):  
W Greeff ◽  
RDV Greeff ◽  
CT Frey ◽  
V Singh
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Case Report ◽  
Surgical Technique ◽  
Femoral Component ◽  
Knee Pain ◽  
Fatigue Failure ◽  
Knee Arthroplasty ◽  
English Literature ◽  
Total Knee

ABSTRACT INTRODUCTION: Reports of fatigue failure of the femoral component of a total knee arthroplasty (TKA) is scanty in the literature. As a result, there are no clearly defined risk factors to aid us in predicting fatigue failure of an implant. Furthermore, these patients may present with non-specific knee pain, which may or may not be well tolerated, depending on the stability of the implant. We report a case of fatigue failure of a poorly cemented femoral component of a TKA in a 72-year-old female, approximately seven years after the initial surgery CASE REPORT: A 72-year-old female presented to our tertiary level arthroplasty unit with new-onset knee pain approximately seven years after undergoing a TKA at our unit. She reported hearing a crack six months earlier, while standing up from a seated position. She had initially presented to her local clinic, but the pathology was missed. She received revision surgery at our institution and was doing well at early follow-up. DISCUSSION: We reviewed the literature on fatigue failure of femoral components in TKA in an attempt to define risk factors. We also summarised all cases of femoral component fatigue failure in the English literature. CONCLUSION: Although femoral component fatigue failure in TKA is rare, the majority of cases have attributed the failure to poor surgical technique. Despite this, certain implants have been failing more often than others, and proposed mechanisms for this exist. Orthopaedic surgeons need to be aware of which implant designs are prone to failure, as well as how meticulous surgical technique can reduce the chances of fatigue failure. Level of evidence: Level 5 Keywords: femoral component, total knee arthroplasty, fatigue failure, stress fracture

Tibiofemoral Contact After Conventional and High-Flexion Posterior Cruciate-Retaining Total Knee Arthroplasty

2003 ◽  
Author(s):  
Ephrat Most ◽  
Guoan Li ◽  
Harry E. Rubash
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Contact Point ◽  
Knee Kinematics ◽  
Testing System ◽  
High Flexion ◽  
Human Knee ◽  
Contact Points ◽  
Total Knee

The human knee is capable of flexing up to 160°, yet most patients do not achieve more than 120° after total knee arthroplasty (TKA). The translation of the tibiofemoral contact points with flexion is important in the overall understanding of knee kinematics and knee stability, particularly in high flexion. In this study, cadaveric knees were used in conjunction with a robotic testing system and TekScan® film to quantify the tibiofemoral contact between 0°–150° for two TKA designs. We found that, for both TKAs, with increasing knee flexion, the peak contact point moved posteriorly and that the contact area decreased with increasing knee flexion.

COMPARISON OF HIGH FLEXION DESIGN AND POSTERIOR STABILIZATION PROSTHESES OF TOTAL KNEE ARTHROPLASTY BY GAIT ANALYSIS

2009 ◽  
Vol 21 (01) ◽  
pp. 71-79
Author(s):  
Wen-Chi Tsai ◽  
Sheng-Chang Chen ◽  
Tung-Wu Lu ◽  
Hwa-Chang Liu
Keyword(s):  
Total Knee Arthroplasty ◽  
Gait Analysis ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Objective Assessment ◽  
Knee Prostheses ◽  
High Flexion ◽  
Significant Difference ◽  
Post Operation ◽  
Total Knee

Introduction: The primary goal of total knee arthroplasty (TKA) is to resolve knee destruction and associated problems at the end stages of diseases such as osteoarthritis and rheumatoid arthritis. High satisfactory rate has been reported in terms of pain relief and correction of deformity. However, the method for objective assessment of the outcome, such as range of motion (ROM) and quantitative evaluation of the clinical outcome of TKA, is to be confirmed. The purpose of this study was mandatory to investigate the ROM objectively and the newly designed prostheses. Materials and methods: The study was done in randomly selected patients who received dynamic measurement of knee function. Twenty-six patients participated in the study. They were divided into two groups (13 patients in A and 13 patients in B group), according to the knee prostheses they had received. Basic knee functions were evaluated in various dynamic activities, including nonweight bearing status of knee flexion, level walking, kneeling, and squatting, using computerized gait analysis techniques (Vicon 512 system). Passive knee ROM and static alignment were measured using traditional goniometer. HSS scores, physical, and neural examination were recorded. Results: After comparing patients in almost similar criteria, results have shown that there was no significant difference between two types of knee prostheses in randomly selective patients. Conclusion: Newly designed prostheses for achieving higher flexion angle cannot guarantee to provide better knee flexion for every patient. A patient, who can achieve higher knee flexion in pre-operative status, will have high flexion results in post-operative result. In other words, poor knee flexion function in pre-operation will lead to poor knee flexion function in post-operation status. Minor prosthesis design has little to do with the surgical outcome of knee flexion.

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