scholarly journals Robotic vs Navigational vs Conventional Primary Total Knee Arthroplasty. Clinical and Radiological Long-Term Results with a Minimum Follow-up of 10 years -Survivalship Analysis-

10.29007/cvdj ◽  
2020 ◽  
Author(s):  
Seung-Min Na ◽  
Gun-Woo Kim ◽  
Lee Nam-Hun ◽  
Young-Woo Chung ◽  
Jongkeun Seon ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Robotic Group ◽  
Navigation Group ◽  
Significant Difference ◽  
Total Knee ◽  
Conventional Total Knee Arthroplasty

The aim of this study was (1) to compare the clinical and radiological outcomes of robotic, navigational and conventional total knee arthroplasty with a minimum follow-up of 10 years, (2) to evaluate the survival rate, (3) and to estimate the accuracy of the three techniques by analyzing the outliers of the total knee arthroplasty (TKA) patients.Methods From January 1992 to December 2008, We evaluated 515 knees who underwent robotic TKA, navigational TKA, or conventional TKA with minimum follow-up of 10 years. Finally, this study including 92 patients (103 knees) who underwent robotic total knee arthroplasty using ROBODOC® , 197 patients (225 knees) who underwent navigational total knee arthroplasty using Orthopilot, and 175 patients (187 knees) who underwent conventional total knee arthroplasty. Hospital for special surgery(HSS) score, Knee Society Score(KSS), Western Ontario and McMaster Universities (WOMAC), and Range of Motion(ROM) were used for clinical evaluation. Mechanical alignment, implant radiological measurements and outliers were analyzed for radiological results. Complication related with surgery was also evaluated. Data were analyzed using SPSS Version 24.0 software and descriptive statistics, paired t‑test, one‑way ANOVA, and Wilcoxon tests. Kaplan-Meier survival analysis was performed for survival rate.Results All clinical assessments including HSS, KSS, WOMAC, and ROM at final follow-up showed excellent improvements in three groups (all, p<0.05), without any significant difference between the groups (p>0.05). In radiologic data, sagittal inclination of femoral implant in robotic group showed better result than another groups with significant difference(p<0.05). The cumulative survival rate was 94.8% in the robotic group, 96.2% in the navigation group, and 92.4% in the conventional TKA group with excellent survival (p=0.563). Complication rate associated surgery was 5.2 % in the robotic group, 5.3% in the navigation group, and 8% in the conventional groupConclusion Our study showed excellent survival with robotic, navigation and conventional TKA and similar clinical outcomes at long-term follow-up. However, in terms of radiological outcome robotic TKA showed accurate position of femoral component. With longer follow-up and larger cohort, the accuracy and effectiveness of robotic TKA on implant survival rate can be elucidated in the future.

The Outcome of Posterior-Stabilized, Rotating Platform Total Knee Arthroplasty at a Minimum Ten-Year Follow-up, a Middle East Institution Experience

2020 ◽  
Author(s):  
Ahmed A. Khalifa ◽  
Mostafa Fayez ◽  
Hesham Elkady ◽  
Ahmed M. Abdelaal ◽  
Maher A. Elassal
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Middle East ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Posterior Stabilized ◽  
Rotating Platform ◽  
Total Knee

AbstractPosterior-stabilized, rotating platform knee prosthesis design was aimed to decrease polyethylene wear for the sake of improving implant survivorship. The purpose of the present prospective study was to evaluate the long-term clinical and radiographic results as well as the survival rate after using a rotating platform, posterior-stabilized knee prosthesis at a minimum of 10 years at a Middle East institution. We compared the results with reports in the literature on western populations. From January 2002 to June 2008, 96 patients (106 knees) underwent total knee arthroplasty (TKA) using a cemented rotating platform posterior-stabilized knee prosthesis. At a mean of 11.5 ± 1.3 years, 85 patients (95 TKAs) were available for clinical, radiographic, and implant survival analysis. At the final follow-up, 78.9% of the patients had excellent Knee Society Scoring system score, the average knee flexion was 110 ± 17 degrees, the average anatomical knee coronal alignment was 186 ± 2 degrees and 187 ± 3 degrees for varus and valgus knees, respectively. Five (5.2%) knees were revised of these: two for bearing dislocation, two for aseptic loosening, and one for infection. The Kaplan-Meier survival rate was 94.7% for all revisions and 97.8% when only revision for aseptic loosening considered as the end point. At a long-term follow-up, reasonable clinical and radiographic outcomes had been achieved after using a rotating platform, posterior-stabilized knee prosthesis in our population with acceptable survival rate reaching up to 95%, which is comparable to reports from the western population.

scholarly journals Survival rate of cemented versus cementless tibial component in primary total knee arthroplasty over 5 years of follow-up: comparative study of 109 prostheses

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 36 ◽  
Author(s):  
Victor Pacoret ◽  
Etienne Kalk ◽  
Ludovic Labattut ◽  
Guillaume Girardot ◽  
Emmanuel Baulot ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Primary Total Knee Arthroplasty ◽  
Fixation Method ◽  
Significant Difference ◽  
Total Knee ◽  
Primary Total Knee

Introduction: Knee osteoarthritis is the main indication for primary total knee arthroplasty (TKA). It is now accepted that cementless implantation of the femoral component provides equivalent results to cemented one, however, the optimal fixation method of the tibial component remains controversial. The purpose of this study was to compare the survivorship of cemented versus cementless tibial baseplate in primary total knee arthroplasty. Materials and methods: We carried out a retrospective, monocentric study, including 109 TKA (Zimmer® Natural Knee II ultra-congruent mobile-bearing) implanted between 2004 and 2010 for primary osteoarthritis, comparing 2 groups depending on tibial component fixation method, one cemented (n = 68) and one cementless (n = 41). Clinical (Knee Society Rating System (KSS), Hospital for Special Surgery (HSS) scores, range of motion) and radiodiological outcomes were assessed at last follow-up with a minimal follow-up of 5 years. Results: Mean follow-up were 8.14 [5.31–12.7] and 8.06 [5.22–12.02] years, respectively, in cemented and cementless groups. The tibial component survival rate was 100% [95CI: 91.4–100] in the cementless group and 97.1% [95CI: 89.78–99.42] in the cemented group (2 aseptic loosenings) (p = 0.27). Radiolucent lines were present in 31.7% (n = 13) of the cementless and 44.1% (n = 30) of the cemented baseplates (p = 0.2). The postoperative KSS knee score was higher in the cementless group (99 ± 3 vs. 97 ± 7.5; p = 0.02), but there was no significant difference in KSS function, global KSS and HSS scores. Mean range of flexion was 120 ± 10° in the cementless group and 122.5 ± 15° in the cemented group (p = 0.37). No significant differences were found on the radiographic data or on complications. Conclusion: In this study, the survival rate of the tibial component is not influenced by its fixation method at a mean follow-up of 8 years in osteoarthritis, which confirms the reliability of cementless fixation in primary TKA.

What is the role of cemented fixation in total knee arthroplasty? The two-year results of a randomized RSA controlled trial

2021 ◽  
Vol 103-B (1) ◽  
pp. 98-104 ◽  
Author(s):  
Bas van Ooij ◽  
Inger N. Sierevelt ◽  
Harm M. van der Vis ◽  
Daniël Hoornenborg ◽  
Daniël Haverkamp
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Hybrid Fixation ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
Total Knee

Aims For many designs of total knee arthroplasty (TKA) it remains unclear whether cemented or uncemented fixation provides optimal long-term survival. The main limitation in most studies is a retrospective or non-comparative study design. The same is true for comparative trials looking only at the survival rate as extensive sample sizes are needed to detect true differences in fixation and durability. Studies using radiostereometric analysis (RSA) techniques have shown to be highly predictive in detecting late occurring aseptic loosening at an early stage. To investigate the difference in predicted long-term survival between cemented, uncemented, and hybrid fixation of TKA, we performed a randomized controlled trial using RSA. Methods A total of 105 patients were randomized into three groups (cemented, uncemented, and hybrid fixation of the ACS Mobile Bearing (ACS MB) knee system, implantcast). RSA examinations were performed on the first day after surgery and at scheduled follow-up visits at three months, six months, one year, and two years postoperatively. Patient-reported outcome measures (PROMs) were obtained preoperatively and after two years follow-up. Patients and follow-up investigators were blinded for the result of randomization. Results RSA secondary stabilization did not show a significant difference between the three types of fixation. A maximum total point motion of less than 0.2 mm in the second postoperative year was shown in each group, which suggests stabilization of the implant. At 24 months after surgery, PROMs significantly improved compared to baseline in all treatment groups. No significant difference was observed between the three groups. Conclusion Secondary stabilization measurements in this study demonstrated no significant difference between the groups. In all groups migration stabilized after initial settling of the implant. For this implant the long-term outcome is not expected to be influenced by the type of fixation to the bone. Cite this article: Bone Joint J 2021;103-B(1):98–104.

scholarly journals Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jake von Hintze ◽  
Mika Niemeläinen ◽  
Harri Sintonen ◽  
Jyrki Nieminen ◽  
Antti Eskelinen
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

2019 ◽  
Vol 33 (01) ◽  
pp. 034-041 ◽  
Author(s):  
Theodore S. Wolfson ◽  
David Novikov ◽  
Kevin K. Chen ◽  
Kelvin Y. Kim ◽  
Afshin A. Anoushiravani ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Subgroup Analysis ◽  
Blood Management ◽  
Folate Supplementation ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Total Knee

AbstractDespite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

scholarly journals Titanium-Nitride Coating Does Not Result in a Better Clinical Outcome Compared to Conventional Cobalt-Chromium Total Knee Arthroplasty after a Long-Term Follow-Up: A Propensity Score Matching Analysis

Coatings ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 442 ◽  
Author(s):  
Georg Hauer ◽  
Lukas Leitner ◽  
Marc C. Ackerl ◽  
Sebastian Klim ◽  
Ines Vielgut ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Cobalt Chromium ◽  
Tin Coating ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Cocr Alloy

Background: The impact of titanium nitride (TiN) coating on implant components is controversial. TiN coating is proposed as having superior biomechanical properties compared to conventional cobalt-chromium (CoCr) alloy. This study compared long-term clinical data as well as meteoro-sensitivity in patients who underwent total knee arthroplasty (TKA), with either CoCr alloy or TiN coating. Methods: In this retrospective observational study, the clinically approved cemented “low contact stress” (LCS) TKA with conventional CoCr coating, was compared to un-cemented TiN-coated “advanced coated system” (ACS) TKA. Propensity score matching identified comparable patients based on their characteristics in a one-to-one ratio using the nearest-neighbor method. The final cohort comprised 260 knees in each cohort, with a mean follow-up of 10.1 ± 1.0 years for ACS patients and 14.9 ± 3.0 years for the LCS group. Physical examinations, meteoro-sensitivity, and knee scoring were assessed. Results: The clinical and functional Knee Society Score (KSS) (82.6 vs. 70.8; p < 0.001 and 61.9 vs. 71.1; p = 0.011), the postoperative Visual Analogue Scale (VAS) (2.9 vs. 1.4; p = 0.002), and the postoperative Tegner Score (2.6 vs. 2.2; p = 0.001) showed significant intergroup differences. The postoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) was similar (79.9 vs. 81.3; p = 0.453) between groups. Meteoro-sensitivity of the artificial joint was significantly more prevalent in the ACS patient cohort (56% vs. 23%; p < 0.001). Conclusion: This study suggests that TiN coating does not provide improved clinical outcomes in this patient cohort after a long-term follow-up. Interestingly, sensitivity to weather changes were more correlated with un-cemented ACS implants.

Prospective randomized trial of standard versus highly crosslinked tibial polyethylene in primary posterior-stabilized total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 33-39 ◽  
Author(s):  
P. F. Lachiewicz ◽  
J. A. O’Dell
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Randomized Study ◽  
Posterior Stabilized ◽  
Function Score ◽  
Score Change ◽  
Osteolytic Lesions ◽  
Significant Difference ◽  
Total Knee

Aims There is insufficient evidence to recommend the use of alternative polyethylene bearings in modular, fixed-bearing total knee arthroplasty (TKA). The purpose of this study was to compare standard polyethylene (SP) and highly crosslinked polyethylene (XLP) tibial liners in posterior-stabilized TKA, with osteolysis as the primary outcome and clinical results and the rate of re-operation as the secondary outcomes. Patients and Methods This is a single-surgeon, prospective randomized study involving one design of modular posterior-stabilized TKA. An analysis of 122 TKAs with an SP compression moulded liner and 123 with an XLP liner was performed, with a mean follow-up of six years (2 to 11). Patients were evaluated clinically using the Knee Society score, Lower Extremity Activity Score (LEAS), and the presence of an effusion, and standard radiographs were assessed for radiolucent lines and osteolytic lesions. Results Osteolysis was present in four TKAs (3.3%) in the SP group, and no knees in the XLP group (p = 0.06). There were no significant differences between the Knee Society total score, change in total score, knee function score, change in function score, LEAS, and change in LEAS in the two groups. There was a significant difference in the presence of an effusion (10/122 with SP liners, 1/123 with XLP liners; p = 0.02). There was no significant difference in the rate of re-operation between the two groups (p = 0.36). There were no complications related to the XLP liner. Conclusion At this length of follow-up, there were no advantages and no complications related to the use of this XLP tibial liner. The presence of effusion and small osteolytic lesions was more frequent with SP than XLP liners, but of unknown clinical significance. Cite this article: Bone Joint J 2019;101-B(7 Supple C):33–39

scholarly journals Long-Term Postoperative Total Knee Arthroplasty Flexion Scores in Relation to Body Mass Index

2020 ◽  
Author(s):  
Matthew A. Siegel ◽  
Michael J. Patetta ◽  
Angie M. Fuentes ◽  
Armaan S. Haleem ◽  
Craig W. Forsthoefel ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
P Value ◽  
Preoperative Body Mass Index ◽  
Total Knee

AbstractKnee range of motion (ROM) is an important postoperative measure of total knee arthroplasty (TKA). There is conflicting literature whether patients who are obese have worse absolute ROM outcomes than patients who are not obese. This study analyzed whether preoperative body mass index (BMI) influences knee ROM after patients' primary TKA. A retrospective investigation was performed on patients, who underwent primary TKA at an academic institution, by one of three fellowship-trained adult reconstruction surgeons. Patients were stratified according to their preoperative BMI into nonobese (BMI < 30.0 kg/m2) and obese (BMI ≥ 30.0 kg/m2) classifications. Passive ROM was assessed preoperatively as well as postoperatively at patients' most recent follow-up visit that was greater than 2 years. Mann–Whitney U tests were performed to determine statistical significance at p-value <0.05 for ROM outcomes. No statistically significant differences were observed when ROM in the nonobese group was compared with ROM in the obese group both preoperatively (105.73 ± 11.58 vs. 104.14 ± 13.58 degrees, p-value = 0.417) and postoperatively (105.83 ± 14.19 vs. 104.49 ± 13.52 degrees, p-value = 0.777). Mean follow-up time for all patients was 4.49 ± 1.92 years. In conclusion, long-term postoperative ROM outcomes were similar between patients who were nonobese and patients who were obese.

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