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Li, Xinyu, Changjiang Wang, Yuan Guo, and Weiyi Chen. "An Approach to Developing Customized Total Knee Replacement Implants." Journal of Healthcare Engineering 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/9298061.
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Total knee replacement (TKR) has been performed for patients with end-stage knee joint arthritis to relieve pain and gain functions. Most knee replacement patients can gain satisfactory knee functions; however, the range of motion of the implanted knee is variable. There are many designs of TKR implants; it has been suggested by some researchers that customized implants could offer a better option for patients. Currently, the 3-dimensional knee model of a patient can be created from magnetic resonance imaging (MRI) or computed tomography (CT) data using image processing techniques. The knee models can be used for patient-specific implant design, biomechanical analysis, and creating bone cutting guide blocks. Researchers have developed patient-specific musculoskeletal lower limb model with total knee replacement, and the models can be used to predict muscle forces, joint forces on knee condyles, and wear of tibial polyethylene insert. These available techniques make it feasible to create customized implants for individual patients. Methods and a workflow of creating a customized total knee replacement implant for improving TKR kinematics and functions are discussed and presented in this paper.
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Rao, Nandan, Abhishek Shashikant Patil, and Kunal Bansal. "Uncemented Total Knee Replacement- Rediscovering the Past." Journal of Clinical Orthopaedics 7, no. 1 (2022): 126–34. http://dx.doi.org/10.13107/jcorth.2022.v07i01.495.
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Total knee replacements (TKR) both cemented and uncemented were developed almost simultaneously in the 1980’s. Cemented TKR found favor among the surgeons due to its technical ease and early failure of uncemented TKR due to poor design. In the past two decades; however, interest has been generated in uncemented TKR both because of design improvements which, in turn, has led to better results, especially in young active, obese, and geriatric but active patients where cemented TKR’s have been found to have increased failure rates. Active research is ongoing to refine the designs of uncemented TKR and future holds promise for this re-emerging technique and implant. This review helps to summarize the reasons for increasing interest in uncemented TKR, the newer designs and their results and the future developments expected.
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Khan, Farooq Azam, Waqas Ali, Bilal Ahmad Abbas, Khalid Mehmood, Nisar Ahmed, and Talha Qureshi. "Comparison of All-Polyethylene Tibial Versus Metal-Backed Tibial Component in Total Knee Replacement Surgery." Pakistan Journal of Medical and Health Sciences 17, no. 4 (May 6, 2023): 245–58. http://dx.doi.org/10.53350/pjmhs2023174245.
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Introduction: Total knee replacement (TKR) is the most successful procedure in Orthopedics. The selection of an ideal implant relies on better survivorship, restoration of functional activities and cost-effectiveness. This study compared the effectiveness of all-polyethylene (AP) versus metal-backed tibial (MTB) implant in TKR patients in terms of objective and subjective patient related outcomes. Objectives: To compare the effectiveness of all-polyethylene tibial implants versus metal-backed tibial implants in total knee replacement patients in terms of improvement in the American Knee Society Score (AKSS). Methodology: It was a nonrandomized controlled trial done in the Orthopaedic Department of the Sharif Medical City Hospital, Lahore, after approval by the institutional ethical committee. Fifty patients of grade IV knee joint osteoarthritis for greater than six months were included by nonprobability convenient sampling technique. The patients were allocated equally into standard treatment and intervention groups; patients underwent TKR with MTB implants in the standard group and AP implants in the intervention group after taking informed written consent. The AKSS score was calculated pre-operatively, 3 months and 6 months after surgery by the team member not involved in surgical planning. Results: A statistically significant improvement was observed in pre-operative to post-operative knee scores (p-value = 0.004) and functional scores (p-value = 0.001) with TKR. When the means of knee scores were compared between AP and MTB implants, there was no significant difference between the two groups between pre-operative and post-operative knee scores and functional scores. Practical implication Conclusion: There is no significant difference in knee score between the all-polyethylene and metal-backed implants regarding pain and functional status. All-polyethylene implants are a better substitute for MTB implants due to their cost-effectiveness, particularly in countries with financial constraints. The most practical implication of the current study is health economics. In a developing country with a low per capita income, expensive implants can be swapped with low cost implants to bring the cost of the procedure down. Keywords: All-polyethylene tibial, Metal-backed tibial, Total knee replacement, American Knee Society Score, AKSS.
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Wilding, Christopher P., Martyn Snow, and Lee Jeys. "Which factors affect the ability to kneel following total knee arthroplasty? An outpatient study of 100 postoperative knee replacements." Journal of Orthopaedic Surgery 27, no. 3 (September 1, 2019): 230949901988551. http://dx.doi.org/10.1177/2309499019885510.
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Background: Kneeling is an important activity of daily living, holding social, religious and occupational value. Following total knee replacement (TKR), many patients report they are unable to kneel or have been advised not to kneel. Methods: We observed 100 consecutive knee replacements in 79 patients attending outpatient clinic at a minimum 5 months post-TKR. The patients were asked to fill out a questionnaire detailing whether they were able to kneel prior to their knee replacement and whether they thought they were able to kneel since their knee replacement. The patients were then asked to kneel on a padded examination couch and then onto a pillow on the floor for 15 s. Degree of flexion achievable was also recorded. Results: Of the knees with patella resurfacing, 78.6% were able to kneel compared to only 45.6% knees with native patellae. Two-tailed Fisher’s exact test showed this difference to be statistically significant ( p = 0.001). The χ 2 analysis showed that those patients with an achievable flexion of angle of greater than 100° were significantly more likely to be able to kneel than those with a flexion angle of less than 100° ( p = 0.0148). Comparing posterior cruciate ligament (PCL) retaining against PCL sacrificing implants, there was no statistically significant difference in kneeling ability ( p = 0.541). Conclusion: Kneeling remains an important function in patients undergoing TKR, with patella resurfacing significantly improving the likelihood of a patient being able to kneel.
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Khan, Haziq Dad, Sayed Sohail Akhtar, Waleed Ali, Adil Saidullah, and Summar Fatima. "Outcome of Total Knee Replacement in Morbid Obese Patients." Pakistan Journal of Medical and Health Sciences 16, no. 12 (December 31, 2022): 530–33. http://dx.doi.org/10.53350/pjmhs20221612530.
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Aim: The purpose of our study was to determine the outcomes of total knee replacement in morbidly obese patients. Methodology: This prospective analysis was carried out on 128 morbidly obese patients (BMI> 40 kg/m2) in the Department of Orthopedic Surgery, Federal Govt. Polyclinic Hospital (FGPC) Islamabad, Mardan Medical Complex, Mardan and Bacha Khan Medical Complex, Swabi for the duration from January, 2021 to June, 2022. Demographic details, anthropometric parameters, and radiological assessment were recorded. Pre and post-operative radiological assessments included alignment, implant position, and radiolucent lines presence around the implant were compared. Outcome of TKR such as pre and post-operative functional score, knee society score, age, diagnosis, gender, laterality, and type of prosthesis were assessed and compared. SPSS version 25 was used for data analysis. Results: Of the total 128 TKR in morbid obese patients, the incidence of unilateral and bilateral TKR was 10 (7.8%) and 118 (92.2%) respectively. The overall mean age of the patients was 62.00 ± 8.12 years. Out of 126 TKR patients, there were 11 (8.6%) males and 117 (91.4%) females. Out of 10 unilateral TKR groups, males and females were 4 (40%) and 6 (60%) respectively. In the bilateral TKR group, there were 7 (5.9%) males and 111 (94.1%) were females. The mean BMI was 42.84 ± 3.46 kg/m2 with a range of 40-60 kg/m2. Based on Knee Society Scores and Functional Scores, Pre-operative mean knee score and functional score was 26.4 and 48.8, p=0.01 compared to post-operative 83.7 and 74.2, p=0.07 respectively. A higher prevalence for post-operative radiolucent lines was 28% against pre-operative 9%, p=0.01 were observed. During follow-up, the complications rate was 17.2% (n=22). Post-TKR complications such as superficial wound infection, deep joint infection, and deep vein thrombosis was found in 12.5% (n=16), 1.6% (n=2), and 3.1% (n=4) respectively. Conclusion: Our study found that prior to total knee replacement, patients with BMI>40 kg/m2 should lose weight to maintain weight reduction criteria. Knee arthroplasty's growth rate and epidemiological changes in morbid obese patients were the particular issues regarding total knee replacement highlighted in the present study. Based on our study, morbidly obese patients could be suitable candidates for total knee replacement. Morbid obese patients should be counseled. Keywords: Total Knee Replacement, Unilateral, Bilateral, Morbid Obese Patients
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Sivarasu, Sudesh, and Lazar Mathew. "KINEMATIC ANALYSIS AND 3D FINITE ELEMENT ANALYSIS OF A MOBILE-BEARING ARTIFICIAL HIGH FLEXION KNEE." Biomedical Engineering: Applications, Basis and Communications 21, no. 04 (August 2009): 279–85. http://dx.doi.org/10.4015/s1016237209001337.
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Total knee arthroplasty (TKA) has been the end-time surgical procedure for pain relief and movement restoration in cases of severe arthritis. The knee implant design plays a vital role in deciding the activity levels of a patient after total knee replacement (TKR). In about 90% of younger patients undergoing the knee replacement surgeries, the restriction is not from the subject but from the implant design. This paper discusses parameters affecting the activity levels after TKR. It also briefs the design aspects of a novel knee design that allows the normal high flexion activity even after TKR. The application of finite element modeling in medical applications has been evolving as the field of high importance especially in the development of medical devices. The TKA has been in existence for over six decades till now. The generic artificial knee implants used in the TKA have the restriction in its range of motion of about 90°. A new design allowing flexion extension range of over 120° was designed with a view to facilitate partial squatting and the same is used for the analysis purpose. The loading conditions of 10 times the body weight are considered. The finite element analyses of the designs were carried out based on standard biomaterial used in orthopedic implants. In this paper, we have discussed the results of analyses of an artificial knee with titanium (Ti) alloy. The results of the analyses were used in identifying areas of extreme stresses within the design and the spot prone for higher deformation. Based on these results, slight modification on the designs was carried out. The results are also verified whether the body is within the linear deformation levels. As the results obtained were very satisfactory, the models have been recommended for prototyping.
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Zadorožnijs, Sergejs, and Konstantīns Kalnbērzs. "Ignoring Digital Templating Leads to Prosthetic Overhang in Total Knee Replacement." Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 72, no. 5 (October 1, 2018): 279–84. http://dx.doi.org/10.2478/prolas-2018-0026.
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Abstract Published studies on the accuracy of digital templating in total knee replacement (TKR) have employed standard knee, but not hip-to-ankle radiographs. A retrospective study was conducted in our hospital on patients undergoing TKR due to osteoarthritis in a period of six consecutive months. Templating was performed using a calibrating 25 mm metallic ball and Agfa Orthopaedic Tools software by a surgeon not involved with the operation. The surgeon performing the templating was blinded to the size of the implants inserted. Postoperative knee anteroposterior and lateral radiographs were then checked for the presence of prosthetic overhang of ≥ 3 mm. In total, 132 Caucasian adults were included in the study. Femoral overhang occurred in 33%, whereas tibial overhang in only 6% of cases. The exclusion of prosthetic overhang cases significantly improved the accuracy of size detection; exact match for femur increased from 55% to 69%, and for tibia from 70% to 73%. All implants were predicted to within one size in all cases. Digital templating using a calibrating 25 mm metallic ball, Agfa Orthopaedic Tools software and hip-to-ankle and knee lateral radiographs is an accurate method of predicting the knee implant to within one size. Ignoring this procedure leads to prosthetic overhang.
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Maag, Chase, Ioan Cracaoanu, Jason Langhorn, and Mark Heldreth. "Total knee replacement wear during simulated gait with mechanical and anatomic alignments." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 235, no. 5 (January 31, 2021): 515–22. http://dx.doi.org/10.1177/0954411921991269.
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Total knee replacements (TKR) have historically been implanted perpendicular to the mechanical axis of the knee joint, with a commensurate external rotation of the femur in flexion relative to the posterior condylar axis (PCA). Although this mechanical alignment (MA) method has typically offered good long-term survivorship of implants, it may result in alignment of the implant that departs significantly from the native Joint Line (JL) in extension and flexion for a considerable portion of the patient population. There is a growing interest with surgeons to implant TKR components more closely aligned to the natural JL (Anatomic Alignment-AA) of the patient’s knee joint to reduce the need for soft tissue releases during surgery, potentially improving knee function and patient satisfaction. Using a previously-validated finite element model of the lower extremity, implant- and alignment-specific loading conditions were developed and applied in a wear experiment via a six-degree-of-freedom joint simulator. MA was defined as 0° Joint Line (JL), 0° varus hip-knee-ankle (HKA) angle, and 3° external femoral rotation. AA was defined as 5° varus JL, 3° varus HKA, and 0° femoral rotation. The experiment returned wear rates of 3.76 ± 0.51 mg/million cycles (Mcyc) and 2.59 ± 2.11 mg/Mcyc for ATTUNE® cruciate-retaining (CR) fixed bearing (FB) in MA and AA, respectively. For ATTUNE posterior-stabilized (PS) FB in AA, the wear rate was 0.97 ± 1.11 mg/Mcyc. For ATTUNE CR rotating platform (RP), the wear rates were 0.23 ± 0.19 mg/Mcyc, 0.48 ± 1.02 mg/Mcyc in MA and AA respectively. Using a two-way ANOVA, it was determined that there was no significantly difference in the wear rates between AA and MA ( p = 0.144) nor the wear rate of ATTUNE PS FB in AA significantly different from either ATTUNE CR FB or ATTUNE CR RP.
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Motwani, P., A. Jariwala, and N. Valentine. "DOES NAVIGATION TOTAL KNEE REPLACEMENT REALLY MAKE A DIFFERENCE?" Journal of Musculoskeletal Research 16, no. 02 (June 2013): 1350007. http://dx.doi.org/10.1142/s0218957713500073.
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Background: Computer Navigation in Total Knee Replacement (TKR) has completed more than a decade since its inception. From that time, numerous studies have been done to see its effect on the variables of surgery and its outcome. Some studies have shown that it is definitely beneficial while others have negated its superiority over conventional techniques. This is an early outcome study on the results of navigation TKR in terms of alignment and clinical outcome at three years post-operatively. Methods: In the present study, 128 patients who had undergone navigation TKR (128 TKR) between January 2006 and November 2009 were included. The navigation system used was orthoPilot®. Patients were assessed post-operatively at one and three year using knee society score (KSS) and knee function score (KFS). All patients completed one year follow-up and 55 patients completed three year follow-up. From 128 patients, 40 navigated TKR patients operated between November 2007 and 2009 and were compared with 40 patients operated by conventional TKR operated between July 2007 and December 2008. Results: The mean KSS at 1 year post-operatively was 85.60 and at 3 years was 85.87. The mean KFS at 1 year post-operatively was 69.30 and at 3 years was 68.00. There was no statistically significant difference between navigation TKR and conventional TKR in terms of anatomical femoro-tibial alignment, femoral component alignment in coronal and sagittal plane and tibial component alignment in coronal plane. However, there was statistically significant difference between tibial component alignment in sagittal plane (p = 0.000) between both the groups. Conclusion: Computer navigation TKR affords a possibility to place both the femoral and tibial component very precisely without the risk of any greater axis deviation from ideal value. It helps in reducing the outliers in alignment of the limb and that of component and that improves the overall implant survival for a long time post-operatively.
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Cristofolini, L., S. Affatato, P. Erani, W. Leardini, D. Tigani, and M. Viceconti. "Long-term implant—bone fixation of the femoral component in total knee replacement." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 222, no. 3 (March 1, 2008): 319–31. http://dx.doi.org/10.1243/09544119jeim328.
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Success of total knee replacement (TKR) depends on the prosthetic design. Aseptic loosening of the femoral component is a significant failure mode that has received little attention. Despite the clinical relevance of failures, no protocol is available to test long-term implant—bone fixation of TKR in vitro. The scope of this work was to develop and validate a protocol to assess pre-clinically the fixation of TKR femoral components. An in vitro protocol was designed to apply a simplified but relevant loading profile using a 6-degrees-of-freedom knee simulator for 1 000 000 cycles. Implant—bone inducible micromotions and permanent migrations were measured at three locations throughout the test. After test completion, fatigue damage in the cement was quantified. The developed protocol was successfully applied to a commercial TKR. Additional tests were performed to exclude artefacts due to swelling or creep of the composite femur models. The components migrated distally; they tilted towards valgus in the frontal plane and in extension in the sagittal plane. The migration patterns were consistent with clinical roentgen-stereophotogrammetric recordings with TKR. Additional indicators were proposed that could quantify the tendency to loosen/stabilize. The type and amount of damage found in the cement, as well as the migration patterns, were consistent with clinical experience with the specific TKR investigated. The proposed pre-clinical test yielded repeatable results, which were consistent with the clinical literature. Therefore, its relevance and reliability was proved.
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Shuib, Solehuddin, Mohammad Arsyad Azemi, Iffa Binti Mohd Arrif, and Najwa Syakirah Hamizan. "Design for Additive Manufacturing and Finite Element Analysis for High Flexion Total Knee Replacement (TKR)." Journal of Mechanical Engineering 18, no. 2 (April 15, 2021): 97–110. http://dx.doi.org/10.24191/jmeche.v18i2.14963.
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The patient from the Asian region always demanded a fully functional knee implant, which implied a high-flexion range of motion. Most of their daily life activities utilized the deep knee flexion which flexed until 165° such as the Japanese proper sitting style and Muslim prayer position. The problem of the study is extending the range of motion or achieving the high flexion of total knee replacement as the traditional total knee replacement was incapable to achieve more than 115°. Hence, the purpose of this study is to achieve a modified design of a knee implant that can flex up to 165° by carried out a static structural analysis in the ANSYS R16. There are 0°, 90°, 135°, and 165° angles of flexion with a different net force based on the percentage of body weight implemented on the knee implant. The analysis includes total deformation, Von Mises stress, shear stress, and contact pressure on knee implant were observed and compared to find better modification design. The total deformation had been decreased by about 69% at 0° flexion, 58.5% at 90° flexion, 90.93% at 135° flexion. The contact pressure also had been decreased by about 99.2%, 22.2%, 99.98% at angle flexion of 0, 90, and 135, respectively. The same declination happened to von Mises stress at about 85.05%, 9.52%, and 88.04% at the same angle of 0, 90, and 135, respectively.
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Dammer, Rebecca H., Carmen Zietz, and Rainer Bader. "A Comparison of Wear Patterns on Retrieved and Simulator-Tested Total Knee Replacements." Journal of Functional Biomaterials 13, no. 4 (November 19, 2022): 256. http://dx.doi.org/10.3390/jfb13040256.
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Aseptic implant loosening is the most common reason for revision surgery after total knee replacement. This is associated with adverse biological reactions to wear debris from the articulating implant components. To predict the amount of wear debris generated in situ, standard wear testing of total knee replacement (TKR) is carried out before its clinical use. However, wear data reported on retrievals of total knee replacement (TKR) revealed significant discrepancies compared with standard wear simulator studies. Therefore, the aim of the present study was to compare the wear patterns on identical posterior-cruciate-retaining TKR designs by analyzing retrieved and experimentally tested implants. The identification and classification of wear patterns were performed using 21 retrieved ultra-high-molecular-weight-polyethylene (UHMW-PE) inserts and four sets of inserts of identical design and material tested in a knee wear simulator. These four sets had undergone different worst-case conditions and a standard test in a wear simulator according to ISO 14243-1. Macroscopic and microscopic examinations of the polyethylene inserts were performed, including the determination of seven modes of wear that correspond to specific wear patterns, the calculation of wear areas, and the classification of the damage over the whole articulating area. Retrieved and standard wear simulator-tested UHMW-PE inserts showed significant differences in wear area and patterns. The total wear areas and the damage score were significantly larger on the retrievals (52.3% versus 23.9%, 32.7 versus 22.7). Furthermore, the range of wear patterns found on the retrievals was not reproducible in the simulator-tested inserts. However, good correspondence was found with the simulator-tested polyethylene inserts under worst-case conditions (third body wear), i.e., deep wear areas could be replicated according to the in vivo situation compared with other wear test scenarios. Based on the findings presented here, standard simulator testing can be used to directly compare different TKR designs but is limited in the prediction of their in situ wear. Preclinical wear testing may be adjusted by worst-case conditions to improve the prediction of in situ performance of total knee implants in the future.
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Nisar, Sohail, Jeya Palan, Charles Rivière, Mark Emerton, and Hemant Pandit. "Kinematic alignment in total knee arthroplasty." EFORT Open Reviews 5, no. 7 (July 2020): 380–90. http://dx.doi.org/10.1302/2058-5241.5.200010.
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Kinematic alignment (KA) is an alternative philosophy for aligning a total knee replacement (TKR) which aims to restore all three kinematic axes of the native knee. Many of the studies on KA have actually described non-KA techniques, which has led to much confusion about what actually fits the definition of KA. Alignment should only be measured using three-dimensional cross-sectional imaging. Many of the studies looking at the influence of implants/limb alignment on total knee arthroplasty outcomes are of limited value because of the use of two-dimensional imaging to measure alignment, potentially leading to inaccuracy. No studies have shown KA to be associated with higher complication rates or with worse implant survival; and the clinical outcomes following KA tend to be at least as good as mechanical alignment. Further high-quality multi-centre randomized controlled trials are needed to establish whether KA provides better function and without adversely impacting implant survival. Cite this article: EFORT Open Rev 2020;5:380-390. DOI: 10.1302/2058-5241.5.200010
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Mudiganty, Srikanth, Chethan Jayadev, Richard Carrington, Jonathan Miles, James Donaldson, and Robert Mcculloch. "TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH SKELETAL DYSPLASIA." Orthopaedic Proceedings 105-B, SUPP_13 (August 7, 2023): 37. http://dx.doi.org/10.1302/1358-992x.2023.13.037.
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AbstractIntroductionTotal knee replacement (TKR) in patients with skeletal dysplasia is technically challenging surgery due to deformity, joint contracture, and associated co-morbidities. The aim of this study is to follow up patients with skeletal dysplasia following a TKR.MethodologyWe retrospectively reviewed 22 patients with skeletal dysplasia who underwent 31 TKRs at our institution between 2006 and 2022. Clinical notes, operative records and radiographic data were reviewed.ResultsAchondroplasia was the most common skeletal dysplasia (8), followed by Chondrodysplasia punctata (7) and Spondyloepiphyseal dysplasia (5). There were fourteen men and eight women with mean age of 51 years (28 to 73). The average height of patients was 1.4 metres (1.16–1.75) and the mean weight was 64.8 Kg (34.3–100). The mean follow up duration was 68.32 months (1–161). Three patients died during follow up. Custom implants were required in twelve patients (38.71%). Custom jigs were utilised in six patients and two patients underwent robotic assisted surgery. Hinged TKR was used in seventeen patients (54.84%), posterior stabilised TKR in nine patients (29.03%), and cruciate retaining TKR in five patients (16.13%). One patient underwent a patella resurfacing for persistent anterior knee pain and another had an intra-operative medial tibial plateau fracture which was managed with fixation. No revisions occurred during the follow up period.ConclusionDespite the technical challenges and complexity of TKR within this unique patient group, we demonstrate good implant survivorship during the study period. Cross sectional imaging is recommended preoperatively for precise planning and templating.
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NGUYEN, Ho-Quang, Trieu-Nhat-Thanh NGUYEN, Thinh-Quy-Duc PHAM, Van-Dung NGUYEN, Xuan Van TRAN, and Tien-Tuan DAO. "Crack Propagation in the Tibia Bone within Total Knee Replacement Using the eXtended Finite Element Method." Applied Sciences 11, no. 10 (May 13, 2021): 4435. http://dx.doi.org/10.3390/app11104435.
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Understanding of fracture mechanics of the human knee structures within total knee replacement (TKR) allows a better decision support for bone fracture prevention. Numerous studies addressed these complex injuries involving the femur bones but the full macro-crack propagation from crack initiation to final failure and age-related effects on the tibia bone were not extensively studied. The present study aimed to develop a patient-specific model of the human tibia bone and the associated TKR implant, to study fatigue and fracture behaviors under physiological and pathological (i.e., age-related effect) conditions. Computed tomography (CT) data were used to develop a patient-specific computational model of the human tibia bone (cortical and cancellous) and associated implants. First, segmentation and 3D-reconstruction of the geometrical models of the tibia and implant were performed. Then, meshes were generated. The locations of crack initiation were identified using the clinical observation and the fatigue crack initiation model. Then, the propagation of the crack in the bone until final failure was investigated using the eXtended finite element method (X-FEM). Finally, the obtained outcomes were analyzed and evaluated to investigate the age-effects on the crack propagation behaviors of the bone. For fatigue crack initiation analysis, the stress amplitude–life S–N curve witnessed a decrease with increasing age. The maximal stress concentration caused by cyclic loading resulted in the weakening of the tibia bone under TKR. For fatigue crack propagation analysis, regarding simulation with the implant, the stress intensity factorand the energy release rate tended to decrease, as compared to the tibia model without the implant, from 0.152.5 to 0.111.9 (MPa) and from 10240 to 5133 (J), respectively. This led to the drop in crack propagation speed. This study provided, for the first time, a detailed view on the full crack path from crack initiation to final failure of the tibia bone within the TKR implant. The obtained outcomes also suggested that age (i.e., bone strength) also plays an important role in tibia crack and bone fracture. In perspective, patient-specific bone properties and dynamic loadings (e.g., during walking or running) are incorporated to provide objective and quantitative indicators for crack and fracture prevention, during daily activities.
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Kvale, Eirik, Rocio Chicon Rueda, and Noel Fitzpatrick. "Limb-Sparing Surgery in Two Cats Using a Femoral Endoprosthesis with an Integrated Total Knee Replacement Implant." Veterinary and Comparative Orthopaedics and Traumatology 35, no. 02 (January 18, 2022): 134–42. http://dx.doi.org/10.1055/s-0041-1742184.
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Abstract Objective The aim of this study was to describe a novel limb-sparing technique for the management of feline bone neoplasia using a custom-made femoral endoprosthesis in combination with a total knee replacement (TKR) prosthesis. Methods Two cats with distal femoral bone tumours underwent pelvic limb salvage procedures with custom-made implants designed from patient-specific computed tomography images to replace the distal femur and the stifle. In case 1, the first-generation implant was a combination of a cemented femoral endoprosthesis with a uniaxial hinged cemented TKR prosthesis. Due to aseptic loosening of the endoprosthesis, revision was performed with a second-generation femoral endoprosthesis modified with a short intramedullary peg and a lateral bone plate for immediate stability. In case 2, a third-generation endoprosthesis with an intramedullary peg and two orthogonal bone plates for immediate stability, combined with a custom-designed rotationally hinged cemented TKR prosthesis, was used. Clinical and radiographic follow-up was recorded. Results After revision surgery in case 1 and with the third-generation implant in case 2, no complications were encountered. Both cats showed minor mechanical restriction of stifle range of motion and good clinical long-term outcome without local tumour recurrence. Conclusion The combination of a femoral endoprosthesis and a TKR prosthesis can be a viable alternative for distal femoral limb salvage in cats.
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Hoellwarth, Jason, Atiya Oomatia, and Munjed Al Muderis. "MEDIUM-TERM OUTCOMES OF TRANSTIBIAL OSSEOINTEGRATION IN ASSOCIATION WITH TOTAL KNEE ARTHROPLASTY." Orthopaedic Proceedings 105-B, SUPP_10 (June 1, 2023): 18. http://dx.doi.org/10.1302/1358-992x.2023.10.018.
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IntroductionTranstibial osseointegration (TFOI) for amputees has limited but clear literature identifying superior quality of life and mobility versus a socketed prosthesis. Some amputees have knee arthritis that would be relieved by a total knee replacement (TKR). No other group has reported performing a TKR in association with TTOI (TKR+TTOI). We report the outcomes of nine patients who had TKR+TTOI, followed for an average 6.5 years.Materials & MethodsOur osseointegration registry was retrospectively reviewed to identify all patients who had TTOI and who also had TKR, performed at least two years prior. Four patients had TKR first the TTOI, four patients had simultaneous TKR+TTOI, and one patient had 1 OI first then TKR. All constructs were in continuity from hinged TKR to the prosthetic limb. Outcomes were: complications prompting surgical intervention, and changes in daily prosthesis wear hours, Questionnaire for Persons with a Transfemoral Amputation (QTFA), and Short Form 36 (SF36). All patients had clinical follow-up, but two patients did not have complete survey and mobility tests at both time periods.ResultsSix (67%) were male, average age 51.2±14.7 years. All primary amputations were performed to manage traumatic injury or its sequelae. No patients died. Five patients (56%) developed infection leading to eventual transfemoral amputation 36.0±15.3 months later, and 1 patient had a single debridement six years after TTOI with no additional surgery in the subsequent two years. All patients who had transfemoral amputation elected for and received transfemoral osseointegration, and no infections occurred, although one patient sustained a periprosthetic fracture which was managed with internal fixation and implant retention and walks independently. The proportion of patients who wore their prosthesis at least 8 hours daily was 5/9=56%, versus 7/9=78% (p=.620). Even after proximal level amputation, the QTFA scores improved versus prior to TKR+TTOI, although not significantly: Global (45.2±20.3 vs 66.7±27.6, p=.179), Problem (39.8±19.8 vs 21.5±16.8, p=.205), Mobility (54.8±28.1 vs 67.7±25.0, p=.356). SF36 changes were also non-significant: Mental (58.6±7.0 vs 46.1±11.0, p=.068), Physical (34.3±6.1 vs 35.2±13.7, p=.904).ConclusionsTKR+TTOI presents a high risk for eventual infection prompting subsequent transfemoral amputation. Although none of these patients died, in general, TKR infection can lead to patient mortality. Given the exceptional benefit to preserving the knee joint to preserve amputee mobility and quality of life, it would be devastating to flatly force transtibial amputees with severe degenerative knee joint pain and unable to use a socket prosthesis to choose between TTOI but a painful knee, or preemptive transfemoral amputation for transfemoral osseointegration. Therefore, TTOI for patients who also request TKR must be considered cautiously. Given that this frequency of infection does not occur in patients who have total hip replacement in association with transfemoral osseointegration, the underlying issue may not be that linked joint replacement with osseointegrated limb replacement is incompatible, but may require further consideration of biological barriers to ascending infection and/or significant changes to implant design, surgical technique, or other yet-uncertain factors.
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Plassard, Jeremy, Jean Baptiste Masson, Matthieu Malatray, John Swan, Francesco Luceri, Julien Roger, Cécile Batailler, Elvire Servien, and Sébastien Lustig. "Factors lead to return to sports and recreational activity after total knee replacement." SICOT-J 6 (2020): 11. http://dx.doi.org/10.1051/sicotj/2020009.
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Introduction: The number of total knee replacements performed (TKR) is increasing and so are patient expectations and functional demands. The mean age at which orthopedic surgeons may indicate TKR is decreasing, and therefore return to sport (RTS) after TKR is often an important expectation for patients. The aim of this study was to analyze the mid-term RTS, recreational activities, satisfaction level, and forgotten joint level after TKR. Methods: Between January 2015 and December 2016, 536 TKR (same implant design, same technique) were performed in our center. The mean age at survey was 69 years with a mean follow-up of 43 months. All patients who did not have a follow-up in the last 6 months were called. Finally, 443 TKR were analyzed. RTS was assessed using the University of California Los Angeles Scale (UCLA), forgotten joint score (FJS), and Satisfaction Score. Results: In this study, 85% of patients had RTS after TKR with a mean UCLA score increasing from 4.48 to 5.92 and a high satisfaction rate. Satisfaction with activity level was 93% (satisfied and very satisfied patients). The RTS is more important for people with a higher preoperative UCLA score and a lower American Society of Anesthesiologist score (ASA). Each point increase in ASA score is associated with reduced probability to RTS by 52%. Discussion: RTS and recreational activity were likely after TKR with a high satisfaction score. Preoperative condition and activity are the two most significant predictive factors for RTS. Level of evidence: Retrospective case series, level IV.
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Abbassian, Ali, Balarama Datla, and RA Brooks. "Detection of Orthopaedic Implants by Airport Metal Detectors." Annals of The Royal College of Surgeons of England 89, no. 3 (April 2007): 285–87. http://dx.doi.org/10.1308/003588407x179026.
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INTRODUCTION We performed a questionnaire study to establish the frequency and consequences of the detection of orthopaedic implants by airport security and to help us advise patients correctly. All published literature on this subject is based on experimental studies and no ‘real-life’ data are available. PATIENTS AND METHODS A total of 200 patients with a variety of implants were identified. All patients were sent a postal questionnaire enquiring about their experience with airport security since their surgery. RESULTS Of the cohort, 154 (77%) patients responded. About half of the implants (47%) were detected, but the majority of patients (72%) were not significantly inconvenienced. When detected, only 9% of patients were asked for documentary evidence of their implant. We also found that patients with a total knee replacement (TKR) had a greater chance of detection as compared to those with a total hip replacement (THR; 71% versus 31%; P = 0.03). CONCLUSIONS All patients, and in particular those with a TKR, can be re-assured that, although they have a fair chance of detection by airport security, a major disruption to their journey is unlikely. We advise that documentation to prove the presence of an orthopaedic implant should be offered to those who are concerned about the potential for inconvenience, but such documentation is not required routinely.
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Lakhani, Amit, Ena Sharma, Jose Antonio De Compos Martins, and Rita Alcada. "Ligament Balancing in Severe Osteoarthritis Knee with Large Cyst and Bursae - A Rare Case Report with Review of Literature." Journal of Evolution of Medical and Dental Sciences 10, no. 16 (April 19, 2021): 1174–76. http://dx.doi.org/10.14260/jemds/2021/249.
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The main indication of total knee replacement (TKR) is pain and restricted range of motion of the knee. The key to a successful total knee replacement is correct alignment in flexion and extension. Here we report a case of TKR in severe osteoarthritis (O / A) knee with a large cyst on the medial side of the knee, resulting in the problem of ligament balancing and management with help of an Arthrex Internal brace. Proper diagnosis and treatment plan help to overcome the challenging cases of varus knee. The indication of total knee replacement is pain and restricted range of motion of the knee. Several authors have reported successful outcomes on patient satisfaction in the follow-up of almost ten to fifteen years. 1 Additionally, the results of surgery are satisfactiry with good implant survival. 2 But some patients indeed have poor results and some may require revision surgery in a short duration. The key to a successful total knee replacement is correct alignment and stability in flexion and extension.3 The ligament after balancing of the correctly aligned knee must consider the function of the resected ligaments in flexion and extension, because in TKR both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are usually sacrificed. In other words, total knee replacement is a soft tissue surgery in which bone is replaced. In the varus knee, medial side structures are tight and compensatory laxity on the lateral side. So knee stability should be managed by the remaining ligamentous structures that are both medial and lateral collateral and capsular ligaments. 4 The gap technique is the gold standard for ligament balancing in total knee replacement. 5 That is the execution of equal medial and lateral gaps as well as balanced flexion and extension gaps. This is usually obtained by medial side release in varus knee as the medial side is contracted and lateral side release in valgus knee accordingly. Here we report a case of TKR in severe osteoarthritis knee with a large cyst on the medial side of the knee, resulting in the problem of ligament balancing and management.
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Silwal, Suvekshya, Bimala Kumari Sah, Lal Kumari Gurung, and Kapil Amgain. "Lived Experiences of Clients with Total Knee Replacement Residing in Kathmandu." Journal of Karnali Academy of Health Sciences 2, no. 1 (June 11, 2019): 60–69. http://dx.doi.org/10.3126/jkahs.v2i1.24415.
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Introduction: Total Knee Replacement (TKR) is an increasingly common treatment for severe knee osteoarthritis and the main indication is pain. Subjective factors affect the way in which individuals express their real-life experiences thus, this study aimed in bringing to the fore the personal perspective and interpretation of clients with (TKR). The objective of this study was to explore the lived experiences of clients with total knee replacement.
Methodology: Phenomenological qualitative research design was used where participants were selected from hospital record of Tribhuwan University Teaching Hospital and Nepal Orthopedic Hospital of Kathmandu. Based on the lived phenomenon, similar sharing of experiences from seven among nine participants with the in-depth interview was obtained. The data was collected for 2 months period where data analysis went simultaneously to reveal the concepts. Then the interview was transcribed manually following the thematic analysis phases of Gibson.
Results: The results indicated that most (5/7) expressed their ability to walk independently. Four clients (4/7) reported they could perform household chores and had no difficulty travelling in vehicles. Despite those positive results, all respondents (7/7) after TKR faced difficulties sitting down and the majority (6/7) faced difficulty climbing stairs. Four had difficulty in standing up and lying. Three had queries about the treatment process; swelling of lower legs and life of the implant.
Conclusion: The emerged five themes: impact of the treatment regimen, mobility issues, treatment modalities, supportive environment and inadequate health counselling revealed that although there is mixed result of treatment outcome, all respondents are satisfied as they got rid of the continued severe knee pain; hence, the respondents are following some safety and precaution measures for the better outcome. Adequate health counselling emphasizing in the rehabilitation programmes after TKR should be prioritized.
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Aljawder, Abdulla, Dana Alomran, Mohammed Alayyoub, and Fahad Alkhalifa. "Immediate Postoperative Portable Radiograph After Total Knee Replacements: A Necessity or a Burden?" Open Orthopaedics Journal 12, no. 1 (May 31, 2018): 173–79. http://dx.doi.org/10.2174/1874325001812010173.
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Background:Total Knee Replacement (TKR) is one of the most commonly performed orthopaedic surgery(1). Immediate postoperative portable radiographs are performed after primary TKR in order to identify any potential complications and technical flaws. It also serves as a reference for comparison with subsequent radiographs. The aim of this study was to evaluate the clinical and economical value of these radiographs in TKR. It compares the quality of the portable radiograph, taken immediately post-operation, with in-suite radiographs taken 5-7 weeks post-operationMethods:In this retrospective study, a consecutive series of 389 TKR patients from January-2011 to March-2015 were reviewed. Radiological evaluation consisted of assessing the beam angle and the exposure on the images. Implant positioning was also compared by measuring the anatomical axis to look for component alignment discrepancies.Results:The quality of the portable recovery room radiograph was overall inferior to the radiology suite radiograph regarding both beam angle and exposure. Component alignment discrepancies were also identified in the angle measurements between both types of radiographs.Conclusion:Therefore, our study demonstrated that there is no clinical or financial value obtained from postoperative portable radiograph. Furthermore, Immediate recovery room radiographs should be avoided from being performed routinely and may only be used in cases where the surgeon is utilizing a new implant or technique. No external funding was provided for this study from any source.
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STAUNTON, D. M., R. MOHAN, J. R. CARTER, and A. J. HIGHCOCK. "Total knee replacement survivorship by Design Philosophy: are we ignoring medial pivot design? Analysis based on the UK National Joint Registry." Acta Orthopaedica Belgica 89, no. 1 (March 30, 2023): 37–43. http://dx.doi.org/10.52628/89.1.9913.
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The UK National Joint Registry(NJR) has not reported total knee replacement (TKR) survivorship based on design phi- losophy alone, unlike its international counterparts. We report outcomes of implant survivorship based on design phi- losophy using data from NJR’s 2020 annual report. All TKR implants with an identifiable design philosophy from NJR data were included. Cumulative revision data for cruciate-retaining(CR), posterior stabilised(PS), mobile-bearing(MB) design philosophies was derived from merged NJR data. Cumulative revision data for individual brands of implants with the medial pivot (MP) philosophy were used to calculate overall survivorship for this design philosophy. The all-cause revision was used as the endpoint and calculated to 15 years follow-up with Kaplan-Meier curves. 1,144,384 TKRs were included. CR is the most popular design philosophy (67.4%), followed by PS(23.1%), MB (6.9%) and least commonly MP (2.6%). MP and CR implants showed the best survivorship (95.7% and 95.6% respectively) at 15 years which is statistically significant at, and beyond, 10 years. Observed survivorship was lower at all time points with the PS and MB implants (94.5% for both designs at 15 years). While all design philosophies considered in this study survive well, CR and MP designs offer statistically superior survivorship at and beyond 10 years. MP design performs better than CR beyond 13 years yet, remain the least popular design philosophy used. Publishing data based on knee arthroplasty design phi- losophy would help surgeons when making decisions on implant choice.
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Fowler, Timothy J., Alex L. Aquilina, Ashley W. Blom, Adrian Sayers, and Michael R. Whitehouse. "Association between surgeon grade and implant survival following hip and knee replacement: a systematic review and meta-analysis." BMJ Open 11, no. 11 (November 2021): e047882. http://dx.doi.org/10.1136/bmjopen-2020-047882.
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ObjectiveTo investigate the association between surgeon grade (trainee vs consultant) and implant survival following primary hip and knee replacement.DesignA systematic review and meta-analysis of observational studies.Data sourcesMEDLINE and Embase from inception to 6 October 2021.SettingUnits performing primary hip and/or knee replacements since 1990.ParticipantsAdult patients undergoing either a primary hip or knee replacement, predominantly for osteoarthritis.InterventionWhether the surgeon recorded as performing the procedure was a trainee or not.Primary and secondary outcome measuresThe primary outcome was net implant survival reported as a Kaplan-Meier survival estimate. The secondary outcome was crude revision rate. Both outcomes were reported according to surgeon grade.ResultsNine cohort studies capturing 4066 total hip replacements (THRs), 936 total knee replacements (TKRs) and 1357 unicompartmental knee replacements (UKRs) were included (5 THR studies, 2 TKR studies and 2 UKR studies). The pooled net implant survival estimates for THRs at 5 years were 97.9% (95% CI 96.6% to 99.2%) for trainees and 98.1% (95% CI 97.1% to 99.2%) for consultants. The relative risk of revision of THRs at 5 and 10 years was 0.88 (95% CI 0.46 to 1.70) and 0.68 (95% CI 0.37 to 1.26), respectively. For TKRs, the net implant survival estimates at 10 years were 96.2% (95% CI 94.0% to 98.4%) for trainees and 95.1% (95% CI 93.0% to 97.2%) for consultants. We report a narrative summary of UKR outcomes.ConclusionsThere is no strong evidence in the existing literature that trainee surgeons have worse outcomes compared with consultants, in terms of the net survival or crude revision rate of hip and knee replacements at 5–10 years follow-up. These findings are limited by the quality of the existing published data and are applicable to countries with established orthopaedic training programmes.PROSPERO registration numberCRD42019150494.
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Fahmy, Mahmoud, and Ahmed Fouad Seifeldin. "The impact of infrapatellar fat pad excision versus preservation after total knee replacement on anterior knee pain, functional outcome and patellar height: Randomized controlled trial." Journal of Orthopaedics, Trauma and Rehabilitation 29, no. 1 (April 8, 2022): 221049172210857. http://dx.doi.org/10.1177/22104917221085723.
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Introduction Although better surgical exposure is encountered with the excision of infrapatellar pad of fat (IPPF) during total knee replacement (TKR), some studies showed an increase in anterior knee pain and other specific complications associated with such a step. The purpose of this study was to add in literature a new comparison between IPPF excision and preservation during TKR, focusing on the anterior knee pain, functional range, oxford knee score and patellar height through a randomized clinical trial Methods This prospective randomized study was conducted from 2016 to 2019 on 90 patients with knee osteoarthritis treated with elective primary TKA by same surgeons at one hospital with the same implant design with a mean follow up of 18 month. Patients were randomized into two groups: one group including patients with IPPF complete excision and the other group include patients with IPPF preservation. No patella resurfacing was done. Pre and postoperative anterior knee pain was recorded and compared using VAS score in addition to Oxford knee score. Results At 6 months follow-up, 10 knees and 14 knees (27%) had anterior aching discomfort with a mean postoperative extension were −5.3 and −5.2 in IPPF preservation and excision group patients, respectively. There was no statistically significant differences between both groups regarding anterior knee pain, range of motion, oxford knee score or patellar height measurement through the follow up period. No patellar complications were recorded in all cases. Conclusion Although Infrapatellar fat pad excision in TKA resulted in a minor increase in number of patients with postoperative anterior knee pain, it was of no statistically significant difference. Hence, whenever a better surgical exposure is needed, IPPF excision should be considered. Additional large scale randomized studies should be added to the calling literature for more result validation and guidelines formulation.
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Mangado, N., C. Quevedo, L. Lozano, S. Suso, and M. Cerrolaza. "TO WHAT EXTENT THE COMBINATION OF STEM LENGTH AND STEM INCLINATION DO AFFECT THE PERFORMANCE OF THE TIBIAL COMPONENT IN KNEE IMPLANTS?" Biomedical Engineering: Applications, Basis and Communications 27, no. 02 (March 17, 2015): 1550018. http://dx.doi.org/10.4015/s1016237215500180.
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Mechanical loosening, instability, mechanical fractures and poor quality of bone are some factors that strongly influence the deterioration of knee implants. After a total knee replacement (TKR), proximal tibial bone suffers a resorption due to stress-shielding caused by the implant. The formation of weakening bone zones and loss of bone is one of the most clinical concerns. The aim of this work is to evaluate the geometry of the implant stem to improve the implant lifespan. A three-dimensional model of the tibial component has been generated using computerized tomographies (CT) reconstruction and CAD software. Stresses distribution at the interface bone-implant considering several combinations of stem lengths and stem inclinations have been analyzed using finite element analysis (FEA). High levels of resorption risk have been observed, when using different stem-lengths and varus inclination.
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Shi, J. F., C. J. Wang, T. Laoui, W. Hart, and R. Hall. "A dynamic model of simulating stress distribution in the distal femur after total knee replacement." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 221, no. 8 (August 1, 2007): 903–12. http://dx.doi.org/10.1243/09544119jeim256.
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The aim of this study has been to develop a dynamic model of the knee joint after total knee replacement (TKR) to analyse the stress distribution in the distal femur during daily activities. Using MSC/ADAMS and MSC/MARC software, a dynamic model of an implanted knee joint has been developed. This model consists of the components of the knee prosthesis as well as the bones and ligaments of the knee. The femur, tibia, fibula, and patella have been modelled as mixed cortico-cancellous bone. The distal part of femur has been modelled as a flexible body with springs used to simulate the ligaments positioned at their anatomical insertion points. With this dynamic model a gait cycle was simulated. Stress shielding was identified in the distal femur after TKR, which is consistent with other investigators' results. Interestingly, higher stresses were found in the bone adjacent to the femoral component peg. This dynamic model can now be used to analyse the stress distribution in the distal femur with different load conditions. This will help to improve implant designs and will allow comparison of prostheses from different manufacturers.
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Zadorožnijs, Sergejs, and Konstantins Kalnberzs. "The Reliability and Accuracy of Knee Implants Sizing Predicted by Digital Templating." Acta Chirurgica Latviensis 12, no. 1 (December 1, 2012): 29–31. http://dx.doi.org/10.2478/v10163-012-0006-8.
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Summary Introduction. Osteoarthritis of the knee is a common and frequently symptomatic illness. Total knee replacement (TKR) has evolved as an accepted, cost-effective and efficacious treatment modality for osteoarthritis and other forms of arthritic conditions of the knee joint. Preoperative planning is an important part of the surgical procedure. The inability to accurately determine the magnification factor of the radiograph is one of the major problems in analog preoperative planning of TKR. With the use of calibration objects, the digital images can be corrected for the magnification factor. Aim of the Study. We aimed to determine the reliability and accuracy of digital templating in the pre-operative work-up for TKR. Materials and Methods. A retrospective study was done in 105 caucasian adults, who had osteoarthritis of the knee. Digital templating was performed using a calibrating 25-mm metallic ball and Agfa Orthopaedic Tools digital software package by a surgeon not involved with the operation, who was blinded to the size of the implant inserted. The Press Fit Condylar Sigma Knee system was used in all the patients. Digital anteroposterior and lateral radiographs of the knee were used in measuring the implant size. The results from digital images were compared with the size of actual femoral and tibial implants used at the time of surgery. Results. The correct size of the implant was predicted in 73 of 105 (69,5%) of the femoral and 70 of 105 (66,7%) of the tibial components. The correct size of the whole system was predicted in 58 of 105 (55,2%) cases. The digital preoperative planning predicted 104 of 105 (99,0%) femoral and tibial implants and 103 of 105 (98,1%) whole systems to within one size. Conclusions. We conclude that digital templating using a calibrating 25-mm metallic ball and Agfa Orthopaedic Tools digital software is a reliable method of predicting the implant to within one size.
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Picard, F., A. H. Deakin, J. V. Clarke, J. M. Dillon, and A. W. Kinninmonth. "A quantitative method of effective soft tissue management for varus knees in total knee replacement surgery using navigational techniques." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 221, no. 7 (July 1, 2007): 763–72. http://dx.doi.org/10.1243/09544119jeim272.
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Total knee replacement (TKR) has become the standard procedure in management of degenerative joint disease with its success depending mainly on two factors: three-dimensional alignment and soft-tissue balancing. The aim of this work was to develop and validate an algorithm to indicate appropriate medial soft tissue release during TKR for varus knees using initial kinematics quantified via navigation techniques. Kinematic data were collected intra-operatively for 46 patients with primary end-stage osteoarthritis undergoing TKR surgery using a computer-tomography-free navigation system. All patients had preoperative varus knees and medial release was made using the surgeon's experience. Based on these data an algorithm was developed. This algorithm was validated on a further set of 35 patients where it was used to define the medial release based on the kinematic data. The post-operative valgus stress angles for the two groups were compared. These results showed that the algorithm was a suitable tool to indicate the type of medial release required in varus knees based on intra-operatively measured pre-implant valgus stress and extension deficit angles. It reduced the percentage of releases made and the results were more appropriate than the decisions made by an experienced surgeon.
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Kebbach, Maeruan, Iman Soodmand, Sven Krueger, Thomas M. Grupp, Christoph Woernle, and Rainer Bader. "Biomechanical Assessment of Mobile-Bearing Total Knee Endoprostheses Using Musculoskeletal Simulation." Applied Sciences 12, no. 1 (December 24, 2021): 182. http://dx.doi.org/10.3390/app12010182.
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The purpose of this computational study was to analyze the effects of different mobile-bearing (MB) total knee replacement (TKR) designs on knee joint biomechanics. A validated musculoskeletal model of the lower right extremity implanted with a cruciate-retaining fixed-bearing TKR undergoing a squat motion was adapted for three different MB TKR design variants: (I) a commercially available TKR design allowing for tibial insert rotation about the tibial tray with end stops to limit the range of rotation, (II) the same design without end stops, and (III) a multidirectional design with an additional translational degree-of-freedom (DoF) and end stops. When modeling the MB interface, two modeling strategies of different joint topologies were deployed: (1) a six DoF joint as a baseline and (2) a combined revolute-prismatic joint (two DoF joint) with end stops in both DoF. Altered knee joint kinematics for the three MB design variants were observed. The commercially available TKR design variant I yielded a deviation in internal-external rotation of the tibial insert relative to the tray up to 5° during knee flexion. Compared to the multidirectional design variant III, the other two variants revealed less femoral anterior-posterior translation by as much as 5 mm. Concerning the modeling strategies, the two DoF joint showed less computation time by 68%, 80%, and 82% for design variants I, II, and III, respectively. However, only slight differences in the knee joint kinematics of the two modeling strategies were recorded. In conclusion, knee joint biomechanics during a squat motion differed for each of the simulated MB design variants. Specific implant design elements, such as the presence of end stops, can impact the postoperative range of knee motion with regard to modeling strategy, and the two DoF joint option tested accurately replicated the results for the simulated designs with a considerably lower computation time than the six DoF joint. The proposed musculoskeletal multibody simulation framework is capable of virtually characterizing the knee joint dynamics for different TKR designs.
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Panzram, Benjamin, Mira Mandery, Tobias Reiner, Tobias Gotterbarm, Marcus Schiltenwolf, and Christian Merle. "Cementless Oxford Medial Unicompartmental Knee Replacement—Clinical and Radiological Results of 228 Knees with a Minimum 2-Year Follow-Up." Journal of Clinical Medicine 9, no. 5 (May 14, 2020): 1476. http://dx.doi.org/10.3390/jcm9051476.
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(1) Background: Studies show several advantages of unicompartmental knee replacement (UKR) over total knee replacements (TKR), whereas registry based revision rates of UKR are significantly higher than for TKA. Registry data report lower revision rates for cementless UKR compared to cemented UKR. The aim of this study was to assess clinical and radiological results of cementless Oxford UKR (OUKR) in an independent cohort. (2) Methods: This retrospective cohort study examines a consecutive series of 228 cementless OUKR. Clinical outcome was measured using functional scores (Oxford Knee Score (OKS), American Knee Society Score (AKSS), Hannover Functional Ability Questionnaire for Osteoarthritis (FFbH-OA), range of motion (ROM)), pain and satisfaction. Radiographs were analyzed regarding the incidence of radiolucent lines (RL), implant positioning, and their possible impact on clinical outcome. (3) Results: At a mean follow-up of 37.1 months, the two and three year revision free survival-rates were 97.5% and 96.9%. Reasons for revision surgery were progression of osteoarthritis, inlay dislocation and pain. All clinical outcome scores showed a significant improvement from pre- to postoperative. The incidence of RL around the implant was highest within the first year postoperatively (36%), and decreased (5%) within the second year. Their presence was not correlated with inferior clinical outcome. Implant positioning showed no influence on clinical outcome. (4) Conclusion: Cementless OUKR showed excellent clinical outcome and survival rates, with reliable osteointegration. Neither the incidence of radiolucent lines nor implant positioning were associated with inferior clinical outcome.
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Dao, Tien Tuan, and Philippe Pouletaut. "A Hertzian Integrated Contact Model of the Total Knee Replacement Implant for the Estimation of Joint Contact Forces." Journal of Computational Medicine 2015 (October 13, 2015): 1–9. http://dx.doi.org/10.1155/2015/945379.
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The prediction of lower limb muscle and contact forces may provide useful knowledge to assist the clinicians in the diagnosis as well as in the development of appropriate treatment for musculoskeletal disorders. Research studies have commonly estimated joint contact forces using model-based muscle force estimation due to the lack of a reliable contact model and material properties. The objective of this present study was to develop a Hertzian integrated contact model. Then, in vivo elastic properties of the Total Knee Replacement (TKR) implant were identified using in vivo contact forces leading to providing reliable material properties for modeling purposes. First, a patient specific rigid musculoskeletal model was built. Second, a STL-based implant model was designed to compute the contact area evolutions during gait motions. Finally, a Hertzian integrated contact model was defined for the in vivo identification of elastic properties (Young’s modulus and Poisson coefficient) of the instrumented TKR implant. Our study showed a potential use of a new approach to predict the contact forces without knowledge of muscle forces. Thus, the outcomes may lead to accurate and reliable prediction of human joint contact forces for new case study.
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Wimmer, Markus A., William Nechtow, Thorsten Schwenke, and Kirsten C. Moisio. "Knee Flexion and Daily Activities in Patients following Total Knee Replacement: A Comparison with ISO Standard 14243." BioMed Research International 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/157541.
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Walking is only one of many daily activities performed by patients following total knee replacement (TKR). The purpose of this study was to examine the hypotheses (a) that subject activity characteristics are correlated with knee flexion range of motion (ROM) and (b) that there is a significant difference between the subject’s flexion/extension excursion throughout the day and the ISO specified input for knee wear testing. In order to characterize activity, the number of walking and stair stepping cycles, the time spent with dynamic and stationary activities, the number of activity sequences, and the knee flexion/extension excursion of 32 TKR subjects were collected during daily activity. Flexion/extension profiles were compared with the ISO 14243 simulator input profile using a level crossing classification algorithm. Subjects took an average of 3102 (range: 343–5857) walking cycles including 65 (range: 0–319) stair stepping cycles. Active and passive ROMs were positively correlated with stair walking time, stair step counts, and stair walking sequences. Simulated knee motion according to ISO showed significantly fewer level crossings at the flexion angles 20–40° and beyond 50° than those measured with the monitor. This suggests that implant wear testing protocols should contain more cycles and a variety of activities requiring higher knee flexion angles with incorporated resting/transition periods to account for the many activity sequences.
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Koenen, P., M. M. Schneider, T. R. Pfeiffer, B. Bouillon, and H. Bäthis. "The Impact of Pinless Navigation in Conventionally Aligned Total Knee Arthroplasty." Advances in Orthopedics 2018 (2018): 1–6. http://dx.doi.org/10.1155/2018/5042536.
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Background. Restoration of the mechanical axis is a main objective in total knee replacement (TKR). Aim of this study was to analyse the verification tool of a pinless navigation system in conventional TKR (cTKR). Methods. In a prospective study, 147 TKR were performed by conventional technique. Using the “pinless verification” mode of a smartphone based navigation system, the cutting block position and final resection plane for distal femur and proximal tibial resection were measured. If necessary, the block position or resection level were optimized, corrections were protocolled. Postoperatively, standardized radiographs were performed. Results. In 65.3%, intraoperative measurements changed the surgical procedure (corrections: 20.4% femoral, 25.9% tibial, 19% both). The additional time for surgery compared to cTKR averaged 6 minutes (79 ± 15 versus 73 ± 17 minutes). Using navigation data, the final femoral and tibial axes were in 93% within a range of ±2°. A mean difference of 1.4° and 1.6° could be shown between the final measurement of the navigation system and the postoperative mLDFA and mMPTA. Conclusion. Intraoperative pinless navigation has impact on the surgical procedure in the majority of cTKR. It represents a less time-consuming tool to improve implant position while maintaining the routine of conventional technique.
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Mohd Mukhtar, Natrisya Qistina, Solehuddin Shuib, Muhamad Azhan Anuar, Mohd Fairudz Mohd Miswan, and Mohd Afzan Mohd Anuar. "Design Optimisation of Bi-Cruciate Retaining Total Knee Arthroplasty (TKA) Prosthesis via Taguchi Methods." Mathematics 11, no. 2 (January 7, 2023): 312. http://dx.doi.org/10.3390/math11020312.
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Total knee replacement has become a viable option for treating severe knee arthritis. The demand for more kinematically functional implants that better replicate natural knee kinematics led to the development of total knee arthroplasty (TKA), including bi-cruciate-retaining (BCR) TKA. However, optimised design parameters of BCR TKA knee implants that can help achieve a long-term prosthetic survival rate remain unknown. Therefore, this study aimed to investigate the effect of the design parameters of BCR TKA knee implants on the mechanics of knee joints and optimise and individualise the knee implant design parameters using the Taguchi method incorporating finite element analysis. Herein, experimental factors and levels were selected and nine finite element models of BCR TKA knee implants were developed to optimise the design of the following parameters: the curvature ratio on the sagittal plane, curvature ratio on the coronal plane, and tibial slope. In addition, finite element analysis was used to determine the effect of the design parameters on the peak contact stress on ultra-high-molecular-weight polyethylene (UHMWPE) and its deformation. Consequently, among the three parameters that affect the peak contact stress and its deformation, the curvature ratio on the sagittal plane had the greatest effect (range = 10.96), followed by the curvature ratio on the coronal plane (range = 3.54), and the tibial slope (range = 2.56). The optimal design parameters for the BCR TKA knee implant were a curvature ratio of 1.5 on both the sagittal and coronal planes and a tibial slope of 5°. Under these conditions, the peak contact stress and deformation were 25.80 MPa and 0.0835 mm, respectively. The optimisation method based on finite element analysis and the Taguchi method can produce one of the highest-performing BCR TKA knee implant designs, thereby reducing the peak contact stress and deformation. This method sheds fresh light on the development of the BCR TKA knee implant as well as biomechanical decision-making to implant the TKA prosthesis correctly.
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Lee, Hye Kyeong, Sung Min Kim, and Hong Seok Lim. "Computational Wear Prediction of TKR with Flatback Deformity during Gait." Applied Sciences 12, no. 7 (April 6, 2022): 3698. http://dx.doi.org/10.3390/app12073698.
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Loss of lumbar lordosis in flatback patients leads to changes in the walking mechanism like knee flexion. Such variations in flatback patients are predicted to alter the characteristics of total knee replacement (TKR) contact, so their TKR will show different wear characteristics with a normal gait. However, the relevant study is limited to predicting the wear depth of TKR for normal gait mechanisms or collecting and analyzing kinematic data on flatback gait mechanisms. The objective of this study was to compare wear in TKR of flatback patients with people without flatback syndrome. The main difference between the normal gait mechanism and the flat back gait mechanism is the knee flexion remain section and the tendency to change the vertical force acting on the knee. Thus, in this paper, A finite element-based computational wear simulation for the gait cycle using kinematic data for normal gait and flat gait were performed, and substituting the derived contact pressure and slip distance into the Archard formula, a proven wear model, wear depth was predicted. The FE analysis results show that the wear volume in flatback patients is greater. The results obtained can provide guidance on the TKR design to minimize wear on the knee implant for flatback patients.
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Pasquier, Gilles, Matthieu Ehlinger, and Didier Mainard. "The role of rotating hinge implants in revision total knee arthroplasty." EFORT Open Reviews 4, no. 6 (June 2019): 269–78. http://dx.doi.org/10.1302/2058-5241.4.180070.
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Hinged implants are the most constrained knee replacement prostheses. They are very useful in complex cases of total knee arthroplasty (TKA) revision. Hinged implants have evolved with rotating bearings and modularity that allows local joint reconstruction or segmental bone replacement. They are required when significant instability persists in cases with inadequate collateral ligaments and significant flexion laxity. They are now used when a large bone defect is reconstructed, or when bone fixation of the implant is questionable especially in the metaphyseal zone. The use of hinged implants in TKA revision is associated with high complication rates. Published outcomes differ based on the patients’ aetiology. The outcomes of rotating-hinged implants used in septic revisions or salvage situations are poorer than other types of revision and have a higher complication rate. The poor general health of these patients is often a limitation. Despite these relatively poor results, hinged implants continue to have a place in revision surgery to solve major instability or to obtain stable bone fixation of an implant when the metaphysis is filled with bone grafts or porous devices.Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180070
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I Akinmokun, Olasode, Nwachukwu N. Ibeabuchi, Sekinat A. Adejumobi, Abisola S. Ajayi, and Oyinlola O. Thomas. "Distal femoral arthropometry in Nigerians and its correlation to total knee replacement implants." Ghana Medical Journal 55, no. 4 (December 1, 2021): 241–347. http://dx.doi.org/10.4314/gmj.v55i4.3.
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Introduction: Total Knee replacement (TKR) is performed to relieve pain and restore both the mechanical axis and joint line whenever indicated. Most of prostheses being used for TKR were manufactured using dimensions from Caucasians’ measurements. This study documented the dimensions of distal femora of Nigerians and correlated the dimensions with different TKR prostheses.Materials and methods: Fifty-six matured femora were measured. Dimensions of distal femora from other regions were retrieved from published articles. The dimensions of TKR prosthesis were extracted from product monographs. Analyses were done with Microsoft excel 2010 (Microsoft Corporation, Redmond, Washington, United States) and STATA version 13 (StataCorp, Texas. USA). Statistical significance was set at p ≤ 0.05Results: The average Mediolateral dimension was 79.3 ± 4.4 mm. The anterioposterior dimensions of the medial and lateral condyles were 63.7 ± 3.6 mm and 64.9 ± 3.3 mm respectively. There were no significant differences between the left and right distal femur. The average aspect ratio calculated was1.23 ± 0.05. There was a mismatch of aspect ratio of the distal femora and those of the prostheses. Equations that can be useful both clinically and in forensic medicine were generated.Conclusion: This study has provided measurements that can be considered when the designing of a suitable femoral component of total knee prosthesis for Nigerians. This study also provided equations that can be used to estimate the dimensions of the medial and the lateral condyles and femoral length from parts of distal femur in forensic medicine.
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Asikin, Muhamad Zharif, Muhammad Fathi Hayyun, and Mohamad Fauzlie Yusof. "A viable option for immediate mobilisation: Primary total knee replacement with supplementary osteosynthesis for acute complex tibial plateau fracture in elderly." Journal of Orthopaedics, Trauma and Rehabilitation 29, no. 1 (February 23, 2022): 221049172210758. http://dx.doi.org/10.1177/22104917221075827.
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The principle of periarticular fracture is well established. However, the gold standard in treating tibial plateau fracture remains controversial. Lack of adequate soft tissue and complexity of the fracture involved succumbs to poor postoperative outcomes and high complication rate for infection, implant failure and non-union. Furthermore, the treatment of the elderly complicates the decision. It is because time is an essence since decubitus complication is associated with prolonged immobilisation. In addition, other complication related to this fracture such as accelerated secondary osteoarthritis and pain leads to further immobilisation. Traditionally, secondary total knee replacement (TKR) is indicated for this type of fracture, while the initial aim is to achieve bone healing. However, its failure related complication, the detrimental challenge in addressing ligament balance, extensor mechanism scarring and patella mal-tracking, thus, it is not commonly practised. The author has successfully demonstrated the use of primary TKR with supplementary locking plate in a post-traumatic Schatzker V tibial plateau fracture in a 75-year-old gentleman to allow immediate weightbearing. Thus, removing the complication associated with immobilisation and exhibit the advantage of TKR in obtaining a painless functional knee. In successive follow-up shows a favourable outcome and improved functional knee outcome compared to the premorbid state.
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Dusak, I. Wayan Suryanto, Dwiwahyonokusuma ., and I. Gusti Ngurah Paramartha Wijaya Putra. "Profile of total knee replacement patients and short term outcome in the sanglah public hospital 2018: a case reports." International Journal of Research in Medical Sciences 8, no. 7 (June 26, 2020): 2684. http://dx.doi.org/10.18203/2320-6012.ijrms20202918.
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Total knee replacement (TKR) is considered to be among the most successful type of orthopedic surgery, with 15-year-survival-rate of implant exceeding 95%; furthermore, the improvement in quality of life is very significant. This study aims to describe the demographics, length of hospitalization and short-term outcome observed in patients undergoing TKR at Sanglah Hospital in 2018. All patients undergoing TKR at Sanglah Hospital in 2018 have been prospectively entered into our database. A total of 59 patients were recorded on 2018 for this study and 1 revision TKR patient and 2 patients with incomplete data were excluded. At baseline, 78.6% patients were female, 72.3% were Balinese and 84.1% were housewives. The mean age of patients was 63 years old. Authors also record that 44 (78.6%) patients are Overweight patients (BMI 25.00-29.99 kg/m2), 11 (19.6%) patients are at Obese Class I (30.00-34.99 kg/ m2) range, and only 1 (1.8%) patients have normal weight (18.50-24.99 kg/m2). As many as 51.8% patients had right TKR and 49.2% left TKR. The modus of patient’s length of stay is 7 days with 27 (48.2%) patients started to walk on the 4th day. VAS was recorded at level 4/10 on 92.9% patient. Drain was removed after 3 days on 42 (75%) patients. 15 patients (26.8%) had PRC transfusion due to anemia after operation.
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Jang, Jae Young, Miji Kim, Daehyun Lee, Hyung Eun Shin, and Chang Won Won. "INFLUENCE OF TOTAL KNEE REPLACEMENT ON LEAN MASS MEASUREMENTS USING DUAL-ENERGY X-RAY ABSORPTIOMETRY." Innovation in Aging 6, Supplement_1 (November 1, 2022): 693–94. http://dx.doi.org/10.1093/geroni/igac059.2542.
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Abstract Sarcopenia and osteoarthritis often occur together. Many sarcopenic patients with osteoarthritis are managed by total knee replacement (TKR). The prevalence of TKR is increasing in older adults; however, metal implants can lead to the overestimation of lean mass (LM) in dual-energy X-ray absorptiometry (DXA). However, studies considering metal implants in DXA measurement of LM are scarce. Comparisons without and with automatic metal detection (AMD) are important for accurately measuring LM. Therefore, this study examined the effects of TKR on LM. Twenty-four subjects (mean age: 76.4±4.0 years) who underwent TKR were selected from the Korean Frailty and Aging Cohort Study. A GE Lunar iDXA (GE Healthcare Lunar, Madison, WI, USA) system was applied twice (with and without AMD). Leg LM was significantly overestimated in the right and left legs with TKR. The LMs with and without AMD were 6017.1±199.3 g and 5493.7±171.3 g, respectively (p< 0.001), in the right leg, and 5657.1±220.1 g vs. 5173.7±201.8 g, respectively (p< 0.001) in the left leg. The appendicular lean mass index (ALMI) without and with AMD was 6.5±0.6 kg/m2, 6.1±0.6 kg/m2 (p< 0.001). In addition, only one subject was classified as having low muscle mass without AMD, which increased to four based on AMD according to the Asian Working Group of Sarcopenia 2019 guidelines. The overestimated leg LM in subjects after TKR decreased with AMD. Furthermore, LM with AMD increased the prevalence of low appendicular LM in the diagnosis of sarcopenia. Therefore, metal implants should be considered to accurately measure LM using DXA.
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Zylberberg, Alejandro, Gillian Bayley, Luca Gala, and Paul R. Kim. "Primary Total Knee Arthroplasty Twenty Years after Distal Femoral Cement Augmentation of a Giant Cell Tumor." Case Reports in Orthopedics 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/283294.
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We present a case of knee reconstruction 20 years after treatment of a giant cell tumor (GCT) with curettage and cementation. There is currently an ongoing debate whether cement or allograft bone is the preferred material for filling the void after GCT curettage. In this case we were able to readily implant a primary total knee replacement without disturbing the existing well-interdigitated large cement bolus and did not require any stems or augments for the reconstruction. Given the ease of TKR implantation in this patient, we feel that the use of cement following curettage of a GCT lesion is a better choice than allograft bone which may not provide enough structural support for the knee reconstruction and lead to a much more extensive procedure.
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Lai, Mun Chun, Jerry Yongqiang Chen, Ming Han Lincoln Liow, Darren Keng Jin Tay, Ngai Nung Lo, Hee Nee Pang, and Seng Jin Yeo. "Is constraint implant with metaphyseal sleeve a viable option for revision TKR with preoperative coronal plane instability and bone defect?" Journal of Orthopaedic Surgery 28, no. 2 (January 1, 2020): 230949902092631. http://dx.doi.org/10.1177/2309499020926313.
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Background: Metaphyseal sleeves have been used as metaphyseal filling implants to address bone loss during revision total knee replacements (TKRs). This study aims to compare the 2-year clinical and radiological outcomes of constraint implant with bone defect and constraint implant without or minimal bone defect in revisions TKR with preoperative coronal plane instability. Materials and Methods: Seventeen cases of constraint implants with metaphyseal sleeve matched paired with 34 cases of constrained condylar knee (CCK) prosthesis. Age, gender, body mass index and aetiology for revision surgery were recorded. Clinical outcome measures included Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Oxford Knee Score (OKS), physical component summary (PCS) and mental component summary (MCS). Radiological outcome measures included joint line changes, hip–knee–ankle angle (HKA), coronal femoral angle (CFA) and coronal tibial angle (CTA). Result: Patients in sleeve group showed significant improvement in KSKS, KSFS and OKS (38 ± 7, 35 ± 6 and 20 ± 2 points, respectively, p < 0.001), while they were 19 ± 3 and 6 ± 2 points for PCS and MCS, respectively ( p < 0.001 and p = 0.021). These postoperative scores after surgery were similar between the two groups at 6 months and 2 years. The sleeve provides comparable result in joint line restoration; the postoperative HKA, CFA and CTA were all comparable between the two groups. Conclusion: Metaphyseal sleeve with constraint implant is a viable option for revision TKR with preoperative coronal plane instability and significant bone defect. It is able to achieve similar clinical outcomes and joint line restoration compared to CCK prosthesis at 2-year follow-up.
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Simpson, Cameron J. R. W., Evan Wright, Nathan Ng, Ngee J. Yap, Solomon Ndou, Chloe E. H. Scott, and Nick D. Clement. "Patellar resurfacing versus retention in cruciate-retaining and posterior-stabilized total knee arthroplasty." Bone & Joint Journal 105-B, no. 6 (June 1, 2023): 622–34. http://dx.doi.org/10.1302/0301-620x.105b6.bjj-2022-0970.r2.
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AimsThis systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) on the incidence of anterior knee pain, knee-specific patient-reported outcome measures, complication rates, and reoperation rates.MethodsA systematic review of MEDLINE, PubMed, and Google Scholar was performed to identify randomized controlled trials (RCTs) according to search criteria. Search terms used included: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, and patellar retaining. RCTs that compared patellar resurfacing versus unresurfaced in primary TKA were included for further analysis. Studies were evaluated using the Scottish Intercollegiate Guidelines Network assessment tool for quality and minimization of bias. Data were synthesized and meta-analysis performed.ResultsThere were 4,135 TKAs (2,068 resurfaced and 2,027 unresurfaced) identified in 35 separate cohorts from 33 peer-reviewed studies. Anterior knee pain rates were significantly higher in unresurfaced knees overall (odds ratio (OR) 1.84; 95% confidence interval (CI) 1.20 to 2.83; p = 0.006) but more specifically associated with CR implants (OR 1.95; 95% CI 1.0 to 3.52; p = 0.030). There was a significantly better Knee Society function score (mean difference (MD) -1.98; 95% CI -1.1 to -2.84; p < 0.001) and Oxford Knee Score (MD -2.24; 95% CI -0.07 to -4.41; p = 0.040) for PS implants when patellar resurfacing was performed, but these differences did not exceed the minimal clinically important difference for these scores. There were no significant differences in complication rates or infection rates according to implant design. There was an overall significantly higher reoperation rate for unresurfaced TKA (OR 1.46 (95% CI 1.04 to 2.06); p = 0.030) but there was no difference between PS or CR TKA.ConclusionPatellar resurfacing, when performed with CR implants, resulted in lower rates of anterior knee pain and, when used with a PS implant, yielded better knee-specific functional outcomes. Patellar resurfacing was associated with a lower risk of reoperation overall, but implant type did not influence this.Cite this article: Bone Joint J 2023;105-B(6):622–634.
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Kennedy, J. A., E. Burn, H. R. Mohammad, S. J. Mellon, A. Judge, and D. W. Murray. "Lifetime revision risk for medial unicompartmental knee replacement is lower than expected." Knee Surgery, Sports Traumatology, Arthroscopy 28, no. 12 (February 12, 2020): 3935–41. http://dx.doi.org/10.1007/s00167-020-05863-3.
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Abstract Purpose Unicompartmental knee replacement (UKR) is widely considered to be a pre-total knee replacement (TKR) particularly in the young. The implication of this is that it is sensible to do a UKR, even though it will be revised at some stage, as it will delay the need for a TKR. The chance of a UKR being revised during a patient’s life time has not previously been calculated. The aim of this study was to estimate this lifetime revision risks for patients of different ages undergoing UKR. Methods Calculations were based on data from a designer series of 1000 medial Oxford UKR with mean 10-year follow up. These UKR were implanted for the recommended indications using the recommended surgical technique. Parametric survival models were developed for patients of different ages based on observed data, and were extrapolated using a Markov model to estimate lifetime revision risk. Results The estimated lifetime revision risk reduced with increasing age at surgery. Lifetime revision risk at age 55 was 15% (95% CI 12–19), at 65 it was 11% (8–13), at 75 it was 7% (5–9), and at 85 it was 4% (3–5). Conclusion Provided UKR is used appropriately, the lifetime revision risk is markedly lower than expected. UKR should be considered to be a definitive knee replacement rather than a Pre-TKR even in the young. These lifetime estimates, alongside established benefits for UKR in speed of recovery, morbidity, mortality and function, can be discussed with appropriate patients when considering whether to implant a UKR or TKR. Level of evidence III.
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Gamero, V., J. Valdivia, E. Davila, and M. Cerrolaza. "INFLUENCE OF THE GEOMETRY OF THE ATTACHING PEGS OF THE FEMORAL COMPONENT OF A KNEE PROSTHESIS." Biomedical Engineering: Applications, Basis and Communications 28, no. 03 (June 2016): 1650017. http://dx.doi.org/10.4015/s1016237216500174.
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Several factors such as instability, misalignment, mechanical fractures and poor quality of bone are some factors that strongly influence the deterioration of knee implants. After a total knee replacement (TKR), proximal tibial bone suffers a resorption due to stress-shielding caused by the implant. The formation of weakening bone zones and loss of bone is one of the most clinical concerns. Then, the study, modification and improving of the simulation methods to analyze implants is a subject of the most concern. Thus, this work is focused in the analyses of the influence of the geometry and inclination of the attaching pegs in the femoral component of knee implants. The aim is to evaluate the geometry of the implant stem to improve the stresses distribution and to increase the implant lifespan. Stresses distribution at the attaching pegs of the femoral component, by considering several combinations of diameters, lengths and inclinations, have been analyzed using finite element analysis (FEA). The analysis was conducted for the [Formula: see text][Formula: see text]mm, L [Formula: see text] 13 mm and [Formula: see text] [Formula: see text] 0[Formula: see text], in three different positions of the gait cycle. The variation of the geometry of the attaching pegs generated changes in the stresses distribution in bone. As the diameter increases, the stresses decrease in the femur. The medial areas of the implant appear to be the most likely regions to show bone resorption.
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Nakano, Naoki, Kiyonori Mizuno, Koji Takayama, Shinya Hayashi, Ryosuke Kuroda, and Tomoyuki Matsumoto. "Outcomes of total knee replacement with the use of a NexGen MIS Tibial Component (Mini-keel) : a systematic review." Acta Orthopaedica Belgica 87, no. 3 (September 30, 2021): 469–78. http://dx.doi.org/10.52628/87.3.12.
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NexGen MIS Tibial Component (Mini-keel) is a tibial component specially developed for minimally invasive surgery in total knee replacement (TKR), and the size limitations of its design and the modular system could affect tibial fixation strength, however, this has not been precisely evaluated thus far. This study aimed to systematically review the literature describing the outcome following TKR with the use of a Mini-keel. Electronic searches of databases were undertaken in July 2019 by two experienced orthopaedic surgeons according to the PRISMA guidelines for literature describing the outcomes of TKR with the use of a Mini-keel. Quality of studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The initial search found a total of 623 studies from all the databases. Seven studies met all the inclusion criteria and were eligible for critical appraisal and quality assessment. In total, 2,198 cases were included in the systematic review. Thirty-five revision cases due to aseptic loosening were found from the systematic review. Two studies were negative about using a Mini-keel and three studies were positive about it, while the other two studies did not judge the quality of a Mini-keel. There have been conflicting conclusions among studies for the use of a Mini-keel. There remains a paucity of prospective cohort studies between TKRs with the use of a Mini-keel and those with the use of a conventional implant, which makes it difficult to determine the usefulness and reliability of this implant.
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Cretu, Bogdan, Zsombor Panti, Mihai Nica, Bogdan Serban, Mihnea Popa, Răzvan Ene, and Cătălin Cîrstoiu. "Lower Limb Deformity and Total Knee Replacement." Romanian Journal of Orthopaedic Surgery and Traumatology 1, no. 2 (December 1, 2018): 121–27. http://dx.doi.org/10.2478/rojost-2018-0090.
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Abstract As the population becomes more active and life expectancy increases, gonarthrosis has proportions of epidemics. Total knee arthroplasty (TKA) is an intervention that decreases pain and gives the patients the possibility of quickly returning to the desired level of activity. It is an intervention with a patient satisfaction rate of about 90-95% with a survival of the implant over 15 years of 90%. When dealing with TKA the following elements should be taken into account: clinical examination (walking analysis), leg deformities and knee alignment (foot deformation management), posterior tibial tendon dysfunction, cavovarus foot, posttraumatic deformity, neuropathic arthropathies, ankle arthrosis, foot deformities and knee arthroplasty. Ankle or foot deformity may be causes of progression of gonarthrosis or a TKA failure. Post-operative alignment of TKA is an extremely important element in the long-term survival of the prosthesis. By improving biomechanical alignment of the complete pelvic limb, TKA survival and patient satisfaction will increase.
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Barink, M., N. Verdonschot, and M. de Waal Malefijt. "A different fixation of the femoral component in total knee arthroplasty may lead to preservation of femoral bone stock." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 217, no. 5 (May 1, 2003): 325–32. http://dx.doi.org/10.1243/095441103770802487.
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Good femoral bone stock is important for the stability of the femoral component in revision knee arthroplasty. However, the primary total knee replacement (TKR) may cause significant loss of bone stock in the distal anterior femur. Earlier stress-induced bone remodelling simulations have suggested that a completely debonded component may save bone stock in the distal anterior region. However, these simulations did not consider the fixation of a debonded implant and possible secondary effects of micromotions and osteolysis at the interface. The current study tries to combine the preservation of bone stock with adequate component fixation. Different bone remodelling simulations were performed around femoral knee components with different sizes of bonding area and different friction characteristics of the debonded area. The fixation of the femoral component with different bonding characteristics is quantified with calculated implant-bone interface stresses. The results show that a bonded femoral component with a debonded inner side of the anterior flange may significantly reduce bone resorption in the endangered distal anterior femur, without jeopardizing the fixation of the femoral implant. This effect may be obtained in vivo by using a femoral component with a highly polished inner side of the anterior flange.
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Reid, A/Prof Michael, Dr Benjamin Parkinson, Dr Adam Parr, Dr Christopher Conyard, Dr Drew Armit, and Dr Helen Anscomb. "The accuracy of Intramedullary Femoral alignment in Total Knee Replacement in the prescence of ipsilateral Hip Replacement." Orthopaedic Journal of Sports Medicine 5, no. 5_suppl5 (May 1, 2017): 2325967117S0016. http://dx.doi.org/10.1177/2325967117s00164.
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Objectives: During total knee replacement (TKR) surgery, the most commonly used method for aligning the distal femur appropriately is via an intramedullary (IM) distal femoral alignment rod. The alignment of the rod itself is reliant on the isthmus which is used to most accurately place the rod in the correct anatomical axis. In the instance of something preventing the rod from entering the isthmus correctly, such as a hip replacement, then the degree of accuracy could be assumed to be even less. Mechanical-anatomical malalignment has been shown to decrease the implant (TKR) survival and so methods of increasing accuracy of alignment relative to the mechanical axis have been developed. At present the most accurate method intraoperatively is computer navigation and several studies have demonstrated improved alignment. An increasing number of patients year on year are having both knee and hip replacements and as the population ages the likelihood of having both a knee and hip replacement will also increase. We propose that the presence of a hip replacement within the isthmus of the femur may further decrease the accuracy of the IM alignment of the femur leading to incorrect implant positioning. Methods: The study was conducted on 10 cadaveric specimens (20 femurs). Computational navigation instrumentation was attached in turn to each femur and the ideal alignment data recorded in a standard fashion by a single operator (principal investigator). A standard entry port was then be made in the femur for the introduction of the IM rod. An IM rod was then inserted with the distal femoral cutting block in the accepted position recorded blindly on the computer navigation (both in terms of varus/valgus alignment to the mechanical axis and the degree of flexion). The process was then repeated at 3 levels to represent primary and revision hip lengths from the greater trochanter (replicating the changes that would occur in the presence of a hip replacement) The process was recorded three times at each level. Results: The resection angles between the cutting surface and the mechanical axis were measured and collected by means of computer navigation system. The results show that the IM alignment had mean Valgus of 0 degrees +/- 0.8 but with a hip replacement in situ this increased to 0.46 degrees +/- 1.49 (range 2.5 varus to 4.5 valgus), with a revision stem 0.825 +/- 1.68 (range 2.5 varus to 4.5 valgus) and long stemmed revision 1.325 +/- 2.09 (range 5 varus to 6.5 valgus). In terms of Flexion IM alignment had a mean flexion of 0.92 +/- 1.7 (range 3 extension to 4 flexion) but with a hip replacement in situ this increased to 1.88 degrees +/- 2.03 (range 2.5 extension to 8.5 flexion), with a revision stem 2.35 +/- 2.2 (range 2.5 extension to 8 flexion) and long stemmed revision 2.75 +/- 2.16 (range 3.5 extension to 7 flexion). Conclusion: This Study concludes that the prescence of a hip replacement, in particular long stemmed prosthesis, further reduces the accuracy of IM alignment in the Femur for Total Knee Replacement. Consideration of an alternative method, such as navigation, should be considered in such situations.